Roghmann Mary-Claire, Schimmenti Lisa A, Williams Christopher S, Swartz Talia H
Acad Med. 2025 Jan 1;100(1):72-77. doi: 10.1097/ACM.0000000000005857. Epub 2024 Sep 4.
This study describes the structure and timing of the clinical education components of MD-PhD programs to illustrate how variations in preclerkship curriculum correlate with the opportunity for early clinical exposure and other key program characteristics.
A survey was disseminated to U.S. MD-PhD programs on May 25, 2022, asking about the preclerkship curriculum length (long [> 18 months], medium [13-18 months], or short [12 months]), United States Medical Licensing Examination Step 1 timing (relative to the PhD training and clerkships), and opportunity for clerkships before the PhD phase. This survey was supplemented with data from publicly available sources to include 92 MD-PhD programs.
This study found a wide range of MD-PhD clinical curricula. A strong association was found between shorter preclerkship curriculum length and the opportunity for clerkships before the PhD (10 of 50 programs [20%] with long preclerkship curriculum, 19 of 35 programs [54%] with medium preclerkship curriculum, and 7 of 7 programs [100%] with short preclerkship curriculum; P < .001). Variations in United States Medical Licensing Examination Step 1 timing also exist based on preclerkship curriculum length and the opportunity for clerkships before the PhD. Shorter preclerkship curriculum length was associated with National Institutes of Health funding of the MD-PhD program (20 [40%] of long, 25 [69%] of medium, and 6 [86%] of short preclerkship curricula; P = .006) and larger MD-PhD program size (35 students with long, 70 with medium, and 86 with short preclerkship curricula; P < .001). Preclerkship curriculum length was not associated with public vs private medical schools, although the West had shorter preclerkship curricula.
This study underscores the need for collaborative efforts to gain insights into the effectiveness and implications of educational interventions in MD-PhD programs, ultimately informing future training strategies and policies.
本研究描述了医学博士-哲学博士（MD-PhD）项目临床教育组成部分的结构和时间安排，以说明临床前课程的差异如何与早期临床接触机会及其他关键项目特征相关联。
2022年5月25日向美国MD-PhD项目发放了一项调查问卷，询问临床前课程时长（长[>18个月]、中[13 - 18个月]或短[12个月]）、美国医师执照考试第一步的时间安排（相对于博士培训和临床实习）以及在博士阶段之前进行临床实习的机会。该调查辅以公开来源的数据，涵盖92个MD-PhD项目。
本研究发现MD-PhD临床课程存在广泛差异。临床前课程时长较短与博士阶段之前进行临床实习的机会之间存在强烈关联（临床前课程长的50个项目中有10个[20%]，临床前课程中的35个项目中有19个[54%]，临床前课程短的7个项目中有7个[100%]；P <.001）。美国医师执照考试第一步的时间安排也因临床前课程时长以及博士阶段之前进行临床实习的机会而有所不同。临床前课程时长较短与MD-PhD项目获得美国国立卫生研究院的资助相关（临床前课程长的20个项目中有20个[40%]，临床前课程中的25个项目中有25个[69%]，临床前课程短的6个项目中有6个[86%]；P =.006）以及MD-PhD项目规模较大（临床前课程长的有35名学生，临床前课程中的有70名，临床前课程短的有86名；P <.001）。临床前课程时长与公立或私立医学院校无关，不过西部的临床前课程时长较短。
本研究强调需要共同努力，以深入了解MD-PhD项目中教育干预措施的有效性和影响，最终为未来的培训策略和政策提供参考。
