Feb. 2003 Reporter Home

AAMC Spearheads New Quality Initiative

State Budget Cuts Put Strain on Teaching Hospitals

Innovations in Medical Education: "Communicating in Other Ways"

"A Shot in the Dark": the smallpox vaccination program

Dual-Degree Programs

Viewpoint: Women in Medicine: The Work that Remains

A Word from the President

"A Day in the Life of a Medical Student"

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AAMC Newsroom

Managing Editor Scott Harris sharris@aamc.org Staff Writer Elissa Fuchs efuchs@aamc.org

Dual-Degree Programs: Medical Students Walk the Extra Mile

Eric Singer, M.D. - M.A. student, Georgetown University School of Medicine

No one said medical school would be easy, but despite the well-known rigors most medical students face, a growing number of them are tackling heavier academic loads and passionately pursuing dual degrees. As current healthcare challenges make the practice of medicine more complex, these students are building an extra foundation to their education by learning about where medicine meets public health, business, ethics, and basic science.

The academic options for medical students interested in this path vary, from combining M.D.'s with M.P.H. or Ph.D. degrees - whose academic focus often relates to medicine - to pursuing seemingly disparate additional degrees like M.B.A.'s or J.D.'s. Many medical schools offer programs that slightly compress the time required to receive two graduate degrees, but despite this shorter route, some medical students still choose to acquire them outside of an official joint-degree program.

Jared Kesselheim, 25, a student at Harvard Medical School (HMS), has done just that. Although Harvard does not offer a joint M.D. - M.B.A. program, Kesselheim chose to get degrees from the school's prestigious medical and business schools simultaneously. He has already completed two years at HMS and has almost finished his M.B.A. program. After he receives his M.B.A. degree in June, he will return to medical school and finish off the remaining two years.

"Before I chose to pursue an M.B.A. in addition to my M.D., I was looking for what I might do to round out my medical education," says Kesselheim. Thinking about how recent changes in health care have increased the need for business and management expertise in the medical profession, he decided to pursue an M.B.A.

Despite his decision to pursue a graduate business degree, Kesselheim will still tread the traditional path of doctors-in-training, and will go into residency after finishing medical school. Eventually, he says, he wants to get involved in the management of an academic medical center.

"I would like to use my educational background and at some point transition from being a physician who works well at taking care of patients, to one who helps an academic medical center meet the challenges of the next two decades," Kesselheim says. "Health care is only getting more complex and has more and more constraints imposed on it, so that the management of an academic medical center in that environment will become extremely challenging."

He believes his M.B.A. training will make the transition from academic medical center physician to hospital manager a little easier. "If an administrator has an M.D., has gone through residency and practiced medicine, the credibility that results from this experience can help him or her get the job done more effectively."

Molding a physician-scientist

Isabel Newton, M.D. - Ph.D. student, Wake Forest University School of Medicine

Isabel Newton, 26, an M.D. - Ph.D. student in the combined-degree program of Wake Forest University School of Medicine (WFUSOM), also thinks that her two degrees will give her a unique perspective that will consequently turn her into a better healthcare professional.

"I chose to pursue an M.D. - Ph.D. because I am very interested in both fields, and because I believe that a career in each field can be enhanced through knowledge of the other," Newton says. "To me, the perspective of the physician-scientist is an ideal, a fusion of two unnecessarily separate fields."

She has completed two years of medical school and a year and a half of graduate school. Her dual-degree program lasts seven years, after which she will receive a Ph.D. from WFUSOM's Department of Neurobiology and Anatomy, in addition to her M.D.

"I think medical school has given me a sense of the context, of the reason why we [Ph.D. students] do the research that we do," says Newton. "It also helps me to be less myopic. In graduate school, you become an expert in a tiny little sub-portion of a narrow field. Medical school helps me keep my perspective about how [this field] applies and where it lies in relation to everything else."

Similarly, graduate school has offered Newton an important perspective that has been particularly useful in her medical school studies, she says. "Graduate school has taught me to question everything, to be critical and careful and to think of the many elements that may interact to produce a given effect," she says. "This type of thinking should be applied to medicine; in medicine, we tend to accept things as facts more than we do in basic science, partly due to time restraints."

Newton's list of lessons learned during her dual-degree experience does not stop here. "Another thing I have learned from my graduate training is that I want to have a life, so I am trying my hardest to keep things in balance, both logistically and mentally," says Newton. "It is very easy to be consumed by school or work."

Balance and bioethics

Another M.D. - Ph.D. candidate who has strived, successfully, to balance a demanding academic schedule with a fulfilling life outside of school is Joseph Mancias, 25, a third-year student at Weill Medical College of Cornell University. He is a Ph.D. candidate at the Department of Cellular Biochemistry and Biophysics in the Cornell Graduate School of Medical Sciences' Sloan-Kettering Institute.

Despite lab time that can last 12 hours, six days a week, Mancias also manages to find time to sing in a choir. "While in New York, I've been able to sing concerts in Carnegie Hall and Lincoln Center," he says. In addition to singing, Mancias also volunteers in student organizations, one of which organizes a camp for children who are burn survivors.

Joseph Mancias, M.D. - Ph.D. student, Weill Medical College of Cornell University

Mancias studies under the prestigious Medical Scientist Training Program, which is funded by the National Institutes of Health, so he does not have to worry about the debt most graduating medical students deal with. The program trains highly qualified students to use basic science techniques to solve problems in human disease, combining the graduate education curriculum of one of the basic sciences with the curriculum of a medical school.

The idea to pursue a dual degree came about when Mancias was doing research in college. "At the time, I was doing research that was related to Alzheimer's disease," explains Mancias. He was also volunteering at a local hospital, where he saw the devastating effects of the disease on elderly patients. "I thought that linking these two things, being able to both care for patients and make new discoveries in the lab which might help care for these patients and millions of other people, would be a fulfilling career path," he says.

Eric Singer, 27, an M.D. - M.A. student from Georgetown University School of Medicine, also is excited about the prospect of a career in medicine. Singer has already acquired a master's in liberal studies, with a concentration in ethics and the professions, under Georgetown's School of Continuing Education. He will graduate from medical school in May.

"I like the service aspect of the profession, the feeling of helping people, as well as the science of it," explains Singer. "The motivating factor for me in pursuing a dual degree was having a career that I really enjoyed.

"I worked at Georgetown's Center for Clinical Bioethics taking calls with the Ethics Consult Service, often being called to the intensive care unit to discuss futility issues with critical care doctors and the patients' families," he says. "At the same time, I read about the philosophical foundations of bioethics for my master's degree. So I was able to see both the theoretical side and the very practical side of medical ethics."

Singer's training will be invaluable in his practice of medicine, he says. "The study of ethics helps medical students with the communication skills that are so crucial for practicing doctors. So many of the difficulties that I saw when working with the Ethics Consult Service were breakdowns in communication between doctors and patients. To have difficult conversations at difficult times with people is hard to do, and the training I've received during my master's program has helped me to work on those skills."

Worldwide views

Other dual-degree medical students, in their undying attempts to make a difference, are extending the reach of their expertise to worldwide health issues. Terri Stillwell, 24, an M.D. - M.P.H. second-year student at Tulane University School of Medicine, is focusing part of her training on complex emergencies and natural disasters.

"Through my various classes, I have learned how to approach a multitude of international settings, how to assess local health needs, and how to implement needed programs," explains Stillwell. "Eventually, I hope to work in an international setting, and [my M.P.H.] degree will help me understand how to approach various healthcare systems that are far different from our own."

The combined-degree program at Tulane can be completed over a four-year period, says Stillwell. She admits that studying under this dual-degree program is "undoubtedly the hardest" thing she has ever done, but it also has offered her a greater perspective on the world that awaits her. "Public health not only accounts for the science of medicine; it accounts for the ethics and the politics that often complicate matters," Stillwell says.

"The healthcare systems that exist in the world today were not created overnight and certainly will not be corrected overnight, but simply knowing that I was part of the attempt [to correct them] is enough satisfaction. Thoreau once said, 'Men will lie on their backs, talking about the fall of man, and never make an effort to get up.' I refuse to be one of those individuals."

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