• Acknowledgements
• Summary
• Introduction
• Background
• Study Design
  • MSTP Graduate Population and Sample
  • Comparison Groups
  • Data Sources
• Educational and Career Outcomes
  • Time to Latest Degree
  • Clinical Internship and Residency Training
  • Postdoctoral Research Training Support
  • Clinical Fellowships
  • Research Activity
  • Sources of Research Support
  • Publications
• Professional and Research Activities
  • Academic and Other Types of Appointments
  • Clinical Activities
  • Types of Journal Publications
• Conclusions
• Notes and References
• Appendices
  • Appendix I: Academic Department Classifications
  • Appendix II: Methods
  • Appendix III: Definitions and Criteria Used in Analyses of Curricula Vitae
  • Appendix IV: Statistical Tables

In what ways do the careers and research activities of MSTP graduates differ from those of graduates of other combined-degree or Ph.D. programs?

Several differences between MSTP graduates and members of the comparison groups emerge when selected characteristics of their professional activities are examined. In terms of these characteristics, MSTP graduates appear most similar to non-MSTP M.D.-Ph.D.s from the same institutions--both groups are likely to be employed in academia with appointments in a clinical or in both a clinical and a basic science department, and both have similar patterns of publication in clinical or mixed-type publications. Such similarities are not surprising, particularly given that individuals in the non-MSTP group participated in many of the same core training activities as their MSTP counterparts, were expected to complete the same degree requirements, had many of the same career aspirations (e.g., pursuing an academic career), and most likely benefited from the MSTP-sponsored training efforts (e.g., seminars and speakers) at those institutions.

Compared to MSTP graduates, MSTP trainees who received only an M.D. degree and M.D.-Ph.D.s from non-MSTP institutions appear to have less research-intensive careers. They are less likely to have research support and academic appointments and are more likely to be engaged in an independent private or group practice. Consistent with this, they have lower rates of publication.

MSTP graduates are more likely than Ph.D. graduates to be employed in academia and are more likely to be located in clinical departments or to have appointments in both a clinical and a basic science department. A high proportion of MSTP graduates complete internship and residency training and many have positions with some clinical involvement. They also are more likely than Ph.D.s to publish in clinical journals or journals that publish both clinical and basic research articles.

These differences reveal a pattern of professional and research activity that differs from that of graduates of traditional research training programs. The settings in which MSTP graduates work and the avenues through which MSTP graduates communicate the results of their research suggest a closer integration of their research activities with the practice of medicine. Although their involvement in patient care may be lower than that of other groups of M.D.-degree recipients, it appears that their clinical interests and training have influenced the nature of their research, and the research training they received through the MSTP contributed to their ability to mount successful research programs relevant to human health and disease.

The National Institute of General Medical Sciences (NIGMS) established the Medical Scientist Training Program (MSTP) in 1964 to support research training leading to the combined M.D.-Ph.D. degree. The program was designed to train investigators who could better bridge the gap between basic science and clinical research by providing both graduate training in the biomedical sciences and clinical training offered through medical schools. What began in 1964 with three programs has now grown to 32 MSTP programs funded through the National Research Service Act.²  In FY 1996, the MSTP supported approximately 870 students, of which about 240 were new trainees appointed that year.³

Since the inception of the MSTP, several assessments of the programs have been conducted, including those by NIGMS,⁴ the National Research Council (NRC) and the Association of American Medical Colleges (AAMC),⁵  and some of the MSTP-funded institutions themselves.^6 7 8 9  The career outcomes of graduates from eight MSTP programs were summarized by Martin in 1991.¹⁰ These studies documented the success of MSTP graduates in establishing research careers, but none of the studies included graduates of all funded MSTP programs, and no study since the 1981 NRC/AAMC study (which included only the first 53 MSTP graduates) provided data on the success of comparison groups.

Three studies attempted to distinguish the nature of the research activities of MSTP graduates from those of other groups of M.D. and M.D.-Ph.D. recipients.^5 11 12  However, in only one of these studies were the careers of MSTP graduates compared to those of other Ph.D. recipients in the biomedical sciences.¹²  Contrasting these two groups may help distinguish MSTP graduates from more traditional biomedical Ph.D. recipients in terms of their employment settings, their involvement in both research and clinical practice, the sponsors of their research, and the types of journals in which they publish.

This study was designed to assess the success of MSTP graduates in establishing research careers and the types of careers and research activities of MSTP graduates compared to graduates of other combined-degree or Ph.D. programs. The data were drawn from existing National Institutes of Health (NIH) databases as well as from curricula vitae (c.v.) provided by graduates of MSTP programs and members of several comparison groups.

MSTP graduates have also been shown to be active in research and successful in obtaining NIH support for these efforts. The estimated proportion of graduates entering research careers ranges from 74 percent (reported in the NRC/AAMC study) to virtually all graduates surveyed in some of the studies conducted by individual MSTP institutions. In the NRC/AAMC study, MSTP graduates and comparison groups of M.D.s who had received other forms of NIH training support all had high rates of success in obtaining NIH research support. However, MSTP graduates were more likely than other groups to apply for funding in the first place.

In a small number of studies, an attempt was made to characterize the type of research conducted by MSTP graduates and comparison groups of physician-investigators. The NRC/AAMC study found that MSTP graduates were less likely than other groups of physician-investigators to publish in journals containing high proportions of clinical observations and clinical studies. Based on a sample of 82 MSTP graduates from three research-oriented medical schools, Ahrens also concluded that the majority of their publications focused on non-clinical research rather than clinical or patient-oriented topics.¹¹  More recently, Sutton and Killian found that applications for NIH research grants submitted by MSTP graduates were as likely to be classified as "laboratory research" as were proposals from applicants who had received only the Ph.D. degree.¹²

Different definitions have been used to distinguish clinical from non-clinical or laboratory research in these studies. The inclusion of human subjects is sometimes among the criteria used to make this distinction. For example, in the study by Sutton and Killian, clinical and laboratory research grant applications were distinguished using a definition of patient-oriented research developed by the NIH Division of Research Grants Clinical Research Study Group. One of the criteria in this definition is the inclusion of human subjects. While laboratory research projects do not meet this definition of clinical research, they nevertheless may have varying degrees of clinical relevance. In this study, indicators are used that might reveal these distinctions.

This study was designed to assess the career outcomes of M.D.-Ph.D. recipients who received MSTP support and to compare these outcomes to those of selected groups of other graduates (both M.D.-Ph.D.-degree holders and Ph.D. recipients). The outcomes chosen reflect postgraduate training and career involvement in research, along with a small set of variables related to involvement in clinical activities (see Appendix III). A set of broad indicators (not simply whether the research involves human subjects) was used to characterize the research activities of MSTP graduates and members of the comparison groups. These variables were limited to those contained in available data sets (e.g., the NIH grant application and award files) and ones that could be reliably extracted from individuals' curricula vitae.

MSTP Graduate Population and Sample

The study group population included all individuals who had been MSTP trainees and who met several criteria, which are specified in Appendix II. The 1161 individuals who met these criteria were stratified by year of Ph.D. into four cohorts: 1971-75, 1976-80, 1981-85, and 1986-90.¹³  Random samples of approximately 120 individuals were selected from the three most recent cohorts and combined with the 1975 cohort, yielding a final sample size of 410.¹⁴  Some characteristics of the MSTP graduates sample and the comparison groups (defined below) can be found in Appendix Table 2 (in Appendix IV).

Comparison Groups

Four comparison groups were constructed as follows (a more detailed description of the construction of these groups is provided in Appendix II):

MSTP M.D. Only (n = 269). This group consisted of all MSTP participants who earned the M.D. degree but did not complete the Ph.D. degree. Because the number in each cohort was relatively small, all individuals meeting these criteria were included in the study.¹⁵

Ph.D. Graduates (n = 398). For each sampled MSTP graduate, a Ph.D. recipient who had been supported on a non-MSTP NIH training grant for a minimum of 12 months was selected who matched the MSTP trainee on: 1) Ph.D.-granting institution, 2) year of receipt of Ph.D. degree, 3) field of Ph.D. degree, and 4) gender.¹⁶

Non-MSTP M.D.-Ph.D.s from MSTP Institutions (n = 314). This group consisted of all M.D.-Ph.D.-degree holders who graduated from the same institutions as the MSTP graduates, but who did not receive MSTP support. No individuals from the earliest cohort (1971-75) were identified.¹⁷

M.D.-Ph.D.s from Non-MSTP Institutions (n = 314). This group consisted of M.D.-Ph.D.-degree holders from institutions without MSTP training programs. No individuals were found for the 1971-75 cohort.¹⁷ The study included a random sample from the population of 380 individuals who were identified.

Data Sources

Data on postdoctoral training and career outcomes were drawn from two sources. Existing NIH databases were used to collect records of NIH fellowship and research grant applications and awards for the entire sample of individuals selected for the study. (Complete application and award records were available for fellowships through fiscal year 1995 and for research grants through fiscal year 1996.)

Additional information was extracted from the curricula vitae of the sampled individuals. Individuals were contacted by telephone or e-mail and asked to supply a current curriculum vitae that included positions held since graduation, publications, and sources and dates of any grant support. The curricula vitae were also used to acquire information on postdoctoral fellowships, clinical internships and residencies, and involvement in clinical activities. In order to standardize data that might be affected by the passage of time (e.g., publication records), only those activities occurring through 1995 were recorded from the curricula vitae and used in the analyses.

Curricula vitae were received from approximately two-thirds of the total sample. The number of curricula vitae received and the proportion that they represent of the total sample (after making any necessary group reassignments based on more accurate degree information) are shown in Appendix Table 4 (in Appendix IV). The group from whom curricula vitae were received (shown in Appendix Table 3 of Appendix IV) was comparable to the original sample with respect to gender, race/ethnicity, and field of Ph.D.

Educational and Career Outcomes

Figure 1. Elapsed Time from Baccalaureate Degree to Latest Degree, in Years
(from extant data).*

*Sufficient data not available for 1975 cohort

Note: Sources of support may total more than 100% in each column because some
individuals received support from more than one source.

Table 2. Percent of Total Sample Who Applied for Individual NIH Postdoctoral Fellowships (from extant data).

* No 1975 cohort

* No 1975 cohort

Figure 2. Percent of Each Group Who Performed a Clinical Fellowship (from c.v. data).

* No 1975 cohort

Figure 3. Percent of Each Group Who Performed Both Postdoctoral Research Training
and a Clinical Fellowship (from c.v. data).

* No 1975 cohort

Research Activity As suggested in previous studies of MSTP programs, data on applications for NIH research grants show that a high proportion of MSTP graduates have pursued research careers. The proportion of each group who applied for NIH research grants through fiscal year 1996 is shown, by cohort, in Figure 4.20  (Due to the unavailability of data beyond fiscal year 1996, the proportion applying within each group decreases with later cohorts.) MSTP graduates were more likely to apply for NIH research grants than were MSTP trainees who received only an M.D. degree and other M.D.-Ph.D.s, whether they were from an MSTP institution or from non-MSTP institutions.21  There were no significant differences between MSTP graduates and Ph.D. graduates. There also were differences among the groups in the number of applicants who were successful in obtaining support (Figure 5). MSTP graduates who applied for NIH research grants were very successful--74 percent eventually received at least one award. In addition, MSTP applicants for NIH research grants were more successful than applicants from the three other M.D. or M.D.-Ph.D. groups (55 percent of applicants from the MSTP M.D. only group, 62 percent of applicants from the non-MSTP M.D.-Ph.D.s from MSTP institutions group, and 53 percent of applicants from the M.D.-Ph.D.s from non-MSTP institutions group were successful in obtaining support). Once again, MSTP graduates did not differ significantly from Ph.D. graduates, 72 percent of whom were successful in obtaining funding.

Figure 4. Percent of Sample Who Applied for NIH Research Grants (from extant data).

Figure 5. Success Rate of Applicants for NIH Research Grants (from extant data).

Figure 6. Percent of Total Sample Who Received NIH Research Grants (from extant data).

Figure 7. Percent of Respondents Who Reported Research Support from Any Source
(from c.v. data).

Table 5. Percent of Respondents Who Cited Each Source of Research Support (from c.v. data).²²