Eric G. Neilson
Submitter: Lewis H Nelson | lnelson@wfubmc.edu
Wake Forest University School of Medicine
Published May 2, 2003
Dear Editor:
The Personal Perspective article in JCI, March 2003, vol 111, by Eric G. Neilson was circulated to the Committee on Admissions (COA) of Wake Forest University School of Medicine (Wake Med). The responses of the committee as commentary on the article are offered as a balance to Dr. Neilson’s opinions. The COA of Wake Med is composed of thirteen people with MD and five people with PhD degrees. There are thirteen men and five women members.
If research becomes a focus and a necessity for admission to medical schools, committees will see applicants who will claim to be eligible for the Nobel Prize. The grain of truth within the previous cynical statement is that admissions committees have long ago learned that some applicants are capable of stating anything they think will enhance acceptance to medical school. Making research a focus of admission criteria will not necessarily increase the number of MD researchers.
Based on Dr. Neilson’s article it is apparent that not all admissions committees think the same way. There is a firm consensus from our COA that the medical school, not the admissions committee, is responsible for encouraging research by medical students. This is supported by one of the conclusions from the author’s reference in which the researchers state, “Cohort data obtained by tracking individuals from matriculation to graduation revealed that women who expressed strong research career intentions upon matriculation were more likely than men to decrease their research career intentions during medical school.” Wake Med strives to admit applicants with broad backgrounds and with experiences that separate the applicant from others—travel, special talents, fluency in languages, exceptional leadership experience, and real in depth experiences in research and patient care. The interview process seeks not only to explore the personality of the applicant but also the depth of the claims made by the applicant to find those with true and meaningful experiences. The committee believes that the curriculum at Wake Med is designed to support and stimulate the medical student’s interest in research by providing faculty mentors and a special day for presentations of students’ research. Monetary support and awards are provided for their efforts.
The admission committee’s composition would be expected to reflect the academic faculty; hence it is not surprising to find only two to four percent MD/PhDs on the committee. Many of the MDs, who comprise sixty-three percent of the COA, have active basic or clinical research programs. One would argue that those, combined with the twenty percent of members with PhDs, constitute a committee which possesses first-hand knowledge and appreciation of the importance of research. A PhD is not a prerequisite for “good” science, because many MDs still perform bench research. Unfortunately, there is a crisis in academic medicine caused in part by decreasing reimbursement and increasing legal risks. These lead to decreased time spent in teaching and research at academic centers. Although the admissions committee is fully aware of these restrictions, it is unrealistic to think that changing the type of student admitted will correct them.
Having ninety-one percent of the admissions committee members (100% at Wake Med) as volunteers should be viewed positively because they are willing to serve as a commitment to seeking the very brightest and best students who have a passion for patient care and science. These conscientious members of the COA do not “live in a private world where little is known of the social context from which decisions arrive,” but instead are practicing physicians coping with all the health and social problems of their patients while doing research and teaching, and research scientists who coping with all the demands of grant funding, research, and teaching.
Although the author lauds the increasing diversity of admissions committees as an “important exception,” he states that some of this diversity (the larger number of women in medical school) is detrimental to the future of research. He further hypothesizes that “modern admissions committees actually resist applicants who have an aptitude for scientific achievement,” citing as evidence one applicant whom he supported who was wait-listed because “she had not done much volunteer work.” At many medical schools, a significant proportion (thirty percent at Wake Med) of the class is admitted from the wait list, so that position is not as bad as the author implies. It is ironic that the author protests that the woman was not accepted while in the previous paragraph he complained about the increasing number of women being admitted who are less likely to do research.
Rather than continue to argue the editorial point by point, our COA feels that the admissions committees are not as out of touch as suggested. It continues to recognize the multifaceted applicant who is an undifferentiated future physician. The COA agrees with the author that we desperately need research scientists bearing one or both degrees, that there is a crisis in academic medicine about which the general public is unaware, and that medical schools must be the leaders in addressing these issues.
Submitter: Douglas P. Olson | OlsonDP@hotmail.com
National Institutes of Health
Published April 16, 2003
Dr. Neilson writes about a topic important not only to medical schools, but one of great relevance to the future of medicine as a whole. His thoughts and ideas are clearly well developed and supported, and my own recent experiences only serve to further substantiate his beliefs.
Since graduating from college, I have worked for nearly five years in research laboratories. I have studied, learned and contributed [albeit on small levels] to the fields of pediatric oncology, stem cell biology and HIV/AIDS – three areas of great medical and popular interest. During the medical school interview process at different schools, I was surprised that only once was I asked about the research I had done. All of the other “probing” questions were much more nebulous, and typically were in relation to my ideas about the role of medicine in situation x,y or z, et cetera. [N.B.: This interview experience is not specific to me – it is much the same for friends of mine in similar situations].
This seeming lack of interest in the potentially budding research careers of applicants, I would venture, is further evidence that research credentials are secondary to the humanism that admission committees seek ensure their students possess. I firmly beleive that teaching bedside manner, ethics, and ways in which to deal with difficult medical situations is extremely necessary in medical school; humanism, empathy, compassion and genuineness can not be “learned” in your twenties, thirties or forties [the age of most medical school applicants] – at this point, you’ve either got it or you don’t. This may be the reason that admission committees are seemingly obsessed with making sure students possess these “unlearnable” qualities, but to do so at the expense of scientific accomplishment casts a shadow of doubt about the future of curing disease and improving quality of life through better therapy, care and treatment. With nearly 10,000 applicants to medical schools each year, I daresay there is ample chance to be completely certain that each and every person admitted will have the qualities to become both a compassionate AND a scientific physician.
Only research – be it clinical, laboratory, or a fusion of the two - will allow us to make strides in preventing and curing disease as we enter a new, uncharted chapter of medicine. The prologue to this chapter must begin at the level of admission committees and their acceptance of first year medical students.
Submitter: Wafik S. El-Deiry | wafik@mail.med.upenn.edu
University of Pennsylvania
Published April 16, 2003
I enjoyed reading the Perspective by Dr. Nielsen in the JCI. He is absolutely right, and something really needs to be done about the growing shortage of physician scientists. Fixing the problem has a chance in the long run to lower health care costs and improve quality of life.
I think physician scientists are one of our most precious national resources who must be nurtured, encouraged and increased in numbers. To do this properly requires much greater investment of funds not only to support their medical education so they don't end up with enormous debts that drive them into private practice, but also an investment in their careers. The latter is crucial at many levels. Efforts by private organizations such as the Hughes Institute can have some impact in promoting and supporting physician scientists, but it is only a drop in the bucket. It is extremely important for the National Institutes of Health and other organizations (both public and private) to put a much higher value on molecular translational research and its potential benefit to patients, along with the development of objective measures of whether current programs are delivering on their promise. Addressing the shortage of physician scientists must be a national priority if we are to ultimately impact on human health in a consistent and meaningful way. The increase in numbers of physician scientists must also be balanced with the recognition that a combined career in medicine and research is difficult and that only a select few will ultimately be capable of functioning in both the clinical world and the research world simultaneously. The career path is difficult not only to obtain the M.D. and Ph.D. degrees but also to maintain and improve clinical skills, to continue to be productive scientifically and to remain competitive for research awards. Appropriate mentoring is required at various stages of this career, as well as a better definition of various alternatives available for physician scientists. Clearly physician scientists do many different things and balance medicine, research and administration in various ratios which vary at different times in their career. It is also clear that formal MSTP programs are not the only path to a successful career as a physician scientist as evidenced by for example the number of nobel prizes won by physicians who are not Ph.D.'s. It may be of interest to obtain data on careers of individuals who were interested in medical research but were denied entry into medical school; did they reach their goal anyway? It may be worth it to find ways to attract individuals who are turning away from medicine (and science) altogether because of worsening problems of paperwork, managed care, and stress associated with obtaining and keeping grant funds. The career of a physician scientists can be fun and extremely rewarding, and so this needs to be known by college students thinking about career options. Attracting and supporting the strongest candidates with the help of greater resources invested in careers may begin to reverse this serious problem.