AAMC Reporter: December 2006

"Year-Out" Student Researchers Learn in the Lab

NIH research fellow Andrew Demidowich performs immuno-histochemistry staining on pathologic lung tissue slides

Not too long ago, Sarah Davis learned a cardinal rule of research. But it had nothing to do with pipettes or petri dishes, and it came far outside the pages of a textbook or the walls of a lecture hall. She learned you have to roll with the punches.

"I was thinking I would do a study on a certain medication, but a month later it was discovered that the medication had a serious side effect," she said.

"That's when we had to change our project. I've learned to be flexible, and that if something's not going to happen in a way that you want, you have to know how to revamp."

Davis, who is between her third and fourth years at the University of Texas Southwestern Medical Center at Dallas Southwestern Medical School, is one of 245 medical and dental students who attended the fourth annual Clinical Investigator Student Trainee (CIST) forum, held recently at the National Institutes of Health in Bethesda, Md. CIST is designed for students participating in research fellowships or so-called year-out programs, in which they spend a year away from the classroom conducting laboratory research.

"With CIST and with [student research fellowships], we want to captivate medical students and get them sucked into the excitement of research," said John I. Gallin, M.D., director of the NIH Mark O. Hatfield Clinical Research Center and one of the creators of the CIST forum.

CIST participants came from one of seven year-out fellowship programs: NIH's Clinical Research Training Program (CRTP), the Doris Duke Clinical Research Fellow program, the Fogarty International Center- Ellison Medical Foundation Overseas Fellows, the General Clinical Research Centers of the National Center for Research Resources, the Howard Hughes Medical Institute Fellows, the Howard Hughes Medical Institute/NIH Research Scholars, and the Sarnoff Cardiovascular Research Foundation Fellows.

Davis, who is participating in the Doris Duke fellowship with a research project titled "Effect of Bisphosphonates on Bone Mineral Density and Quality of Life in Patients with Duchenne Muscular Dystrophy," said that her work as a fellow is quite challenging, but the intent of the programs is not complicated.

"It's great just to learn the basic principles of research," Davis said.

While these and several similar programs exist across the medical education continuum, some feel they are underrecognized or under-utilized in academic medicine, particularly at a time when there is growing evidence of a shortage of young biomedical researchers.

"There are some medical schools where research is part of the culture, and there are some where that is not the case," said Frederick P. Ognibene, M.D., director of CRTP and co-organizer of the CIST forum. "As a career option, clinical research has perhaps not received the attention it should... Year-out programs focus on the nuts and bolts of clinical research. And the hope is to get students to enjoy what they are doing and get them hooked on it as a viable career."

Recent data have shown that the number of new physicians pursuing research careers has not appreciably changed in the past 40 years, despite extraordinary advancements in scientific understanding and a historic increase in opportunities for translating scientific discoveries into the improvement of medicine and public health. And there is evidence that the researcher population is aging—the average age of investigators receiving their first NIH R01 grants is now 42 for Ph.D.s, and 43 for M.D.s. Comparatively low salaries and a decreasing pool of research grant funding are often cited as forces that detract from the research profession. But proponents counter that the potential for scientific discovery is as high as it has ever been, and anyone who chooses the physician-scientist path will find a rich and rewarding career.

"I think there's a real sense that the number of researchers is dwindling, and there's this perception that the environment is averse because of the funding situation," Gallin said. "Young people see their mentors not getting funded, and they wonder how they will ever do it…But there's a real need for this work. If you go into this area, you will be valued and cherished. And you will be OK. We want to counterbalance all of the gloom-and-doom mentality."

Elise Kohn, M.D., head of the molecular signaling section of the NIH's National Cancer Institute Laboratory of Pathology and a longtime mentor to student research fellows, said year-out programs are a solid building block for any potential researcher.

"I wish they had had these programs when I was a student," she said. "It's an opportunity to expose yourself to all the career trajectories in research while you are still in training. I've met some amazing students, and we reach out to them as a way to develop tomorrow's physician-scientist leaders."

The specifics of each program vary, but most follow a similar template. All appropriately qualified medical students with an interest (but not necessarily extensive experience) in research are welcome to apply for a year-out program. Fellowships can take place on school grounds, at a central location such as the NIH, or in one of several other facilities at home or abroad. While some feature classroom activities that augment the actual research work, all programs overwhelmingly focus on hands-on laboratory or clinical projects, for which students partner with an appropriate mentor in their area of interest. Student fellows in each of the seven programs included in the CIST forum receive annual stipends ranging from $18,000 to $28,400. Many programs also offer full health insurance coverage and supplemental funds for training, clinical expenses, and even travel or relocation.

Scott Hennerman, who hopes to become a radiologist and will begin his fourth year at Columbia University College of Physicians and Surgeons after completing his Doris Duke fellowship, said the paid expenses lead to educational opportunities in and of themselves.

"They pay for you to go to conferences," he said. "And if you need books or equipment, you can apply for them to get it for you. It's good to have so much support behind you, from your mentor primarily, but also from the program itself. It really allows you to advance yourself intellectually."

Beyond the intellectual liberation, fellowships can be equally valuable as social vehicles.

"This is an early chance to experience peer contact and networking," Ognibene said. "The research world is a relatively small one, so these students will definitely be seeing each other again along the way. This is a maturing year for the students as well as an educational one. This is the first year that many of them are living on their own." Students and organizers also acknowledge the programs' drawbacks—most notably, that student fellows fall a year behind in their medical school education—but add that the program's rewards are well worth any sacrifices.

"It delays graduation from medical school, but you benefit by being in such a focused environment," Ognibene said. "If I were a medical student today, with all the progress and the tools that are available for researchers, I would definitely take a look at a year-out program, because there is an amazing range of opportunities."

Laura Prolo, who is between her second and third years at Stanford University School of Medicine and attended CIST as a Howard Hughes Medical Institute fellow, said her year-out program allowed her to taste all aspects of the research experience.

"I have been immersed in this structure of doing research and just spending my time thinking about my project," Prolo said. "I'm learning how to specifically dissect a question and put together an entire project, from doing the basic science to presenting my findings at the end."

Ognibene said student fellows undergo real metamorphosis during their year of research.

"I think I can honestly say that no student has ever told me they had a bad experience," he said. "It really is a life-changing year for them."

—By Scott Harris

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