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ABSTRACT - Traditionally, clinician scientists in the UK have been trained by a sequence of medical school, junior hospital posts, MRCP and research leading to a PhD. Thereafter they undertake a mixture of more senior middle-grade jobs leading to senior or lecturer consultant posts and beyond. Experience in the USA has shown how it is possible for young doctors to complete a PhD successfully while still at medical school, giving the graduate a combined MBBS and PhD qualification earlier in their career. UCL instituted such an 'MBPhD' scheme 18 years ago. The first graduates are now attaining chairs. Here, we review the experience of such a course in the UK context.
KEY WORDS: graduate medical education, physician-scientist, MBPhD
History
Modern, science-based medicine can continue to deliver improved medical care and better outcomes only by effective research. Key to the prosecution of clinical research are investigators who are not only scientifically proficient but also clinicians. Such people have always been scarce. The dual training is lengthy and expensive; it is a minority interest among medical students.
In the UK and Europe, 'physician scientists' (medically qualified researchers) have traditionally trained by a well-trodden route in which individuals with a medical qualification (MBBS or MBChB in the UK) hold junior medical jobs until they achieve their postgraduate qualification (e.g. MRCP in the UK). After this, the individual breaks offinto research aimed at a PhD qualification. Subsequently, the individual mixes research with further clinical training until the age of about 35, when he or she might be promoted to a senior research fellowship or a senior lectureship at consultant level. This pathway has served many people well and remains in common use to this day.
However, this process has its disadvantages. PhD completion rates for medically qualified graduates can be low, although the highly competitive and massively funded MRC fellowships are very successful (PM Stewart, P Maxwell, personal communication). The proportion of those embarking on PhDs after obtaining a postgraduate medical qualification who finally enter a true research career is not known. Before embarking on a career in science, doctors are already habituated in the loud, urgent, hurried ways of clinical medicine, which are different from those of careful, rigorous science.
In the 1950s, American universities, led...