MD–PhD프로그램에서 전통적 생의학/임상의학 이외의 분야를 권장해야 하는가? (Academic Medicine, 2015)

MD–PhD프로그램에서 전통적 생의학/임상의학 이외의 분야를 권장해야 하는가?

Should MD–PhD Programs Encourage Graduate Training in Disciplines Beyond Conventional Biomedical or Clinical Sciences?

Ryan J. O’Mara, MS, Stephen I. Hsu, MD, PhD, and Daniel R. Wilson, MD, PhD

MD–PhD프로그램의 목적은 미래의 생의학연구자로서 독창적 역량을 지닌 의사-과학자의 양성이다. 현재로서는 생의학/임상의학 분야를 제외한 다른 분야의 의사-과학자가 매우 부족한 상황이며, 이는 MD–PhD프로그램에서 통상적이지는 않으나(nontranditional), 건강에 영향을 주는 요인에 매우 근접한(germane) 분야의 박사과정 연구를 허용하거나 더 나아가 적극적으로 권장해야 할 것인가에 대한 문제를 제기한다. 이 문제가 중요한 이유는 대학의학의 궁극적인 목표가 모든 사람들에게 최고의 건강과 건강형평성을 제공하는 것이기 때문이다. 의학과 진료, 의료접근성과 전달체계도 이러한 건강형평성을 향상시키는 데 중요한 것은 사실이나, 그것만으로 건강불평등을 해소하기는 어렵다. 지역사회와 사회 전반에 걸친 복잡한 건강 문제를 해결하기 위해서는 전통적인 생의학/임상과학을 이외의 분야를 다루는 연구자들이 필요하다. 건강형평성의 진정한 발전을 이루기 위해서는 교육과정을 통해서 건강의 거시적 결정요인과 미시적 결정요인 모두에 대한 의사-과학자를 준비해나가야 한다. 저자들은 MD-PhD프로그램에서 비전통적이라 할 수 있는 역학, 통계학, 인류학, 사회학, 윤리학, 공공정책, 경영, 경제, 교육, 사회복지, 정보과학, 정보통신, 마케팅 등의 분야를 허용하고 더 나아가 적극 권장하여야 한다고 주장한다. 현재와 앞으로 다가올 건강요구를 충족시키기 위해서 비전통적분야를 전공하는 MD-PhD학생을 값진 생의학 연구인력으로서 더 반기고 지원하야 할 것이다.

The goal of MD–PhD training programs is to produce physician–scientists with unique capacities to lead the future biomedical research workforce. The current dearth of physician–scientists with expertise outside conventional biomedical or clinical sciences raises the question of whether MD–PhD training programs should allow or even encourage scholars to pursue doctoral studies in disciplines that are deemed nontraditional, yet are intrinsically germane to major influences on health. This question is especially relevant because the central value and ultimate goal of the academic medicine community is to help attain the highest level of health and health equity for all people. Advances in medical science and practice, along with improvements in health care access and delivery, are steps toward health equity, but alone they will not come close to eliminating health inequalities. Addressing the complex health issues in our communities and society as a whole requires a biomedical research workforce with knowledge, practice, and research skills well beyond conventional biomedical or clinical sciences. To make real progress in advancing health equity, educational pathways must prepare physician–scientists to treat both micro and macro determinants of health. The authors argue that MD–PhD programs should allow and encourage their scholars to cross boundaries into less traditional disciplines such as epidemiology, statistics, anthropology, sociology, ethics, public policy, management, economics, education, social work, informatics, communications, and marketing. To fulfill current and coming health care needs, nontraditional MD–PhD students should be welcomed and supported as valuable members of our biomedical research workforce.

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• The greatest obstacles to health equity are disparities in behavioral or environmental risk factors and the social and economic conditions that shape those behaviors and environments.11 People’s health and chances of dying prematurely are influenced far less by the clinical care they receive than by the social conditions— family integrity, housing, neighborhoods, education, employment, and income—in which they live.12 These “upstream” social determinants are too important to health equity for medical leaders to continue ignoring them.

• Traditional biomedical and clinical sciences cannot effectively address the behavioral, environmental, social, economic, political, cultural, familial, and other nonmedical causes of health inequities.

• The flagship of MD–PhD program funding—the Medical Scientist Training Program (MSTP) of the National Institute of General Medical Sciences (NIGMS)—offers no specific definition or limitation of graduate scientific training:  
• MSTP participants may choose from a wide range of research training programs in the biological, chemical, or physical sciences. Other disciplines in which MSTP participants can pursue graduate study include the computer sciences, social and behavioral sciences, economics, epidemiology, public health, bioengineering, biostatistics, and bioethics.16

• At one leading institution, MD–PhD students training in a biomedical science receive MSTP-supported tuition waivers, medical insurance, and stipends. At that same institution, MD–PhD students training in a social science receive considerably less financial support (through non-MSTP sources).

• Alternatively, the scarcity of nontraditional MD–PhD scholarship may originate with the students. They may be unaware of opportunities and support for nontraditional graduate training, uncertain of its relevance to their medical careers, or skeptical of its value.

• Having a rich diversity of scholarship is an important goal of many academic institutions and programs. Diversity of scholarship includes not just 
• individuals creating new knowledge (discovery) but also 
• individuals connecting knowledge to other knowledge (integration), 
• communicating knowledge (teaching), and 
• making knowledge accessible and useable (application).18

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Acad Med. 2015 Feb;90(2):161-4. doi: 10.1097/ACM.0000000000000540.

Should MD-PhD Programs Encourage Graduate Training in Disciplines Beyond Conventional Biomedical orClinical Sciences?

O'Mara RJ1, Hsu SI, Wilson DR.

Author information

Abstract

The goal of MD-PhD training programs is to produce physician-scientists with unique capacities to lead the future biomedical research workforce. The current dearth of physician-scientists with expertise outside conventional biomedical or clinical sciences raises the question of whether MD-PhDtraining programs should allow or even encourage scholars to pursue doctoral studies in disciplines that are deemed nontraditional, yet are intrinsically germane to major influences on health. This question is especially relevant because the central value and ultimate goal of the academic medicine community is to help attain the highest level of health and health equity for all people. Advances in medical science and practice, along with improvements in health care access and delivery, are steps toward health equity, but alone they will not come close to eliminating health inequalities. Addressing the complex health issues in our communities and society as a whole requires a biomedical research workforce with knowledge, practice, and research skills well beyond conventional biomedical or clinical sciences. To make real progress in advancing health equity, educational pathways must prepare physician-scientists to treat both micro and macro determinants of health. The authors argue that MD-PhDprograms should allow and encourage their scholars to cross boundaries into less traditional disciplines such as epidemiology, statistics, anthropology, sociology, ethics, public policy, management, economics, education, social work, informatics, communications, and marketing. To fulfill current and coming health care needs, nontraditional MD-PhD students should be welcomed and supported as valuable members of ourbiomedical research workforce.