Meeting in the Middle: Creating the Biomedical Workforce of the Future

Meeting in the Middle: Creating the Biomedical Workforce of the Future

Biomedical science is advancing at a record pace and undergoing fundamental changes along the way. Divisions between various branches of biology are weakening, while connections between biology and physical science, engineering, and mathematics are strengthening. With the growth of biotechnology, applications of basic science have become increasingly commonplace. Meanwhile, clinical medicine has become more complex; clearly, many newly emerging biomedical applications can contribute to the improved practice of medicine, which philanthropic efforts can support. Unfortunately, this merging of the biological and physical, of basic and applied, generally has not been mirrored by new educational programs. Society is faced with the need for training at the interface between basic and clinical science, closing the distance between bench and bed. Given the complexities of this effort, we need to forge connections that allow appropriate experts to meet in the middle.

The Howard Hughes Medical Institute (HHMI) is answering this challenge by supporting efforts aimed at bringing students from various parts of the spectrum together to create and deploy new, innovative uses of science for medicine. Both professional (M.D.) and graduate (Ph.D.) programs offer opportunities to recruit and train a new advanced workforce. We are currently supporting several different programs to create research-intensive physician-scientists as well as medically oriented basic scientists.

Although an increasing number of medical students have been exposed to authentic research as undergraduates, few have had opportunities to experience full-time research for periods longer than, at best, a summer. Even fewer have approached biomedically relevant research armed with disease-based knowledge of human biology. HHMI is addressing this need in two programs that make it possible for medical students to take one or two years away from formal medical training to engage in full-time research. Both programs are successfully channeling medical students into research careers.

The HHMI-NIH Research Scholars program brings medical and dental students to the campus of the National Institutes of Health (NIH), houses them together in a renovated convent, and places them in NIH laboratories under the mentorship of NIH scientists. By housing the scholars together, we can provide additional activities such as a weekly seminar featuring scientists from the NIH intramural research program and HHMI investigators from our seventy-two host institutions around the nation. The scholars also form their own journal clubs and present results of their ongoing research to each other, forming intellectual and professional ties that persist long after they return to their home schools. The NIH campus, housing one of the world's largest collections of biomedical scientists, provides outstanding research opportunities for students from any medical school. This year, 161 students from seventy-six institutions competed for the forty-two places in the program.

The HHMI Research Training Fellowships for Medical Students program similarly makes it possible for medical students to take time off from their medical studies for a year of uninterrupted mentored research at any nonprofit research institution. The program allows students to pursue research programs at either their home institution or another suitable site. By working in a laboratory at their home institution, students can start a project part time before entering our program and/or continue a project after completing the program. This year, there were two hundred applications for sixty-six awards. Medical fellows will conduct research at twenty-six different institutions, and students from fourteen medical schools will be doing research at an institution other than the school in which they are matriculated.

Students from both programs are united in an annual meeting at HHMI and connections are continued at alumni organizations formed at major sites around the nation. We have assessed the outcome of these programs and have found that alumni of both programs are about as likely to pursue a career in academic medicine as students with an M.D./Ph.D. degree, and about eight times more likely than students who receive just an M.D. degree. Finally, to enable our students to initiate successful academic research careers, we have introduced an early career support program this year, open to our alumni at the start of their first full-time academic positions. The program will provide three years of flexible funding and protected time for research for newly minted faculty in their vulnerable first few independent years in the academy.

On the other side of the training divide, the new HHMI Med into Grad Initiative has been developed to support the integration of medicine into Ph.D. graduate education. A goal of this initiative is to create a cadre of researchers who have the knowledge and skills necessary to appreciate and address clinically relevant biological problems from the perspective of basic science. The initiative has awarded $10 million to thirteen institutions to foster this integration. For example, Stanford University will initiate a Masters of Medicine program that offers a formal pre-clinical medical curriculum to students admitted to any of the institution's Ph.D. training programs. The students will have a physician co-mentor who will help them formulate clinically meaningful questions for their dissertation research. In a related but somewhat different approach, Rice University will partner with the University of Texas M.D. Anderson Cancer Center to develop a training program for bioengineering Ph.D. students. This program will integrate courses in bioengineering, biology, and medicine; require clinical internships; and encourage jointly mentored Ph.D. projects.

Common to all of the supported programs is a vision of fundamental science being marshaled to address clinically relevant questions, usually by forming bridges between clinical and basic faculty. It is our hope that beyond graduate thesis research projects that connect bench to bed, these programs will create lasting ties between basic and clinical departments and yield a new cadre of scientists who go forward practicing and teaching collaborative science as they in turn become the faculty of the future. We anticipate that these new scientists will appreciate which biological problems are of the greatest clinical relevance and will be positioned to apply new biological knowledge to create tools for improved human health.

In summary, it is clear that modern medicine is increasingly based on science and that exciting and fulfilling new science can be applied to medicine. More programs are needed that incorporate training at the interfaces of disciplines to create lasting collaborations among diverse practitioners. Students are powerful innovators and connectors, forcing fresh ideas and practices to come together. Private philanthropy is perfectly suited to catalyze new experiments in education; the need and opportunity is there to do much more.

Peter J. Bruns is vice president for grants and special programs at the Howard Hughes Medical Institute, a nonprofit medical research organization with hundreds of biomedical scientists working at the forefront of their fields.