title: Incubating the research independence of a medical scientist training program graduate: a case study.
abstract: OBJECTIVE
  Physician-scientists play a critical role in discovering new biological knowledge and translating findings into medical practices that can improve clinical outcomes. Collectively, the National Institutes of Health (NIH) and its affiliated Medical Scientist Training Programs (MSTPs) invest upwards of $500,000 to fully train each of the 900+ MD/PhD students enrolled in these programs. Nevertheless, graduates face the challenges of navigating fragmented intervals of clinical training and research engagement, reinitiating research upon completing their residencies, managing financial pressures, and competing for funding following what is typically four or more years of research inactivity. Together, these barriers contribute to the high attrition rate of MSTP graduates from research careers.
  
  
  METHODS
  The authors designed and implemented (2009-2014), for a single trainee, an alternative postgraduate training model characterized by early research engagement, strategic mentoring, unyoked clinical and research milestones, and dedicated financial support.
  
  
  RESULTS
  The pilot training experiment was so successful that the trainee secured an NIH project grant and completed his transition to research independence 3.5 years after starting the experimental training schedule-nearly 9 years earlier (based on age) than is typical for MD/PhDs transitioning from mentored to independent research. This success has demonstrated that unyoking research engagement from conventional calendar-based clinical training milestones is a feasible, effective means of incubating research independence in MSTP graduates.
  
  
  CONCLUSIONS
  The authors encourage the design and application of similar unconventional approaches that interweave residency training with ongoing research activity for appropriate candidates, especially in subspecialties with increased MSTP graduate enrollment.
authors.affiliation: Dr. Dzirasa is assistant professor and house staff officer, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina. Dr. Krishnan is professor, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, and dean, Duke-NUS (National University of Singapore) Graduate Medical School, Singapore. Dr. Williams is president, Gladstone Institutes, San Francisco, California.
authors.forename: Kafui
authors.initials: K
authors.lastname: Dzirasa
authors.forename: Ranga R
authors.initials: RR
authors.lastname: Krishnan
authors.forename: R Sanders
authors.initials: RS
authors.lastname: Williams
mesh_terms: D035843:Biomedical Research / Q000193:education* / Q000458:organization & administration*; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005240:Feasibility Studies; D006801:Humans; D008611:Mentors; D009316:National Institutes of Health (U.S.); D017009:Professional Autonomy; D011570:Psychiatry / Q000193:education; D014146:Training Support / Q000458:organization & administration; D014481:United States