Clinical continuity during dual-degree training

Not all MD/DO-PhD programs are structured in the same way. However, common among the structures out there is a period of time between the beginning of medical school training and the end, which is occupied by PhD research. After the PhD, you go back to medical school and suddenly you’re in the hospital at 4 am asking patients if they’ve pooped or you’re in clinic trying to do a physical exam on a fussy child. If you haven’t thought about or done anything clinical in years, this can certainly be a shock.

At the same time, you’re integrating with a whole new medical school class, which has been made even more difficult in the setting of COVID-19 (Calco, JCTS [2020]).

This “major chasm” that occurs during the PhD years has been historically recognized, and programs are addressing this chasm through the development of clinical continuity opportunities. However, these vary widely between programs and have not been well studied as a collective.

A few years ago, myself and some of my fellow student leaders of the American Physician Scientists Association decided to study this. The motivation began out of discussions with the Institutional Representatives of the organization. The Membership Committee did a preliminary survey. Then the Policy Committee set out to do a comprehensive survey, seeking out Institutional Review Board approval so that we could eventually publish this data for broader dissemination.

This manuscript is now available from the Journal of Clinical and Translational Science. You can read it here.

As a trainee, here are the things that are most helpful to know:

Again, there is wide variation among programs. If you haven’t started your dual-degree training, this could be something useful to ask about during your interviews.

The clinical continuity experiences rated as more efficacious were:

  • Standardized patient encounters
  • Mentored clinical experiences
  • Clinical skills review sessions
  • Preclinical courses/review sessions
  • Clinical volunteering

The clinical continuity experiences rated as less efficacious were:

  • Clinical case reviews
  • Clinical journal club
  • Medicine grand rounds

The strategies offered vary based on proximity to clinical re-entry. For example, clinical skills review sessions and preclinical/review courses were typically only offered within 8 weeks of clinical re-entry while other experiences like clinical volunteering, mentored clinical experiences, and medical grand rounds were available throughout PhD training.

We also don’t know which of these are the best to truly prepare students for the transition back. There are many outcomes that need to be assessed with respect to these experiences not just performance in clinical skills during the clerkship years but also student confidence in their knowledge and skills and overall wellbeing amongst the period of transition. I have a feeling that there is not going to be one best way to do this and it will have to be specialized to the learner.

Importantly, these clinical continuity experiences are typically voluntary and so the amount that you do during your PhD is mostly up to you. Your PhD years are the one time you will be able to have time solely dedicated to thinking about research questions so enjoy them (yes it is possible to enjoy them!) and do not distract yourself *too much* with clinical experiences or other obligations.


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