Double agents

What’s harder than getting a professional degree or a graduate degree? Doing them both at the same time. This month, The POST highlights some of the most prestigious dual-degree programs at the Health Science Center and the students who are devoted to forging a unique path between two fields.

By April Frawley Birdwell

Robbie Regenhardt has volunteered at the Equal Access Clinic throughout his M.D./Ph.D. training./Photo by Maria Belen Farias.

A few things have changed since he started medical school in 2007. Most of his classmates from his first and second years are now second-year residents. He’s still readjusting to the more rigid schedule of medical school versus the comparatively autonomous hours of a scientist. And, understandably, with years of science under his belt, he approaches his cases just a little differently than his new classmates.

On his first clinical rotation in obstetrics and gynecology, a mother’s water broke weeks before the baby could survive outside the womb. Little could be done to save the baby, but the case triggered an idea. Was it possible, he wondered, to recreate the womb by putting saline or artificial amniotic fluid back in the mother?

He wasn’t sure if it was a naïve idea, but he decided to research it anyway. He found several studies that showed some promising findings of amnioinfusion for these babies, but also some downsides, such as a higher risk of infection. He showed everything to the residents he was working with on the case.

“You cannot be afraid to ask simple, dumb questions. A lot of people won’t,” Regenhardt says. “A lot of people are afraid of looking dumb. But from the scientist’s perspective, you try not to worry about things like that, because that is how you learn.”

As a student in the UF College of Medicine’s M.D./Ph.D. training program, Regenhardt is learning not only how to provide the best care possible to patients, but also how to integrate this care with a career in research that can advance the field of medicine forward in new ways.

In essence, that’s the goal of almost all dual-degree programs, to forge new paths that straddle the lines between disciplines and produce students with unique skills. The College of Medicine’s M.D./Ph.D. program specifically is known for providing students with a place to combine medical training with diverse fields in the basic sciences and in less traditional disciplines, such as anthropology and epidemiology, pairings that are less common nationally but could leave students well-positioned to take on leadership roles or to make groundbreaking discoveries.

“There is a category of students who recognize the interfaces between two fields of interest, be it science and medicine, medicine and business, medicine and engineering, health and art or whatever it might be,” says David S. Guzick, M.D., Ph.D., UF senior vice president for health affairs and president of the UF&Shands Health System. “For students who want to explore such interfaces across disciplines, it is helpful for them to be exposed to both fields from first principles and fashion a career based on that. When you learn a discipline from its foundations, you develop a deeper understanding and can apply that knowledge in a more creative manner.”

That said, it’s not a path for everyone. The number of students who graduate from M.D./Ph.D. programs each year numbers in only the hundreds nationally, according to the Association of American Medical Colleges. And there is a drop-off between the number of students who enter and the number who actually finish, although the total number of graduates has increased just over 5 percent during the last decade.

“A lot of people look at you like you are crazy when you say you want to get an M.D. and a Ph.D.,” Regenhardt says. “A lot of M.D.s will say you can do research without getting a Ph.D. and a lot of Ph.D.s will tell you ‘If you like science just do that, why complicate things?’ But the reason we do this is we like science and we like taking care of patients, too. It gives you very formal training and complete perspectives in both areas, and hopefully being able to mix the two will create unique perspectives.”

This month, The POST introduces you to a few of the students who are on this path and takes a closer look at some of the programs across the Health Science Center, that are helping them attain skills outside of the traditional lines of one discipline.

D.M.D./Ph.D.

Scott Harden is the College of Dentistry’s first D.M.D./Ph.D. student./ Photo by Maria Belen Farias.

Scott Harden is in his last year of dental school and his 10th year of college overall. So when he signed on to become the UF College of Dentistry’s first combined D.M.D./Ph.D. student, he heard more than one “Why?” from his family and friends.

For Harden, the answer is simple. He loves research. He spent two years working in an electrophysiology laboratory while he was getting his master’s degree in molecular biology and microbiology, and even though he loves dentistry, he really missed research once he entered dental school.

He began spending time in the lab of College of Dentistry researcher Shannon Wallet, Ph.D., who encouraged him to look into completing a dual degree.

“Scott had the right set of skills. I knew he could succeed,” Wallet says.

At the suggestion of Dean Teresa Dolan, leaders in the college, including Wallet, had been developing the program for a while. The goal, Wallet says, is to prepare students for careers in academic dentistry, so they can conduct research that advances the field and still provide clinical care to patients.

Harden was the first to sign up. Unlike an M.D./Ph.D. program, in which students complete their Ph.D. training midway through their medical education, students in the D.M.D./Ph.D. will complete their doctoral training during their final “year” of dental school. Instead of graduating with his dental class this year, Harden’s last year of dental school will stretch out over the next four years. He will work in a lab, take classes and spend time each week in the clinic so that his patient care skills stay fresh.

His goal this year is to find a lab and mentor in the field of neuroscience, which may sound like a strange fit for a dentist, but he sees numerous possibilities.

“Many emerging advances are the result of collaborations between different departments and fields,” Harden says. “I’m in an exciting position to collaborate from the clinical perspective and with my background in computer and electrical engineering. I don’t know what I will do yet, but know it will be exciting.”

 M.D./Ph.D.

Last year as a new M.D./Ph.D. student, Brittney Newby worked with her classmates to design their own clinical trial. For the scholars, it was an early lesson in what life as a physician-scientist will be like, juggling medicine, or in this case medical education, with research demands.

It’s a lesson program director Stephen Hsu, M.D., Ph.D., tries to teach students from the first time they interview to get into the program. He reminds prospective students to consider whether they want to be a physician-scientist, with a foot in both worlds, or whether they would really be happier doing one or the other.

Students spend anywhere from seven to eight years in pursuit of the M.D./ Ph.D., and the schedule can be grueling, a constant balancing act of tests, patients and lab work.

Like many of the students who enter the program, Newby knew she wanted to be a doctor. Her brother was diagnosed with hypothyroidism as a child, and she can remember firing question after question at his doctor, and how patient he was with her. The impression and interest stuck with her. But in college, a professor encouraged her to do a summer research internship. She loved it.

“You’re exploring. You’re doing things no one has ever done before,” Newby says. “When I graduated I was torn as to what to do because I really wanted to go into medicine.”

After spending two years working in a lab at Children’s Hospital Boston and volunteering at a free health care clinic, Newby enrolled in UF’s M.D./Ph.D. program. Incidentally, she was the first African-American woman ever admitted to the program.

Newby is focused on Type 1 diabetes research. But one of the program’s niches is that it brings in students from a variety of fields beyond those traditionally associated with the M.D./Ph.D.

“If a scholar can convince me that the skill sets from a certain field can be applied to advance the clinical-translational mission and actually affect people’s lives and break down barriers to the delivery of health care, then we will do our best to help them achieve that,” Hsu says. “We have to start thinking more broadly about what we are training students to do.”

For a role model as to how this can work, students need look no further than the leader of the UF&Shands Health System. Guzick paired his own medical training with a doctorate in economics. He specialized in a technique called econometrics and was able to use his economics training to develop methods and statistical models of clinical practice.

“I was able to take straightforward tools from another field and apply them in a fresh way,” Guzick says. “That gave me an opportunity to develop a career in academic medicine, because I had skills very few other people had.”

In addition to getting students involved in research from the start, UF’s M.D./Ph.D. program also requires students to stay involved with the medical side during the years they are working on their Ph.D.s. As part of the program’s social mission, students are required to spend time working with patients in need, namely at the Equal Access Clinic or at the College of Medicine’s mobile clinic.

“I want them to be exposed to real-world medicine and the real-world needs of people,” Hsu says.

That thought sums up how Newby feels about why she chose this path. For her, getting to meet patients and talk to them about their problems makes the research side of her world even more important.

“It brings the research to life,” she says. “Research has the potential to help people who are suffering from these diseases.”

D.V.M./M.P.H.

Seth Colman is combining his training in veterinary medicine with a Master of Public Health degree./Photo by Jesse S. Jones

Seth Colman was sick for 2,054 days. He counted them.

Diagnosed with ulcerative colitis as a UF undergrad, Colman underwent two surgeries, missed an entire year of school and escaped the situation with a deeper interest in public health.

Colman chose to pair his first love, animal medicine, with his newfound interest, public health, through one of the newer dual-degree programs UF has to offer, the Doctor of Veterinary Medicine/Master of Public Health program.

Although it is a newer program — the first crop of students graduated in 2011 — the D.V.M./M.P.H. program actually extends back to a time when veterinarians spent most of their days taking care of food animals and making sure the food supply was safe, says Traci Krueger, D.V.M., M.P.H., the program’s director.

“That was one of the reasons veterinarians were so valuable, we did not want to be eating unhealthy animals,” Krueger says. “As our culture has evolved, veterinarians are now primarily caring for pets. But people still do this work.”

The program arms veterinarians with the skills to take care of their animal patients while also helping to keep humans safe. Pairing these degrees also prepares them for specific types of careers, either ensuring the safety of the food supply or working with government agencies on the public health ramifications of diseases that pass from animals to humans. Nearly three-quarters of emerging diseases in humans originate from animals. Another plus for students is that the program typically only takes them one extra summer to complete their coursework.

Colman, who is in his last year of the program, hopes to eventually work for a government agency, combining his passion for clinical medicine and public health. He spent six weeks working at the Centers for Disease Control and Prevention during the summer as part of an epidemiology elective program.

“The CDC is a pretty amazing place,” he says. “I got to work with veterinarians and (human medicine) physicians and Ph.D.s working together for the common goal of solving real-world health problems. This One Health model of collaboration allows the CDC to more effectively target public health goals, and presents tremendous opportunity for advancements in both clinical care and public health.”

Considering a dual degree?

Tackling two tough degrees is not for the faint of heart. Some programs involve seven to nine years of training, not even counting the added years of residency for medical students. And there can be other sacrifices, too. Friends move away. Significant others finish their training and leave. The student lifestyle can grow wearisome. Regenhardt says he tells students who are interested to just be honest with themselves when they are considering it, and not pursue it simply for a few extra letters behind their names.

“Really make sure this is something you want to do and have a passion for it,” Regenhardt says. “For those of us who complete combined programs, it doesn’t feel like a sacrifice because it is what we want to do and what we are meant to do.”

For a list of dual-degree options within the UF Health Science Center’s six colleges, click here.