|Home | About | Journals | Submit | Contact Us | Français|
There have been questions about the efficacy of medical scientist training programs (MSTPs) in training the next generation of physician scientists. 1,2 Although studies have identified postgraduate specialty choices of a subset of these students, 3,4 to our knowledge none have generated data based on a complete evaluation of graduates from all MSTPs. To better understand postgraduate choices of all National Institutes of Health (NIH)-sponsored MSTP graduates, we conducted a census of graduates from 2004 to 2008.
Graduate placement data from NIH-sponsored MSTPs were collected from official program websites for 2004 to 2008. Preliminary match data were not collected if the graduate matched into a PGY-2 residency program. If no such website was available, directors of MSTPs were surveyed for postgraduate choices of graduates from their program. Identifying information was removed from data, which were then analyzed for frequency of specialty choice. Number of US seniors entering a specialty was obtained from the websites of the three allopathic residency match programs: National Resident Matching Program 5, San Francisco Match, and the Urology Match.
Relative risk comparing MSTP graduates versus all other US medical school seniors for entrance into a specialty was determined. Data for preliminary-only matching graduates were excluded in calculation of relative risk. P-values for relative risk were calculated using the chi-square test, or two-sided Fisher Exact Test when expected cell frequencies fell below 5, with significance set at 0.05. Analyses were performed using SAS 9.1 (SAS Institute, Cary, NC).
Graduate data were obtained from the websites of 34 of the 43 MSTPs; the remaining 9 programs were surveyed, and all responded. Positions filled by graduates from NIH-funded MSTPs and all other US seniors were tabulated for each specialty (Table). The most common residencies for MSTP graduates were internal medicine (n=367 [24.6%]), pathology (n=154 [10.3%]), pediatrics (n=149 [10.0%]), and diagnostic radiology (n=103 [6.9%]). For specialties with more than 100 positions from 2004 to 2008, MSTP graduates as compared to all other US seniors were most likely to enter residencies in radiation oncology (relative risk [RR], 8.01; 95% confidence interval [CI], 6.40 -10.03), child neurology (RR, 7.65; 95% CI, 4.67 -12.53), and pathology (RR, 5.48; 95% CI, 4.68 - 6.42). MSTP graduates were least likely to enter residencies in family medicine (RR, 0.03; 95% CI, 0.01 - 0.09), emergency medicine (RR, 0.16; 95% CI, 0.10 - 0.25), and obstetrics/gynecology (RR, 0.18; 95% CI, 0.11 - 0.30). Graduates not entering the match constituted 4.4% of total MSTP graduates. MSTP graduates were less likely to pursue residencies in primary care or surgical specialties. Further analysis of these data is available at the study website.6
These findings are consistent with previous data indicating that MD/PhD graduates are more likely to enter internal medicine, dermatology, neurology, and pathology and less likely to enter family medicine, obstetrics/gynecology, or emergency medicine. 3,4 However, this study also indicated that MSTP graduates are more likely to enter radiation oncology and child neurology, while they were less likely to enter anesthesiology and orthopedic surgery.
This study was limited by the assessment at graduation; data were not collected for graduates changing career path. These data cannot predict long-term outcomes since they did not assess any post-residency career choices. Because only small numbers of MSTP graduates and US seniors entered some specialties, some relative risk estimates may be susceptible to chance error.
Nevertheless, this study provides an initial baseline for further analysis of trends in early outcomes of MSTP graduates. For specialties that are not traditionally associated with strong physician-scientist role models, residency program directors and national specialty organizations may need to explore methods to retain physician-scientists as members of academic medicine communities.
Funding/Support: Mr Paik was partially supported by T32 GM008361 from the National Institute of General Medical Sciences, National Institutes of Health.
Role of the Sponsor: The funding organization had no role in the design and conduct of the study; in the collection, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.
Author Contributions: Mr Paik had full access to all of the data and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Paik, Lorenz.
Acquisition of data: Paik.
Analysis and interpretation: Paik, Howard, Lorenz.
Drafting of the manuscript: Paik, Howard, Lorenz.
Critical revision of the manuscript for intellectual content: Howard, Lorenz.
Statistical analysis: Paik, Howard.
Study supervision: Lorenz.
Financial Disclosures: None reported.
Additional Contributions: The directors of MSTPs, the MD/PhD section of the AAMC GREAT group, Bert Shapiro, PhD, (NIH), the American Physician Scientists Association, the San Francisco Match, and the American Urological Association Match supported this project. None of these persons or organizations received any compensation for their support.