CITAC news update: Increasing Evidence On The Value Of Clinician-Investigator Training Programs In Canada

                                                                                                                                            Written by Patrick Steadman; edited by Ellen Zhou and Kirill Zaslavsky

     During 2016, CITAC members worked hard to establish answers to pressing questions on Canada’s clinician-investigator (CI) training. This hard work continues CITAC’s tradition of conducting research on CI training and publishing this work and is especially relevant following changes to Canada’s support of CI training in 2015 (Webster). CI’s are important to the medical and research community as they are clinicians who spend at least 50% of their time working on essential research. Clinician-scientists are those who spend 80% of their time on research.

     A fundamental question that had remained open in Canada was how successful are MD-PhD programs at training CIs? While in the US, NIH-funded programs report that 66% or more (depending on data source) of their graduates become clinician-scientists (Brass et al., 2010). No similar measures have been compiled for Canada until now. From Zhou et al. (2016), who surveyed all alumni of McGill’s MD-PhD program found that of those that have completed training, 60% had roles defined as clinician-scientists. For its part, University of Toronto’s latest annual report states that 55% of its graduates have become clinician-scientists (found here). CITAC has completed a national survey of graduates from all MD-PhD programs in Canada, which has been accepted in CMAJ Open. To date, 60% of the graduates have become clinician-scientists, and nearly 90% are primary investigators on research grants with 77.8% holding more than one. This data clearly demonstrates that Canadian MD-PhD programs are a vital source of clinician-investigators for our healthcare system.

    The survey also highlighted several areas that facilitate trainee success. For example, a key pillar of training is mentorship by peers and senior CIs. This has been discussed before by CITAC (see Yoon et al., 2013) and examined in detail by Jones et al. (2016), who surveyed MD-PhD program directors and trainees on program structure, funding, and integration of research and clinical training available within their institutions. Surprisingly, we found that more than half of all programs did not have formal mentorship opportunities, a serious barrier to trainee success. Furthermore, stipend amount and tuition varied, especially when students were in the MD portion of their training. Such variability in trainee support, coupled with limited mentorship opportunities, may compromise the success of training programs in generating CIs. CITAC strongly believes that MD-PhD training programs would benefit from sharing practices and data on how individual program structures meet their trainee needs. A key goal for CITAC this year is to improve communication across member institutions and between trainees and program leadership. This nationwide collaboration can help increase opportunities for mentorship, career development opportunities and help inform design of best practices for training clinician-scientists.

    CITAC also examined the role of non-governmental organizations (NGOs) for promoting research in medical students (Manoranjan et al., 2017). By collaborating with the Mach-Gaensslen Foundation, CITAC analysed data on the 621 Canadian medical student research projects sponsored since 2005. Using pre- and post-research questionnaires and 5 and 10-year follow-up they found 96% of students would recommend a similar experience to other medical students and similarly that it was of great value to their medical training. At 10 years following the experience, 41.67% of respondents were physicians with a research component in their career and 58% held faculty appointments at a medical school. It is unclear whether these students would have become clinician researchers without the experience, but within this cohort participants report the experience as being impactful.

    Taken together, our work over the past year highlights the importance of supporting and expanding clinician-investigator training capacity in Canada. Though dwindling in proportion to the overall number of medical graduates, clinician-investigators remain a vital national resource that is fundamental to continued integration of medicine with research. In 2017, CITAC will continue to advocate for addressing trainee needs and increasing the viability of the clinician-investigator career pathway by encouraging nationwide collaboration across training programs and stakeholders.

 

References:

1. Brass, L. F., Akabas, M. H., Burnley, L. D., Engman, D. M., Wiley, C. A., & Andersen, O. S. (2010). Are MD-PhD programs meeting their goals? An analysis of career choices made by graduates of 24 MD-PhD programs. Academic Medicine : Journal of the Association of American Medical Colleges, 85(4), 692–701. http://doi.org/10.1097/ACM.0b013e3181d3ca17

2. Jones, A. A., Ng, E., Deguise, M.-O., Mak, L., Ouyang, B., Sivapragasam, M., et al. (2016). MD/PhD Training in Canada: Results from a national trainee and program director review. Clinical and Investigative Medicine …, 39(4), E132–9.

3. Manoranjan, B., Dey, A. K., Wang, X., Kuzyk, A., Petticrew, K., Carruthers, C., & Arnold, I. (2017). Role of non-government organizations in engaging medical students in research. Journal of Investigative Medicine : the Official Publication of the American Federation for Clinical Research, 65(3), 709–716. http://doi.org/10.1136/jim-2016-000348

4. Webster, P. C. (2015). CIHR cutting MD/PhD training program. Canadian Medical Association Journal, 187(12), E381–2. http://doi.org/10.1503/cmaj.109-5124

5. Yoon, J.-Y., Appleton, T., Cecchini, M. J., Correa, R. J., Ram, V. D., Wang, X., et al. (2013). It begins with the right supervisor: Importance of mentorship and clinician-investigator trainee satisfaction levels in Canada. Clinical and Investigative Medicine , 36(6), 269–276.

6. Zhou, T. E., Savage, P. A., & Eisenberg, M. J. (2016). Canadian M.D.-Ph.D. Programs Produce Impactful Physician-Scientists: The McGill Experience. Journal of Biomedical Education, 2016(4), 1–4. http://doi.org/10.1155/2016/3836467

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