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Short-tracking is not a short-cut
Fellow talks about her experience with the American Board of Internal Medicine Research Pathway.
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Ever since I was in college I had a desire to pursue a career in endocrine research. From my senior thesis project studying the role of hCG receptor in placenta, I was hooked on the fascinating world of hormone-receptor interactions and the beautiful simplicity of negative feedback. With my background in biochemistry, I was drawn to the study of nutrient metabolism and decided to pursue a career in diabetes and obesity research.
 Dawn Belt Davis |
I entered the MSTP (Medical Scientist Training Program) at the University of Chicago and obtained my MD and PhD degrees. I already knew I wanted to pursue a fellowship in endocrinology, so I took the advice of several mentors and chose to follow the Research Pathway for my clinical training.
Many readers may be more familiar with this pathway as “fast-tracking” or “short-tracking.” Personally, I find both these nicknames somewhat offensive, since there is nothing “fast” or “short” about my training process. I have met several other trainees who are also pursuing this pathway, and the most notable commonality is a lack of understanding on the part of institutions, mentors and even the trainees themselves about the requirements and benefits of this program. That is why I chose to write this article, to dispel some common myths and explain the structure of the Research Pathway.
About the Pathway
In 1997, the American Board of Internal Medicine announced the initiation of the Research Pathway as an option for trainees interested in pursuing a career in either clinical or basic research. This pathway was initiated to help increase the number of physician-scientists and to formalize a training pathway that had been utilized in a less standardized way in the past.
The basic premise of this pathway is that trainees complete two years of internal medicine training and then move directly into fellowship training. They complete the standard amount of clinical fellowship training (12 months of full-time clinical work for endocrinology) and then have three years of research training. During the research years, the trainee maintains at least one half-day of clinic per week. Therefore, the total number of years spent in training programs is six, which is equal to a standard three-year internal medicine residency and a three-year endocrine fellowship. Full details of the program can be found on the American Board of Internal Medicine website at http://www.abim.org/certification/policies/research/requirements.aspx.
Even though the number of people pursuing this pathway is small, I think it is important for endocrinologists as a group to understand this program. First, I think more residents and medical students should be encouraged to consider this program if they have a strong interest in endocrine research. The decision to enter this program must be made early, since it requires application to the endocrine fellowship program of your choice during the fall of your intern year.
In my mind, endocrinology is the perfect subspecialty to utilize this training pathway.
The final year of internal medicine training is often filled with months in the ICU and other intensive hospital-based training developing critical care and inpatient management skills not often used by a practicing endocrinologist. Also, the outpatient-based practice of endocrinology lends itself well to a full-time commitment to research. There are certainly millions of interesting questions waiting to be answered in this ever-expanding field.
Misconceptions about the program
As I have talked with people about this program, I have encountered several misconceptions that I would like to dispel.
First, completing training through the Research Pathway does not mean that you are less qualified as a clinician. In fact, I am completing more time in clinical fellowship training than some of my colleagues who are doing a two-year fellowship. Research Pathway graduates are board certified in both internal medicine and endocrinology, and they are not allowed to take their board exams until they have completed the usual number of years of training (three for medicine and five for endocrine). This means we take and pass our board examinations after one year away from full-time clinical work in that specialty, which requires a strong foundation of knowledge and intensive study.
Secondly, time spent on research is not akin to vacation, relaxation or an easy rotation. In fact, I work longer hours and have much more stress on my days in lab than I do when on clinical service.
Finally, for other trainees in this pathway or considering starting on this road, I would strongly caution you to take an active role in your training process. Many program directors are unfamiliar with this pathway, and you will need to fully understand the requirements to ensure that you are receiving adequate support for both your research and your clinical training.
Must love research
My experiences in the Research Pathway have generally been positive. I am now in my sixth year of training, having completed three years of endocrine fellowship and now spending an additional year pursuing mentored research projects. I completed my internal medicine residency at the University of Washington but chose to move to the University of Wisconsin for my fellowship to be closer to family and to work with my current mentor.
It was difficult applying for fellowship shortly after starting my internship. I remember flying out to my interviews post-call from the ICU and returning just in time to be on call again. I almost fell asleep during a few especially one- sided interviews!
Because my fellowship program is a two-year program, the final year of endocrine fellowship was also difficult. As I saw my endocrine fellow cohorts graduating and taking boards, I returned for another year of continuity clinics and journal clubs. Luckily, I have been able to commit more fully to my research this past year and am very excited about the interesting results we have already discovered, and the many projects I have planned for the coming year.
As I always tell people, you have to truly love research and discovery to commit to this life, since the rewards are fleeting and rare. However, when they do come it is an amazing feeling to know that you have uncovered something new that will ultimately contribute to the health of your patients or the understanding of a disease that you see in clinic every week.
Dawn Belt Davis, MD, PhD, is a Clinical Instructor in the Alan Attie Lab, Department of Biochemistry at the University of Wisconsin-Madison, a former fellow in Endocrinology, Diabetes, and Metabolism, and a member of Endocrine Today Editorial Board.