Hanna is a MD/PhD student at the University of Illinois and an aspiring physician scientist who aims to specialize in hepatobiliary cancers. She is also passionate about teaching, leadership, and advocacy. The energy she once used to pep up crowds as a college marching band member is now directed toward exciting and educating others about science and medicine, especially through her tweets at @MDPhDToBe and her blog at www.mdphdtobe.com.
I started blogging almost 13 years ago (!!!) to share my MD/PhD application personal statements and begin to help others 1) learn about this pathway (especially if they did not know this pathway even existed like me as an undergrad) and 2) navigate entering and staying in the physician-scientist pathway. I remember how challenging it was to write my personal statements at that time and wanted to share my (now *cringe*) personal statements to help others out.
Fortunately, I again had the opportunity to share a personal statement after successfully applied to internal medicine residency and physician-scientist training programs.
Once again, I have a personal statement to share! After my first year of residency, I applied to gastroenterology fellowship and am about to now complete my first year of fellowship! It has been a wild ride and I am so glad for the path I have taken to get there!
Hanna’s Gastroenterology Personal Statement
My first year of residency has taught me incredibly many things. Including this one irrefutable fact: Patients with cirrhosis are sick. Really truly sick. Among the sickest patients we care for, often needing ICU level care. Residency has also taught me another related fact: Liver transplantation saves lives and changes near death into vitality before our eyes. This was crystalized for me through the case of a young man with primary sclerosing cholangitis/autoimmune hepatitis overlap who had just been transferred to the general medicine floor from the ICU – skin yellow, belly bloated, mind altered. Despite his initial improvement and despite my best efforts, over the next week his condition worsened. He had already experienced the disappointment of two liver transplant offers falling through earlier in the year. He was high on the transplant list again, but we remained cautiously optimistic. Luckily, this time was in fact the charm, and he went to surgery late on a Saturday night. Two days after surgery, I visited him in the ICU. He looked like a completely different man. We both had tears in our eyes before he could even mutter “thank you.” Being able to care for patients with complex sequelae of liver disease and seeing the impact of getting them to this life-saving treatment motivates me to pursue a career in gastroenterology.
The significance of this moment was heightened by my long-term interest in the liver, which began as a graduate student. I initially pursued a PhD to better understand how normal cells can be transformed into cancer cells, growing independently of the body’s eloquent feedback mechanisms. Studying this process in the context of hepatocellular carcinoma, I grew to appreciate that the development of cancer was a late stage of disease, as most cases arise in patients with cirrhosis, which itself is a result of progressive inflammation, metabolic changes, and fibrosis that occur over decades. As the liver is a source of many diseases, I became interested in understanding common pathways that could contribute to the progression of liver disease and therefore be potential therapeutic targets, ultimately reducing the need for liver transplantation, an opportunity available for so few. This led me to study a scaffolding protein that is regulated by bile acids, which accumulate in many liver diseases and function as signaling molecules in addition to their role in fat absorption. During my PhD, I showed that upregulation of this protein could be protective in the context of metabolic and cholestatic liver injury but at the same time promoted the growth of hepatocellular carcinoma. I was awarded a NIH NRSA F30 Individual Predoctoral MD/PhD Degree Fellowship from the National Cancer Institute to support this work, which has resulted in 2 first/co-first author publications. There is still so much to learn about how these adaptive and maladaptive pathways interplay in the progression of liver disease, and I am excited to continue to explore these questions throughout my career.
My goal is to become an academic physician-scientist who specializes in the care of patients with liver disease and with a research focus on the metabolic pathways that contribute to the pathophysiology of liver disease. I want to address the gaps in these areas from both the bench and the bedside by leading an active research laboratory, caring for patients, and using my expertise to impact others through advocacy, education, and outreach. I am looking for a gastroenterology fellowship program that can be a home for my next phase of training by providing intensive clinical training while also fostering my development as a physician-scientist. [Institution] would be an excellent home for my training, with local researchers including [researcher #1], [researcher #2], and [researcher #3].
This last sentence is perhaps one of the most important (and sometimes most difficult) parts.
Why is it important? 1) It shows the program that I am interested enough in their program to have done the research about their program to have identified potential research mentors. 2) It shows how the program is a good fit for me because they have people doing research in topics that I would want to work on, so that they can realistically help me achieve my career goals in the way that I want to achieve them – you need to be a good fit for them but they also need to be a good fit for you.
Why is it difficult? You may not know what you want to do! It’s hard to have a perfect vision of your future and its scary to commit! Don’t worry, you always have the chance to change your mind, but I think having a specific vision (if you’re able to articulate it) truly makes a personal statement impactful. Even though I had just applied to residency 2 years prior and my future goals have not significantly wavered, I still had a period of time while preparing my fellowship application where I was wondering if my purpose was the same and if I was articulating it in the most impactful way. Now I am a year into fellowship and have started my research with a great mentor and am confident that I made the right choice for me.
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.
Whenever people ask me for advice for graduate school, my first response is to have an organization system that works for you. Let me tell you why.
It is the fall of 2021. I am in my last med school rotation, anxiously awaiting residency interview invites. I get an email from my PhD advisor – “Hey we are working on a grant. Did you ever treat cells with [this reagent] and measure [this protein expression]?” I had completed my PhD more than 2 years prior, but I was able to go to a single excel document, search for a few key search terms, and see if anything came up. I did not have to go through an endless search through folders on my computer or say “I know I did it I just don’t have the data anymore”.
While this was after my PhD was done and I was no longer obligated to help with my lab’s grants (#academiaproblems – don’t work for free!), I had many similar experiences during my PhD years where more recent data had me re-thinking previous data and I was glad that I was able to go back to easily find the data from years before. I was also able to go back and find other useful information like how I troubleshot certain problems. My organization system also came in use for finding reagents in the lab and limiting my time searching through -80 C freezers and liquid nitrogen stores.
This is not to say that my organization system was perfect – I certainly learned from many mistakes – but it still highlights the fact that some extra time spent documenting will save you time (and your lab money) in the long run.
Organizing data
Lab Notebook
While electronic lab notebooks were becoming more widely used during my graduate school time, I began with a physical notebook and stuck with it throughout. I did use an overall hybrid way of organizing my data, however, since most data these days are acquired in an electronic format.
Some people choose to organize their data by project, but what worked best for me is to just put them in chronological order. I saved the first few pages of each notebook for a table of contents that I initially filled out by hand but by the end would wait until the notebook was full and then I would type up the table of contents, print it out, and tape it in (way easier to do and read than doing it by hand). The only exception is that I ended up putting all of my mouse genotyping data in a separate notebook that I could bring with me to the mouse house to make sure I was correctly marking cages.
My lab notebooks at the end of my PhD. | Instagram: @MDPhDToBe
In addition to the physical notebook and table of contents, I ended up making an excel document as a searchable table of contents where each sheet corresponded to a different physical notebook, then I had columns for page number, date, and then a shorthand description of what was included on the page that included the technique (western blot, qPCR, etc.), the samples used, and the read outs. For example, “Western Blot – WT and KO fed/fasted mice – P-ERK, ERK, GAPDH”. This way, I would search for all pages with western blot data, all pages with data for my fed/fasted study, or specific read outs such as all pages with P-ERK expression. Having a consistent naming system allowed me to rapidly identify the required data, as I mentioned in the example in the intro.
As I approached the end of my PhD and dissertation writing was nigh (thus I was spending less time in the lab itself), I also ended up taking photos with each page of my physical notebook so that I could reference it from home. This was helpful so that I could see my notes about each set of data in addition to seeing the raw data itself on my computer. This was especially useful to find western data for the same samples but where the raw data may be collected on different days (see how next to each western image below I include a date in a numbering format described below – this helped me find the raw data on my computer). As shown below, each gel/set of gels that I ran had its own page within my notebook where I would put all of the info together. Admittedly, I could have included more info about my westerns such as the concentration of antibody used, whether it was in BSA or milk, etc. but I honestly got a little lazy.
Raw Data
Just as I filled out my lab notebook chronologically, so too did I keep my raw data in a chronological format on my computer. I used a naming system for my folders and documents that made it so that my documents showed up in chronological order whether I went through the folders or I searched my computer for a certain document. This format involved a year-month-day numbering – the absolute best numbering format (shout out to my undergrad lab for teaching me this!) Unfortunately, I don’t have access to the server that holds my raw data anymore, but below is an example of how the folders were structured. Within my data folder, there was a folder for the year. Within this, each month had a folder labeled with the year then month and “XX” to indicate that any day was included. Within each month folder, there were folders for each day that I had data to include, which as you can see below sorted appropriately in order. Then within each of the day folders, I had all of the raw data collected on that day.
Analyzed Data
When it came to analyzed/synthesized data for papers, I then sorted the data separately from my chronological, raw data folders. Each paper had its own top level folder. Within that folder, there were folders for figures, drafts, etc. as well as a folder for data. Since I did mostly mouse experiments and these mouse experiments ended up generating quite a bit of data, I mostly organized this data folder by experiment type (if mouse, then by sex, age, type of treatment, length of treatment, etc. or if cell culture then cell type and treatment). Within each experiment folder, I organized data by type such as protein expression (western blot), mRNA expression (q-RT-PCR), histology, etc.
Organizing supplies
In addition to organizing my experimental data, I also had a system to organize supplies and know exactly where certain things could be found. This was particularly important for items kept in very cold places (-80 freezer and liquid nitrogen especially) because it is absolutely no fun to spend endless time searching in these places for something that you need. 🥶
Cell lines
Our cell line stocks were stored in liquid nitrogen in 9×9 or 10×10 boxes. We had enough stocks for some lines that I had entire boxes dedicated to tubes of HepG2 or HEK293T cells, for example. However, even within these boxes there were variation of the passage number of the cell stocks. With the help of my lab mates, I created an excel document that was kept on our shared server where we recorded the EXACT location of each cell line stock. The document was structured where each sheet was a different box – numbered rack 1/box 1, rack 1/box 2, etc. Within each sheet, there was a row for each coordinate in the box: row A/column 1, row A/column 2, row A/column 3; etc. It was a lot of work up front to go through and put the information into the excel document (it helped having 1 person to look at the tube, keeping the whole box on dry ice, while another person input information in the excel document to minimize the time the tubes were out of the liquid nitrogen). Importantly, as a result, I could know that the tube I wanted was in this box number on this rack, and once I got that box out I could know that the tube was in this specific coordinate within the box! The challenge was keeping this updated as tubes were removed or added (usually folks updated), but at least it gave us a starting point to try to make the whole process easier. I only had to recheck all the tubes/update the excel sheet once during my 5 years in the lab.
Tissue samples
Working with mice, I accumulated a lot of tissue samples that had to be stored at -80 C. To keep track of all of these (and to combine some data for my projects), I also had an excel document. I had one sheet dedicated for a table of contents, which box # had which experiment’s samples and which -80 C freezer was that box located (we had both a chest and an upright freezer). Then each box had its own respective sheet within the excel document to outline more info about its content.
One particularly useful thing I did with this is that I actually included all of the data about each mouse in this excel document. This included ear tag number, genotype, sex, date of birth, sac date, experimental condition (control vs treatment), as well as data collected at the time of sacrifice such as body weight, liver weight, adipose tissue weight, and any other info that was collected. Finally, I also marked which tissue were present in the box – including but not limited to liver, adipose tissue, gallbladder (as I was in a bile acid lab, we always collected this but I never actually did anything with it!) I did this for a couple of reasons – 1) I needed to organize the data somewhere, it might as well be in this document and 2) at some point when I left the lab, others could easily go to find out what I had and all of the data for it instead of having to go search through multiple lab notebooks to hopefully find all of the data organized by the date that the tissue were collected (as I unfortunately had to do for a few projects I worked on from previous lab members).
Primers
My lab did a lot of qPCR to measure gene expression, so we had a lot of primer stocks. I personally had 4-5 boxes of primer stocks that I had created during my PhD. Since these need to be in pairs (and things in pairs often find a way to become separated), I assigned each primer a specific location in these boxes. Just as I did with the cell culture stocks, I made an excel sheet that noted the exact location of each tube. In addition, I put the primer sequence in the excel sheets so that, again, all the info was accessible in the same place.
Now, one extra thing I did in this case that was helpful is that in addition to this electronic documentation, I also wrote the box # and coordinate on the top of each tube – for example, “Box 2 A8”. I bought a bunch of those little dot stickers to make it easier to label. This labeling was important because I was not the only person using these primers. Having the location labeled on the top made it easier for everyone else (and myself) to put these back where they belong.
Organizing Papers
Something that I always worked on doing (but never found a good, consistent format) was organizing the papers that I had downloaded and [sometimes] read. In the beginning, I tried using reference managers like Zotero (because it was free) however I wasn’t a fan of the format. I tried downloading the PDFs and organizing them into folders based on general topics, but then I’d forgot to check these folders and would end up downloading the same paper multiple times. Some of the main papers I references throughout my PhD were ones that I ended up printing out, reading, and highlighting multiple times without realizing I had already done so until I found another version of it already printed out at home. In the end, I was ok with this redundancy because it was often nice to go back to a paper I had previously read with a new outlook given my more recent data or based on other papers I had read. It wasn’t exactly efficient but there was still some positive aspect to it.
When it came to writing papers and my dissertation, what ended up working for me was to create a word doc where I would organize my references alphabetically by last name. As I was working on the draft of my documents, I would include the reference as (last name, year) in the text. Then, when I got ready to actually submit the manuscript, I would use a reference manager (End Note or Zotero) to actually put in the references and format them appropriately for each journal. A couple reasons I did this are 1) my lab typically wanted to do this using End Note and I didn’t want to buy it so my other option was to only use it on the computers at lab and 2) I had heard horror stories of references linked by reference managers getting messed up when sharing a document with someone. However, linking all the references at the end could be a very time consuming process (for my 100+ page dissertation draft that I wrote for my prelim exam, it took 6+ hours! I watched Grey’s Anatomy the whole time…) So when it came to my final dissertation, I actually just left my references in the format (last name, year) in the text and copied the text from my separate references document into the references section of my final dissertation document.
I hope this was a helpful way to think about organization as a grad student, whether you are just starting out or are near the end. Again, this is by no means a perfect way to organize and some of it was certainly time consuming, but I think it paid off in the end. I would love to hear how others kept organized during graduate school or if you have other advice for students starting graduate school!
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:
Internal Medicine Training – 24 months of accredited categorical internal medicine training (a minimum 20 months must involve direct patient care responsibility)
Clinical Subspecialty Training – 12-24 months depending on the subspecialty
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
18 months: gastroenterology, hematology/oncology, pulmonary/critical care medicine, or rheumatology/allergy and immunology
24 months: cardiology
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 gutand good luck!!!
After MD/PhD training, what do you do? The world is in fact your oyster 🦪, but in this post I’ll outline how you can continue on the physician-scientist pathway while also continuing your clinical training.
First, a note. You do NOT need to continue to practice medicine as a physician-scientist. Aka you do not need to go to residency. You go to residency if you actually want to provide care to patients as a physician. If you just want to have your current level of medical training (MD/DO/MBBS) inform your work as a researcher or in another space (i.e., academia, industry, government, or elsewhere), you do NOT in fact need to go to residency (save yourself the time – this is already a long road 😫).
This is a post for if you do want to practice clinical medicine and the next step of your journey is residency. In this case, there is a division of paths based on the specialty you plan to practice. I am going into internal medicine, so that is my bias, but here I will try to link to resources that can be helpful for hopeful physician-scientists in other areas of medicine, though my advice and experience is coming from the perspective of internal medicine.
Typically, you apply to residency at the beginning of the 4th year of medical school. Applications are due in September through the Electronic Residency Application Service (ERAS) and interviews are scheduled from October through January. To further explore specialties in general, check out the AAMC Careers in Medicine resource (link).
Research in Residency
If you’re interested in wet lab research (e.g., biology, chemistry) or other research that is more time consuming, you may want to look for a program that has dedicated time for research. These come by many names. Depending on your chosen specialty, I recommend searching residency program websites for how they describe their research opportunities during residency.
In internal medicine, I found programs titled “Physician Scientist Pathway”, “Physician-Scientist Track”, “Science in Residency Program”, “ABIM Research Path”, “Physician-Scientist Training Pathway”, “Resident Research Path”, for example. Basically, there’s a lot of different names, so a google search for one of these terms will not bring up all the programs that fit the same description.
Despite the variances in names, these programs often followed a similar format. In internal medicine, that format is based on the American Board of Internal Medicine’s (ABIM) requirement for internal medicine training. There is a specific research pathway approved by the ABIM that is recommended only for physicians who intend to seriously pursue a career in basic science or clinical research. Within this pathway, there is an option to “short track” residency training to 2 years of internal medicine training instead of 3, with a required subspecialty fellowship training of 12-24 months of clinical requirements (length depends on subspecialty) plus 3 years of protected research time. This protected research time is really the important part of this training because this is setting the basis for your future research/lab. It is possible that other specialties have similar policies that dictate how residency programs may be able to shorten your physician-scientist journey.
The Long Road
This certainly sounds like a long time, especially after 8-9 years of MD/PhD training (some people can get into these pathways without the PhD but they have usually spend a number of years doing research outside of medical school that yields publications, so that is often almost a similar amount of time). Let me put this into perspective:
I can go through the ABIM research pathway, where I do 2 years of internal medicine training, 1-2 years of subspecialty fellowship clinical training, and 3 years of protected research training, for a total of 6-7 years of postgraduate training as a physician-scientist trainee. I may need 1-2 more years of research to get funding/papers that would make me competitive for a research position, but then I’m still on the track for an academic research position.
Alternatively, I can *just* complete my clinical requirements of 3 years of internal medicine training and 2-3 years of fellowship training, for 5-6 years of postgraduate training as a physician.
Or I can opt not to practice medicine but I still want to do post-doctoral research in a lab with hopes that I can get an academic faculty position. As an example, one of my grad school professors once shared the length of time applicants considered for faculty positions in our department had spent in their post doc training. These varied from 4-10 years, with an average of 7 years (n = 5).
Thus, you are looking at 5-6 years if you *just* want to practice medicine in a subspecialty, 6-7(+2?) years if you want to do a subspecialty and research, and 7 years on average if you want to *just* do research. It may be longer than some alternate options, but it may be more bang for your buck to do the physician-scientist route.
How to Learn More
It can be hard to know where to begin. So here’s a few of the main resources I used when preparing to apply:
AAMC Physician-Scientist Training Program info page. Here you can find links to more specific info about different specialties including internal medicine, pediatrics, emergency medicine, and psychiatry, and pathology. Specifically within the archives, there are webinars on preparing your PSTP or research residency application, broader discussions of what is a PSTP, and many specialty-specific webinars (expanding beyond internal medicine).
If you have any further questions about this next phase of training, feel free to reach out via the contact tab. I’ll try to continue producing this kind of content and it is helpful for me to know what is helpful for you!
Back in the day, I shared my personal statements for MD/PhD programs (yes statements! – the MD, MD/PhD, and research statement). Now that I’ve matched to residency, it’s time I share another example personal statement to help those who come after me. If you want to just read my personal statement, skip to the bottom. If you want to understand my thought process around my residency personal statement, keep reading.
Unlike applying to medical school, where I was trying to get any school to “Pick me. Choose me. Love me”, when it came to the residency personal statement I had a more specific ask in mind. I knew the specialty I intended to pursue and had a more clear vision for the career I hoped to have. I also had a more developed 🌟story🌟 of how I came to be the person that I am and how my vision for my future has been shaped. This both made it easier and harder to write.
For context, I applied to internal medicine programs, especially those that supported the training of physician-scientists. If they didn’t have a research pathway, track, …thing, I didn’t apply. I also am 99.9% sure that I want to do gastroenterology as a subspecialty and am considering transplant hepatology, so almost all of the programs I applied to had a transplant hepatology fellowship at the same institution so that I could be exposed to this pathway.
Given that context, my goals for my personal statement were:
Show my commitment to internal medicine as a specialty. Even though I am very interested in gastroenterology, I am first and foremost going to be an internal medicine physician (and applied to programs to specifically train me as an internal medicine physician), so I kept my personal statement focused on this. For research programs that requested subspecialty interest within the personal statement, I included my interest in gastroenterology at the end of the statement, though you can also see my interest in gastroenterology through the patient story I chose and my PhD research topic (which doesn’t always have to directly align with your chosen specialty going forward but in my case helped).
Highlight my value of the personal side of medicine. Why am I continuing with clinical medicine instead of only doing research? You maybe thought doing all of medical school would be able to show this, but it is incredibly important to show that you want to do the residency training because you actually want to practice medicine (again, residency programs are training you to actually practice medicine). I showed this by discussing one of my most memorable patients, the connection we were able to form, and how I hope to continue to have these types of relationships with patients – something I would not be able to do if I were to *only* do research going forward.
Emphasize that I have interests outside of clinical medicine and that I am looking for a program that will support my development in these areas. Not only are clinical medicine and research important to me, but so too is advocacy, which is a much less common area of involvement for medical students/residents. I showed my commitment to research by discussing how my experience as a researcher mimics the thought process involved in diagnostic reasoning. My story also includes my introduction to internal medicine as a specialty through the lens of advocacy. Thus, it was a natural flow from one idea to the next and allowed me to make a clear, linear 🌟story🌟.
What I didn’t want to do:
Reiterate my CV. Note that I did not list any of the awards that I received. I did not list all of my experiences in any organization. Instead, I picked a couple of experiences and elaborated more in depth on aspects of these experiences that were not included in my CV. The purpose of the personal statement is to make it *personal*. Reviewers could see the evals I received on my clerkships, but they wouldn’t have otherwise known about how much my relationship with just one patient meant to me. They could see from my CV that I’ve been involved in professional organizations, but they wouldn’t see how the stories told at my first advocacy day in Washington, DC showed me the priorities of internal medicine physicians and how that made me want to go into the specialty. They could see that I got a PhD in Molecular and Integrative Physiology, but they couldn’t see how I valued including a cultural and historical context to my dissertation. It is the *specific details* in each of these that truly added to my application and made my personal statement a 🌟story🌟.
Tell the reader what it means to be an internal medicine physician. The members of the admission committee know what it means to be an internal medicine physician – they are, in fact, one themselves; you do not need to tell them what it means to practice in whatever specialty it is that you are applying. Even when I got close to this – saying internists have a comprehensive yet focused approach to the patient – I pulled it back to talking about myself and how my thought process as a PhD student aligns with that of internal medicine physicians. It is your *personal* statement, so it is ok to keep the focus on YOU.
Go longer than 1 page. The character limit in ERAS does allow you to go beyond 1 page of text, but DO NOT do this. People get bored with longer statements/may not fully read. Keep it short, keep it simple. Also note that 1 page in your word doc may not be the same as 1 page on ERAS. Definitely work on it in a document on your computer, but then paste it into ERAS every now and then to see if it would actually fit on a page when you preview the document.
And now, without further ado,
🥁🥁🥁*Drumroll*🥁🥁🥁
here is my internal medicine residency personal statement:
One of my most memorable patients was a man I met during my internal medicine clerkship. The gray-haired English professor, with a booming voice, told me in slow, fragmented, but intentional words how he wrote off his weight loss because of a stroke earlier in the year. In a quieter voice, he revealed that he had been having bloody stools much longer than he had originally disclosed and expressed shame for not getting a screening colonoscopy many years ago. Through our daily interactions and my active listening, we had built a relationship in which he felt comfortable disclosing a part of his story that he had not told another soul. The last day I saw him, I wished him well on his hemicolectomy scheduled for the following week – he was diagnosed with stage IIIB adenocarcinoma. It is the utmost privilege to build such a trusting relationship with a patient, to learn parts of their story no one else has known, and to help them navigate their health journey. These relationships motivate me to pursue internal medicine.
My path toward internal medicine began as a first year MD/PhD student when I was already aware that the impact of physicians on their patients’ health, while profound, was limited by factors outside of medicine itself. With an early interest in an internal medicine subspecialty, I attended the American College of Physicians Leadership Day in Washington, D.C. to learn how to be an advocate, with a humble hope that I could help improve the healthcare system for my future patients. As we planned how to advocate on Capitol Hill, what stood out most was that the purpose of our advocacy always went back to how it would help our patients. We shared patients’ stories including one who could not afford their $4 monthly blood pressure medications after losing their job and another diagnosed with advanced cancer because they put off seeing a physician due to lack of health insurance. This patient-centered focus – an extension of the patient-physician relationship – and the broad spectrum of patient stories is what made me decide, first and foremost, that I want to be an internal medicine physician.
Over the next seven years, what has continued to draw me to internal medicine is the rigorous approach of both generalists and subspecialists to every patient. As an aspiring academic physician-scientist, I also value this comprehensive yet focused approach both at the bedside and at the bench. Just as it is essential to begin with a broad differential diagnosis, I began my molecular and integrative physiology PhD dissertation with quotes from Shakespeare’s Hamlet and the 15th century physician Paracelsus to introduce a discussion of how the understanding of the liver has evolved since the time of ancient civilizations. This was followed by a meticulous biochemical discussion of the scaffolding protein I studied in the liver, expanding what is known of its role in metabolism and cancer. Both views are essential for the process of discovery, to connect seemingly disparate datapoints into a unifying understanding of a patient’s illness and its underlying biochemical mechanisms and then to apply this knowledge to their treatment.
Within internal medicine, I have found a community of advocates and scientists who care for patients how I aspire to care for patients, with a focus on the patient’s whole story and with a relationship that extends from the bedside to the bench and even to the halls of Congress. Since that day in Washington, D.C., I have been an active member in this community, from planning local events to help my classmates learn about internal medicine to speaking on behalf of all medical students on the American College of Physicians Board of Regents. I am looking for a residency program that can be a home for my next phase of training by providing intensive clinical training while also allowing me to develop as an advocate and scientist.
*If personalizing the statement to a program, I would then include only a couple sentences such as about my geographic connection to the area, a clinical interest that would fit there, or potential (up to 3) potential research mentors that I have identified at the institution.
MD, PhD To Be 