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Subspecialists get boost from UCLA program

From the March 1998 ACP Observer, copyright 1998 by the American College of Physicians.

By Jennifer Fisher Wilson

Just as Alan M. Fogelman, FACP, became chair of the UCLA department of medicine in 1992, workforce data began to show a clear oversupply of subspecialty internists.

This news hardly shocked anyone at UCLA, but it made the faculty's goal of increasing the number of internists training to be subspecialty scientists more difficult to achieve. How could UCLA convince internists to enter an already crowded field to do the research and development behind new treatments for clinical problems?

The answer came in an innovative program designed by Linda L. Demer, FACP, chief of cardiology at UCLA, that combined graduate school with clinical training for the first time. The program, known as Specialty Training and Advanced Research, or STAR, allows internists to pursue translational research—and a PhD—while completing a residency and fellowship. Translational research applies basic science techniques to clinical problems.

Unlike typical medical scientist training programs in which students pursue a medical degree and a PhD simultaneously, STAR program trainees begin working on their graduate degree only after gaining hands-on clinical experience in their residency. According to Dr. Fogelman, the trainees' clinical knowledge gives them a leg up on doing the sophisticated research needed for such clinical problems as the genetics of cancer outcomes or the bacteria that causes stomach ulcers.

Typically, STAR fellows begin with a year of residency training, followed by research for three to four years interspersed with further residency and fellowship training. Physicians maintain continuity of clinical training at least part time, even during PhD research. Throughout the program they are paid as much as their equivalent house officers, and UCLA pays the interest on their loans.

Physicians may begin the STAR program at any point in training from the fourth year of medical school, so some enrollees enter the program later in their training. For instance, board-certified internists may apply to the STAR program for a PhD and fellowship to complete their subspecialty scientist training.

Applications have poured in since UCLA started the program in 1994, but since it takes physicians up to seven years to complete the STAR program, just a handful of spots open up every year to new candidates. Consequently, just 7% to 10% of applicants are accepted each year. Currently, 55 physicians are enrolled.

The application process itself is complicated. A fourth-year medical student who wants to be a gastroenterologist, for example, must apply through the STAR program to an internal medicine residency, a gastroenterology fellowship and graduate school. STAR organizes and facilitates the process, but is not a part of decision-making at any of the three programs.

So far, the few subspecialty scientists who have graduated from the UCLA program have easily found faculty positions at academic medical centers. Not only are STAR graduates promising candidates for faculty positions at medical schools, Dr. Fogelman said, but they are also "extraordinarily attractive to pharmaceutical and biotech industries because they're ideally trained to do translational research, which the industries are most interested in."

Other schools see STAR's appeal. Dr. Demer has received dozens of calls from other schools that want to offer the STAR program, too. Yale and Johns Hopkins have already done so.

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