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MD-PhD is a good idea, and by all means, should be maintained. I think it could, however, use a big facelift. The fact is that even people who truly like scienc

by rscho 10y ago

MD-PhD is a good idea, and by all means, should be maintained. I think it could, however, use a big facelift. The fact is that even people who truly like science are drawn by familial and financial matters to the clinical activities, and particularly to the private practice (because that is where the money and good life is). The shape of the reform to be introduced is a complex one, though. I do not have a definite idea about it. What I would change however, is the curriculum. Currently, the PhD part consists in dabbling into statistics and sometimes also into lab work, with almost no training in basic sciences. I hope that in the future, MD-PhDs are taught much more about statistics in a fundamental way, more about physics, and more about computer science. Because in essence, the role of MD-PhDs should be to bridge the gap in communication that exists between pure scientists and clinical practitioners. Because those two are so far apart, that they currently are unable to understand each other. I am sure the scientists here who have had the occasion to lead a project with doctors know all about it.

Balgair 10y ago
Thanks for the reply! An interesting person to talk to is Dr. Emery Brown at Mass Gen. [0] He is triply elected to the NAS in engineering, medicine, and biology. I recently saw a talk of his about his new auto-anesthesia machine. The data presented was very compelling. It seems his machine, for a 'normal' surgery, preforms much better than an anesthesiologist over many critical factors. The most interesting part was the Q&A afterwards in which the assembled neuroscientists and anesthesiologists tried their best to not understand a thing he presented and tear him down; their jobs were on the line after all. He is a good example of what the MD/PHD should be producing, I think. To your comment, though. In the PHD section, you have to preform as a normal PHD student, ie, you have to publish papers for your PI. The learning and the classes, already at 2 years of very intense study, do not have the time to continue into comp-sci or physics. Nor do the students have the training in the math. To do the comp-sci and physics classes with a modicum of understanding, you must come in with at least: Multi-variable calculus, matrix algebra and differential equations, a total of 6 extra semesters of classes. Most MD/PHD people I have interacted with never took calculus to begin with. The hill to climb is very very long and steep, and unless there is a much larger prize than a possible faculty position at Wherever State Univ. where you still have to publish or perish, you are going to get few people going after it and not just opting into private practice. Also, I have worked with a number of MDs, and yes, there is a Grand Canyon of misunderstanding between bio-peepz and the docs. Neither party really has the time to cross it, and so we just end up trying to use each other. Bio-peepz try to use the doc's name as leverage for increased grant funding from the NIH, and MDs are trying to get the bio people to patent something with their names on it to make more money. In the end, it's all about the money, or lack thereof. [0]https://sleep.med.harvard.edu/people/faculty/150/Emery+N+Brown+MD+PhD https://sleep.med.harvard.edu/people/faculty/150/Emery+N+Bro...
- rscho 10y ago
  Thanks, if I get the occasion, I will be trying to get in touch with Dr. Emery Brown. I actually happen to currently work at a Harvard-affiliated hospital in Boston. On the subject of MD-PhDs, I agree with you on many points. I would still be happy to see the level of basic science capabilities in candidates increase. For example, in my country of origin, a lot of the program is devoted to fundamental biology. While this is indeed useful, I think a fully-fledged MD-PhD should absolutely have basics in fluid mechanics and computer programming/scripting. Being an anesthesiologist myself, I must however admit that I am quite skeptical regarding current automated systems. In time, anesthesiology, surgery (which I think will be the first to go completely), and most of medicine will be performed by machines. The current rate of major complication related to anesthetic care is very, very low. And until they can demonstrate a benefit of automation on those grounds, I would be wary of such machines. This does also mean that the population sample required to demonstrate said benefit will be very, very big. Now if you are evaluating that on grounds of cost-effectiveness, I am quite sure we could already replace most anesthsiologists and surgeons, at the price of many, many more deaths.

by rscho 10y ago

Balgair 10y ago

Thanks for the reply! An interesting person to talk to is Dr. Emery Brown at Mass Gen. [0] He is triply elected to the NAS in engineering, medicine, and biology. I recently saw a talk of his about his new auto-anesthesia machine. The data presented was very compelling. It seems his machine, for a 'normal' surgery, preforms much better than an anesthesiologist over many critical factors. The most interesting part was the Q&A afterwards in which the assembled neuroscientists and anesthesiologists tried their best to not understand a thing he presented and tear him down; their jobs were on the line after all. He is a good example of what the MD/PHD should be producing, I think. To your comment, though. In the PHD section, you have to preform as a normal PHD student, ie, you have to publish papers for your PI. The learning and the classes, already at 2 years of very intense study, do not have the time to continue into comp-sci or physics. Nor do the students have the training in the math. To do the comp-sci and physics classes with a modicum of understanding, you must come in with at least: Multi-variable calculus, matrix algebra and differential equations, a total of 6 extra semesters of classes. Most MD/PHD people I have interacted with never took calculus to begin with. The hill to climb is very very long and steep, and unless there is a much larger prize than a possible faculty position at Wherever State Univ. where you still have to publish or perish, you are going to get few people going after it and not just opting into private practice. Also, I have worked with a number of MDs, and yes, there is a Grand Canyon of misunderstanding between bio-peepz and the docs. Neither party really has the time to cross it, and so we just end up trying to use each other. Bio-peepz try to use the doc's name as leverage for increased grant funding from the NIH, and MDs are trying to get the bio people to patent something with their names on it to make more money. In the end, it's all about the money, or lack thereof. [0]https://sleep.med.harvard.edu/people/faculty/150/Emery+N+Brown+MD+PhD https://sleep.med.harvard.edu/people/faculty/150/Emery+N+Bro...

rscho 10y ago
Thanks, if I get the occasion, I will be trying to get in touch with Dr. Emery Brown. I actually happen to currently work at a Harvard-affiliated hospital in Boston. On the subject of MD-PhDs, I agree with you on many points. I would still be happy to see the level of basic science capabilities in candidates increase. For example, in my country of origin, a lot of the program is devoted to fundamental biology. While this is indeed useful, I think a fully-fledged MD-PhD should absolutely have basics in fluid mechanics and computer programming/scripting. Being an anesthesiologist myself, I must however admit that I am quite skeptical regarding current automated systems. In time, anesthesiology, surgery (which I think will be the first to go completely), and most of medicine will be performed by machines. The current rate of major complication related to anesthetic care is very, very low. And until they can demonstrate a benefit of automation on those grounds, I would be wary of such machines. This does also mean that the population sample required to demonstrate said benefit will be very, very big. Now if you are evaluating that on grounds of cost-effectiveness, I am quite sure we could already replace most anesthsiologists and surgeons, at the price of many, many more deaths.