M.D.-Ph.D. Program Harvard Medical School Winter/Spring 1998 Newsletter

Articles in this issue:

New Dean Gets With the Program

by Molly Lanzarotta

As the arrival of the new Dean of Faculty was heralded at Harvard Medical School this fall, students and faculty of the M.D.-Ph.D. Program were fortunate to receive a personal introduction to Dr. Joseph B. Martin. Dr. Martin, himself an M.D., Ph.D., presented the keynote address at the Program's 15th Annual Retreat, held in Chatham on Cape Cod, October 17 through 19, 1997.

In his address, "Vision of the Clinician-Researcher in the Twenty-First Century," as well as in discussions of his top priorities as HMS Dean, Dr. Martin has established himself as a key supporter of dual degree training, expressing "unabashed enthusiasm" for the Program. He identifies the M.D.-Ph.D. Program as critical to attracting top talent to the faculty of HMS and is exploring increasing the size of the Program.

"As you know from my presentation at the October retreat," Dr. Martin reemphasized for this article, "I am firmly committed to strengthening further and expanding, if possible, the M.D.-Ph.D. track at HMS. We will be accepting 12 students in 1998, and hope to maintain that level next year."

Dr. Martin's interest in the future of clinical research is a long held one. In a 1990 article in Academic Medicine on the training of physician-scientists, Dr. Martin wrote that the continued need for the clinician- researcher is unequivocal, but the crucial challenge for leaders in the medical community is how to guarantee their continued success. He cited an opportunity-resource paradox: "Never before has the opportunity been so great--but the resources are limited and the message being sent to our aspiring younger colleagues is more negative that it should be." In his new role at Harvard, Dr. Martin is clearly ready to address that challenge.

Dr. Martin returns to Harvard Medical School after eight years at the University of California, San Francisco, where he served first as Dean, and then Chancellor. He holds an M.D. from the University of Alberta and a Ph.D. in anatomy from the University of Rochester. When he left the Harvard community in 1989, he was chief of neurology at Massachusetts General Hospital and the Julieanne Dorn Professor of Neurology at HMS. Returning now as Dean of the Faculty of Medicine at Harvard Medical School, Dr. Martin has emerged as a supporter of, and source of inspiration for, the students of the M.D.-Ph.D. Program.


A Conversation with Alan Michelson, M.D., Ph.D.

Alan M. Michelson is a 1986 graduate of the Harvard M.D.-Ph.D. Program who completed his thesis work with Stuart Orkin in the Division of Hematology-Oncology at Children's Hospital. An internship in Medicine at Brigham and Women's Hospital (BWH) was followed by a postdoctoral fellowship with Tom Maniatis in the Department of Molecular and Cellular Biology at Harvard University. In 1992, Dr. Michelson joined the HMS faculty as an Assistant Professor in the Division of Genetics of the Department of Medicine at BWH. Currently, he spends all of his professional time engaged in laboratory investigation (his research interest is in the molecular and genetic control of muscle and heart development, using Drosophila as a model system) and teaching (both in the Medical and Graduate Schools). He also is an Assistant Investigator of the Howard Hughes Medical Institute, serves on the Board of Tutors in Biochemical Sciences at Harvard College, is the M.D.-Ph.D. Fellow of the HMS Castle Society, and is involved in admissions and advising for the M.D.-Ph.D. Program.

Editor: What would you say was a defining moment in your decision to do research and teaching in the basic sciences that excludes patient contact?

Dr. Michelson: As a student, both in graduate and medical schools, I consistently received advice to pursue postgraduate clinical and research training. Most of my advisors were involved to varying degrees in both clinical practice and laboratory investigation. Since this arrangement had worked well for them, it seemed natural to advise the next generation of trainees to pursue a similar career path. However, what they hadn't considered was the growing complexity of our profession. During the decade or more that separated my mentors' training from my own, it had become increasingly difficult for young people to achieve and maintain a level of excellence in both clinical medicine and research. Many factors contributed to this, including rapid technological advances in a variety of research fields, an explosion of new medical and scientific information, increased competition from Ph.D. basic scientists, and a declining pool of research dollars. All of these issues persist and, more recently, the advent of managed care and the ensuing changes manifest in our health care delivery system are having an even greater impact on the ability of the physician-scientist to successfully pursue a combined scientific and clinical career.

It was not until internship that I became sufficiently aware of the above issues to make the difficult decision that would eventually determine my career path. That year was the first time I fully appreciated the enormity of what was required to become a first-rate doctor-a commitment I felt able and willing to make, but only if it would contribute significantly to my future work. Given that I already was determined to pursue a primarily scientific career, I felt the prolonged clinical training experience was not compatible with my overall goals. Furthermore, I knew that I faced a considerable investment in postdoctoral research training if I was to become a successful independent investigator. So, I entered a basic science lab after internship and used this opportunity to switch research fields.

Changing fields enabled me to learn an entirely new biological system and to address questions that were just then beginning to captivate my interest. The cost of this decision was increased time spent as a postdoc, which would have been a much more difficult commitment had I continued in a clinical setting. I think that this issue is one that our current students continue to face.

One recommendation I have for students, particularly toward the end of the M.D.-Ph.D. Program, is to carefully observe others who are at various steps ahead of them in the academic world. How do students perceive fellows, as well as younger and older faculty members, coping with the challenges that will face them in the near future? What does it take to develop an independent research program? What is required to both fund and manage a competitive laboratory? How is a successful grant application written at the postdoctoral and higher level? What is the role of good mentoring in facilitating the career of a more junior individual, and how can one identify an appropriate mentor? Although personal experience is critical to answer many of these questions and to develop the skills entailed by others, it is not too soon to begin identifying useful strategies and successful models in these areas.

Editor: You have helped the M.D.-Ph.D. Program in developing a system of "Key Contact" faculty to give advice and support to students. How will this re-source work?

Dr. Michelson: Students should take advantage of all the advising opportunities available to them. These include the thesis advisory committees in their graduate programs, the advisors assigned to them in their Medical School societies, as well as the newly instituted "key contacts" system created by the M.D.-Ph.D. Program.

Each of these entities meets a different need in students' lives. Thesis committees primarily focus on specific research guidance during the graduate school years. Society advisors can help students navigate various practical issues, such as transitions from the laboratory to clinical rotations and from medical school to residency training. While the Program's key contacts potentially could provide input in each of these areas, this system affords a unique type of guidance since a student is free to approach any key contact faculty member based on prior knowledge of their background and areas of interested in combining clinical cardiology and basic cardiovascular research could identify at least one M.D.-Ph.D. faculty member who has completed training in these areas and currently is developing a related career path. Input on more general issues could also be sought, such as the advantages and disadvantages of pursuing a residency or entering directly into a postdoctoral research fellowship. The opportunity may also evolve to establish a close, long-term mentoring relationship with a compatible faculty member who might be in the best position to provide truly personal guidance or intervention should a specific need arise.

Editor: What questions do you suggest M.D.-Ph.D. students ask themselves when choosing a laboratory for research training?

Dr. Michelson: This is an area that deserves very careful consideration because it has far-reaching implications for one's entire career. Such a decision is made twice: once for Ph.D. training and again for a postdoctoral fellowship. The issues are similar at each stage, but some unique factors also must be considered.

The most vital first step is to settle on an area of research that addresses an important question and that captivates one's interest. Neither a particular experimental system nor set of experiments need be selected at this point. Rather, it is sufficient to focus on a somewhat general field, for example, organogenesis or cell cycle regulation. Next, one should identify the various laboratories in which this question is being productively studied, read recent publications from each, and visit the principal investigators to see where their future work is being directed. At the Ph.D. level, a rotation is an excellent way of taking a particular laboratory for a "test drive."

Additional factors to consider include the size of the research group, extent of the P.I.'s presence in the laboratory (does he/she work at the bench themselves, travel a lot, involve themselves with experimental details or just the "big picture"?), particular experimental approaches being utilized, and facilities and equipment available for the work. Whether one wants to be a member of a large or a small group is an individual preference, but consideration should be given to how a group's size might affect establishing one's own niche and independence, obtaining access to the P.I., learning new techniques, troubleshooting experimental problems, and utilizing laboratory resources. Here is where the choice might be influenced by whether one is seeking a Ph.D. or postdoctoral research experience since priorities appropriately change as more experience and capacity for independence are obtained.

Students should also remember that their postdoctoral training affords an opportunity to switch fields as their interests evolve, so they need not be concerned with whether their choice for their thesis work will sustain them as independent investigators. The latter point is much more relevant to the postdoc who is contemplating the transition to a junior faculty position.

Editor: Are there some final thoughts with which you would like to conclude?

Dr. Michelson: At some point in each M.D., Ph.D.'s career, there is bound to be a realization that it is not possible to continue all aspects of clinical, research, teaching and administrative activities if one wants to pursue each component at the very best of one's ability. For me, this meant making the difficult decision to follow one primary direction, that being basic research. This decision was influenced by what I most enjoy doing and what I personally find most challenging. Using these same criteria, others will select a path that may be similar to or quite different from mine. What is important is that the individual's choice be appropriate for them and best serve their professional and personal goals.

In retrospect, my particular choice has afforded me a significant benefit by enabling me to focus on my present research program without being drawn away by clinical responsibilities. Those who attempt to maintain major commitments to patient care and teaching, as well as laboratory investigation, will likely have difficulties balancing all of their professional endeavors while still finding time for their personal and family lives. These are issues that students should at least begin to consider as they contemplate their future careers toward the end of the M.D.-Ph.D. Program.


Aspen's Mountain Air Inspires Refreshing Discussion of Future

by John C. Elfar

A conference focusing on the pressing issues of the day for the M.D.-Ph.D. student meets annually in Aspen, hosted by the University of Colorado Medical Scientist Training Program (MSTP). For twelve years, this meeting has aimed to unify many different programs in a forum for learning and discussion. This past summer's meeting was attended by roughly 100 students and an equal number of faculty, directors and administrators.

The scientific focus of the meeting was "Molecular Medicine: Experimental approaches to understanding and treating disease." In addition to a host of fabulous student oral presentations and posters, there were talks given by many prominent figures in molecular medical science today. The speakers included the current director of the National Institutes of Health and famed cancer biologist, Dr. Harold Varmus. Other distinguished scientists who spoke were: Dr. Pamela Bjorkman, an accomplished immunologist and biophysicist from Caltech; Dr. Eric Olsen, a geneticist from the University of Texas and editor-in-chief of Developmental Biology; Dr. Barry Bloom from Albert Einstein School of Medicine, a pioneering investigator in infectious disease; and Dr. Inder Verma, a professor at the Salk Institute who spoke on gene therapeutic paradigms.

Perhaps the most pertinent part of the conference was the forum discussion on the career paths and the future of the M.D.,Ph.D. The panel consisted of both Harold Varmus and Barry Bloom, as well representatives from Novartis and Merck, two large biotechnology companies. When asked to describe the experiences that led them to their current positions, the panelists' answers were diverse. Each had chosen a very different path into the medical sciences, highlighting the differences between those with classical graduate and medical degrees. The discussion seemed a bit tense as students questioned their own roles in the future of medical science. "It may very well be that we're not the best predictors of the future of such highly qualified individuals. After all, none of us are M.D., Ph.D.'s" said one panelist. One of the most fueled parts of the discussion concerned the appropriateness of clinical research as a scenario for graduate education. Some panelists thought that it would be beneficial if MSTP students had a better grounding in epidemiology as well as the development of model systems for pre-clinical trials. Others ardently opposed any move away from the training in rigorous biological basic science that is the mainstay of the graduate experience for most students.

The meal times provided an opportunity to interact with students from other combined degree programs across the country. The students sent as envoys to represent their respective schools varied in both age as well as career interest. Some had their sights set on purely research oriented careers while still others pointed in a more clinical dir-ection. By far the most popular trend seemed to be to delay this decision to a later time. For one weekend in Aspen, those few people involved in the construction of medical scientists from all over the country gathered to meet and grow. An expanding family of diverse interests was represented by both the faculty, students, directors and administrators that attended. How this small group evolves, and how the medical and scientific communities greet their newest members, remains to be seen.

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