A Rigorous Multi-Stage Adventure Leads to the MD/PhD

"Choose Your Own Adventure" is the subtitle Eric Landsness has coined for the Medical Scientist Training Program (MSTP) at the University of Wisconsin School of Medicine and Public Health (SMPH) in which he is enrolled.

The Medical Scientist Training Program, also called the MD/PhD program, combines high-quality medical training with rigorous graduate-level research culminating in a doctoral dissertation.

Video: Sarah Wernimont appreciates that the Medical Scientist Training Program allows a good school-life balance.

Candidates spend their first two years in medical school, then obtain a PhD degree prior to completing their last two years of medical school. A bridging curriculum ensures that students maintain clinical skills during their research years, and stay engaged in research during their MD years.

The program's physician-scientist graduates are highly sought-after for their unique abilities to work at the interface of clinical care and basic science research. Grounded in both worlds, the graduates of the MSTP also make major contributions to the understanding and improvement of human health.

Landsness' "adventure" began with the dream of becoming an engineer who designs medical devices to help people in need. Upon completing a bachelor's degree in electrical engineering at the University of Washington in Seattle, he felt it was natural to pursue a combined MD/PhD degree in the Badger State.

Though his family is based in the northwestern United States, it includes several UW-Madison graduates: his mom from the School of Nursing; dad from the College of Engineering; maternal grandfather, B. Jack Longley, Sr., MD '42, and uncle, B. Jack Longley, Jr., MD '79, from the School of Medicine and Public Health.

"The SMPH and MSTP have been very flexible in helping me tailor this program to meet my needs and educational goals," says Landsness.

He looks forward to combining the clinical and research skills he is acquiring, as well as his affinity for electrical engineering, in a future career at an academic medical center, which would also provide him the opportunity to teach.

Benefits of the Dual Degree

For Medical Scientist Training Program alumnus Peter Todd, MD '04, PhD '02, a similar goal has become a reality. Now the Bucky and Patti Harris Professor and assistant professor of neurology at the University of Michigan, he is the co-director of the National Fragile X Consortium Clinic at Michigan.

Todd's UW-Madison neuroscience PhD and medical degree led him to an internship and adult neurology residency at the Hospital of the University of Pennsylvania in Philadelphia, and a subsequent fellowship in neurogenetics and movement disorders at the University of Michigan. He entered the tenure-track faculty position at Michigan in 2010.

"I do what MD/PhDs are trained to do - I run a lab targeted at translational research in neuro-degenerative diseases, which takes approximately 80 percent of my time. I also see patients with those types of disorders about 20 percent of my time, and teach residents and students in both research and clinical settings," Todd explains.

MD/PhDs generally are prepared better than others to develop clinically applicable research, test it and make it available to help people in need.

"I believe that the integrated MD/PhD degree makes me a much better researcher and more likely to have my work impact clinical care for patients than if I had only one degree," Todd says.

Matching Students and Mentors

The program's leadership team includes:

• Director Deane Mosher, MD, professor of medicine and biomolecular chemistry
• Associate director Anna Huttenlocher, MD, professor of pediatrics and medical microbiology and immunology
• Associate director Robert Blank, MD, PhD, associate professor of medicine
• Associate director Brad Schwartz, MD, professor of medicine
• Administrator Paul Cook, PhD

Medical Scientist Training Program leaders begin providing students myriad opportunities to learn about UW-Madison researchers early on in the program - usually at the onset of medical school. They coordinate weekly seminars, journal clubs, annual symposiums, retreats and more.

One leader serves on the thesis committee for each Medical Scientist Training Program student, and each director teaches an MSTP-specific course in the first two years of medical school.

Mosher says: "Our biggest role is to get to know the students so we can help match them up with the most appropriate research mentor who will allow them to do exciting research and get through in a reasonable amount of time."

As with all Medical Scientist Training Program candidates, Landsness spent the summer between his first and second years of medical school doing three research rotations with the goal of choosing a lab and mentor for his graduate research.

Sleep and brain plasticity research being conducted by Giulio Tononi, MD, PhD, professor of psychiatry, piqued his interest, leading him to choose Tononi as his research mentor. He also worked closely with Ruth Benca, MD, PhD, professor of psychiatry and director of Wisconsin Sleep, and Chiara Cirelli, MD, PhD, associate professor of psychiatry.

During the PhD component of the program, students function fairly independently as research investigators. They learn to propose hypothesis-driven research in a rigorous scientific process, conduct experiments that will test the hypothesis, analyze the data and present the results in a peer-reviewed manner so they can reach solid scientific conclusions.

For instance, Landsness' research focused on whether patients in minimally conscious and vegetative states sleep. He helped master the use of a device to allow high-density electroencephalographic (EEG) recordings from the scalp using 256 electrodes, which provides a richer set of data on which to base theories compared to the standard eight electrodes.

Then, using his engineering and medical training, he applied the use of the sleep cap to measure slow wave sleep patterns to help determine whether a patient is in a minimally conscious or vegetative state, and published the findings in Brain.

The new cap is now used by many researchers in brain studies and has the potential to be used as a clinical tool to determine the level of consciousness, and related prognoses, of severely brain-damaged patients.

Freedom to Follow Interests

Mosher says students can pursue research in practically any field, including engineering, epidemiology, biostatistics and the social sciences. He and Huttenlocher emphasize that few, if any, institutions compare to UW-Madison in the breadth and depth of graduate programs available to students and relevant to medicine.

Landsness, who completed his PhD and just transitioned to his third year of medical school, praises other aspects of the program as well.

"It's one of the best medical-scientist training programs in the U.S. due to its excellent level of mentorship, leadership and assistance with transitions, plus the freedom for students to pursue the research of their choice," he says.

Mosher applauds the campus leaders who have supported the program since its inception in 1986. Jointly sponsored by the UW School of Medicine and Public Health and the UW-Madison Graduate School, the MSTP earned accreditation by the National Institutes of Health (NIH) in 1998. Thanks to an institutional training grant from the NIH and funding from the School of Medicine and Public Health, Medical Scientist Training Program students receive a stipend and have their tuition waived.

Drawing candidates from across the country, program staff interviewed more than 200 applicants and enrolled 12 new candidates for 2011, for a total of 78 students now in the program. A total of 56 students have graduated from the MSTP.

"The quality of our students is incredible," says Huttenlocher, who will become director upon Mosher's upcoming retirement.

A Rewarding Adventure

Medical Scientist Training Program leaders have reduced the average student's time in the program to eight years. They remain flexible, though, allowing for more time when special circumstances arise or when students wish to pursue deeper levels of research.

For example, Landsness' classmate Sarah Wernimont chose to spend an extra year in the lab so that she could develop additional research projects while starting a family.

A Winona, Minnesota, native with a bachelor of science degree in biochemistry from the University of Chicago, Wernimont chose a basic science research track focused on the role of T-cells in immunology for her doctoral work.

"I wanted a really strong foundation in basic science, and am fascinated by the field of immunology - including the many pieces that go into generating an immune response to keep you healthy and keep you from developing cancer," she explains. Wernimont, now in her third year of medical school, completed her PhD in Huttenlocher's lab.

"My research relates to how T-cells get to places where they need to be activated and the activation process. Your body is filled with T-cells, whose function is to kill infected cells and cancer cells, but not to indiscriminately kill healthy tissues. When they encounter antigen-presenting cells (APCs), the T-cells receive a signal indicating that they should attack; the T-cells then adhere to the APCs via receptor proteins called integrins," she explains. "I learned that T-cell integrins are regulated very differently compared to how other integrins work."

She has published her work widely in journals such as Journal of Immunology, Blood, Journal of Biological Chemistry and Molecular Immunology.

Wernimont says committing to a program that may take eight or more years can seem daunting initially.

"However, it's not just those years without life happening," she says. "You have to establish a good balance among all aspects of your life to make it work. This is life, and it's important to enjoy the process."

She and her husband, Kirke Rogers, MD '08, met on their mutual first day of medical school. Their daughter, Alice, was born during Wernimont's fourth year of her PhD work. Rogers is now completing an anesthesiology residency at UW Hospital and Clinics, and Wernimont is starting to think about her future residency choices - and a career in rheumatology or maternal-fetal medicine.

While Wernimont admits it's sometimes difficult to manage the logistics of the MD/PhD program and parenthood, she credits her parents, in-laws and close friends who are always willing to help. Fellow MD/PhD students also step up.

"The MD/PhD group is so close-knit. We've had weddings, babies, good times and bad times together, and we're there for each other whenever needed," says Wernimont.

Todd, in Michigan, stresses the importance of balance.

"Given that MD/PhD training can sometimes take up to 15 years from beginning medical school until starting a first faculty position, it is important to remember that you can't put off starting the rest of your life, such as getting married, having children, trying new things, having hobbies and spending time with friends," he says.

It's a rewarding adventure, Todd adds.

"You really need to want research to be a major component of what you do in the long term to succeed," he says. "But I think I have the best job in the world, and I am never bored, so I recommend it despite the challenges involved. My advice is to make sure you enjoy the journey at each stage."

By Kris Whitman

This story appears in the fall 2011 issue of Quarterly.