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Troubling times ahead for capacity building as the CIHR cuts the MD/PhD Awards Program

Troubling times ahead for capacity building as the CIHR cuts the MD/PhD Awards Program

For the last several years, our School of Medicine has offered our students the exceptional opportunity to combine research training with a medical education through our MD/PhD-MD/Master’s program. This unique program provides benefits to both scholarship and the professional development of physician-scientists by allowing for better integration of clinical and research training experiences, and also provides better opportunities for fostering translational research. MD/PhD students bring a distinctive, clinical/translational perspective into their laboratories, and conversely, these students also bring a basic science perspective to share with their fellow medical students.

Our MD/PhD program is in keeping with the strategic direction of the Canadian Institutes of Health Research (CIHR) mandate for “building research capacity and training the next generation of health researchers”…or at least it used to be. Earlier this month, the CIHR made the perplexing announcement that its MD/PhD Awards Program would no longer be funded beyond 2021. This CIHR program provided stipend support for about 20 incoming MD/PhD students from across Canada, for up to six years.

Dr. Brian Bennett, Associate Dean of Graduate and Postdoctoral Education, and the Director of the MD/PhD Program here at Queen’s explains that the suspension sends a mixed message to the research community. CIHR has received expert advice that Canada needs to increase the number of health clinician scientists, and yet it has decided to cancel a national program designed for this very purpose. “As a group, MD/PhD Directors from across the country are obviously very disappointed with this decision. At Queen’s, the MD/PhD program admits three exceptional students per year, and the Program funding we receive from CIHR accounts for about a third of the stipend support we provide to them. With the discontinuation of CIHR funding, these costs will necessarily be shifted to the Faculty and to individual PhD supervisors. The end result is less money available for supporting the educational and research mission of our Faculty.”

Current MD/PhD students at Queen’s are also frustrated by the announcement. Lauren Mak is in her second year of the program and is the current Clinician Investigator Trainee Association of Canada (CITAC) institutional representative for Queen’s. “This career path ultimately lends to the bridging of the clinical and research realms, which is essential for progressing knowledge and patient care. Funding from CIHR not only recognizes the financial burden that students like myself are taking on by delaying the start of our careers but that we are also dedicating ourselves full time for seven to ten years to become exceptional physician scientists. The funding cuts from CIHR will negatively impact the future generation of Canadian health care innovators.”

Dr. John Fisher, Director of Research for the Faculty of Health Sciences here at Queen’s, clarifies that North American and global research organizations continue to struggle with the challenge of funding innovative health research programs (Alberts et al., PNAS 2014, 2015). This reflects the success and impact of the biomedical research community, which is accompanied by new opportunities such as personalized/precision medicine associated with the Human Genome project (FitzGerald Sci Transl Med 2015), fundamental discoveries that promise new therapeutics (Benovic Cell 2012) and the significant need for health services and health of populations research.

So given the above, why does the MD/PhD program cut by the CIHR matter so much that CITAC has launched a petition to reinstate funding? A simple answer might be that at a time when Singapore, mainland China, and even the budget-challenged National Institutes of Health (NIH) have introduced new programs to support starting investigators (Daniels PNAS 2014; Gottesmann NEJM 2013), the loss of the CIHR sponsored MD/PhD Awards Program is our canary in the mineshaft for health research. Canada needs to support the next generation of physician investigators, who will enhance the health of Canadians.

Dr. Fisher explains that the unique role of clinician scientists/investigators is widely acknowledged. Our colleagues at the University of Calgary summarized the importance as the need for the clinician scientist to bridge “the ravine between the ever-growing mountain of scientific knowledge and the demanding patient centered clinical care.” (Clin Invest Med 2014) Gottesmann (NEJM 2013) summarized this wonderfully in his NEJM article on the importance of NIH in nurturing clinician scientists, where he noted that MD scientists contribute disproportionately to Nobel Prizes in Physiology or Medicine, since less than two percent of MDs indicate research as a primary focus in their careers (Gottesman NEJM 2012; Garrison & Deschamps Faseb J 2015). He noted “the major contributions that clinically trained scientists have made to our understanding of human biology have come not from anything unique about their research skills, but rather from their perspective derived from clinical experience or training that enables them to define and pursue important problems in human biology…”

It is also clear that an MD/PhD training impacts positively on future research success compared to others. For example, applicants with MD/PhD training have success rates for NIH funding that are approximately one-third higher than applicants with MD training alone (Marsh & Todd 2014 AM J Med). Although the size of the MD/PhD cohort in Canada may not be sufficient to perform a similar analysis for CIHR, these programs enhance future research success, while providing research training at a critical time in early career development.

It may go without saying that the CIHR MD/PhD Awards Program is not the only aspect that requires attention within the Canadian health research landscape. However, revisiting the abolition of the MD/PhD program remains a low cost and effective means to contribute to the future engagement and success of clinician investigators required for Canada’s role in global health.

I would like to sign off by thanking Drs. Bennett and Fisher for their valued contributions to this post. The three of us welcome your thoughts on the cuts to the MD/PhD program in the comments below, or better yet, drop by the Macklem House. My door is always open.

Richard

 

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B. Alberts, M.W. Kirschner, S. Tilghman and H. Varmus. Opinion: Addressing systemic problems in the biomedical research enterprise. PNAS 112(7):1912-1913, 2015.

G. A. FitzGerald. Evolution in translational science: Whither the CTSAs? SciTransl. Med. 7 (284):1-3, 2015.

J.L. Benovic. G-Protein coupled receptors signal victory. Cell 151: 1148-1150, 2012.

M.M.Gottesman, The role of NIH in nurturing clinician –scientists. NEJM 368(24):2249-2250, 2013.

R.J. Daniels. A generation at risk: Young investigators and the future of the biomedical workforce. PNAS 112(2):313-318, 2015.

D. Miller, C.S. Thorton, M.B. Keough, J.I. Roberts, B. Yipp, M. Hollenberg, J.T. Bau, M. Peplowski, and P.L. Beck. A prescription that addresses the decline of basic science education in medical school. Clin Invest Med 37(5):E284-E291, 2014.

H.H. Garrison and A.M. Deschamps. NIH research funding and early career physician scientists: continuing challenges in the 21st century. FASEB J. 28:1049-1058, 2014.

J.D. Marsh and R.F Todd. Training and sustaining physician scientists: what is success? Am.J.Med. 128(4):431-436, 2015.

Stephen Archer

Mon, 06/26/2017 - 15:26

Dear Richard: I agree with your assessment. The decision to make this cut is bad policy and also almost impossible to understand. The cost of the program was tiny (ie some individual scientsts receive more CIHR funding than the country’s entire MD/PhD program. Cutting the program does not improve the funding environment for faculty and impairs our talent pipeline. Great science requires smart young peopel even more than it requires fancy and expensive tools and research centres.

As a grateful recipient of CIHR funding I am reluctant to bite the hand that feeds me BUT-this is a mistake and I encourage all faculty to complete Dr Bennett’s petition (as I have done myself) and let CIHR know we consider this an “error in judgement that should promptly be reversed.”

Stephen Archer

Jim Martin

Mon, 06/26/2017 - 15:27

Dear Richard,
You have made many important points in your posting. An additional consideration, albeit not the principal one, is the fact that the training of medical students is increasingly pragmatic and the basic science underpinning our understanding of disease is being reduced to a bare minimum. Knowledge of pathophysiology is being sacrificed removed in favor of diagnosis and treatment based on pattern recognition and guidelines. We will continue to need scholarly graduates in medical school that will challenge the curriculum and their tutors.
Jim Martin

Jim Martin

Jim

I couldn’t agree more. The trends are very worrisome.

Richard

reznickr

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