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Pathways to become a physician-scientist. The figure depicts the pathways open to college students in the US; it does not include time a student may spend on post-baccalaureate activities, such as working as a technician in a research laboratory. The most straightforward path is to matriculate into an MD-PhD Program and pursue postgraduate clinical and research training after graduation from the MD-PhD Program. Some students may not be aware of the combined-degree path, or may not be ready to commit to the length training (8 years on average), and matriculate into MD programs, where they become interested in pursuing a research career; they may then be able to transfer into an MD-PhD program affiliated with their medical school, or they may graduate and pursue more extensive postdoctoral research training. Other students want to pursue a research career, but become interested in translational/clinical research during/after their PhD training. They can matriculate into MD programs and pursue postgraduate clinical and research training after receiving their MD. Transfers from PhD to MD-PhD programs tend to be rare, as reflected in the stippled path
Source publication
Background:
Physician-scientists (the physician-scientist workforce) are aging, and there are too few physician-scientists in the pipeline to replace those who retire. Moreover, the pipeline is leaky because some trainees and junior physician-scientists choose other career paths. Significant attention has been directed toward patching the leaking...
Citations
... In our study, publications and funding were included as metrics of physician-scientists career progression and attainments, as they were included as metrics of extrinsic career success in a comprehensive career-success model for physician-scientists [33]. The amount of SCI publications, receipt of national research funds and the impact factors (IFs) of academic journals have previously been documented as indicators of academic achievement or sustained research involvement of physician-scientists [31,34,35]. Although there are other important metrics indicating academic career progression, such as professional meeting presentations, tools/resources/assay development, expert panel participation and awards, they were not included in our study due to a lack of complete and reliable data sources. ...
Background
Despite extensive efforts to revitalize the physician-scientist pipeline, attrition has been observed along the physician-scientist developmental pathway. Research exposure during clinical training is considered an important factor favoring the decision to pursue an academic career pathway.
Methods
The authors sought to identify factors associated with academic career progression among junior physician-scientists following the completion of an intensive research training program, using the framework of the Social Cognitive Career Theory (SCCT), to benefit the design of efforts to revitalize the physician-scientist career pipeline. We conducted a retrospective study of 108 physicians who completed a long-term research training program abroad during residency, or within a few years post-residency completion, between 2010 and 2017. With potential predictors of academic career progression prioritized by SCCT, multivariable logistic regression was used to identify predictors of sustained research involvement, high productivity and high research competency after training, respectively. The SCCT was used to illuminate our findings.
Results
Co-publications with training supervisors abroad and medical oncology/pediatric oncology as a clinical specialty were positively associated with sustained research involvement and high productivity. Joining the training program after the age of 36 was negatively associated with high research competency. All of the predictors shared a common feature of high correlation with both self-efficacy and environmental elements, the reciprocal interactions of which may affect the career progression of physician-scientists.
Conclusions
Insights gained through this analysis provide policy recommendations for the designing of efforts to revitalize the physician-scientist career pipeline. Priorities should be given to institutional oversight to ensure strengthened self-efficacy at the beginning of one’s academic career, by providing long-term research training opportunities to young residents and promoting co-publications with their training supervisors during the training. In order to avoid the negative impact to self-efficacy caused by patient-related burnout or academic isolation, academic medical centers should take measures to guarantee protected research time, and to develop a positive culture encouraging mentoring relationships between junior and experienced physician-scientists in medical departments.
... A recent qualitative study of perceptions of physician-scientists' success identified differences in the views of clinical academics depending on gender and career stage [26]. Therefore, to ensure views were representative of the group, purposive sampling was carried out and a balance between established and trainee clinical academics and male and female clinical academics was maintained (Table 1). ...
... The literature, however, presents a mixed picture of the importance of integrity to success as a clinical academic. Gotian et al., interviewing 21 physicianscientists at different career stages identified 23 subjective and objective characteristics that were associated with success as a clinical academic, but honesty and integrity were not among the characteristics identified [26]. In contrast, almost all the 25 clinical academics interviewed in another study developing a competency framework for clinical academics mentioned the importance of professional ethics and integrity [17]. ...
... It has been shown that cross-disciplinary teams have better outcomes and produce work of higher scientific impact [40], and clinical academic trainees rate opportunities to expand their collaborative network highly [41]. Other studies have shown collaboration and relationship building are key measures of success as a clinical academic [26,33]. Willingness to help others and agreeableness are of intermediate importance to our participants, suggesting a need for balance between helping others with their goals and retaining focus on one's own goals. ...
Background
Clinicians who divide their time between clinical work and research have contributed to some of the most fundamental breakthroughs in medicine in recent history, yet their role is not always well-understood or valued. Understanding the factors which contribute to career success for clinical academics is critical for supporting this workforce. Social Cognitive Career Theory (SCCT) provides a conceptual framework for career success, incorporating personal and environmental factors.
Purpose
The aim of this study is to explore clinical academics’ construal of successful clinical academic practice and to contribute to a holistic view of the professional identity of the clinical academic.
Methodology
Using a constructivist technique, repertory grid, the authors interviewed ten clinical academics at different career stages in one-to-one structured interviews conducted virtually between November 2020 and April 2021. Data from the interviews were analysed qualitatively and quantitatively. Common themes were identified, analysed, and ranked according to importance with respect to successful clinical academic practice. Using SCCT as a framework, constructs were categorised as personal factors, organisational factors, competencies and person-environment fit. A differential analysis between established/trainee and female/male participants was carried out.
Summary of results
One hundred and thirty-three constructs were elicited and categorised into 20 themes (constructs). There was consensus among participants that 6 were of high importance with respect to successful clinical academic practice, 8 of intermediate and 4 of low importance, with no consensus on 2 constructs. Personal factors of high importance include innovation and integrity. Competencies including research and teaching skills are highly important, and ability to collaborate is also considered central to successful clinical academic practice. Female participants expressed greater concerns about the impact of familial responsibilities on career progression.
Discussion and conclusions
This study highlights the importance of interactions between the person and environment, and characterises the important attributes of successful clinical academics including personal factors such as integrity and innovation.
... It is important to understand both subjective and objective measures of success as perceived by physicianscientists. This includes due recognition of the contribution made to the field [33], engagement in interdisciplinary and translational research, societal recognition [33,36], contribution to mentoring resulting in quantitative propagation of professional legacy [37], and quantity and quality of publications. ...
... It is important to understand both subjective and objective measures of success as perceived by physicianscientists. This includes due recognition of the contribution made to the field [33], engagement in interdisciplinary and translational research, societal recognition [33,36], contribution to mentoring resulting in quantitative propagation of professional legacy [37], and quantity and quality of publications. ...
... Achieving early success in research is critical for physician-scientists, as it improves their self-efficacy, ultimately leading to long-term engagement in the field of research [36]. 3. Understanding determinants of satisfaction by physicianscientists: To retain the physician-scientists, adequate attention should be given to the factors which influence satisfaction levels in both the junior and senior physicianscientists [33]. The factors influencing the satisfaction level of junior scientists include setting up of an enabling environment, consisting of facilities (research labs), funds (finances, scholarships, fellowships, etc.), and the right human ecosystem of fellow researchers along with a freedom to pursue research diligently and independently with adequate protected research time [38,60]. ...
IntroductionThis scoping review was undertaken to assess the current status of physician-scientists, including the challenges associated with their enrollment and retention, measures of success, and determinants of their satisfaction, all of which contribute to the dwindling numbers of physician-scientists aptly referred to as a “leaking pipeline” of physician-scientists.MethodsA total of 2555 research documents from three databases, viz. Scopus, Web of Science, and PubMed, were selected. A total of 40 documents were considered for final analysis following the 5-stage framework of Arksey and O’Malle.ResultsMedical institutions should promote and sustain enrollments by addressing various perceived parameters of success and satisfaction. The challenge of attrition due to individual, regulatory, and sociocultural considerations also needs to be addressed.Conclusions
Medical institutions should focus on establishing well-documented career tracks with provisions for career advancement, promotion of team science, raising mentors, giving preference to students with peer-reviewed publications for post graduate (PG) admissions, and establishing a separate office for career development and guidance for physician-scientist. It is equally important to address the factors which promote retention and prevent attrition, viz. measures of success and determinants of satisfaction. Additional measures include creating a cadre of physician-scientists in government organizations, fostering collaboration of physician-scientists with incubation centers and startups, and adding additional mandatory curriculum components focused on project-based training.
... They are extensively trained to better carry out the institutional missions of discovery and treatment. Physician scientist success is intricately tied to AMC success; however, success is difficult to define for these individuals (Gotian & Andersen, 2020;Marsh & Todd, 2015). For our study population, physician scientist success is defined as those who can identify the right scientific and medical problems and subsequently find clinical solutions through research (i.e., they both problem posers and problem solvers) (Gotian & Andersen, 2020). ...
... Physician scientist success is intricately tied to AMC success; however, success is difficult to define for these individuals (Gotian & Andersen, 2020;Marsh & Todd, 2015). For our study population, physician scientist success is defined as those who can identify the right scientific and medical problems and subsequently find clinical solutions through research (i.e., they both problem posers and problem solvers) (Gotian & Andersen, 2020). Schafer (2010) said physician scientists are indispensable to the medical research enterprise because they bring a unique perspective by asking scientific questions based on their direct experience with patients. ...
... We conducted an inductive qualitative study based on semi-structured interviews of physician-scientists (i.e., individuals that have earned Medical Doctor (MD) and Doctor of Philosophy (PhD) degrees) (Gotian & Andersen, 2020). The research employed grounded theory as outlined by Strauss and Corbin (1998), and subsequently extended as constructivist grounded theory per Charmaz (2006), as the primary means of data collection and analysis. ...
This study investigated factors influencing success of physician scientists in Academic Medical Centers. These organizations and individuals drive healthcare in the United States. Translation of scientific discovery to medical practice moves at an astoundingly slow and ineffective rate. We must understand what contributes to physician scientist success to speed up translation. Through a lens of dialectic process theory, a grounded theory approach identified emergent factors from lived experiences of 31 individuals, at various experience levels, with MD and PhD degrees. Role balance, autonomy, organizational support, teamwork, life-cycle mentorship, and relational capacity were relevant factors impacting success. Role balance was important for success. Teamwork, organizational support, and life-cycle mentorship helped individuals grow, achieve balance, and respect, but relational capacity emerged as a critical driver for realizing both individual and organizational success. One person cannot execute these complex roles on their own, but development of deep and meaningful relationships through teamwork, collaboration, and life-cycle mentorship are essential for life satisfaction and success.
... There is some evidence to suggest women physician-scientists are more likely to focus on both objective measures (publications) and relational skills (networking, collaboration, and public recognition) while their men counterparts are more likely to focus on their effect to science and subjective characteristics such as boldness, confidence, and critical thinking. 74 Physician mothers, in particular, may define success as the ability to manage the accumulation of home and work caregiving responsibilities. Clearly, one size does not fit all when it comes to defining physician career success. ...
Physician mothers face unique challenges related to family planning, pregnancy, childcare, work-life integration, inequities, and biases that may have serious widespread implications. There is a paucity of available information on the extent and ramifications of such challenges and related solutions. The purpose of this critical review of the literature was to identify and summarize challenges and solutions pertaining to physician mothers. A comprehensive literature search of databases (PubMed, CINAHL, EBSCO MegaFILE, and APA PsycInfo on Ovid) from January 1, 2008, to December 31, 2018, identified empirical articles that addressed challenges, policies, or solutions specific to physician mothers. Search terms included: physician, doctor, surgeon, specialist, hospitalist, pediatrician, woman, female, gender, mom, mother, maternity, breastfeed, pregnant, baby, infant, parent, parenthood, child, bias, status, stigma, inequity, discrimination, equal, unequal, justice, childcare, daycare, babysit, and nanny in various combinations. Seventy-one articles met inclusion criteria and were analyzed to identify categories and themes related to challenges and solutions for physician mothers. Themes for challenges were categorized by level of influence (individual, organizational and health care system, and societal); themes for solutions were categorized by approach and intervention (mentorship, childbearing and child-rearing support, addressing barriers to career satisfaction and work-life integration, and identification and reduction of maternal bias in medicine). Physician mothers face challenges that have negative implications for individuals, organizations and the health care system, and society. Clear understanding of associated challenges and potential solutions is a critical first step to address biases and barriers affecting physician mothers.
... In a 2003 survey of nearly 500 MD-PhD students in their final years of training, almost 60% of respondents disagreed with defining a physicianscientist as "someone who holds at least an MD and performs research as his/her primary professional activity," seeing teaching and patient care as a crucial part of their careers [8]. A recent qualitative study identified that personal definitions of success varied by career stage and gender of the researcher [9]. This highlights discrepancies among stakeholders, trainees ...
Success and the next generation of physician-scientists - Chu J Hsiao, Adriana M. Fresquez, Briana Christophers
Emergency physicians (EPs) are well positioned to perform medical research. EPs are exposed to a wide range of disease types, medical specialties, and treatment modalities. Furthermore, emergency medicine (EM) serves as the safety net for the U.S. health care system. The diverse exposure provides a vast opportunity for EP to perform many worthwhile research projects. Yet, EM has historically had the lowest amount of funding and a lower number of National Institutes of Health–funded research projects. Many suggest the etiology is a “leaky” educational pipeline with loss of many potential physician‐scientists over the training and development course. Current research training options for the EM physician‐scientist includes MD‐PhD, 4‐year EM residency program and postresidency fellowships. While each has its advantages and disadvantages, we describe an additional educational alternative of EM physician‐scientists, which we have named the integrated–dedicated research period within an EM residency. We describe the features of these programs and preliminary results from the graduates and current trainees.
The limited number and diversity of resident physicians pursuing careers as physician-scientists in medicine has been a concern for many decades. The Anesthesia Research Council aimed to address the status of the anesthesiology physician-scientist pipeline, benchmarked against other medical specialties, and to develop strategic recommendations to sustain and expand the number and diversity of anesthesiology physician-scientists. The working group analyzed data from the Association of American Medical Colleges and the National Resident Matching Program to characterize the diversity and number of research-oriented residents from US and international allopathic medical schools entering 11 medical specialties from 2009 to 2019. Two surveys were developed to assess the research culture of anesthesiology departments. National Institutes of Health (NIH) funding information awarded to anesthesiology physician-scientists and departments was collected from NIH RePORTER and the Blue Ridge Medical Institute. Anesthesiology ranked eighth to tenth place of 11 medical specialties in the percent of “research-oriented” entering residents, defined as those with advanced degrees (Master’s or PhDs) in addition to the MD degree or having published at least 3 research publications before residency. Anesthesiology ranked eighth of 11 specialties in the percent of entering residents who were women but ranked fourth of 11 specialties in the percent of entering residents who self-identified as belonging to an underrepresented group in medicine. There has been a 72% increase in both the total NIH funding awarded to anesthesiology departments and the number of NIH K-series mentored training grants (eg, K08 and K23) awarded to anesthesiology physician-scientists between 2015 and 2020. Recommendations for expanding the size and diversity of the anesthesiology physician-scientist pipeline included (1) developing strategies to increase the number of research intensive anesthesiology departments; (2) unifying the diverse programs among academic anesthesiology foundations and societies that seek to grow research in the specialty; (3) adjusting American Society of Anesthesiologists metrics of success to include the number of anesthesiology physician-scientists with extramural research support; (4) increasing the number of mentored awards from Foundation of Anesthesia Education and Research (FAER) and International Anesthesia Research Society (IARS); (5) supporting an organized and concerted effort to inform research-oriented medical students of the diverse research opportunities within anesthesiology should include the specialty being represented at the annual meetings of Medical Scientist Training Program (MSTP) students and the American Physician Scientist Association, as well as in institutional MSTP programs. The medical specialty of anesthesiology is defined by new discoveries and contributions to perioperative medicine which will only be sustained by a robust pipeline of anesthesiology physician-scientists.
Purpose:
To describe the literature on clinician-scientist training programs to inform the development of contemporary and inclusive training models.
Method:
The authors conducted a scoping review, searching the PubMed/MEDLINE, CINAHL, and Embase databases from database inception until May 25, 2020. Studies presenting primary research that described and evaluated clinician-scientist training programs were identified for data abstraction. On the basis of deductive and inductive methods, information about program characteristics, curricula, teaching strategies, and success metrics was extracted. The extracted variables were analyzed using descriptive statistics.
Results:
From the initial 7,544 citations retrieved and 4,974 unique abstracts screened, 81 studies were included. Of the 81 included studies, 65 (80.2%) were published between 2011 and 2020, 54 (66.7%) were conducted in the United States, and 64 (79.0%) described programs that provided broad clinician-scientist training. Few programs provided funding or protected research time or specifically addressed needs of trainees from underrepresented minority groups. Curricula emphasized research methods and knowledge dissemination, whereas patient-oriented research competencies were not described. Most programs incorporated aspects of mentorship and used multiple teaching strategies, such as direct and interactive instruction. Extrinsic metrics of success (e.g., research output) were dominant in reported program outcomes compared with markers of intrinsic success (e.g., career fulfillment).
Conclusions:
Although programs are providing clinician-scientists with practical skills training, opportunities exist for curricular and pedagogic optimization that may better support this complex career path. Training programs for clinician-scientists can address contemporary issues of wellness and equity by reconsidering metrics of program success and evolving the core tenets of their education models to include equity, diversity, and inclusion principles and patient-oriented research competencies.
