Participatory Approach to the Development of MD-PhD Training Objectives

Introduction

MD-PhD programs started in 1950s and currently enroll approximately 5,400 scholars in over 90 active training programs. However, nationally established training objectives are lacking. The National MD-PhD Program Outcomes Study¹ provided key benchmarks for U.S. MD-PhD programs but did not reference exemplars of specific training objectives. Similarly, the current NIH-NIGMS call for the Medical Scientist Training Program funding² lists a number of observable training outputs but remains silent on the objectives for the program planning, implementation, and evaluation. Although most training programs are developed by senior faculty with considerable research and educational experience, direct trainee engagement gives voice to these essential program beneficiaries. We report on a participatory program development approach to engage scholars in discussing and conceptualizing MD-PhD training objectives and priorities.

Methods

For this educational development study, from January to August 2019, MD-PhD scholars from a large U.S. Southeastern academic medical center participated in four rounds of discussions. All current 41 MD-PhD trainees were invited to participate, and 30–35 participated in each round.

We used concept mapping, a mixed-method, participatory approach to program development, to collect and interpret data.³ Concept mapping blends the strengths of text-analytic and multivariate statistical methods, has high internal representational validity,⁴ results in the meaningful interpretation of respondent inputs and considers the data as a whole and subgroups to ensure analytic rigor.⁵ The process includes six activities: preparation (participant selection and focused prompt development); statement generation (brainstorming of statements); statement structuring (sorting and rating); multidimensional scaling and cluster analysis; interpretation (through the statement and cluster list); and utilization.

Concept mapping meetings took place during the regular monthly program dinners. First, MD-PhD scholars generated statements in response to the prompt: “What should be the goals and outcomes of a top medical scientist training program?” At the second meeting, copies of unique statements were distributed for sorting into similar sets. Working in 11 small groups, MD-PhD scholars sorted the statements into sets based on perceived similarities. For multidimensional scaling and cluster analysis, each group of statements was recorded as a separate string, converted into a matrix, and analyzed to produce a list of clusters. Cluster membership of initial statements, provisional cluster labeling, and cluster interpretation were presented to the scholars at the third meeting. An open discussion resulted in the writing of six specific training objectives for each cluster. Finally, during the fourth round of discussions training objectives were presented together with the overall program logic model.

Results

In total, 153 statements were received. Multidimensional scaling resulted in four clusters that were labeled community, competencies, process, and program structure. Subsequently, statements within each cluster were examined for repeating topics and themes, which showed that the competencies cluster represents program content and trainee experience in the program, process cluster relates to the specific strategies and implementation of program activities, and community and program structure clusters represent the institutional infrastructure, global culture, and environment in which the training occurs. The discussions during the interpretation step of the concept mapping led to the decision to merge the latter two clusters, Table 1.

Table 1.

Clusters and Representatives Quotes in Response to the Prompt: “What should be the goals and outcomes of a top medical scientist training program?”

Cluster	Representative Quotes
Competencies (training program content)	“navigate a laboratory, competently teach students, ask important and specific scientific questions, and practice medicine at an elite level” “ask a relevant question, develop a protocol to answer question, implement the protocol, analyze the data, and summarize the data to be eventually published” “apply a knowledge base to new problems and challenges”
Process (training and program implementation)	“allowing students to pursue individualized training opportunities i.e. not every student should be required to do the exact same thing” “supporting the student exploration in their fields of interest” “a structured curriculum including program resources to assist scholars through major milestones and transitions while still promoting flexibility and creative education opportunities” “facilitation of stage-relevant guidance and structure to promote optimal resource and mentorship opportunities”
Community and program structure (trainee network and shared culture)	“service-oriented students of both science and medicine looking for ways in which they can integrate their skills and interests in pursuit of pushing the boundaries of their fields” “people who can connect the fields of science and medicine” “students from a wide variety of backgrounds with a wide variety of goals and aspirations” “a collaborative learning environment that fosters personal and professional friendships and values mental/ emotional health of scholars” “a supportive social environment to promote retention in the program”

Subsequently, three categories of developed training objectives included: trainee development (i.e., cognitive, attitudinal, and behavioral performances expected to demonstrate mastery), program process and structure, and training environment and culture, Table 2.

Table 2.

Medical Scientist Training Program Objectives

By the end of the training, participation trainees will
Trainee development	Have skills in design, conduct, and dissemination of clinical/translational research.
	Show motivation, integrity, and commitment for leadership in translational research.
Program process and structure	Experience individualized mentoring and guidance in translational scholarship and career development.
	Apply knowledge and skill to a variety of careers as clinician scientists.
Training environment and culture	Be skillful in working in culturally and scientifically diverse teams.
	Function in and promote collaboration environments, which advance professional development and growth.

Discussion

In the absence of national guidelines, individual MD-PhD programs can engage in participatory efforts and employ robust, systematic methods to develop training objectives. Establishment of training objectives also addresses the calls for the alignment of medical and research training curricula.⁶ The concept mapping of training objectives represents a replicable participatory model that medical schools can adopt to develop training objectives and to evaluate the concordance of directorate and scholar training priorities. In summary, systematic approach to training development also results in meso-level educational theories and increases evaluation capacity.