Re-examining physician-scientist training through the prism of the discovery-invention cycle

The training of physician-scientists lies at the heart of future medical research. In this commentary, we apply Narayanamurti and Odumosu's framework of the "discovery-invention cycle" to analyze the structure and outcomes of the integrated MD/PhD program. We argue that the linear model of "bench-to-bedside" research, which is also reflected in the present training of MD/PhDs, merits continual re-evaluation to capitalize on the richness of opportunities arising in clinical medicine. In addition to measuring objective career outcomes, as existing research has done, we suggest that detailed characterization of researchers' efforts using both qualitative and quantitative techniques is necessary to understand if dual-degree training is being utilized. As an example, we propose that the application of machine learning and data science to corpora of biomedical literature and anonymized clinical data might allow us to see if there are objective "signatures" of research uniquely enabled by MD/PhD training. We close by proposing several hypotheses for shaping physician-scientist training, the relative merits of which could be assessed using the techniques proposed above. Our overarching message is the importance of deeply understanding individual career trajectories as well as characterizing organizational details and cultural nuances to drive new policy which shapes the future of the physician-scientist workforce.