Reflections From the Liminal Space: MD/PhD in Health Professions Education – Raising the bar or moving the goal post?

The KeyLIME co-hosts are taking the week off … but we wouldn’t leave you hanging – we’ve got some reflections from the liminal space from Teresa! ~ICE Blog Admin

By Teresa Chan (@TChanMD)

Many people have noticed that in health professions education, there is a new cadre of researchers that are emerging in the past few years – the Clinician-PhD Scientist.  As part of the Liminal Space section, we invited one early career educator (Dr. Taryn Taylor (@TarynSuzanne) MD/PhD, Western University) and one medical student (Alice Cavanaugh (@alicemccavanagh), MD/PhD candidate, McMaster University) to tell us about their experiences and their thoughts around the advantage of this route.  I hope you enjoy this interview.

Q: How did you arrive at the decision to do your PhD?

TT: Many people had the same wide-eyed reaction when I announced my intention to pursue a PhD in Health Professions Education during my residency in obstetrics & gynecology. It was mostly disbelief, as if they’d heard me wrong, “But, why?” Sure, it seemed like a crazy thing to do in the middle of an already demanding training program but I saw it as a tremendous opportunity. It meant that I could continue to benefit from the stellar supervisory committee I had accrued during my Masters program and it provided the protected time I needed to truly immerse myself in the field of medical education while developing a program of research. The alignment between my doctoral work, which was situated in postgraduate medical education, with my lived experience as a trainee was also advantageous.

AC: When I started my doctoral studies in Health Policy – in my case, before I’d even applied to medical school – it felt like a turn towards questions I’d deferred during my MA in Gender Studies, refocusing my attention on practical realities and hidden curricula in medicine. At that point, colleagues often expressed surprise when I told them I was interested in a clinical profession since my work was mostly theoretical and my academic trajectory wouldn’t look much like most of the clinicians in my field. In health policy – and in health professions education, frankly – it’s more common for physicians to pursue doctoral research after practicing for a while, with practical experiences in healthcare systems driving their research questions. Although I initially worried that this might be seen as a strike against my application, studying medical education at the same time that I finish my own MD has opened up opportunities for research that keep me going every day.

Q: How do you feel like you will eventually integrate your scholarly work and clinical care?

TT:  I believe integration comes naturally to clinician scholars. Research questions abound in our daily lives as clinicians within the clinical training environment. The real challenge is deciding which projects to pursue, who are the appropriate collaborators, where the funding is coming from, and how to engage trainees in these projects. I am living proof that compulsory research exposure during training can completely change the course of a trainee’s career so I try to collaborate with residents and medical students often.

AC: I agree with Taryn. At academic centres, education is a day-to-day reality of many physicians’ clinical practice, whether it’s being shadowed by a first-year medical student, supervising a clinical clerk, or mentoring a resident or fellow. If your research is focused on medical education, every one of these encounters opens up new avenues for research. When I think about the ‘bench to bedside’ paradigm in physician-science, I also imagine who else is clustered around the bedside; the clinician-scientist is almost always also a clinician-educator.

Q: How did you arrive at your area of scholarly focus?

TT: My program of research evolved over the years, as most do, and was directly informed by my lived experiences as a resident. When I was beginning my Masters, resident duty hours remained a very contentious topic as work hour regulations were undergoing further reform in the United States and Canada was deciding whether to initiate legislated regulations. One group of researchers found that sleep hygiene education failed to change resident behaviours, which came as no surprise; however, I discovered that the researchers generally had no idea what the residents were doing post-call.  This led to my first study and further studies snowballed from there. My research supervisors and collaborators pushed me to think beyond work hours, which led me to explore fatigue as a social construct and a shared experience that is relevant to all health care providers.

AC: Lived experience also played a central role in shaping my doctoral research questions. In my case, these experiences were from volunteer work with a Sexual Assault Crisis Centre in my community. During trips to the ER, accompanying people who’d recently experienced sexual assault, I noticed that clinicians who saw these patients seemed uncertain or unsure how to respond. This got me wondering what these clinicians were actually learning about sexual violence in their medical training, and how else they might know about issues like bodily autonomy, consent, and sexual agency. When I return full time to my research in November 2019, I’ll be analyzing undergraduate medical curricula from across Canada, interviewing medical residents, and talking to community stakeholders to try and understand how we can better support physicians to support these patients. In the last two years, public conversations about sexual violence and harassment have been at the centre of our cultural consciousness and I want to understand how medical learners are reckoning with these insights in the context of their clinical work.

Q: What are some of the benefits of doing a PhD as a clinician? What informed your decision to do a PhD (in particular, rather than/in addition to a Master’s)?

TT: My decision to pursue a PhD was fairly pragmatic. The opportunity came along at the right time. I knew that I had a passion for research. I fully intended to continue exploring the many unanswered research questions that my earlier studies had unearthed. If I had done so outside of a formal doctorate program, I would not have had the protected time nor the salary support to do so. I’m also a very goal-oriented person; having a timeline and various deadlines along the way meant that I was much more productive than I otherwise would have been had I been doing research “on the side”. While negotiating for a full-time faculty position, having a PhD was also advantageous because it led to a shared expectation that I would benefit from funded and protected time.

AC: Protected time, plain and simple. I grew up watching my mum – who is a psychiatrist – stay at work late and then come home to work even later; seeing her battle to protect her time beyond her clinical work gave me a pretty clear picture of the struggle physicians face in finding time to do all of the things. Knowing that I wanted to have a research career, I opted for a MD/PhD program in the hopes of setting an expectation for the rest of my career.

What are some of the challenges?

AC: Balancing Time. This In medical school – and particularly in a three-year program – there is so much content to master; as a student with a non-science background, sometimes it feels like it takes me twice as long to get through tutorial prep as my colleagues, to say nothing of the time it takes to keep my research moving forward, or do the optional clinical placements that give us a sense of what practice actually feels like. I’m still trying to find balance, honestly: learning how to say no to research opportunities, to protect time for studying, and to make space for exercise, cooking,  and seeing my loved one. I think though, that these are challenges that I’ll be negotiating for my entire career and I’m glad to be getting the practice now. I was organized before but now – now I’m really organized.

TT: It can be difficult balancing Identities – researcher, clinician, personal life. As a resident enrolled in the Clinician Investigator Program, it sometimes felt like my identity as a researcher was blossoming while my identity as a clinician faltered. The disjointed training schedule that I had chosen meant that I lacked near-peers with whom I could compare my progress. (I imagine this is how many trainees feel when they return from parental leave during training.) Transitions were especially difficult. Every time I felt myself gaining momentum in either sphere of my life, it was time to switch gears. I learned to be proactive in seeking out opportunities to enhance my clinical skills where I felt they were lacking. I have also unapologetically chosen to narrow my scope of practice, which has allowed me to make the most of my research and clinical worlds.

What is your advice for someone considering an MD/PhD? 

AC: Think honestly, carefully, and critically: what about this trajectory is appealing to me? With a PhD – much like medicine – there are periods of time where no amount of prestige or social capital or wanting not to disappoint someone will be enough to keep you going; you have to need to answer the questions you’re asking, and have a vision for why the work is worth it.

Featured image via geralt on Pixabay