Correct Answers to the Why MD/PhD Essay

If you read my article on Why You Should Consider the MD/PhD Career Path, then you might now have multiple reasons for Why MD/PhD. However, most of the reasons I describe in that article don’t belong in this essay. You must play the game to be taken seriously in the application process. The Why MD/PhD essay is 1 of 3 main essays required for the primary application to MD/PhD programs; the others are the Personal Statement and the Significant Research essay. I have published my views on writing an effective Personal Statement, which you can read here, and the Significant Research essay will be out soon.

In this article, I’m going to tell you the “correct” answers for Why MD/PhD based on my own experiences. I believe that these reasons are correct because MSTPs are supported through NIH funding, which aims to generate medical scientists who will contribute to perpetuating the system in which they were trained. The MSTP admissions committee is also largely comprised of people who have followed an academic path and thus have additional bias in their selection. If you write about career ambitions of going into private practice, becoming an entrepreneur, or anything that doesn’t involve academic research to some extent, you’re probably not the applicant MSTPs are seeking. Nevertheless, having the “correct” answers doesn’t mean that you have what it takes to write a successful essay. You must demonstrate in 3000 characters with spaces that you have had the requisite experiences necessary to recognize why the dual degree path is the right fit for you and that you are prepared to take on the long, integrated course of training. Remember, like the Personal Statement, the key to standing out is to infuse your unique life, clinical, and research experiences into the narrative with compelling writing and a central focus on you.

4 “correct” reasons for pursuing MD/PhD include, but are not limited to:

• The synergy of the dual degrees
• To bridge disparate groups of physicians and scientists
• Desire to become an academic physician-scientist
• The perspective informed through duality

Synergy

The synergy of the joint MD and PhD degrees is a key reason for pursuing combined training programs. You undergo an integrated curriculum that allows you to see the big picture and appreciate the fundamental mechanisms of a system. Earning an MD means that you have developed foundational knowledge of both “normal” and pathological human anatomy and physiology as well as basic pharmacology, and the art of patient care.

As you transition from preclinical coursework into the clinical setting, you learn that medicine is indeed as much of an art as it is a science. Each person presents different variables that need to be accounted for in the design of effective treatments and health maintenance plans. You might have 5 patients with high cholesterol and diabetes, and each person could find optimal management of their conditions through a different combination of pharmacologic and lifestyle therapies. This approach requires thoughtful trial and error guided by clinical acumen.

While the research laboratory is principally a scientific domain, it too, in practice, requires mastery of the art of experimental design. This is a major reason why replication of results across different labs is difficult. For example, if you want to obtain images of intact neural circuits in the retina as they exist in vivo, one lab might fix the tissue in paraformaldehyde for exactly 15 minutes, use ultra-filtration of secondary antibodies, and incubate for 7 days to ensure clean fluorescence and full tissue penetration. In contrast, another lab might find that 12 minute fixation without filtration and with an incubation of 10 days is more the sweet spot. When you then consider that each group might also acquire images with different protocols for confocal laser power and acquisition speed, and that these results inform the narratives used in figures, publications and grants, you start to realize how consistent experimental technique and design is critical for replicable science.

So, what about synergy? Your MD/PhD education is integrated across both domains in a manner that preserves the integrity and compounds the knowledge of each training program. Through your training, you will begin to see the nuance in patient care and laboratory research and recognize how your experience in one domain enhances your insights into the other. When discussing how to translate discoveries from the lab to the clinic, you will have a better understanding of the practical barriers that limit translatability of basic science research into clinical trials and patient care. What seems practical on paper or in a grant pitch might not be feasible clinically, and if the reviewers are all PhD scientists, this might be a lost consideration. As a clinician-scientist, you are equipped with the experiences to understand the potential implications and complications of a given research plan in the context of patient care.

Bridge

As an MD/PhD student, you get to engage in the culture, politics, and practice of both clinical medicine and laboratory research. You will find that the MDs and PhDs approach problems with different goals and perspectives, and the problems that each are interested in frequently misalign. To give a compelling basic science talk to a purely clinical audience is a skill one should strive to achieve, and it’s not trivial. The reality is that many aspects of basic science research are a long, long way from being clinically tractable and implemented into patient care. For example, I appreciate that my PhD research on the basic neural mechanisms of dysfunction in retinal disease is unlikely to enhance clinical management of the disease. Still, there are other application areas, such as improving our understanding of how neurons and neural circuits respond to specific signaling perturbations — as is the case in neurodegenerative diseases, brain-computer interfaces, and retinal stem cell implants. When physicians and scientists come together to solve problems in a constructive and collaborative manner, the possibilities are remarkable.

Moreover, a common response to the Why MD/PhD question is that the student felt frustrated with the limits of clinical medicine and desires to push the needle forward. This is a great response, and it is also in part what inspired me. I kept seeing patients come into the emergency room with incurable problems like chemotherapy-induced neuropathy, diabetic foot disease, chronic pain, and neuropsychiatric distress. The physicians would provide a treatment that helped the patient feel better for the moment, but the pain and distress would return not long thereafter. I felt that as a physician under these circumstances, I would be unfulfilled to send a person home knowing well that their problem would return. For the chemotherapy-induced neuropathy, I wanted to understand the mechanistic nature of the neuropathy and design experiments to target and ameliorate the root cause of the pain. The bridging of observations from the clinic into the lab, and vice versa from “bench to bedside” are important reasons for wanting to pursue the dual MD/PhD path.

Academic Physician-Scientist

Academia is a haven for those who desire a career of research, complex clinical medicine, teaching, and administration. Nowadays, it seems tough to get a professorship in academia and acquire funding that will allow you thrive, but once you do get a foot in the door, the rat race is on. I don’t mean to speak negatively of academia. I have been part of this system for about a decade with one foot in and one foot out. I have jumped through the hoops and played the game, quite well. There’s so much good that has come from my experience, and I am grateful daily for the opportunities I have been awarded to pursue my interests at the highest levels and deepest depths. It’s the administrative box-checking, politics, and gatekeeping that I abhor. Nevertheless, you will be expected to proclaim an interest in becoming an academic physician-scientist in your Why MD/PhD essay and interview. Note I did not say you should lie; you should proclaim an interest. It will be obvious if this is not genuine. You should keep an open mind throughout this process. The MD/PhD programs want to know that after they contribute nearly a million dollars toward training you, that you will stick around the academic system to pass the baton to the next generation.

What should you write about in the Why MD/PhD essay with respect to academia? You should profess your desire to be a teacher and mentor and express your goal of starting a research lab that competes for top funding opportunities and raises the bar of cutting-edge research. You should explain how the complex and rare clinical cases in academic institutions provide opportunities to practice medicine at a high level. You should recognize the politics, as well. There’s a reason that first-generation and underrepresented students are a minority in this career path: it’s complicated to figure out how to play this game without a rulebook. You should therefore make it an explicit goal of your career to shatter glass ceilings and open the door wider for minority groups to learn the rules and establish a more diverse, equitable, and inclusive status quo. Without these initiatives, I would not be a MD/PhD student today. DEI has unfortunately become a buzzword, but its true meaning and intent is needed more than ever in academia and medicine.

Duality

The perspective of duality is a principal reason I chose to pursue the MD/PhD career path. My upbringing as a Moroccan-American exposed me to contrasting cultures, languages, and perspectives on the two sides of my family, and I realized from an early age that this duality had a transformative impact on how I saw the world. By engaging deeply in two contrasting perspectives, you gain novel insight that neither perspective alone could have provided. This perspective is born from the synergy and empowers the bridging that the MD/PhD training provides. It equips you with a certain adaptability and skillset that allows you to pursue diverse career paths and connect with others across differences and through barriers.

Therefore, with these 4 “correct” answers in mind, let’s get into how to craft a strong Why MD/PhD essay. Below I’m going to show you an example of a poor essay and a good essay. Details have been changed to protect the writer’s identity.

Poor essay:

“I remember when Devonte came into the medical clinic. His right foot was in a walking boot, each step with it making him wince. As we oriented him into the exam room, Dr. Snow began to examine him. His foot was seriously swollen. Even though it looked severe, he apparently had no broken bones. Dr. Snow decided to take a blood test. The results would come back in a few days and so he was told to come back. When the results arrived, a high uric acid level was measured. Dr. Snow called Devonte back for a follow-up joint fluid test, letting him know of his suspicions of gout. Devonte returned and the test was done. Uric acid crystals were present, confirming gout. Dr. Snow knew what to do right away, prescribing a corticosteroid and Aloprim. I never saw Devonte with that swollen foot again. We were happy to see him healed. Being able to restore someone back to normalcy with medical knowledge is what makes clinical work worthwhile. However, sometimes, treatment that can control or ameliorate the disease isn’t readily available. Sometimes, the best outcome is just temporary improvement due to the lack of understanding.

• From the first paragraph, the student describes a basic clinic encounter in a long-winded way to express that medicine is sometimes effective for disease management, but other times it is not. This should be the focus of their opening sentence. The writer seems to imply that when treatment is not possible, it is sometimes because the answer is beyond current knowledge, and that this result is unsatisfactory. I completely agree.

I remember learning about Alzheimer’s Disease in class. I was surprised to learn of the substantial medical knowledge gap present despite its prevalence. Even though it is known that aging is a factor and the mechanism seems to involve amyloid plaques and tau tangles, the cause of such dysfunction is still unknown, leading to difficulties in a cure. Medical problems such as these motivate my desire in research, research that can eventually make an impact in people’s lives.

• The writer is inspired to do research because diseases like Alzheimer’s have a major impact on people’s lives and we still don’t understand what exactly causes it. It would be better if they described the multiple hypothesized causes of Alzheimer’s and explained their motivation to contribute solutions to this complex, multifactorial problem. Knowledge of the clinical manifestations and variations in disease coupled with deep knowledge of mechanisms of neurodegeneration would be a powerful way to contribute these solutions, but the writer does not offer this perspective.

I have spent over a thousand hours working in the lab. I enjoy the problem-solving aspect inherent in it. In my tissue engineering research project, one of the major obstacles I faced was gathering NMR imaging data. I remember running into many problems my first time. The calibration curve looked odd, requiring me to go back into the manual. The pre-scan image was filled with noise, leading me to realize that the bioreactor was in the wrong position. Other problems occurred, some solvable by the manual or brute force, others leading me to facetime my faculty mentor. In the end of all of the struggles, I remember when that high quality NMR image popped up, causing an outburst of happiness. I spent so many hours in the lab that day and yet it only felt like minutes; the lab was a time vacuum. Despite all of that time and effort, I wasn’t disappointed. Solving issues in your project is satisfying, especially when it can be potentially translatable. There honestly is no other experience like it.

• Ok, they enjoy problem solving and have done an oddly specific amount of research. They provide a narrative about a time they solved a problem in lab and found personal fulfillment from this process. They’ve gone from gout to Alzheimer’s to tissue engineering, and I’m not sure what NMR is in this context. Their motivation for pursuing research is great, and they seem to be driven by the right reasons to pursue this career.

I want to be in a position where I can contribute in the understanding of diseases and solve the medical problems present. However, I want to do more than just solve the gaps, I want to directly impact patients and ameliorate their suffering, applying the research to give the best possible treatment. I think this dual contribution in both science and humanity is the most fulfilling life I can live.”

• The writer closes with an expression of their desire to not just solve research problems, but also to contribute directly to the amelioration of suffering in their patients through an evidence-based approach. Another great reason for this career path, but how does having both the MD and PhD facilitate this goal?

What is this essay missing?

1) The writing is haphazard, 2) it lacks clarity on why training to earn both degrees would be beneficial to reach their goals, and 3) the examples are disconnected and do not convince me that they understand what being a physician-scientist is all about.

How could the student have written this Why MD/PhD essay differently?

“I have found great fulfillment while working with physicians as they solve clinical problems for people suffering from illness. For example, ‘Devonte’ came into the medical clinic, limping with his walking boot and wincing with pain on each step. A blood test revealed that he had high uric acid levels, and the physical exam showed a swollen, hot foot, consistent with gout. Devonte was prescribed a corticosteroid and Aloprim, and not long after, his gout was cured. It feels awesome to provide a practical service that improves a person’s life, and I believe that I will be inspired by this work and patient interactions throughout my career. However, there is often not a straightforward solution in patient care, and a lack of understanding about the cause of disease can be frustrating to the physician and debilitating for the patient. The art of medicine is limited by the science that underpins it. Through my MD/PhD training, I aim to acquire the skills needed to use the art and science across clinical medicine and laboratory research to improve patient care for individuals and society at large.

One area of medicine that brings together this art and science in a life-changing way is skin grafting. Imagine a burn patient who now struggles with both the aesthetic and clinical complications of skin debridement. The teams of technically masterful clinicians reconstruct large swaths of damaged tissue with innovative tools in a delicate manner, but little can be done in the case of graft rejection, or when the damage is too profound. Still, the graft technologies have developed in an extraordinary way over time, and it is due to the benchwork of countless scientists that have empowered clinicians to improve the lives of their patients. This benchwork can be arduous and unforgiving, but at the same time, it can be exhilarating and joyful when a complicated problem gives way to a creative solution.

I have spent over a thousand hours in research laboratories experiencing the spectrum of these emotions — from coping with failure to celebrating success, I have constantly appreciated the opportunity to conduct research. As I think about the patients who could one day benefit from my work, the value of my research in tissue engineering attains new context. My research focuses on optimization of image acquisition for biomaterials using nuclear magnetic resonance (NMR) techniques. To study the structural integrity of a biomaterial, one must be able to visualize the molecular properties that support the connective tissue. This process requires an engineering mindset and is an artform of technical tinkering to find a signal in the sea of noise. I will always remember the feeling of profound contentment that I experienced when the blurry image became clear. It seems like such a small feat, but it clarified for me that my calling was at the interface of the lab and the clinic. To be able to work directly with patients and engineer effective, creative solutions in my lab to help my patients would make for a constantly humbling and satisfying career.”

Feel free to reach me here or via email at info@jakekhoussine.com anytime.