VOLUME 38 | ISSUE 1 | JANUARY-FEBRUARY 2018

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The endangered clinician-investigator profession in Saudi Arabia: curricular attention is required

Ahmed Abu-Zaid

From the College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, United States

How to cite this article:

Abu-Zaid A. The endangered clinician-investigator profession in Saudi Arabia: curricular attention is required. Ann Saudi Med 2018; 38(1): 69-70.

DOI: 10.5144/0256-4947.2018.69


To the Editor: In today’s 21st century, recruiting medical graduates into the largely underrepresented clinician-investigator (also known as physician-scientist) profession is a notable priority internationally,1 and nationally in Saudi Arabia.2,3 Clinician-investigators are defined as practicing clinicians with medi.cal degrees, who contribute clinical, teaching and administrative duties, but most importantly conduct bio.medical research activities as their primary focused profession.1,4 The predominating bulk of clinician-investigators are dual-degree MD-PhD individuals. Characteristically, clinician-investigators have one leg in clinical practice (i.e., patient care) and one leg in scientific enquiry (i.e., academia and research), and hence are uniquely positioned to bridge basic sciences to clinical practice, and catalyze beneficial bench-to-bedside translational research.5 That being said, the role of non-clinician investigators (i.e., PhD scientists) in contributing valuable research should never be under-emphasized. 

 

Medical schools play the most pivotal role in producing clinician-investigators, principally through well-crafted medical curricular designs. Formal training in scientific research, to a larger degree, is a must for a clinician-investigator profession. The formal research training can take place either con.currently during medical curriculum (i.e., completion of a dual-degree MD-PhD program), or after medical school graduation (i.e., completion of a stand-alone PhD graduate program). 

 

Universally, dual-degree MD-PhD programs are well-acknowledged as the curricula intended to steer the student towards the clinician-investigator professions.1 In Saudi Arabia, unfortunately, similar MBBS-PhD curricula are not yet in effect despite the recent call for these programs, and recognition of the benefits of such programs.Current medical school curricula offer only the stand-alone MBBS pro.grams, and they are not properly ‘research-intensive’ enough to warrant proficiency in scientific research by the medical graduates. Three thoughtful queries for investigation are raised here: [I] Do the Ministry of Education (MOE), Saudi Council of Medical Education (SCME) and medical schools really value dual-degree MBBS-PhD curricula as im.portant? [II] In the absence of formal curricular research training, can well-designed auxiliary extracurricular research activities competently instill proficient scientific research training in medical students? And [III] most significantly, are medical students aware of this alternative career—clinician-investigator profession? 

 

Medical students aspiring to the clinician-investigator profession must join stand-alone PhD graduate programs after graduation from medical school. Four plausible questions arise: [I] Are medical students well-prepared for transitioning into PhD postgraduate education in terms of career coun-selling, intellectual preparation and fulfilling admission requirements? [II] What are the medical student’s perceived attitudes, motivators and barriers toward pursuing PhD post.graduate education? [III] Will medi.cal students be interested in joining a 9-year-long dual-degree MBBS-PhD program as follows: 3 years of basic sciences (pre-clerkship years), followed by 3 years of PhD research dissertation, and followed by 3 years of clinical sciences (clerk.ship years)? And [IV] will medical residents be interested in integrat.ing an additional 2-year Masters or a 3-year PhD graduate education into the specialty-specific residency training? These are very substantial questions that have never been investigated and demand immediate exploration. 

 

In Saudi Arabia, the movement toward MBBS-PhD curricula is, actu.ally, in alignment with the ‘doctor and research domain’ highlighted in the Saudi Meds (a competence specification for Saudi medical graduates).6 The healthcare system cannot incur the conceivable waste of today’s clinician-investigator workforces to contribute favorable bench-to-bedside translational enterprises. Moreover, medical students are yet to entertain the valued, despite underrepresented, clinician-investigator profession. To that end, until dual-degree MBBS-PhD programs are formally put into practice,3 I call for an official (mandatory/optional) inclusion of a year-long course titled: ‘introduction to a clinician-investigator profession’ into the final-year of medical school curriculum. This course is under review for implementation at the College of Medicine, Alfaisal University (Riyadh, Saudi Arabia). This course is anticipated to promote interest in, and pursuit of clinician-investigator professions. Generally, the course aims to: 

I. Highlight the importance of scholarly research in today’s 21st century and its close interconnectedness to clinical practice and other healthcare disciplines such as pharmaceu.tical sciences.

II. Emphasize key translational bench-to-bedside discoveries by clinician-investigators, encourage scientific innovation, and promote useful transformation of basic science concepts into applicably beneficial biomedical diagnostics and therapeutics discoveries. 

III. Provide ‘formal’ theoretical and practical (hands-on) training in all types of research including basic science (labora.tory), clinical science (applied patient-focused) and epide.miological (population-oriented) research. 

IV. Offer a closely mentored research dissertation with a mandatory research publication requirement, so that students can envision life as quasi-scientists and experience the pleasures and rigors of scientific publishing. 

V. Provide career counseling in a clinician-investigator profession. 

VI. Extend comprehensive support services on transitioning into PhD graduate programs, in terms of 24/7 assistance, available opportunities, application process, general admission criteria, advantages and disadvantages. 

 

In Saudi Arabia, although the absence of dual-degree MBBS-PhD programs is the major contributing factor to the endangered clinician-investigator phenomenon,2,3 attention should also be paid to other associated deterring factors. One such factor is low income: clinicians who spend most of their time doing research earn relatively less than their colleagues who do mainly clinical work only. As a result, the clinician-investigator profession may not be highly desired.1 In the West, several mechanisms have been proposed to sustain and encourage a bourgeoning generation of clinician-investigators.1,8 These mechanisms should be adopted and largely include: (I) increasing the number of dual-degree MD-PhD programs, (II) better integration of both clini.cal and curricular/extracurricular research training in medical school curricula, (III) focusing and shortening the duration of research training, (IV) offering career counseling, networking and mentoring, (V) en.hancing the research funding, job salaries and productivity incentives, and (VI) improving institutional aspects pertaining to faculty promotion and tenure-track policies. 

 

 

Disclosure of funding 

None. 

 

 

Conflicts of interests 

 

None. 



Ahmed Abu-Zaid, MBBS 

From the College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, United States 

Correspondence: Ahmed Abu-Zaid College of Medicine Al Faisal University Riyadh 11533 M: +966 567566622 aabuzaid@live.com ORCID: http://orcid.org/0000-0003.2286-2181 

Ann Saudi Med 2018; 38(1): 549-550 DOI: 10.5144/0256-4947.2018.549 

 

 

References

1. Sklar DP. We Must Not Let Clinician–Scientists Become an Endangered Species. Acad Med. 2017;92(10):1359-1361. 

2. Alamodi AA, Abu-Zaid A, Anwer LA, Khan TA, Shareef MA, Shamia AA, et al. Undergraduate research: an innovative student-centered committee from the Kingdom of Saudi Arabia. Med Teach. 2014;36 Suppl 1:S36-42. 

3. Abu-Zaid A, Alamodi AA, Alkattan W, Al-kattan K, Obeidat AS. Dual-degree MBBS-PhD programs in Saudi Arabia: A call for implementation. Med Teach. 2016;38 Suppl 1:S9-S11. 

4. Bonham AC. MD-PhD training: Looking back and looking forward. Acad Med. 2014;89(1):21-3. 

5. Abu-Zaid A, Altinawi B. Perceived barriers to physician-scientist careers among female undergraduate medical students at the Col.lege of Medicine - Alfaisal University: a Saudi Arabian perspective. Med Teach. 2014;36 Suppl 1:S3-7. 

6. Zaini RG, Bin Abdulrahman KA, Al-Khotani AA, Al-Hayani AM, Al-Alwan IA, Jastaniah SD. Saudi Meds: a competence specification for Saudi medical graduates. Med Teach. 2011;33(7):582-4. 

7. Abu-Zaid A. Research skills: the neglected competency in tomorrow’s 21st-century doc.tors. Perspect Med Educ. 2014;3(1):63-5. 

8. Ganetzky RD. Becoming a Physician–Scientist: A View Looking Up From Base Camp. Acad Med. 2017;92(10):1373-1374. 

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