Internal Medicine Physician Scientist Training Programs – How do programs compare?

The following is how I approached identifying and comparing internal medicine research pathway programs. The purpose of this post is to offer a clear and comprehensive approach to selecting your potential future academic home; however, this is not necessarily the approach that will work for everyone. Please reach out if you have found other helpful resources or have another way to approach this big decision!


Identifying Programs

There are a lot of internal medicine programs to choose from (at the time of preparing this post my count is 559). The best resource I found to identify residency programs in general was Residency Explorer. This resource has options to narrow down programs by factors such as geographic location and visa status and allows you to put in your info (e.g., Step scores, # of research experiences) to see how you compare to trainees at that program.

To further narrow down programs, I selected based on subspecialty interest. I identified programs that offered my subspecialty of interest using the ACGME Program Search. Gasteroenterology narrowed down my list to 227 programs. Transplant hepatology narrowed down my list further to 59 programs. I’m not 100% sure I want to do transplant hepatology specifically but I knew I wanted to train at a place that offered the fellowship so that I could be exposed to the fascinating world of medical management of liver transplant. Plus, it was easier to start with a list of 59 programs rather than a much larger list.

Next came identifying programs that offer research pathways. Unfortunately these come by many names – “Physician Scientist Pathway”, “Physician-Scientist Track”, “Science in Residency Program”, “ABIM Research Path”, “Physician-Scientist Training Pathway”, and “Resident Research Path” to name a few – and thus do not allow for a simple search. Instead, I had to go to each of the internal medicine residency websites at the locations with my fellowship(s) of interest to see if they listed some sort of research pathway as an option.

Between my subspecialty interest and interest in a research pathway, I had narrowed down my options to 38 programs. Once I had these 38 programs, I then directly compared their research pathway programs.

Tip: Create a table in an excel document to organize your list of programs! My list started with all of the programs with transplant hepatology fellowships and some programs in key geographic locations that I was interested in with gastroenterology fellowships but without transplant hepatology fellowships. I then had columns for 1) has transplant hepatology fellowship and 2) has research residency pathway that I could use to filter down to find the programs that met both criteria.


Comparing Programs

I next organized information about each program in the categories: Goal, Eligibility, Structure, Mentorship/Research, Funding, Fellowship. Not every website had information that fit within each of these categories, but these were the categories that were most consistently discussed across programs.

Goal

All of these programs want to train physician-scientists, but the stated goal of the programs varied. For example, some only spoke to training laboratory scientists, while others had much broader stated interests in training physician-scientists committed to clinical, translational, and/or basic science investigation as well as clinical practice. Some specifically spoke to their goal of helping trainees get their first faculty position. Others spoke to helping candidates become future leaders in academic medicine. In some cases, programs noted how they aimed to help trainees achieve their goals, such as by providing early and individualized support to highly motivated trainees. In some cases these were stated as the specific goals of the program, in other cases I noted what I perceived to be the goal of the program based on what was highlighted close to the top of the page.

Eligibility

With so many programs, you need to be strategic about where you apply. Applying to fewer places where you are a better fit may be just if not more effective than casting a broader net and applying to programs where you are not a top candidate. Some programs specified that they are designed for MD/PhD students only, others expanded this to include MD students with extensive research experience. This was also important to note because it helped me think about the qualities I wanted to highlight in my application – commitment to a career in academic medicine as a physician-scientist, anticipating independent research careers, strong research background. Some even specifically stated that they strongly support the advancement of women and underrepresented minorities in research and clinical careers, which is very important to me

Structure

On Board Certification — The American Board of Internal Medicine is the body that offers certification for internal medicine specialists. While certification is not required for practicing internal medicine, it is the highest standard in internal medicine and its 21 subspecialties and so is typically pursued. As stated on the ABIM website, “Certification has meant that internists have demonstrated – to their peers and to the public – that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care.”

The general requirements for board certification are as follows:

“To become certified in internal medicine, a physician must complete the requisite predoctoral medical education, meet the graduate medical education training requirements, demonstrate clinical competence in the care of patients, meet the licensure and procedural requirements, and pass the ABIM Internal Medicine Certification Examination.”

Specifically the graduate medical education training must:

“The 36 months of residency training must include 12 months of accredited internal medicine training at each of three levels: R-1, R-2 and R-3.”

However, the internal medicine training can be shortened in the context of the ABIM Research Pathway. This pathway requires three components:

  1. Internal Medicine Training – 24 months of accredited categorical internal medicine training (a minimum 20 months must involve direct patient care responsibility)
  2. Clinical Subspecialty Training – 12-24 months depending on the subspecialty
    1. 12 months: adolescent medicine; allergy and immunology; critical care medicine; endocrinology, diabetes, and metabolism; geriatric medicine; hematology; hospice and palliative medicine; infectious disease; nephrology; medical oncology; pulmonary disease; rheumatology; sleep medicine or sports medicine
    2. 18 months: gastroenterology, hematology/oncology, pulmonary/critical care medicine, or rheumatology/allergy and immunology
    3. 24 months: cardiology
  3. Research Training – At least three years of research training at 80 percent commitment

In general, internal medicine residency programs aim to meet the requirements for internal medicine board certification. Some residencies, especially those with research tracks, offer an option to meet the ABIM Research Pathway requirements for internal medicine board certification. However, the format by which they meet these requirements vary.

Within these requirements, there are variations in structure by which programs offer research pathways. Some offer specific rotations for all members of the pathway to think about science at the same time. Some have retreats or special curricula for the physician-scientist trainees. This might include ethics courses, statistics courses, or other types of training. There may be seminars throughout the year or journal clubs, or other opportunities to meet with faculty and outside experts. Within the structure of the program it can also be helpful to now how short-tracking may affect flexibility/rotation schedule. Some programs promote research electives during residency while others advise trainees to wait for fellowship.

If a program does guarantee fellowship, how is it incorporated into the schedule? Does fellowship come immediately after residency with research at the end? Do you start your protected research time after residency and then do fellowship after that? The argument for this being that you can get more data early on and then wait for grant results/revise your grant while you’re doing your clinical training (if you have the time…) Does the fellowship somehow get split around the research years? A GI program told me they typically have trainees do the first year of clinical training, then the research years, then have you do the final 6 months of clinical training at the end to get you ready for being an attending. This may be both institution and fellowship-specific and so may not be clearly delineated on their websites.

Funding

Can’t do science/be a person without that cold hard cash. Funding in many different ways may impact your decision. Most of all is your stipend, which may match that of your purely clinical-training colleagues, though there may be an additional stipend. On top of that, it is important to ask if there’s extra funds available to support research/travel. As you progress into your research years, you may also want to know if programs have T32 fellowship support or how successful they are at helping their trainees get F32 grants. As you begin to think about getting a faculty position, it will be important to get a K award and be training at a program with a good success rate at helping their trainees get this elusive grant. On top of this, some programs outline their process of helping trainees get funding, such as 1:1 meetings, establishing mentorship committees, etc. I also often noted how well funded is the institution in general, if it was mentioned on the residency’s page (I otherwise did not seek this info out).

Fellowship

Some but not all programs I found guaranteed fellowship. In most cases, they did offer the short track that was dependent on going on to do fellowship either at the institution or elsewhere. There are positives and negatives of having guaranteed fellowship. First of all, you of course are guaranteed fellowship, and you do not need to be going through another application process in just a couple of years. You also can begin to build relationships at the institution that you know will carry on into your fellowship and research years. On the other hand, it is a lot more work to change your mind, whether to switch fellowships or even switch institutions for fellowship. If fellowship is not guaranteed, it can be helpful to know the match rate for residents into your specialty of interest and how many programs they typically need to apply to compared to the general categorical resident.

If you are guaranteed fellowship at the program, it is important to know if the fellowship you’re interested in is actually participating in the research pathway. I was turned down by a couple research pathway programs just because the GI fellowship was not accepting research pathway trainees that year and this was not stated on the website. Some places did specifically list which fellowships were available through the program, which was quite helpful.

How to apply

For my sanity/organization, I also took note of any instructions listed on the website for how to apply. There were quite a few different ways that programs preferred to be made aware of your preference. Putting these instructions into a separate document gave me a list to go through and make sure that I was expressing interest in the correct way and made it so I didn’t have to go back to all of their websites later to find this information.

  • ERAS: Some programs had a separate program code specifically for their research pathway. Almost all of the programs I looked at allowed you to apply to both the categorical program and the research pathway.
  • Personal Statement: Some programs wanted you to write in your personal statement that you were interested in the program and which fellowship you were interested in (see the end of my residency personal statement post for how I included that information). I typically did this for programs unless they specifically asked for this information in a different format.
  • Supplemental Application: A few programs had a supplemental application that typically asked you to write about your research and career interests. Sometimes the programs also had you upload examples of your scientific work.
  • Statement of Interest: These were often included in a supplemental application or were sent in an email to the program director or program coordinator. In general, I tried to write a brief overview about myself and my research experience/interests and why I was interested in the program/why the program was a good fit for me (including but not limited to the faculty at the program who could serve as potential research mentors). If there’s interest, I can share an example of one of these some day…
  • Delayed Application: Some programs did not formally consider trainees for the research pathway until the middle of their intern year, but they still did outreach/let you learn for about their research pathway during the residency application process. In this case, no application materials were necessary.

Choosing Where to Apply

For me, the biggest things that narrowed down my list were the number of potential research mentors available at each institution and geography. After all of these years of training, I have a general idea of what kind of research I want to do in the long run and I want to make sure I have many options for mentors available at each institution, as sometimes people leave or are just not the kind of mentor that you need. I had a hard time finding 3 potential mentors at some institutions, which ultimately took them off my list. I also mostly wanted to stay either in the midwest or north east. I didn’t even consider the structure of the internal medicine program itself, for better or worse. You may weigh factors differently.

Upon selecting where to apply, I categorized my programs generally into a top half and a bottom half based on how interested I was in the program/how I generally felt like they were a good fit for me (not necessarily how good of a program they were overall as determined by some kind of somewhat objective measure). Interestingly, a higher proportion of the programs in my top half offered me interviews, suggesting that my gut feeling was reflected in their assessment of me as a good fit for their program. Trust your gut and good luck!!!

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