Wednesday, August 26, 2009

Choosing a Thesis Lab

I've just chosen my thesis lab and the decision wasn't easy. You're basically committing three to four years of your life to this place and your mentor can make or break your career. in my case, I had two great options and it came down to which lab I felt would advance my career more.

While loving the science is important, it is not the only factor that goes into picking a lab. You need to be happy with the lab environment or you will end up hating the science you initially loved so much.

Your mentor is one of the most important components to the decision. You want a mentor who will support you no matter what. Every mentor has a different style. Some will let you wander and experiment for weeks until you ask to see them. Others will stop by your lab bench several times a day to micromanage you. You need to find the style that suits you best. Each has its own advantages and disadvantages. The best way to do this is on rotations. If you are lurking around the lab trying to avoid your mentor, this is not the place for you. You should also use the rotation to ask lab members about what happened to former graduate students and postdocs in the lab. Did the students graduate in a timely manner? What sort of publications did they have? Did the postdocs head on to good jobs? Were there any fights or incidents? These are things you need to know. Make sure you are comfortable talking to this person and that they will set you up with good projects and help you graduate.

Lab environment is also a key component. While lab members come and go you want to make sure there is no person in the lab that irks you so much you will hate going to work. Are lab members overly competitive with each other or do they support each other?

Another factor i slab set-up. Some labs have lab managers and technicians who organize things and take care of a lot of busy work. Other labs do not. While this is not a huge deal, have an organized work environment helps you get your work done. When people are fighting over supplies and things are in disarray it is tough to work. If this is an animal lab - who does the gennnotyping? Who takes care of the animal cages and deals with the animal facility staff?

How flexible will your project be? Will you be allowed to follow your own interests or will you be forced to do what the PI/lab wants done most? Are there financial or spacial constraints in the lab that will prevent you from following your own ideas?

I had two excellent PI's, one young and starting, one more established and experienced. Both lab environments were friendly and organized. Since the MD-PhD is long process I chose the more established PI. He can help me graduate faster, his technicians are wonderful and the science in his lab is more clinical and thus I can relate to the research more. It was a very difficult decision and not one I took lightly. I spoke to program administration for advice as well as more senior students and friends. I weighed all this advice and the pros and cons of each, and finally I went with my gut. Let's hope the next four years proves it's the right decision.

Thursday, August 6, 2009

MSTP vs. MD-PhD (and other useful acronyms)

In a previous post I used the term MSTProgram without fully explaining what it meant. I would like to use this post to explain the difference between and MSTP and other MD-PhD programs.

MSTP stands for Medical Scientist Training Program and it is the designation given to programs that receive funding from the NIH. While most of these programs have an operating budget that comes from several sources besides the NIH they must follow the guidelines the NIH sends out. They also receive on site inspections by a panel selected by the NIH when they submit their competitive grant renewals. MSTP's are generally considered more prestigous than non MSTP programs that offer the dual degree. They also usually have more competitive financial packages and stipends for students.

There are many quality MD-PhD programs that do not receive NIH funding and are therefore not given the MSTP designation. With these schools, as with all schools, you must do your research to make sure it is the right program for you and will offer the right support, mentoring and carer advancement. In a future post I will include a list of common issues you should inquire about when looking into MD-PhD programs.

WHile I am on the subject of acronyms there re a few I wouldlike to define now. Almost everyone in the science field uses them or knows what they mean, and so should you! While I try not to use anything without defining it, I often slip. Sometimes it seems like science has a whole different language, the sooner you learn it the better.

PI: Primary Investigator. This is the head of a lab, essentially your "boss"
MCAT: Medical College Admissions Test What you must take to gain admittance to a medical school
MD: Medical Doctor
DO: DOctor of steopathy. A graduate of an osteopathic medical college. They can do pretty much what a regular MD does but they have also taken courses is manual manipulation and are supposed to be more "hollistic" physicians.
USMLE: United States Medical Licensing Exam. The exam all MD's take to be licensed. It is divided into into three "steps" that you take at different points in your career
COMLEX: The DO version of the USMLE
MS1: Medical Student Year 1. The way you tell people what year of medical school you are in.

There are millions of acronyms related to your particular scientific field or writing a note in a medical chart. I'll deal with those when I have to use them.

Covering Your Hair in the Hospital

One of the most difficult things that I have had to manage so far is figuring out how to cover my hair while I see patients and work in the lab. Expensive wigs and falls are not really made for getting blood or vomit on them, and they have these pieces of hair that are forever getting in your face. They may wear a little better in the lab, except that I experiment with mice and so I would have a wig that perpetually smells of the mouse house. Eew.

In the lab, it's a pretty solvable problem. I can wear a hat, a mitpachat, a bandana you name it. Nobody cares. It keeps my hair covered without obstructing my vision or getting in my face all the time. In the hospital, you have to be more careful. Many patients would not appreciate their Dr. wearing a newsboy cap. It makes them feel like you are unprofessional, on your way out and have no time for them. However I have found that you can easily get away with wearing a bandana. Many of the non Jewish nurses and staff wear them to keep the hair out of their face. You want to be careful though. If you are the type to not let a single centimeter of hair peek out from thebandana in the front then this is not the look for you. Your patients and colleagues will wonder why their Dr., who clearly has cancer, is walking around treating other people instead of resting up and taking care of their own health issues. Plus if you work with cancer patients they wonder how you can have cancer that requires chemo to the point of making you loose your hair and yet look so healthy and fit.

The solution for many female, religious, married physicians that I have spoken too seems to be the ponytail sheitel. They are not as super expenssive as full wigs, they keep hair off your face and they look natural. If you are someone who finds wigs hot and itchy I am afraid this will not solve that issue.

Right now, I'm a happy lab rat with a stack of about 50 different bandanas that match all my outfits. They're cute and functional and I can throw them in the wash with the rest of my clothes. I love them.

Tuesday, August 4, 2009

funding - how can ou live as a student for so long?

MD-PhD programs are unique in that they require student to remain in school for 7-9 years. Once you graduate the idea is for you to become a translational researcher. Not exactly a high paid field. How do you manage this? Well, unlike regular medical students most MD-PhD's are given some sort of funding. However, not all programs are created equal and not all offer the same sort of funding. Always make sure you understand your funding before you sign on to join a program!

Medical Students typically pay high tuition and most take out loans to do so. There are a few excellent scholarships but they are few and far between and you cannot count on obtaining one. Medical students should make sure they are comfortable with the financial aid department at their school and fully understand all loans and repayment options. Once they exit medical school they can usually defer their loans repayment through residency (interest variable depending on the type of loan and consolidation you do), some like to pay as much as they can off as soon as possible. After that they enter the workforce and repay those loans as fast as possible. There are some loan repayment programs for people who work in under served areas or at the NIH. These usually do not cover all your loans but are a great relief as people who enter those professions are usually not receiving a large salary. Not having had to deal with this sort of thing, I do not know all the details.

The best type of MD-PhD funding is the type found at my institution and at all other MSTPrograms (more on the initials in later posts). Your tution is waived for all years by the school and you receive a stipend of about 25,000 - 30,000 a year. Your health insurance is covered as well and sometimes you get an aditional allowance for travel to conferences or lab materials. If you drop the program you are not responsible to pay back tuition, however this is generally considered a very terrible thing to do and the "two and screw" (get two years of medical school for free and then drop the program before the PhD) is considered the most vile thing anyone can do. You are cheating someone who would have become a medical researcher out of their spot in the program and wasting tax payer money. Most people who choose to drop the program do so for compelling personal reasons. Dropping or not finishing is extremely rare at my institution. (drop rate is another great thing to ask about when interviewing at programs). Sounds great right? Well, don't get ahead of yourself. Your MD classmates will be in their well paying jobs by the time you hit residency and you don't actully gain much by not going the MD route with loans. This is not a great way to get a fre MD.

Other non MSTPrograms are not required to follow this funding plan. The next most common plan is one in which your tution is waved and you receive a stipend (variable based on program) however you are responsible for back tuition should you drop. Not a terrbile option. Just check that stipend levels are enough to live by in the area.

Rarely a program will tell you to pay for the first two years of medical school upfront or with loans and upon completion of your PhD you will receive this money back. They have placed it in a seecure account for you. They do this because they see it as an incentive to complete the program. I would avoid this type of program if you have other options. If you must, at least ask them how they plan on handling any interest accumulated on your loans while you are in graduate school.

Then there are the programs that have no funding at all. This is extremely rare in the US. It does happen occasionally in Canada and other countries. There is significant hardship involved in this and I would suggest that if this is your only option you should consider not doing the dual degree or doing them separately with a few years of working and cash accumulation in between. Unless of course you have an independent unlimited cash supply.

Sunday, August 2, 2009

The MD-PhD program timeline

In order to understand where I am right now in my MD-PhD training, you need to understand how MD-PhD programs work. For those of you considering this career option it is good to get a feel for the time commitment involved and the way in which you go about obtaining the dual degree. While a few people do the degrees independently of one another, this usually wastes time. Programs that offer both degrees attempt to streamline the process as much as possible. There are also usually financial benefits to choosing to obtain both degrees as part of a dual degree program (I will discuss those in another post).

Although there are slight variations between programs, the basic schedule is as follows:
Summer before medical school : Research rotation in a lab of your choice
First year of medical school: exactly the same as your MD only peers. Sometimes one or two graduate courses are thrown in.
Summer after first year of medical school: Research rotation in lab of your choice
Second year of medical School: Same as MD only peers. Take USMLE step 1 (first of several licenising exams)
Summer after second year of medical school: Research rotation in lab of your choice
Year 3-6: Join at one of the labs in which you rotated and perform thesis research. Time varies but the goal is for a 3-4 year thesis
Return to Medical School for one and a half years to complete MD degree.

At this point you are awarded the MD-PhD and you have several options. Most choose to do a standard residency, or a 'fast track' research oriented residency. A small minority of students who do not want the option of having a clinical career go straight to a postdoc.

All in all it's 7-8 years before you even hit residency. Time commitment? heavy. But in the end you can speak two languages, you're an MD and a PhD. You can bridge two worlds. Is it for everyone? Definitely not. But for some of us, we can't imagine our lives any other way.

So where am I? Year three. About to select a thesis lab. I got married in middle of second year and I'm beginning to consider starting a family. To complicate things, I married an MD-PhD classmate. It's difficult sometimes to be in a household of two students,but as I said before, even in the toughest of times, I can't imagine it any other way. For one thing, I never would have met my husband. For another, I would never have been satisfied with my career. I would hate to go through life thinking I could have done something better, something more. So when I'm rushing out of work to cook for shabbos or puzzling over life on a two-student budget I just remind myself that in any other situation I would be wasting my potential and not following my dreams. These are the choices I made and I am proud of them. They are not the right choices for everyone, and hopefully this blog will provide you with more information to base your decision on.