• “Science, Medicine, and a Gift of Gab”

• ”From Patients to Proteins”

Patterson adds that the medical students bring a unique mix of training and experience to the Institute’s graduate student population. Students in the MD/PhD programs spend their first two years in medical school before starting the PhD portion of their training, so they arrive at Caltech already primed with a partial medical education. “We think that they bring expertise that our students don’t have in the areas of physiology and pharmacology, and a comprehensive knowledge of human diseases,” he says.

STAR students—already doctors—have even more to offer. With their extensive medical backgrounds, they instantly become a resource for their Caltech colleagues. “You can be an excellent scientist, but sometimes you don’t understand the impact that something can have on diseases,” says Joy Frank, a UCLA professor of medicine and physiology and the director of UCLA’s STAR program. Not only are STAR students learning advanced-level science at Caltech, but by interacting with faculty and students they are contributing their medical knowledge to Caltech research programs. “It’s a two-way street,” Frank says, with the physician/students absorbing information at Caltech and giving back to their fellow Institute investigators.

The medical students who enroll at Caltech typically join research programs that are either not offered at their home universities or are not strong there. “Caltech has strengths that are different from ours, such as computational neuroscience and organic chemistry,” says Stanley Korenman, former director of the UCLA MD/PhD program. “There are imaging facilities at Caltech that we don’t have,” says Brian Henderson, a professor in the department of preventive medicine at USC, and the director of its MD/PhD program.

“Investigations are so specific that there can never be duplications.” If you’re interested in medicine and “you want to have an academic career, you need to be an MD/PhD,” Korenman points out. “It makes sense for clinical departments in research-oriented schools of medicine to seek out these MD/PhDs for their faculties because they are well grounded in both medicine and research.”

Patterson says that, compared to the typical Caltech graduate student, most MD/PhD students are more interested in clinically related research, although at Caltech, that still leaves room for diversity. “They’re spread all over here: applied math, engineering, biochemistry, and chemical engineering,” says Patterson. “A lot are interested in biomedical engineering.” They may work on mouse models of diseases, study vision in primates, or use yeast as a tool to investigate cancer.

While MD/PhD students are subject to the same requirements as other Caltech graduate students, Patterson says that they usually get their PhDs a bit faster, partly because they do two or three summer lab rotations before they start full time at Caltech, which helps them home in early on a research program. “MD/PhD students are also very efficient,” he says. “They know that they’ve got years of medical training ahead of them and don’t want to waste any time.”

For the STAR students, who have often been out of school for a while, it can be quite an adjustment coming to Caltech. “The challenge for the STAR students is that they’re already practicing physicians, and now they have to go back to being a student again after going through med school, internships, and residencies,” Patterson says.

While many MD/PhD students see patients after they leave school, most pursue research programs. “The vast majority go on to do research,” Patterson says.

“Very few switch and do only clinical work, which is good because a lot of money is invested in their research training.” Of those who do both, he says, “I don’t know how they do it. Take the time constraints on the average faculty member at Caltech and add on administrative work and clinical work. The pressure of their schedules is enormous.”

UCLA’s Korenman says that a recent study reported that 62 percent of MD/PhDs end up as scientists in clinical departments, doing research 80 percent of the time. Most of the others do basic research, without clinical duties, in basic-science departments, in research institutes, or in industry. A relatively small number just become clinicians. All three avenues have value, he says, noting that “doctors with MD/PhD degrees are an important link between basic science and clinical medicine.” Agrees USC’s Henderson, “A lot of research still needs to be done by people who have an understanding of clinical diseases and are in a position to bring basic science from lab bench to bedside. A clinician is not trained enough in basic science to make that link.” Nor, he might have added, is a scientist who is not trained in medicine.

After they get their PhD degrees, STAR students usually spend time as postdoctoral fellows before they go off and establish their own research programs. “Doing the PhD changes the way they approach science,” says Frank. “In rigorous labs, like those at Caltech, you must constantly defend the ideas you’re putting forth, whereas in medicine, you learn to live with the frustrations that things don’t always work. Medicine isn’t taught the same way as basic science, so most doctors haven’t been exposed to that kind of critical thinking. We want the STAR students to have the best opportunities in the most critical labs.”

For now, both Caltech and its med-school partners say they are pleased with the collaborations. “We’re very happy with the programs and want to keep them going,” says Patterson. “The ultimate test is what these students do in their future lives. If they get positions in leading medical schools and do world-class research, that will show that the programs were a success. We’ll have to see what happens. Clearly there is a need. There’s a tremendous pool of students who want to do this. But we don’t have enough spaces.”
Caltech’s president David Baltimore, who is currently supervising an MD/PhD student and a STAR oncology fellow, concurs. “We have the capacity to train more students than we now take,” he says, “but we would need to develop further financial resources to be able to train them.”

Baltimore adds, “I believe that a Caltech PhD degree is the perfect complement to an MD, giving the MD/PhD a very strong background to go on in research and teaching. Not only can we provide a strong basic-science training for biomedical research, but with our engineering strength we can help physicians prepare themselves to contribute to advances in medical technology. MD/PhDs are particularly well-positioned to see the clinical relevance of scientific advances and to make special contributions if the focus of their work provides an opportunity to move science or technology in a clinically relevant direction.”