By introducing medical students from underrepresented backgrounds to research early, the program hopes to bring more diversity to research-oriented medicine.
Twelve students who have completed their first year of medical school will spend this summer conducting original research at the University of Colorado. As participants in the CU Department of Medicine’s Research and Equity in Academic Medicine (DREAM) program, these emerging second year medical students will work with CU mentors to generate research results and present (or even publish) their findings.
Increasing and diversifying the pipeline
The program’s goals are two-fold: to increase the pipeline of ‘physician scientists’ – physicians who both provide care to patients and conduct their own research, typically in an academic setting – and to increase underrepresented minorities within that pipeline. What’s more, even students who do not continue in research stand to become better physicians after their experience in the DREAM program.
"The DREAM program is meant to give aspiring medical professionals the opportunity to see how research is done, and to understand the potential impact of research," says David Schwartz, Chair of the Department of Medicine, who launched the program in 2011 with Rob Winn, MD, former Associate Dean of Admissions for the CU School of Medicine. "Not only does the program allow them to participate in research, it also helps them understand the research enterprise, and how that enterprise is intimately connected with the way we take care of patients."
DREAM participants independently select mentors and develop research projects, which they’ll conduct in their mentor’s laboratory for 10 weeks over the summer. Students each receive a $3,000 stipend from the Department of Medicine. At the end of the summer, they’ll present their work to their DREAM cohort, as well as at the Department of Medicine’s annual Research Day. Eventually, about a quarter of the participants will publish their results.
'The interface where progress will be made'
The DREAM program was developed in part because of data showing a large decrease in the number of physician-scientists, who have a unique perspective and expertise. "Someone who’s spent ten years studying clinical medicine and disease processes has something to offer the research effort, and that’s the interface where progress will be made," says John Repine, MD (Waring Professor of Medicine, Associate Dean for Student Advocacy and Director of the Webb-Waring Institute for Cancer, Aging, and Antioxidant Research), who took over the program in 2013. Physician-scientists’ blended perspective also facilitates a team science approach to medical research, in which clinical insight from caregivers at all levels is combined with basic science research from multiple disciplines.
Many medical students see the advantages of combining research with the practice of medicine. "I really like the idea of being able to attack a clinical issue from both sides, working to improve the treatments at the same time as working to help individual patients," says Tessa Harland (left), a first-year med student who will work this summer with Aviva Abosch, MD, PhD (Department of Neurosurgery). Her project will focus on recording signals in parts of the brain associated with movement, to help target electrode therapy for Parkinson’s disease.
However, a June 2014 report from the NIH Physician-Scientist Workforce Working Group (PDF) indicated that only 1.5% of American physicians consider research to be a primary focus area, and less than 1% are principal investigators on NIH grants. Over the past 20 years, the percentage of NIH awardees who are physicians has declined to 30%. Additionally, the report found that the average age of the physician-scientist workface is rising, as younger researchers have not emerged in significant numbers, presaging a demographic crises as this workforce eventually ages out of active research and clinical practice.
"Newly-minted physicians have an alternative to research and academic careers, and it’s lucrative."
One reason for this decline is that new MD’s typically have substantial student loan debt, and practicing as a community physician offers an attractive route to eliminating that debt. "Newly-minted physicians have an alternative, and it’s lucrative, but for some students who get bit by the 'discovery bug,' their career goals unexpectedly change," says Repine. He adds, "It’s remarkable how some students who were not inclined toward research surprisingly find a new career."
Additionally, establishing a career as a research scientist takes time - according to the NIH, the average age at which physician-scientist investigators receive their first independent federal grant is 45. "That’s all the more reason we want to start students in research earlier," says Repine. "Getting early experience, publishing early papers, they can develop a real interest in research that will help take them through that long process, and maybe even accelerate it a little. Starting late is very difficult."
"I think research in an academic environment has the potential to be either a vicious cycle or a virtuous one," adds Brooke Bredbeck (right), who participated in the DREAM program in 2013 and graduated from the CU School of Medicine in 2016. "If you’ve never had any research experience, it’s much harder to ever get started working in a lab, since you need quite a bit of training before you can really contribute to the group. But if you do have any sort of research training, it makes it much easier to get a research job even if the focus area is completely different – they know you understand the different way things work in a research environment." Bredbeck worked in the laboratory of Neda Rasouli, MD (Department of Medicine, Division of Endocrinology, Metabolism and Diabetes) exploring the connection between angiogenesis and insulin sensitivity in an obese population, and later presented her results at the Western Student Medical Research Forum.
A more diverse workforce of physician-scientists
Racial and ethnic minorities comprise over a quarter of the U.S. population, but only 6% of practicing physicians are Latino, African American and Native American (AMSA). The NIH Physician-Scientist Workforce Working Group found similar numbers among physician-scientists, reporting that approximately 75% of physicians who receive independent NIH funding were white, another 20% were Asian, and the remaining 5% were Latino, African American or Native American. Increasing the diversity of researchers, especially those who also see patients clinically, is an important step in addressing health disparities, and asking research questions about medical issues that disproportionately impact minorities.
The DREAM program actively recruits medical students from underrepresented backgrounds, including race and ethnicity, gender, disability, sexual orientation, socioeconomic status, and religious or political affiliation.
"We’re trying to make research part of the process of learning medicine."
Not all DREAM participants will go on to careers in research medicine, Repine notes, but this early and first-hand exposure to research will enable the participants to read, interpret and critically evaluate research findings, making them better physicians. The program also helps position participants for competitive residency programs, and provides mentorship, often long-lasting, from the faculty they work with.
"This project will be a good way to feel out if a research career is what I’m most interested in," says Bryan Nycz (left), a first-year med student whose summer DREAM project will allow him to work with Samuel Dominguez, MD, PhD (Department of Pediatrics) and Daniel Frank, PhD (Division of Infectious Diseases, Department of Medicine). Nycz’s project will study young leukemia patients who get gut infections during chemotherapy, to try to identify risk factors and preventive approaches. "I’m really interested in clinical applications of microbiome studies – using these studies to understand patient outcomes, differentiate between healthy and sick patients, and find new interventions.'
"The mentorship is probably the most important thing I gained from the DREAM experience," says Quan Bui (right), a graduating med student who worked in the laboratory of Mark Geraci, MD (formerly the head of the Division of Pulmonary Sciences and Critical Care Medicine in the Department of Medicine) on a pulmonary hypertension project that extended into his third and fourth years of medical school. "In addition to Dr. Geraci, who was and continues to be a great mentor to me, I also met fellows and other pulmonary researchers, which is important because in ten or fifteen years, I see myself in academia. I know I want to teach, and in terms of research, it might not be basic science research but I will certainly continue some kind of research activities, probably on the clinical or outcomes side."
"Research takes time, and matures with the student as they’re learning. We’re trying to make research part of the process of learning medicine," says Repine. "Our medical students are fortunate that the Department of Medicine is willing to provide substantial stipends to enable students to participate in the DREAM Program each summer."
"My view is that the DREAM program is a small investment in a very large idea," says Schwartz. "My hope is that over time, the program will grow beyond the Department of Medicine, bringing this opportunity to the campus at large."