Tabitha Moses

I owe this blog a few updates about MD/PhD life, but right now as I have transitioned into the graduate school I wanted to address an issue that has been coming up with increasing frequency.

Disclaimer: Although I am talking about my program because that’s my only experience, I know that these problems happen at other programs. I also do not want this to come across as an attack on my program. I am happy with where I am and what I chose to do; however, even good places can have problems and that is what I want to discuss here.

Yesterday I told my program director that it felt like I was the child of divorced parents and perhaps they should go to mediation. Maybe it wasn’t the most tactful way to express myself, but it certainly illustrated my experiences with that particular issue.* We had once again reached a place where the rules of the MD/PhD program conflicted with the rule of the graduate program I am in. Since starting this particular program in August, this issue has come up more than once, and I have a feeling this most recent one won’t be the last.

The MD/PhD program has a set of guidelines and rules as to what its students need to do and by when. We are also provided with the list of classes that we can pass out of when we enter the graduate programs. This makes sense. Years ago, someone high up decided that med school class 1 was the equivalent of grad school class A/B. This allows us to enter the grad school with a set of requirements already completed. Most MD/PhD programs do something like this, although how exactly the credits transfer may differ from program to program. We have extra requirements during the medical and grad years (research/clinical experiences) and there may be other special requirements or rules. These are designed to ensure that MD/PhD students get the best education possible, that they do not waste time (i.e. taking classes that are 100% material they learned in med school), and that they do not lose sight of the MD portion of their MD/PhD degree. In short, they are good for us!

Of course, in addition to the MD/PhD rules, you have to follow whatever requirements there are for the individual MD and PhD portions of the program. Some institutions make this is easier than others; in some places, the MD/PhD programs is so enmeshed and well-known that it is understood how all these requirements overlap; unfortunately, this is not the case everywhere. In the medical school portion, this was understandable: there are approximately 300 MD students in my class, of whom only 3 were MD/PhD. We don’t make up a large portion of the class, so the MD administration doesn’t seem to have set guidelines for us, and [for the most part] there is no clash in requirements (although this may be a bigger issue for me when I return for M3/M4).

The graduate school is a slightly different issue. My program contains 14 students total, of whom 5 are current MD/PhD students. This makes it even more confusing when there are clashes of requirements. The conversation I mentioned at the start of this post regarded qualifying exam requirements. I won’t go into the specifics, but the gist is that MD/PhDs are exempted from the written portion of qualifying exams across all departments because the Step 1 exam is considered to be an equivalent comprehensive exam. The person with whom I was speaking was not aware of this and said that they were under the impression that once an MD/PhD entered the grad program we had to follow the grad program’s rules. This is inherently confusing because the grad school rules may not make sense for MD/PhD students (e.g. taking a class that was already taken in med school).

This leads to the problem and the mildly uncomfortable analogy. A child of divorced parents often travels between two homes. The rules in each may be different, and while this may be confusing at first the child can eventually learn that in one house it’s okay to eat in the living room while in the other they can only eat in the kitchen. These rules may be different but there will not be a situation where the child has to experience both rules in the same house and for the most part it is possible to follow the rules and respect both parents: the child can just eat in the kitchen and not upset either parent.

This is a traditional divorce. But what if, for whatever reason, the parents couldn’t move out of the family home. They divorced, had different rules, but lived in the same house. Now things get trickier. On top of that, some of the rules are directly contradictory. Perhaps parent 1 states that shirts must be folded in a particular way before being put in the drawer, while parent 2 states that all shirts must be hung in the closet.** It becomes impossible to follow the rules of one parent without breaking the rules of the other.

Currently, my experience in this program mimics this latter example. Living in a house with two divorced parents who want nothing to do with each other and each believe their way is right. Perhaps only one of the “parents” has this mind set and the other is more laid back. That’s not always a positive as you may end up with requirements and rules changing partway through the program.

Again, my experience is neither unique to my school nor to the individual programs. It speaks more to a fundamental issue in academia (and medicine) wherein we all work in our little departmental silos. The rules in one department may vastly differ from another, often for arbitrary reasons, but very few people have to deal with that issue so it is rarely addressed. Those of us in dual degree programs have to navigate the stormy waters between departments and find a common ground that works for everyone. We aren’t the only ones with this problem. As more emphasis is placed on team science and interdisciplinary work, these type of conflicts arise in other situations. As an individual student there is not much I can do except fight for myself and hope that I can use my own experiences to ensure that I won’t contribute to this problem further in my own career. Since this problem for MD/PhD students is part of a much wider issue, I am not sure there is an easy fix.

*As a note, I am the child of divorced parents who did not have the most amicable separation, so I do actually know what I’m talking about here!

** I am picking a particularly inane and meaningless example here, but I think you can understand the point.