Making Room for Research During Residency
"Without the research residency, it may have been 6 or 7 years before I got back to the lab." --Michael McCarthy
As he approached the end of his M.D.-Ph.D. program at Rush University in Chicago, Illinois, Robert Sargis expected to spend his next training phase in a traditional 3-year clinical residency, perhaps followed by another year or two of specialty medical training. But for physicians interested in research careers, the traditional residency route has a major disadvantage: a 4- to 5-year gap between graduation and the next opportunity for additional research training.
Fortunately for Sargis and others like him, some institutions offer an accelerated path with a research component. Often called research residencies, these programs typically shift the resident from clinical training to a research fellowship in the 3rd year. Research residencies are designed to prepare future physician-scientists to run their own research programs.
The opportunity to start his research sooner was appealing, but Sargis was eager to find the right balance between solid clinical training and training for the research lab. He says: "The central question was: Do you know medicine as well if you leave internal medicine after 2 years and go into a fellowship program?" The way the research-residency programs are structured, he concluded, he would end up with almost as much patient contact as the clinical residents who completed all 3 years.
After 2 years as a resident at the University of Chicago Hospitals, Sargis went to work with Matthew Brady, an endocrinologist in the University of Chicago's Pritzker School of Medicine, studying the development of adipocytes, the cells that store fat. Sargis has been working in Brady's lab for 2 years now, exploring how environmental pollutants influence the molecular programming of adipocytes. In late March--nearly 4 years after finishing his M.D.-Ph.D.--Sargis was awarded a postdoctoral fellowship from the U.S. National Institutes of Health, the next step on the path to becoming an independent physician-scientist. The research residency, Sargis says, "has really put me on this great track to practice academic medicine."
The structure of research-residency programs varies. A few research-residency programs offer research immersion as early as the 2nd year. At Northwestern University, for example, pathology residents can craft their residencies to satisfy the American Board of Pathology certification requirements and begin establishing themselves in their area of research interest by their 2nd year.
But at most institutions, research residencies parallel traditional clinical residencies for the first year or two, providing intensive clinical training in a specific area of medicine. By the 3rd year, residents begin spending anywhere between half and 90% of their time on a mentored research project. The amount of time spent on research is at the discretion of the resident's research mentor.
At the University of Chicago, the first 2 years of the research-residency program are a focused clinical residency. Residents who intend to enter a subspecialty, such as oncology or endocrinology, then enter a 12- to 18-month clinical fellowship in that area. After completing this clinical portion of their training, residents complete 2- to 3-year research fellowships in which they spend more than 90% of their time in the lab.
Once you're enrolled in a research residency, it can be difficult to change course. Only after completing 3 years of research training do participants in Chicago's research-residency program become eligible for board certification in, say, internal medicine and their specialty area. Research residents who decide to abandon research and enter clinical practice must complete an additional year of residency prior to board certification. "One thing we don't want to have happen is for our trainees to short-track through medicine, short-track through their fellowship, and then jump ship and skip their research training," says Eric Svennson, director of the research-residency program at the University of Chicago.
"The downside is it takes away some of the flexibility, so because you are fast-tracking, if for some reason life situations change, it is a little bit hard to get off that track," Sargis says.
Some specialties, such as internal medicine and surgery, are not suited to a part-time clinical schedule, says David Engman, director of Northwestern's Medical Scientist Training Program, who went through Northwestern's research-residency program. But psychiatry, pathology, and other disciplines allow programs to be more flexible, he adds.
Neuropharmacologist Michael McCarthy was looking for a psychiatry residency at an institution with a strong reputation for neuroscience research, his area of interest. The research-residency program at the University of California, San Diego (UCSD), seemed to fit the bill. The only downside, he says, was that he would have to give up some elective clinical experience and the opportunity to supervise other residents during his 4th year.
McCarthy is happy with his choice. "Without the research residency, it may have been 6 or 7 years before I got back to the lab," he says. "I've been able to generate some preliminary data and submit grant proposals and submit papers as a resident that I realistically wouldn't have had time to do had I done a traditional clinical residency." McCarthy has now completed his 4-year residency and will continue on at UCSD to do a fellowship in the genetics of bipolar disorder. He hopes to use the fellowship to translate his laboratory research findings to the clinic, where he will continue to work for half a day each week.
Research residents are typically offered protected research time, and that time must be paid for with departmental funds or federal grants. Because of the cost, most programs offer only two to four research-residency slots per year. And the demand for those positions is intense. "We're pretty careful in selecting people to go into this research pathway," says Linda Boxer, director of the Stanford Clinical Investigator Pathway. "They have to have had a great deal of research experience, and most of them have done Ph.D.s" in addition to their medical degrees.
Holbrook Kohrt was fortunate, then, in landing a research residency at Stanford as an M.D.-only candidate. His interest in research grew while he did his medical degree at Stanford, so he enrolled in Stanford's research-residency program, which allowed him to do 2 years of traditional residency training with a 3rd-year research fellowship in hematology-oncology.
The research residency helped him decide to pursue a Ph.D., and during his fellowship, Kohrt was accepted into the first class of ARTS-- Advanced Residency Training at Stanford--a Ph.D. program specifically for medical residents who have completed residency and have had a year or two of research experience. The program allows trainees to complete Ph.D.s with full salary support, tuition remission, and health benefits. "The ARTS program is a perfectly designed program for people who are interested in research and who are determining what kind of career they want a little bit later, as opposed to determining it as early as medical school," he says.
Kohrt is working on his Ph.D. while continuing to see patients two half-days per week. "You realize every time you go back to clinic why you are doing what you are doing in lab, and vice versa. I can foresee myself as a PI in the future with this balance of a few half-days in the clinic and the rest in lab."
Karyn Hede is a freelance writer in Chapel Hill, North Carolina.