How to Undertake a PhD as a Medical Professional

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Authors:        Daniyal J Jafree(1,2), Kiron Koshy(1,3), Riaz A Agha(1,4)

Contact person: Daniyal J Jafree

Institutions: 

1 Academic Surgical Collaborative, London, UK
2 University College London, London, UK
3 Brighton and Sussex University Hospitals, Brighton, UK
4 Guy’s and St. Thomas’ NHS Foundation Trust, London, UK


Summary

Applying for a PhD can seem like a daunting task. The decision to commit oneself to 3-4 years of self-directed research, without any guarantee of tangible output, is a significant one. There are also a vast number of projects and supervisors one can apply for, all with their own pros and cons. Finally, when these decisions are made, one has to get through the application process, which can be rigorous and extremely selective. In this article, we explore the decision to undertake a PhD and the options available for medical professionals.

Deciding how, when and where to do a PhD as a medical professional
Should I undertake a PhD?

A standard, full-time PhD in the United Kingdom takes three to four years. These will be dedicated to a particular research question or theme, be it a question in basic science, clinical medicine or surgery. This amount of time to a topic with the appropriate resources and funding enables you to develop considerable experience and knowledge in a given subject area. One of the major advantages of undertaking a PhD is the development of transferrable skills. Communication (both oral and written), organisation and management capabilities, creative and analytical thinking can all be developed during the PhD process, and are beneficial for medical careers. It is also useful, and necessary in some cases, to have been awarded a PhD when applying for certain jobs. For example, there is a great deal of emphasis placed on the when applying for subspecialty training in competitive disciplines, such as cardiology (1). Academic posts, such as clinical lecturer or professorial positions, may require PhDs as a pre-requisite. In an analysis of academic plastic surgeons in the United States, evidence of formal research training, including research fellowship or attainment of a PhD, is associated with higher research productivity and a greater likelihood of funding from the National Institute of Health (2).However, there are downsides to doing a PhD. These factors should be considered carefully prior to applications. The challenges of the PhD can lead to delays in completion and attrition, which imparts stress on the individual and loss of time and resources invested in the candidate (3).

  • While carrying out a PhD usually reaps career benefits in the future, it can be disheartening to watch peers move on with the career progression during research time.
  • Money can be an issue. While many PhDs do provide a stipend for income, taking time out for a PhD often means a drop or stagnation in income if the applicant is changing from full-time work.
  • PhD research can often be stressful, as significant strides do not necessarily come daily and mainly failures usually precede successes. Furthermore, there is no guarantee of success or tangible output, all which depend on the supervisor, project, location, resources available and good fortune!

When should I do my PhD?

The timing of a PhD can be variable across a medical career. Each point in the medical career during which a PhD can be taken has its own advantages and disadvantages, so applicants must choose carefully considering their individual requirements and career ambitions (Figure 1). The earliest do their PhDs before even entering medical school, having started a traditional academic path of a Bachelor’s degree, with or without a Master’s degree, followed by a PhD. Having an in-depth understanding of science may be extremely useful throughout the medical degree, however it can be challenging to maintain scientific competency including publications, presentations and more whilst at medical school. Some opt to do a PhD during medical school, either by taking permission for an interruption of their medical studies, or by registering a part of a course which enables integration of a PhD during medical school. The latter, termed the MBPhD programme in the United Kingdom, have long established programmes in the University College London and the University of Cambridge (4), although other medical schools are now also facilitating this (5). The obvious advantage of this is that one become quickly literate in both science and medicine; with the small number of students registered each year, clinical teaching can be focussed and tailored to the student’s needs and it is thought this programme is particularly useful for those who aspire to careers as clinician or surgeon-scientists (6). In the United States, the dual MD PhD programme is a predictive factor for participation and funding in research careers among neurosurgeons at top institutions (7). However, it is not always clear at medical school which specialty one wishes to pursue, and some see it as advantageous to undertake a PhD in the discipline which they wish to pursue later in their career.The alternative option is to save the PhD for after medical school. There are various time periods within the clinical and surgical pathways when one can apply for a PhD and a variety of funding streams are available for such applicants. Here, there is a great opportunity to link one’s clinical or surgical practice with a PhD of their choice, and it is likely at this point that the applicant will have developed a sufficient network to find the right supervisor for them. However, later in a medical career, individuals have a duty to maintain clinical competency, which can limit the amount of time individuals can commit to their PhD research.

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How should I do my PhD?

Though a full-time PhD in the United Kingdom typically lasts between three and four years, there are different ways in which one can undertake a PhD. Many people register for a PhD independently, by finding and committing to research group and a supervisor first, and then by applying for PhD funding through a charity; research programme; industry or by using funds available from the PhD supervisor. The other major option is to apply for a PhD programme; this is usually an institutionally run process which enables you to pursue a PhD at the host institute whilst undertaking training and workshops in parallel to further your development as a researcher. A head to head comparison between these two approaches, and some of the considerations for each, are provided in Table 1. In general, there tends to be a greater degree of flexibility for considerations such as your supervisor and project with independent PhDs, but programmes have their clear advantages, including the fact that some programmes have already allocated funding for projects, and that many programmes provide parallel training opportunities to encourage the academic development of the student.

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Who should I do my PhD with?

Choosing the right supervisor for you, and a good team to work with, is one of the most important components of a PhD, and can heavily influence its output. First, choosing the research group can be difficult, given the variety of high quality research conducted at institutions worldwide. Looking at a research group’s prior publication history, the impact and frequency of their prior publications is highly recommended. Moreover, the nature of prior papers published and their scope will give you an idea of whether the research questions that the group attempts to tackle align with those of your own.A good supervisor is like a mentor, allowing the student to develop his or her own experience and understanding of the research process, whilst also being an open book for discussion. A supervisor should also be a go to person when things do not go right. We have previously written tips on how to find a supervisor and the elements to consider when selecting one (Jafree et al., 2016). In brief, firstly one must get on with their supervisor. An idea of this can be ascertained at the first meeting, which can be arranged before the application process to scope out the research group and discuss potential projects. A good student-supervisor relationship is essential given the duration of the PhD project and also considering that your supervisor will be a great source for references and letters of recommendation later in your career. Although it is difficult to estimate what a supervisor may be like from a 20-minute meeting, current and former PhD students and research staff may offer useful perspectives.It is also important to consider the amount of time a supervisor will dedicate to you, compared to how much time you require. A student with less research experience in a field, or technique may require considerable guidance and a good supervisor will save precious time and resources by preventing failed attempts. This is also down to individual preference, as some may prefer a more hands-on supervisor, while others may prefer a more autonomous environment. One of the other things to consider is co-supervision. For example, carrying out multidisciplinary projects with two supervisors from different backgrounds, or having access to resources from two different groups at different institutions has its advantages. However, this is not always simple, as one has to be compatible with the work ethic of two different research groups, which may be entirely different. It can also be difficult to understand and communicate in the two different ‘languages’ required for your multidisciplinary project – in a cancer cell modelling project, you may need to be able to effectively communicate between your supervisor from a biology background and your other supervisor with experience in maths and statistics!

What should I do my PhD in?

Deciding upon a PhD project can be extremely difficult, particularly when you want to carry out your PhD project in a topic which you aim to carry on later in your career. Generally, there are a variety of PhD topics on offer throughout the medical career. These may be basic science-based, whereby the participant works in a laboratory performing in vivo work on animal models, or in vitro work on cells, tissues or organoids. Research may also be translational, mixing techniques in basic sciences with the clinical realm, for example projects performing genomics, transcriptomics or proteomics of patient samples. Research may also be purely clinical, and this may be subdivided into observational or interventional research. However, there are a variety of other categories of research which do not fit clearly into this distinction, such as computer modelling and data science, epidemiology and public health. The decision to commit to one of these may be challenging, and may be made easier after medical sub-specialisation, though it may be the case that the PhD performed is not directly related to one’s future career. However, the network, transferrable skills and methodologies developed will help with whatever career path is chosen.Independent of the topic chosen, it is important to consider a few crucial elements. Firstly, one must be very aware of the technical requirements for the project; including whether the research group has the resources to tackle the project and whether the student has the technical skill to achieve these. For example, a medical student with no surgical experience may choose a project using tissue engineering approaches for closure of spina bifida in fetal lambs (8), however, it is questionable whether this is realistic a project, given the technical demand. The duration of the project must also be considered – to run a prospective project in long term outcomes for chronic kidney disease may take years, and full-time PhDs are generally restricted to four years in the United Kingdom. Importantly, it is also worth considering whether the project has relevance to current or future clinical and surgical practice and whether the topic is likely to have high impact or importance. These can be ascertained from keeping up to date with the literature and speaking to individuals with experience in the field.

Conclusion

The decision to commit to a PhD is not an easy one. However, with careful consideration of its timing, the topic of study, and other factors such as the host institution, supervisor and style of research, a PhD can be an extremely rewarding opportunity, by providing dedicated time and resources to enable an individual to have an impact in the field of their choice, ultimately both boosting one’s academic career, and equipping them with transferrable skills that are invaluable to careers even outside of academia.

References

1.         Myat A, Ajufo E, Clarke S. A closer look at a career in cardiology. BMJ Careers [Internet]. 2015 [cited 2017 Oct 12]; Available from: http://careers.bmj.com/careers/advice/A_closer_look_at_a_career_in_cardiology
2.         Lopez J, Ameri A, Susarla SM, Reddy S, Soni A, Tong JW, et al. Does Formal Research Training Lead to Academic Success in Plastic Surgery? A Comprehensive Analysis of U.S. Academic Plastic Surgeons. J Surg Educ. 2016 May;73(3):422–8.
3.         Schoot R van de, Yerkes MA, Mouw JM, Sonneveld H. What Took Them So Long? Explaining PhD Delays among Doctoral Candidates. PLOS ONE. 2013 Jul 23;8(7):e68839.
4.         Stewart GW. An MBPhD programme in the UK: the UCL experience. Clin Med. 12(6):526–9.
5.         Barnett-Vanes A, Ho G, Cox TM. Clinician-scientist MB/PhD training in the UK: a nationwide survey of medical school policy. BMJ Open. 2015 Dec 1;5(12):e009852.
6.         Cox TM R. The MB PhD programme. Training to be a clinician-scientist in the UK. J R Coll Physicians Lond. 1993;27(2):147–50.
7.         Choi BD, DeLong MR, DeLong DM, Friedman AH, Sampson JH. Impact of PhD training on scholarship in a neurosurgical career. J Neurosurg. 2014 Mar;120(3):730–5.
8.         Watanabe M, Li H, Kim AG, Weilerstein A, Radu A, Davey M, et al. Complete tissue coverage achieved by scaffold-based tissue engineering in the fetal sheep model of Myelomeningocele. Biomaterials. 2016 Jan;76:133–43.