Physician-scientists are urgently needed to make progress in the dynamic world of medical healthcare. Currently, there is a worldwide shortage in physicians pursuing a scientific career. Actively engaging students in research in early stages of medical training could help to direct students towards a scientific career and contribute to creating the next generation of physician- scientists. Leiden University Medical Center (LUMC) implemented an extracurricular Honors program with a fundamental orientation towards research. The program starts in the second year of medical training and is comprised of four different tracks in order to attract multiple types of students with different interests. All four tracks offer students scholarly experiences, but differ in content and amount of provided structure. The LUMC Honors program has a clear goal to develop future physician-scientists, and combined with its unique multiple-track model, the program accommodates about 70 students (25%) each year. The number of students in the program has grown and students’ experiences are positive. . . . Keywords Honors Extracurricular research program Physician-scientists Scholarly concentration Background developments in medicine. Being able to critically appraise scientific literature is key in the process of using research in The Canadian Medical Education Directives for Specialists daily clinical practice . (CanMEDS) distinguishes being able to use and being able However, besides all physicians using research, physicians to conduct research as two core competencies of a scholar . who actually conduct research are needed as well. These phy- A common belief in the medical field is that all physicians sicians are needed because it is important to create new knowl- should be able to use research, which is important in forming edge to make progress in the demanding world of medical evidence-based decisions and making a grounded diagnosis healthcare [3, 4, 6, 7]. Physicians combining clinical work [2–5]. In order to integrate scientific knowledge in clinical with doing research in the medical context are called physi- decisions and to ensure that patients receive the best cian-scientists. Physician-scientists offer an opportunity to possible healthcare, physicians should be aware of the latest bridge the gap between science and clinical practice [8–10]. They have the opportunity to identify clinical problems in daily practice, which can be translated into research questions and designs . Subsequently, physician-scientists can trans- * Belinda W. C. Ommering late research outcomes into clinical practice . firstname.lastname@example.org Currently, there is a global shortage in the number of phy- sician-scientists, with too few physicians pursuing a scientific Center for Innovation in Medical Education, Leiden University career [2, 8, 10, 13, 14]. A decline in interest for research Medical Center, Zone V7-P, PO Box 9600, 2300 RC Leiden, the Netherlands among physicians in Canada, the USA, and Europe has been documented . How physicians can be directed towards a Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands scientific career is still a topic of debate, although early en- gagement of medical students in research is mentioned as a Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, the Netherlands possible solution [2, 6, 7, 15–18]. Engaging students in research in early stages of medical education could help to Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands identify a possible scientific career path for these future 452 Med.Sci.Educ. (2018) 28:451–455 physicians, as it could trigger enthusiasm and motivation for make the first step to cultivate the next generation of physi- doing research . This view is shared internationally, as is cian-scientists. The LUMC program can be seen as an extra- reflected in the growing amount of curricular and extracurric- curricular research program, internationally similar to earlier ular courses to engage students in research [2, 19]. mentioned ‘scholarly concentration programs’ . The Some medical schools have designed and implemented LUMC Honors program has a relatively large capacity to ac- mandatory courses in the curriculum with the goal to get stu- commodate students and focuses on providing them with dents acquainted with research, for instance Duke University scholarly experiences. It is an extracurricular two-year pro- implemented a mandatory period of research into the third gram and it has a minimum of 30 ECTS (ECTS = European year of the medical curriculum, and Stanford University inte- Credit Transfer and Accumulation System), which means that grated mandatory research experiences for medical students students have to invest 30 × 28 h of active study. The program through all years of medical training [19, 20]. Leiden gives students the opportunity to experience research in an University Medical Center (LUMC) implemented a curricu- authentic learning situation by actually designing and lum change in 2012, integrating mandatory research courses implementing their own research in one of the departments in undergraduate medical training with the purpose to engage of the LUMC. students in research in early phases of medical training by The program starts with an optional orientation phase in the providing them with active learning experiences . first year of the medical study. All first-year medical students Besides mandatory courses in the curriculum, a trend is are invited to participate in this orientation phase, which is evolving in which medical schools design and implement ex- already unique, as most Honors programs only target so called tracurricular research programs with the aim to involve stu- ‘excellent’ students . The orientation phase consists of dents in research. These research-based programs occur in multiple expert lectures covering the different (bio)medical very different ways and under different names, but share a research areas of the LUMC. These lectures are given by mutual goal to expose students to in-depth inquiry and re- highly experienced physician-scientists. This allows students search experiences with capstone projects like writing a thesis to become familiar with and inspired by research and or a publishable article. Such extracurricular research pro- research-related work, and to get to know the career opportu- grams occur as, for instance, MD/PhD programs, scholarly nities as future physician-scientists. The number of students concentration programs, Capstone programs, Summer who use this opportunity and are actively involved in the Research programs, and Honors programs [19, 22, 23]. orientation phase differs every lecture, ranging from 30 to Leiden University Medical Center designed and implemented 150 out of approximately 300 students in total. Students par- an extracurricular research-based Honors program to engage ticipating in the orientation phase are provided with a possi- students in research. The aim of this monograph is to provide a bility to earn some credits for the actual Honors program, prior to the official start in the second year of medical training. detailed description of the LUMC Honors program to act as reference or inspiration for other medical schools exploring Students participating in the orientation phase can choose to options to implement an extracurricular research-based submit written reports of the expert lectures (in English), sum- program. marizing their content and adding new knowledge from recent literature. The reports are graded by educators specialized in academic writing, scoring students both on content and aca- The Medical Honors Program of the LUMC demic English. If students receive a passing grade for at least four of the meetings, they already earn two credits (2 ECTS) As a faculty that is part of a research intensive university, the for the Honors program, before the official program has even LUMC emphasizes the importance of research and educating started. After this, students can choose to earn another credit future physician-scientists. Therefore, one of the goals of (1 ECTS) by interviewing one or more post-docs and/or PhD medical training is to stimulate students to become familiar students. Students are asked to make a scientific report on the with and engage in research. Students of the LUMC follow content and outcomes of the interviews, which again will be mandatory courses throughout all years of medical training, in graded by educators specialized in academic writing. These which the students are actively engaged in doing small-scale interviews provide the students with an even better impression research projects [21, 24, 25]. Next to these mandatory of the ins and outs of performing research. courses, the LUMC offers an extracurricular Honors program The orientation phase starts in November and ends in June for bachelor students with a fundamental orientation towards of the first year of medical study. Students are not obligated to research. actively participate in the orientation phase; they can still par- The medical Honors program of the LUMC differs from ticipate in the actual Honors program regardless. By and large, traditional Honors programs in its design and main goal, as the the main goal of the orientation phase is to offer students the program originated from a point of view that future physician- possibility to get acquainted with research and the program, and to help students decide if the Honors program seems to be scientists are needed. Hence, the program is largely devoted to Med.Sci.Educ. (2018) 28:451–455 453 a good fit for them as an extracurricular activity during these choices. The department coaches the student in the same medical training. way as it would coach a regular PhD candidate. Next to their During the summer break between the first and the second bachelor studies, students have the opportunity to perform year of medical training students need to decide whether they research and to write at least two scientific papers for their would like to participate in the actual Honors program starting future PhD thesis. in September. They can officially apply during the summer The Journey into Biomedical Sciences track is a program months. The selection for the program is largely based on self- for students who would like to acquire a deeper understanding selection of the student, as three of the four tracks are open to of biomedical sciences and it offers an opportunity to follow a different types of students without having institutional selec- program with a fundamental orientation towards biomedical tion criteria. The MD/PhD track is the only track with limited research. Both the first and second year of this track focuses availability, resulting in institutional selection focusing on on theory and laboratory skills, and upon completion gives the high grades. Although the selection of the MD/PhD track is student the opportunity to combine the Medicine master and comparable to most regular Honors programs, the self- the Biomedical Sciences master in Leiden. Main subjects of selection of students in the other three tracks is a second factor this track are cellular communication, medical genetics and distinguishing this program from regular Honors programs. immunology in the first year, and Molecular Biology and Oncology, communication in science, writing a review, and acquiring and application of laboratory skills in the second Four-Track Model of the Honors Program year. The Clinical Research/Epidemiology track offers both the The Honors program at the LUMC provides four different opportunity to participate in courses about clinical epidemiol- tracks to attract multiple types of students with different ogy and statistics, and the possibility to do a clinical research interests. At the start of the program, the student can choose project. Students can choose what kind of clinical research between one of the following four tracks: the MD/PhD track, they would like to do and are mentored by a senior researcher the Journey into Biomedical Sciences track, the Clinical of the department. An example of a course in this track is Research/Epidemiology track, and the Free Research track. ‘Introduction in Clinical Scientific Research’, where students The four tracks are different in content and approach, but they get to know the different departments of the LUMC. This is a share a fundamental orientation towards research. The distri- popular course and it helps students with the orientation to- bution of students among the four tracks at the start of the wards a specific department, where they could possibly do program in the years 2013–2016 is illustrated in Table 1. their research. Another course of this track gives an introduc- The MD/PhD track prepares the student for, and could be tion in epidemiology by discussing the book of Kenneth Rothman (‘Epidemiology, an introduction’). The the beginning of, a future PhD project. Although every track can be a foundation for a future PhD project, the MD/PhD Clinical Research/Epidemiology track also offers an opportu- nity to follow a 5-day masterclass course in clinical epidemi- track explicitly acknowledges this as its main goal. The track has a limited capacity, accommodating only ten students every ology, in which students are educated in content identical to year. Students are selected by the institution, thus in this re- the education of PhD candidates and clinical researchers. In gard the track is comparable to regular Honors programs. both the first and the second year of this track, the student will Students are selected based on academic performance, curric- actively participate in doing research. ulum vitae, and motivation. The selected students are free to The last track is the Free Research track, which offers choose a department, and autonomous in choosing their re- students the possibility to do a research project in a department search topic. The coordinator of the Honors program and the of their own choice. This track seems suitable for two types of supervisor from the department assist the student in making students. First, this track appeals to students who are eager to do research, but who are not yet ready for long-term commit- ment, as they are still curious to find out which type of re- Table 1 Overview of participating Honors students in 2013, 2014, 2015 and 2016 search and (bio)medical research area suits them best. Second, this track is also attractive for students who already decided 2013 2014 2015 2016 what kind of research they want to do and at what department, committed to doing their own research in one particular area. Medical students 275 265 306 299 The Free Research track offers these students the possibility to Honors students 59 64 72 81 devote their Honors program to conducting their own research MD/PhD 10 10 10 10 at one department. Journey into Biomedical Sciences 13 17 15 18 In contrast to the MD/PhD track, the other tracks are mostly Clinical Research/Epidemiology 17 15 28 25 self-selected. Notably, the Honors program of the LUMC is Free Research 19 22 19 28 designed with maximum flexibility for the participating 454 Med.Sci.Educ. (2018) 28:451–455 students. If students come up with an individualized plan to flexible implementation of the offered tracks and the possibil- earn their 30 credit points, they can approach the Honors co- ity to propose alternative plans. The four tracks of the program ordinator to discuss the possibilities. Additionally to earning differ regarding their provided structure; therefore, the Honors credits in any of the four tracks or from the alternative prop- program as a whole may appeal to different types of students. ositions, all students are required to follow at least one Honors A tailor made program that suits students’ individual needs Class of 5 ECTS offered by the University of Leiden. The and aspirations may be the key to success. We believe this Honors Classes of all Leiden Faculties are coordinated by contributes to the large amount of students participating every the Honors Academy Leiden, and are always interdisciplinary year. Moreover, most students who follow the LUMC Honors by nature. Most of the Honors Classes are in English, and are program would recommend the program to their fellow aimed at broadening students’ intellectual horizon. There is a students. great variation in the offered Honors Classes and the students Additionally, students who recently started the Honors pro- are free to choose whether they prefer to follow an Honors gram were interviewed (n = 6). The students were approached Class in their second or third year. during an Honors meeting and asked if they wanted to partic- Summing up, to receive an Honors Certificate students ipate in orientating interviews. Participation was voluntary need to have earned 30 ECTS, followed an Honors Class, and interviews were conducted by the first author. The aim and passed all the courses in the regular curriculum. of the interviews was to provide insights into reasons students have to participate in the Honors program. Curiosity in com- bination with a need for extra challenge seemed to be the most Outcomes of the LUMC Honors Program important reason to participate in the program, as one student said: ‘Challenge is the biggest reason and also, I want to The LUMC Honors program is fundamentally orientated to- discover new things. I want to understand why something wards research and has the clear goal to develop future phy- works and not only that it works. That is something I miss in sician-scientists. The relative large capacity, self-selection, my study’. Another motive is that students want to learn more and four different tracks to address different types of students about doing research because of their interest in a research contribute to the uniqueness of the program as compared to oriented career, one student stated: ‘I really want to be a re- other, more traditional, Honors programs. Designing an searcher. So the sooner [to start with doing research] the Honors program in this way seems to be attractive for stu- better’. Students also discussed the benefits of doing extracur- dents, as is reflected in the increasing number of participating ricular research for possible future choices. One student men- students over the last few years. From the program’s inception tioned research being ‘very good for your resume’ and another with about 20 students participating in 2010, nowadays, student said ‘if you want to be a specialist, it is self-evident to follow a PhD first. I don’t know what kind of specialist I want the program provides extracurricular research activities for 81 medical students in 2016 (Table 1). This number represents to be, if I want to specialize at all, but I want to keep my 27.1% of one yearly cohort. Most of the extracurricular options open. So it seems good that when I do know what I Honors programs provide only places for few students, so would like to do, I have extra possibilities to do it. That is why having 27.1% of all students in a year participating in an it seems good to become familiar with research and that is extracurricular program is truly exceptional. why I chose the Honors program as extra activity’. Finally, Students of the LUMC Honors program were surveyed students mentioned that participating in the Honors program in 2016 to evaluate the program and its four different tracks was a ‘perfect way to build a network’. (n = 97). A total of 136 Honors students were approached, of whom 97 students participated (71.3%) and anonymously filled out a digital questionnaire regarding their experiences Conclusion in the program. Students from both years of the program and all four different tracks were included. The sample consisted An extracurricular Honors program, aimed at directing more out of 22 students from the MD/PhD track, 18 students from students towards a scientific career as physician-scientists, the Journey into Biomedical Sciences track, 20 students from appears to be an effective tool to actively engage undergrad- the Clinical Research/Epidemiology track, and 30 students uate students in research. By offering the program to more from the Free Research track. From the other seven students, students than only the obviously highly talented ones, and data regarding the track in which they participated was miss- by providing different tracks of interest, the program clearly ing. The evaluation showed that 92.9% of the students were reaches more students. The long-term effects of this program satisfied with the way the goals and opportunities of the pro- still need to be evaluated by analyzing the actual career gram were communicated. Overall, the evaluation indicated choices our students make, number and impact of publica- that the Honors program offered by the LUMC is well appre- tions, scientific presentations and research-related advanced ciated by the participating medical students because it allows degrees like a PhD. However, initial experiences of students Med.Sci.Educ. (2018) 28:451–455 455 11. Harding CV, Akabas MH, Andersen OS. History and outcomes of seem positive already, as is reflected in both the outcomes of 50 years of physician–scientist training in medical scientist training the evaluation and the growing number of students participat- programs. Acad Med. 2017;92(10):1390–8. https://doi.org/10. ing in the Honors program. 1097/acm.0000000000001779. 12. Ommering BWC, Dekker FW. Medical students’ intrinsic versus Acknowledgments The authors would like to acknowledge and thank extrinsic motivation to engage in research as preparation for resi- John O’Sullivan for his critical appraisal of the manuscript. dency. Perspect Med Educ. 2017:1–3. Furthermore, the authors would like to thank Lars Bosman for his help 13. Reinders JJ, Kropmans TJ, Cohen-Schotanus J. Extracurricular re- in gathering data. search experience of medical students and their scientific output after graduation. Med Educ. 2005;39(2):237. https://doi.org/10. 1111/j.1365-2929.2004.02078.x. Compliance with Ethical Standards 14. Goldhamer MEJ, Cohen AP, Bates DW, Cook EF, Davis RB, Singer DE, et al. Protecting an endangered species: training physi- Conflict of Interest The authors declare that they have no conflict of cians to conduct clinical research. 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Medical Science Educator – Springer Journals
Published: Apr 12, 2018
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