MD-PhD and MD-MSc programs—where students pursue a Doctor of Medicine (MD) alongside either a Master of Science (MSc) or Doctor of Philosophy (PhD)—are becoming increasingly recognized for their academic and career-centric benefits. These programs train physicians with strong scientific research backgrounds, equipping graduates with a unique skillset.
However, these courses of study are particularly challenging, typically taking seven to eight years to complete. Students typically begin with two years of pre-clinical medical school, followed by MSc or PhD coursework, after which they return to complete their final years of medical school.
A past study found that students who self-report a marginalized identity have higher rates of burnout and are most likely to experience mistreatment. This is a pattern that Zaid A.M. Al-Azzawi, an MD-PhD student in McGill’s Department of Neurology and Neurosurgery, and Mimosa Luigi, a MD-PhD student in McGill’s Department of Psychiatry, sought to explore in their recent study, published in BMC Medical Education.
In an interview with The Tribune,the two sat down to discuss their inspiration for this project and their results.
“[Our inspiration] really stemmed from the lack of data on the intersection between MD-PhDs and students’ marginalized identities. When you look at the literature, there’s either little data reported, or it’s very institution-specific,” Al-Azzawi explained. “The way in which the reporting is done is not consistent across studies. That was [our] main motivation.”
Al-Azzawai and Luigi analyzed data from an online survey distributed by the Clinician-Investigator Trainee Association of Canada (CITAC) to gain insights that could inform future decision-making from people who manage MD-PhDs and MD-MScs. They included identifying as a woman, living with a disability, being a visible minority, not being born in Canada, and being a primary caregiver as contributing to marginalization.
After analyzing the data, Al-Azzawai and Luigi concluded that MD-PhDs and MD-MSc trainees in Canada face clear challenges, including a lack of institutional support, financial barriers, and a lack of adequate mentorship, with a majority declaring a marginalized identity. Furthermore, marginalized identity trainees responded with more dissatisfaction towards mentorship due to the program’s discontinuity. This structure creates gaps in support, reduces the number of mentors who are of a marginalized identity, and overlooks the added barriers marginalized students face. Their findings underscore the importance of administrators’ approach to these training programs.
The study found that 78 per cent of the trainees identified with one marginalizing factor, and 47 per cent with at least two, showing how many students navigate these already demanding programs while facing overlapping barriers.
“What we found was actually many PhD [students] come and identify with multiple marginalized identities, and that their experiences are reflective of that. Greater marginalized identity identification found greater difficulties or multiple needs that were unmet,” Luigi said.
In tandem with marginalization factors, the researchers examined data concerning trainees’ satisfaction with the quality and experience of the program, mentorship needs, worries about imposter syndrome, and financial stressors.
They found the pattern of decreasing trainee-experience satisfaction aligned with multiple marginalized identities—a direct correlation to past research. Notably, those who identify as having a disability or as a primary caregiver would not participate in the program again due to dissatisfaction with the lack of accommodations provided.
“The issue that comes with a program like this is discontinuity. Needing help with transition points was one of them as well. In Canada, at least, there’s usually an interruption in medical training or the PhD portion as you go along this path. People [returning after] their PhD [coursework] will often find some kind of dissonance with their medical cohort that did not have that interruption or vice versa,” Al-Azzawi added.
This research is pivotal in addressing broad data gaps. With advances in targeted support and surveys that would oversee ongoing issues in these programs, diverse clinician-scientist trainees could thrive without systemic barriers. For now, the study calls for institutions to strengthen mentorship within national networks and to improve funding for MD-PhD and MD-MSc students.