Abstract
Physician-scientists (PS) are the backbone of translational research and groundbreaking medical developments in many developed countries. Formalized PS training programs in the form of MD-PhD/MD-MSc programs in Canada have had a longstanding tradition of producing many exceptional PS researchers, staff, and faculty. However, despite these programs’ growth in size and popularity, PS trainees have consistently reported high rates of burnout, attrition, and lack of adequate mentorship and financial support. Additionally, there has been no formalized research examining the needs and prevalence of PS trainees who identify as having a marginalized identity, who may present different unaddressed needs. For the first time, this work captures the demographics, satisfaction, and needs of Canadian MD-PhD/MD-MSc trainees at the intersection of multiple marginalized identities. The authors utilized data from a cross-sectional survey conducted between June to December 2021 by the Clinician Investigator Trainee Association of Canada. Authors examined five marginalized identities covered by the survey: identifying as a woman, living with a disability, a visible minority, not being born in Canada, and being a primary caregiver during training. Results show that 78% of PS trainees self-identify with a marginalized identity and 47% with at least two identities, a proportion higher than previously published. In addition, specific marginalized identity groups reported differing needs as top priority. Moreover, PS trainees who identified with having a disability and who were primary caregivers during training reported significant dissatisfaction within their training programs. In addition to unique needs for each identity group, certain needs were expressed by all marginalized identity groups such as lack of adequate and specific mentorship during training. This research contributes novel data by examining an underrepresented group of PS trainees and supports previous calls to action within the literature expressing the need for greater oversight and infrastructure to support PS training in Canada.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12909-025-08372-4.
Keywords: MD-PhD, MSc, Medical education, Marginalized, Identity, Canada, Clinican-investigator, Physician-scientist, Mentorship
Introduction
Physician-scientists (PS), as both practicing physicians and active researchers, serve a pivotal role in society as the bridge between science and medicine. In this unique role, PS can leverage their clinical experience to inform research questions, while being well-informed to carry out translational and basic science research to push the boundaries of medicine. However, the modern PS’s work is not limited to medicine and basic science research but rather multi-disciplinary, increasingly including fields such as social sciences, medical education, and bioengineering [1, 2]. In Canada, a major pathway of formalized training for PS exists in the combination of undergraduate medicine with PhD or MSc programs (MD-PhD/MD-MSc). Other paths to the PS career include completing a graduate degree, separately, before or following medical school. While joint program MD-PhD and MD-MSc trainees represent approximately half of North American structured PS training [3, 4], MD-PhD students represent a very small proportion of medical graduates per cohort [5].
MD-PhD/MD-MSc students undergo significant challenges that are unique to their extended education pathway and administrative grey zone compared to their MD-only counterparts. Some of these challenges include lack of mentorship, financial stress from extended training, and difficulties in transitions between training phases, degrees, and career paths [3, 6–9]. MD-PhD students from marginalized communities may face added and specific difficulties due to their identity and the accommodations they may require. Recently, across institutions in North America, there has been an expressed need to address the challenges facing MD-PhD students from marginalized identities and to increase the diversity within this group [10–13]. In both medicine and science, diversity within professional groups serves as the backbone for a well-functioning infrastructure that can handle the evolving demands of diverse patients [14].
In Canada, each university is given the freedom to offer MD-PhD/MD-MSc training however it sees fit, resulting in standard curricula for the MD and departmental PhD portions, but not the integration of both. The funding of programs is also heterogenous across the country, with some offering funding for the entire period of study and others partial or none [15]. This is in contrast to medical curricula which are vetted at multiple levels of government and regulatory bodies such that future doctors achieve a standard minimum level of training prior to independent practice [16]. This translates to lax quality control mechanisms or oversight on the type or length of training that different MD-PhD/MD-MSc trainees undergo. The representation of marginalized identity groups within these programs is thus unclear in Canada. Heterogenous training experiences [6] and little oversight may contribute to burnout and lack of direction in PS trainees. Research shows that many MD-PhD trainees do not choose to leverage their dual degree to pursue research and medicine together but rather practice one or the other [5]. MD-PhD trainees from marginalized identities may be more susceptible to this considering the impacts of identity on professional outcomes [17, 18] and the additional challenges faced by marginalized individuals in higher education in general [19].
Study rationale
MD-PhD/MD-MSc students are, from the outset of training, at a unique crossroads of challenges: infrastructural, educational, and administrative. Students from marginalized identities have the added challenge of battling against more systemic issues. Despite this vulnerable position, research into this unique group of students’ training experiences and demographics is severely lacking. As such it is imperative to listen to MD-PhD/MD-MSc students from marginalized identities to understand their experiences and challenges, and whether there are sufficient supports available. These were amongst the goals of the most recent national Canadian survey on MD-PhD and MD-MSc training performed in 2021 by the Clinician Investigator Trainee Association of Canada (CITAC). Part of this data has been analyzed and reported elsewhere as it relates to the outcomes of PS training and the satisfaction of PS trainees and alumni from MD-PhD programs [20]. The work herein analzes the data to capture the experiences of MD-PhD/MD-MSc students who identify with marginalized identities, adding specifically to the scarce literature on the intersection of multiple identities [21]. Ultimately, the aim of this manuscript is to guide future decision-making related to this group of trainees.
Methods
Setting, design, and study sample
A cross-sectional online survey was developed and disseminated by the Clinician-Investigator Trainee Association of Canada (CITAC), including quantitative and qualitative questions targeting three groups in Canada: (1) trainees and alumni from combined MD-PhD programs; (2) trainees and alumni from combined MD-MSc programs; and (3) trainees and alumni who completed a graduate degree (i.e., MSc or PhD) prior to medical school [20]. The current paper analyzed data from the former two groups with a specific focus on individuals who identified with one or more marginalized identities (see “Dependent variables” for definitions). Surveys were disseminated through the directors and administrative staff of Canadian MD-PhD/MD-MSc programs, in addition to current students and alumni based on CITAC membership. Ethical approval for this research was obtained through the University of Toronto Research Ethics Board (# 00040017). A full description of the survey and its main findings are published in Luigi et al. (2024) [20].
Dependent variables
Five self-reported marginalized identities were examined in this study: identifying as a woman, living with a disability of any kind, identifying as a visible minority, not being born in Canada, and being a primary caregiver at any point in the combined program. Each identity variable represented a binary quantitative question within the survey, except for gender which was multiple choice. No other gender identities could be included as all respondents identified as either woman or man.
Two composite measures were created to further capture the diversity in our sample. First, a marginalized identity score (MIS) was created from the sum of all five identities [0–5]. Second, based on the MIS mean for the sample (i.e., 1.9), a binary variable was created to isolate trainees with 2 or more marginalized identities (i.e., those above the mean).
Outcome measures
The first outcome measure examined was the prevalence of all five individual and both composite marginalized identity dependent variables.
Second, two Likert-scale questions on satisfaction were used: (1) satisfaction with the quality of combined training and (2) whether trainees would do the program again. Both outcomes were transformed from a 4-point Likert (1 = strongly disagree to 4 = strongly agree) to a binary score of 0 (combining scores 1 and 2) and 1 (combining scores 3 and 4).
Third, mentorship needs were first examined through two questions on satisfaction with (1) mentorship opportunities and (2) career planning and advice. Both were also transformed from 4-point Likert scales (1 = not at all satisfied to 4 = very satisfied) to binary variables as above. Further informing mentorship needs, trainees were asked to rate their top three needs amongst 10 possible mentorship needs: choosing a research supervisor and maintaining a good relationship, writing and presentations, transitions in training, navigating institutional processes, work/life balance, career planning and development, psychosocial support, networking, synergizing clinical and research interests, and other.
Fourth, a 4-point Likert scale on worry about imposter syndrome (1 = not at all to 4 = very much yes) was converted into a binary variable as above. The following definition of imposter syndrome was provided to survey respondents: “Imposter syndrome can be defined as a collection of feelings of inadequacy that persist despite evident success. ‘Imposters’ suffer from chronic self-doubt and a sense of intellectual fraudulence that override any feelings of success or external proof of their competence”.
Finally, two outcome variables for financial stressors were included. For one, a 4-point Likert scale question on satisfaction with funding was converted to a categorical variable with possible scores of 0 (no),1 (unsure), and 2 (yes). Moreover, a categorical variable of worry about debt was also used, already featured in the survey as a three-option question with scores of 0 to 2.
Data analysis
All analyses were performed using R statistical software v.4.2.1 (R Core Team, Austria). In addition to descriptive analyses to examine the prevalence of each marginalized identity group, univariate testing was used to examine the difference in outcome variables between identity groups. First, all outcome variables were compared between those identifying with at least one marginalized identity group and those who don’t identify with any, using chi-square test or alternatively Fisher’s exact test where there were less than 5 cases per group. These tests were also repeated between each outcome and the composite binary variable for two or more marginalized identities. Further, when testing the relationship between the MIS and all binary outcome variables, either a Mann-Whitney U or Kruskal-Wallis test was used based on the non-normality of the MIS score using Shapiro-Wilk’s test. Lastly, an ordinal regression model was employed to test the relationship between satisfaction with funding and individual marginalized identity groups to control for the presence of personal debt (binary variable). For all statistical testing, significance was set at p ≤ 0.05.
Results
Response rate
To estimate response rate, enrollment information was obtained on the number of students across all MD-PhD/MD-MSc programs in Canada. Since the survey responses spanned June–December 2021, the possible respondent pool included all students enrolled in such formalized programs in both 2020–2021 and 2021–2022 academic years. This information was gathered for most schools, except Université de Montréal, Université de Sherbrooke and Northern Ontario School of Medicine. The response rate was calculated based on 121 respondents out of 293 (total MD-PhD and MD-MSc students) or 41%. Supplemental digital appendix 1 includes a breakdown of the number of MD-PhD/MD-MSc trainees.
Prevalence of marginalized identities
The sociodemographic characteristics for all respondents, including reporting on the five marginalized identities examined are presented in Table 1. Amongst respondents, 43% identified as women, with the remaining identifying as men. Only 5.9% of respondents identified as having a disability of any kind. While 32.2% were not born in Canada, 41.5% identified as part of a visible minority. Finally, 51.5% indicated having personal debt and 13.5% of trainees had been a primary caregiver during their MD-PhD/MD-MSc training. Taken together, a total of 90 trainees (78.26%) identified with at least one of the five marginalized identities. On average, respondents reported 1.9 marginalized identities (standard deviation (sd) = 1.2, [0–5]) each. Also reported in Table 1 are cumulative identity measures: the MIS and a binary variable for reporting two or more identities (i.e. above average number).
Table 1.
Sociodemographic characteristics of 121 MD-PhD and MD-MSc trainees in Canada
| Sociodemographic characteristic | Number of respondents (percentage) a |
|---|---|
| Age by birth group (n = 110) | |
| 1981–1985 | 1 (0.9%) |
| 1986–1990 | 14 (12.7%) |
| 1991–1995 | 60 (54.6%) |
| 1996–2000 | 35 (31.8%) |
| Ethnocultural group (n = 118) | |
| Caucasian | 61 (51.7%) |
| Asian | 38 (32.2%) |
| Multiracial | 8 (6.8%) |
| Black/Caribbean | 2 (1.7%) |
| Indigenous | 0 |
| Hispanic | 1 (0.9%) |
| Other | 8 (6.8%) |
| First generation university student (n = 121) | 28 (23.1%) |
| Family income (n = 110) | |
| Up to CAD$100 000 | 62 (56.4%) |
| Over CAD$100 000 | 48 (43.6%) |
| Identified as: | |
| A woman (n = 121) | 52 (43.0%) |
| Having a disability (n = 119) | 7 (5.9%) |
| Being a visible minority in Canada (n = 118) | 49 (41.5%) |
| Not born in Canada (n = 118) | 38 (32.2%) |
| Having been a primary caregiver during combined training (n = 104) | 14 (13.5%) |
| Composite identity variables (n = 99) | |
| Marginalized Identity Score | Mean = 1.9 (SD = 1.2) |
| Two or more Marginalized Identities | 46 (46.46%) |
SD standard deviation
aPercentages are reported on the number of respondents to each survey question, not total sample
Satisfaction with training
To capture students’ satisfaction during training, all respondents were directly asked whether they were satisfied with the overall quality of their PS training. Descriptively, trainees who identified with a disability and those who had been a primary caregiver were less satisfied with training quality than their counterparts who did not identify with a marginalized identity. This difference was statistically significant only for individuals identifying with having a disability (33.3% in those with a disability vs. 91.8% in those without, p = 0.001). Further informing significant gaps in satisfaction with MD-PhD/MD-MSc programs, both trainees with a disability (33.3% vs. 86.7%, p < 0.001) and those acting as a primary caregiver (64.3% vs. 86.9%, p < 0.05) were significantly less likely to say that they would attend the program again.
With regards to cumulative identity measures, the MIS was not found to be statistically related to satisfaction with PS training. While a pattern of decreasing satisfaction with training quality was observed in trainees reporting 1, 2 and 3 marginalized identities (92.6%, 88.5%, and 84% respectively), satisfaction for scores of 0, 4, and 5 did not follow this pattern (Fig. 1). Responses to the question of whether trainees would do the program again followed a similar partial pattern without reaching significance.
Fig. 1.
Satisfaction with training according to marginalized identity score. The Marginalized Identity Score represents a sum of the number of identifies self-reported by participants
Mentorship needs
MD-PhD/MD-MSc trainees were surveyed on their satisfaction with their program’s mentorship opportunities in addition to career planning and advice. Respondents identifying with a disability were significantly less satisfied with career planning and advice (16.7% vs. 70.2%, p = 0.01), while the gap between both groups failed to reach significance for overall mentorship opportunities (33.3% vs. 72.9%). No other variables of interest were significantly related to mentorship satisfaction questions. Similar to general satisfaction questions depicted in Fig. 1, decreasing satisfaction scores with mentorship opportunities and with career advice and planning were observed in trainees with a MIS of 1 to 3.
Trainees were also asked to rate their top three mentorship needs amongst the 10 mentorship needs proposed (see Methods: Outcome measures - mentorship needs). The top 3 identified needs for the whole sample were “career planning and development” (N = 78, 24.9%), guidance on “transitions in training” (N = 49, 14.6%), and “help synergizing clinical and research interests” (N = 49, 14.6%). While the three most prevalent needs were the same in trainees with none or with at least one marginalized identity, those identifying as a woman were significantly more likely to rate “choosing a research supervisor and maintaining relationship” (15.0% vs. 33.3%, p = 0.03) and “navigating institutional processes” (11.7% vs. 31.1%, p = 0.01) than individuals who did not identify as a woman. Furthermore, trainees born in Canada were significantly more likely to rate psychosocial support as a need than those who were not born in Canada (11.8 vs 0%, p = 0.05). Supplemental Digital Appendix 2 summarizes mentorship needs for trainees identifying with each of the five targeted marginalized identities.
When considering the effect of having multiple marginalized identities, the MIS was significantly and positively associated with the need for help with navigating institutional processes (p = 0.003). Further, the MIS was negatively associated with the need for psychosocial support (p = 0.03). Moreover, as displayed in Fig. 2, “navigating institutional processes”, “supervision”, and “networking” followed positive trends when more identities were reported by trainees. Inversely, “work/life balance”, “psychological support” and “synergizing clinical and research interests” decreased as top needs with more marginalized identities.
Fig. 2.
Top 3 mentorship needs according to how many marginalized identities were reported. Percentage reporting 10 mentorship needs amongst 121 MD-PhD and MD-MSc Canadian trainees. Abbreviations: Supervision: Choosing a research supervisor and maintaining a good relationship; Publishing: writing and presentations; Transitions: transitions in training; Processes: navigating institutional processes; Work/life: work/life balance; Career dev.: career planning and development; Psychoso.: Psychosocial support; Synergizing: synergizing clinical and research interests
Imposter syndrome and financial stressors
No single marginalized identity or composite identity variable was significantly correlated with imposter syndrome. Regarding MD-PhD/MD-MSc financial stressors, trainees with a disability were significantly less satisfied with funding in their combined program as compared to those without (p = 0.003). This difference remained significant within an ordinal regression model which controlled for having personal debt, with both disability (coefficient = 0.07, 95% confidence interval (CI) = 0.004–0.482, p = 0.02) and personal debt (coeff = 0.40 (95%CI = 0.1680–0.9181, p = 0.03) significantly reducing satisfaction. When asked whether trainees worried about debt, only having debt significantly increased trainees’ worry (p < 0.001). None of marginalized identities or composite measures (i.e., MIS or categorical variables) were significantly correlated with worry about debt.
Discussion
Despite the growing importance of PS in an increasingly complex and evidence-driven medical landscape, serious challenges face MD-PhD/MD-MSc trainees undergoing training in Canada, including a lack of institutional support, financial barriers, and lack of adequate targeted mentorship [8, 21, 22]. The current study presents a first national investigation of how identifying with one or many marginalized identities might exacerbate difficulties and require additional support. The findings revealed that a majority of PS trainees (78.26%) identified with at least one of five marginalized identities, often reporting more than one. Furthermore, trainees in distinct marginalized identity groups reported differing mentorship needs and some associations were found between the number of marginalized identities reported and specific mentorship needs.
Prevalence of marginalized identities
Even though joint training programs are historically known to lack diversity [21], this was not the case in this cohort as 78.3% self-identified as belonging to one of five marginalized identities and 46.5% reported having at least two marginalized identities or more. This suggests that the composition of Canadian MD-PhD/MD-MSc cohorts may be becoming more diverse with time. For sex and gender diversity specifically, recent Canadian [20, 23] and US [24] publications have also reported increases in MD-PhD and/or MD-MSc cohorts. However, it remains difficult to fully evaluate trends through time as there have been no prior reports of the rates of MD-PhD/MD-MSc trainees with marginalized identities other than gender in Canada. A national infrastructure for the routine collection of sociodemographic data in combined programs would be essential to keep track of diversity metrics as well as meet the expressed needs of trainees. Interestingly, many Canadian MD-PhD programs do not track trainee demographic data and thus might not even be aware of the unique needs of diverse trainees within their respective programs. A national surveillance and reporting body that could oversee MD-PhD/MD-MSc programs might help mitigate some of these issues, especially as it relates to non-visible disabilities which are particularly vulnerable to underreporting [25].
Differential outcomes for trainees with marginalized identities
With regards to satisfaction, the data showed a pattern for decreasing satisfaction in those identifying with multiple marginalized identities. Acknowledging the need for a larger cohort investigation to evaluate statistical significance, it is reasonable to expect that trainees who reported multiple marginalized identities could face added stigmatization and greater need for financial, administrative, and mentorship support. The additional challenges and burdens faced by marginalized individuals in general medical training have been previously thoroughly described [26, 27]. For example, students who self-report as belonging to more marginalized identities (including gender, race and sexual orientation) have higher rates of burnout and are more likely to experience instances of mistreatment during medical training [26]. Furthermore, a meta-analysis of 51 studies examining harassment and discrimination in medical education found that between 24 and 50% of medical trainees report experiencing some form of gender or racial discrimination [28]. While Black and Hispanic MD-PhD graduates self-report similar time involvement in research and success in obtaining grants, they are less successful in NIH grant competitions than other racial groups [29]. Racialized PS trainees also report that their career aspirations are more affected by the burden of non-academic stressors such as finances and caregiving [27].
Similarly, those identifying with a disability and primary caregivers were significantly less likely to indicate they would complete an MD-PhD or MD-MSc program again. These findings are important given the lack of previous data on disability status in MD-PhD programs [30]. Individuals with disabilities are increasingly recognized as facing unique challenges in medicine and higher education [25, 31]. Further, primary caregivers’ dissatisfaction with seeking accommodations within combined programs could explain why they would not attend again. Analyses of mentorship needs per identity show that “navigating institutional processes” gained prevalence as a salient need in this specific group of trainees (supplemental Fig. 2).
In accordance with previous literature on PS training both in Canada and internationally [11, 21, 32], the findings again highlighted a lack of adequate mentorship as a significant challenge for MD-PhD and MD-MSc trainees. These findings reinforce previous literature that the most significant weak points within the PS training “pipeline” are during transitions between clinical and research training and when transitioning to independent practice as a PS 7. When examining needs in trainees with specific marginalized identities, additional mentorship needs increased in importance in certain groups (supplemental Fig. 2), including “navigating institutional processes” in primary caregivers and “securing positive research supervision” in women. The composite MIS was also significantly and positively associated with the need for help with navigating institutional processes, suggesting that individualized accompaniment might be necessary to help alleviate the disadvantages afforded by identifying with multiple marginalized groups. A recent study on gender disparities in attaining deanship in US medical schools highlighted how the lack of mentors to offer stepping-stone leadership positions complicated women’s path to deanship [33]. In addition to the data on mentorship needs in various marginalized groups, it can be expected that MD-PhD and MD-MSc trainees from marginalized identities face similar arduous paths toward successful full-time PS and leadership positions. This situation may create a vicious cycle in which marginalized trainees are not well supported by mentors during training and may disengage in greater numbers from the PS pathway [8], leaving future generations without much-needed mentors who represent them and guide them through the hidden curriculum [21].
Moving forward
Looking forward, this study joins previous calls for the creation of a national entity to oversee and standardize data collection on a national scale for MD-PhD and MD-MSc trainees and alumni in Canada [20, 34]. Concerning the pressing mentorship needs highlighted here for marginalized trainees, it has been suggested that a national network of practising mentors be established by the Royal College for all MD-PhD trainees [34]. Such a community of practice, even as a preliminary step to a national overseeing body, might help circumvent the low number of mentors who also identify with marginalized identities within individual schools. The Canadian Association of Physicians with Disabilities represents one such example, albeit not specific to combined training. Other short-term actions could involve highlighting these needs at an institutional level through a multi-institutional effort across formalized MD-PhD and MD-MSc programs in Canada. Example action items could encompass better tracking metrics on demographics, marginalization scores, and difficulties that face current students in these programs [20]. Moreover, individual programs can do more to encourage peer-to-peer and faculty-to-student mentoring and reflective sessions.
Having sufficient financial support is another key priority for PS trainees which was exacerbated for those with a disability in the present study. In Canada, this is compounded by the withdrawal of dedicated MD-PhD funding at the federal level [35]. As a result, each Canadian institution has a different funding scheme for MD-PhDs [4], with most institutions relying on institutional-based funding during medical school and general graduate funding during the PhD phase. Recently, the government of Canada announced new reforms and bolstered support for unified national scholarships for scientific trainees at the master’s, doctoral and postdoctoral levels (https://budget.canada.ca/2024/report-rapport/budget-2024.pdf). This announcement lacked any mention of support for PS trainees. This is in stark contrast to funding for PS trainees in the United States, which not only offers dedicated national funding for MD-PhD trainees through the National Institutes of Health (NIH)’s Medical Science T32 training grant, but also funding for those with marginalized identities at a national level. This includes the longstanding F30 funding that supports MD-PhD trainees throughout their path as well as a specific F31 diversity funding appropriate for individuals with disability, disadvantages and/or from underrepresented racial and ethnic groups (https://www.niaid.nih.gov/grants-contracts/fellowship-grants).
Finally, “navigating institutional processes” was an increasingly important need the more survey respondents cumulated marginalized identities, warranting a re-evaluation of MD-PhD/MD-MSc policies for accommodations and leaves-of-absence at the institutional level. Combined programs notoriously exist in a grey zone between undergraduate medical education and individual research departments, further accentuating lengthy processes, uncertainty, and the potential for not respecting the rights of trainees in their time of need.
Limitations
The work presented provides an initial attempt at capturing the experiences of MD-PhD/MD-MSc trainees with marginalized identities across Canada. However, there are limitations to the work. First, the response rate was estimated at only 41%, and thus several analyses lack the necessary power to show significance in controlled models. This is due in part to the nature by which the survey was disseminated, but could also reflect hesitancy in self-reporting amongst dual-degree trainees, which has been reported previously [25]. Future work should expand survey cohorts.
Second, within the initial survey, identifier questions were not controlled for overlapping responses. Responses which included individuals who self-reported a “marginalized identity” often overlapped with other identifiers. As such, it is difficult to dissect the significance of results as they pertain to a specific marginalized group. However, many of the needs and themes that resulted from this limited analysis are still in coherence with recent published literature concerning MD-PhD/MD-MSc trainees in Canada.
Lastly, disability and self-reported identities were not defined in the initial survey. Moreover, as in previous literature on diversity in MD-PhD programs [11], the definitions of other marginalized identities were reflective of self-reported responses concerning ethnicity, place of birth, and caregiving. Thus, the results presented should be compared to other scholarly work keeping in mind the specific definitions of marginalized identity presented. Future research intentionally designed to study diversity in this context should clearly articulate definitions to participants. It should be noted that definitions of marginalized identities have thus far been relatively study-specific and non-standardized. Therefore, future work should potentially aim to standardize these concepts in consultation with lived-experience groups, which would benefit research methodology and internal MD-PhD/MD-MSc internal tracking efforts.
Conclusion
In conclusion, analysis of national Canadian data on the diversity of MD-PhD/MD-MSc trainees highlights unmet needs in trainees from marginalized identities within PS training programs. The absence of overall administrative and curricular structure, the lack of high-quality mentorship, and increased financial stressors that affect all PS trainees were found to be exacerbated within this subset of PS trainees. Within this cohort, it was especially true for individuals who self-identify with more than one marginalized identity. The findings also document, for the first time in Canadian literature, the significant prevalence of marginalized identities within PS trainees. Despite several studies and calls to action over the years, there has been little progress in the creation of structure that would oversee PS training in Canada, which should include clear equity, diversity, indigeneity, inclusion, and accessibility policies specific to MD-PhDs moving forward. The systemic infrastructure supporting an increasingly diverse PS student body must evolve to prevent attrition and produce clinician-scientists who represent a diverse population. The authors thus advocate for further research into this topic, as well as a national oversight body that could survey, oversee, report, and unify policies on MD-PhD and MD-MSc training programs in Canada.
Supplementary Information
Acknowledgments
Clinical trial
Not applicable.
Biographies
Zaid A. M. Al-Azzawi
An MD-PhD candidate at McGill university and the Montreal neurological institute (The Neuro), Montreal, Quebec, Canada.
Mimosa Luigi
An MD-PhD candidate at McGill University and the Institut national de psychiatrie légale Philippe-Pinel, Montreal, Quebec, Canada.
Charles Yin
A Resident Physician in the Division of Hematological Pathology in the Department of Laboratory Medicine and Pathology at the University of Alberta, Edmonton, Alberta, Canada.
Ehsan Misaghi
An MD-PhD student at the University of Alberta, Edmonton, Alberta, Canada.
Robert X. Lao
An MD-PhD student at the Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Bryce J. M. Bogie
An MD-PhD Candidate at the University of Ottawa and the University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada.
Authors’ contributions
All authors contributed to the content, assembly and review of the final manuscript for this submission. ZAMA and ML are responsible for initial conception of the manuscript. ML, RXL and BJMB carried out all data analyses included in this manuscript.
Funding
This study was funded by the Clinician Investigator Trainee Association of Canada (CITAC).
Data availability
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Ethical approval for this research was obtained through the University of Toronto Research Ethics Board (# 00040017) and adheres to the principles within the Helsinki Declaration. Informed consent was obtained via anonymized electronic signature (via checkbox) for each participant.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.