Teaching Physician-Scientists to Think Outside Their Box
By Catherine Duncan
Most of the easy problems in medicine have been solved. Those that remain are complex and intractable. To solve them, we need physician-scientists who conceive of novel approaches to these problems. The best way to create a generation of physician-scientists who approach these problems from unique perspectives is to recruit students from unique backgrounds, ethnicities, and races.
UT Health San Antonio’s South Texas Medical Scientist Training Program (STX MSTP) is nationally renowned for being one of the most diverse MD/PhD programs. This program actively recruits students who can approach problems from unique backgrounds. The program seeks students who do not think the same way as every other medical student, because they were raised in a different culture.
The NIH’s National Institute of General Medical Sciences Medical Scientist Training Program provides Ruth L. Kirschstein Institutional Predoctoral Training Grant (T32) awards to 51 institutions, including UT Health San Antonio. Each year, the STX MSTP welcomes a class of seven students, each bringing a unique perspective and research background.
Jose E. Cavazos, MD, PhD, assistant dean and director of the STX MSTP, said the program looks for applicants with a passion for biomedical investigation and a desire to translate those biomedical discoveries into medical advances.
“Our institution has graduated clinician-scientists with dual MD and PhD degrees since 1980. We benefit from the rich environment fostered by the NIH-sponsored MSTP T32 training grant as well as the Clinical Translational Science Award (one of 60 in the country), demonstrating the intensive nature of the biomedical research training environment at our university,” said Dr. Cavazos, professor of neurology at UT Health’s Joe R. and Teresa Lozano Long School of Medicine.
According to the federal “Notice of NIH’s Interest in Diversity,” from 2019, “research shows that diverse teams working together and capitalizing on innovative ideas and distinct perspectives outperform homogenous teams. Scientists and trainees from diverse backgrounds and life experiences bring different perspectives, creativity, and individual enterprise to address complex scientific problems. There are many benefits that flow from a diverse NIH-supported scientific workforce, including: fostering scientific innovation, enhancing global competitiveness, contributing to robust learning environments, improving the quality of the research, advancing the likelihood that underserved or health disparity populations participate in, and benefit from health research, and enhancing public trust.”
“U.S News and World Report recently ranked the 51 MSTPs in the country using data based on the class of 2018. We are ranked No. 16 in the country,” Dr. Cavazos said. “However, if you look closely at those programs and only consider the programs that are research intensive with MSTP funding, UT Health is actually among the top six schools.”
He went on to say, “In 2018, our MD/PhD program was ranked as the most diverse MSTP among the 51 NIH-funded MSTPs. In 2021, we have 46 percent women and 48 percent of our trainees qualifying under the new diverse guidelines,” he said. “We are still the most diverse in the country.”
Graduates of the STX MSTP complete their training in an average of 7.9 years versus the national average of 8.6 years. These dual-degree graduates published a mean of 4.5 papers each. “Our goal is to support the training of a diverse group of physician-scientists with the highest quality of clinical care and research skills,” he added.
UT Health MD/PhD graduates include: Suzanne R. Thibodeaux, MD, PhD, assistant professor of pathology and immunology, Washington University School of Medicine; Dat Vo, MD, PhD, assistant professor of radiation oncology, UT Southwestern Medical Center; Josephine Thinwa, MD, PhD, instructor, UT Southwestern Medical Center, and Daniel Barron, MD, PhD, assistant professor, Harvard Medical School.
“Our school is developing a reputation for creating physician-scientists who are accepted to some of the best clinical residencies in the country, including Yale, Stanford, Harvard, New York University, Penn, Johns Hopkins and more. We also have graduates who stay here for their residencies because they want to continue working on research and clinical related to health disparities prevalent in South Texas,” Dr. Cavazos said.
By bringing diversity to the clinical practice and to the laboratory, “we are bringing a new approach—perhaps these physician-scientists can discover new pharmacological interventions—that can improve health care outcomes for those who need it the most,” he added.
Tyler Curiel, MD, MPH, world-renowned physician-scientist and expert in tumor immunology, said he is truly impressed with the MD/PhD students who train in his lab at the South Texas Research Facility, which is on the Greehey Campus of UT Health San Antonio.
“It has been great to see the growth of this program over the years. First and foremost, they are MD/PhD students. Second, some of them are underrepresented minorities. In my lab, I have underrepresented minorities, including women, who all seem to gravitate here,” said Dr. Curiel, who is of Hispanic descent. “Dr. Cavazos is doing a great job of bringing in a diverse and highly talented group of students, and it is really reflected in who the trainees are in this program.”
Dr. Curiel, professor of Medicine and Microbiology, Immunology & Molecular Genetics and Daisy M. Skinner President’s Chair in Cancer Immunology Research, said he also is seeing students wanting to be more than just good physician-scientists. “They also want to be civic leaders and community leaders. A lot of them have been actively involved in service programs that help the underserved,” he said.
For example, Ryan Reyes, PhD, is involved with Frontera de Salud (Border of Health), a program in UT Health San Antonio’s Center for Medical Humanities & Ethics that utilizes multidisciplinary student teams to provide health screenings and referrals in underserved regions of San Antonio and South Texas, he said.
Dr. Reyes earned his PhD in Molecular Immunology and Microbiology in May 2021—under the mentorship of Dr. Curiel and Robert Svatek, MD, MSCI, professor and chair of the Department of Urology and a cancer surgeon—and is now working on completing his MD in May 2023. While attending the University of Arkansas at Monticello, he developed an interest in science. After graduating with his bachelor’s degree, Dr. Reyes received a yearlong NIH fellowship to perform cancer research at Yale University.
“My training at Yale confirmed I wanted a career in science and medicine and saw that MD/PhD training provided a way to do both,” he said. Dr. Reyes said he decided to pursue a career in oncology after watching his mother-in-law run out of treatment options in her battle with terminal metastatic breast cancer. “I want to do the translational research that will discover better treatment options. I want to find a way to save more patients.”
Dr. Reyes said he chose to enroll in the MD/PhD program at UT Health San Antonio because of Dr. Curiel. “He was doing the type of research I want to do. I also saw he had three highly successful MD/PhD students, and he has a track record of outstanding physician-scientist trainees.”
Dr. Curiel and his colleagues are seeking to optimize the effectiveness of immune system-targeting drugs in the treatment of many cancers, including melanoma, bladder cancer, and ovarian cancer.
After earning his MD, Dr. Reyes wants to pursue a career as an adult oncologist. He looks forward to doing an internal medicine residency and then an oncology fellowship.
“I want to do what Dr. Curiel does, combining research and clinical practice in a diverse and underserved patient population. Perhaps I will be able to go back home to East Texas and provide intensive oncology care that wouldn’t be accessible otherwise,” said Dr. Reyes, who is from New Waverly, an East Texas town of 1,200 residents.
Angela Rodriguez Boyd, MD, PhD, completed the program in 2013, earning her PhD in Microbiology and Immunology in 2011 and her MD two years later. She completed her residency in obstetrics and gynecology in 2017 at UT Health where she stayed for her three-year fellowship in maternal fetal medicine. Her clinical and research interests include gestational diabetes, obesity and infectious diseases, which are all prevalent in her hometown of San Antonio.
Now an assistant professor/clinical in obstetrics and gynecology, Dr. Boyd said her path to the MD/PhD program started while earning her bachelor’s degree at The University of Texas at San Antonio Honors College. While working on a research project she heard about John Hart, PhD, professor of biochemistry at UT Health San Antonio. Dr. Hart was examining the structural consequences of mutations that occur in the protein superoxide dismutase 1 (SOD1). Mutations in SOD1 are associated with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.
“Dr. Hart allowed me to perform research in his lab; a new world opened up to me,” Dr. Boyd said. “I went to a research conference where I met a physician-scientist that was conducting research and also treating patients with ALS. I hadn’t even thought about medical school until that moment.” After graduating, Dr. Boyd took a gap year to apply to MD/PhD programs across Texas.
“I decided to stay in San Antonio because I knew I had the support system here that I needed to earn my MD and PhD. I’m so glad I stayed here; I had a 4-year-old and an infant at the time. It was the right path for me,” she said.
Dr. Boyd completed the rigorous program in seven years. During her third year in medical school, she connected with treating women during clinical rotations in obstetrics and gynecology. A rotation during her fourth year allowed her to perform research in obstetrics and gynecology. “That sealed the deal. I saw that I could do both. I can see patients and do research. It really is the best of both worlds,” she added
For her residency, Dr. Boyd interviewed around the country; now with three daughters at home and her support system in San Antonio, she knew she would get excellent training and decided to stay at UT Health with the goal of concentrating on high-risk pregnancies. During her four years of residency, she became more interested in obesity and diabetes. She performed research on gestational diabetes and presented her research locally and nationally. She stayed at UT Health to do her fellowship in maternal fetal medicine. After finishing her fellowship, she was offered the position of assistant professor/clinical with 60 percent of her time devoted to clinical and 40 percent to research with part of that time devoted to teaching medical students and residents.
“I believe this program is ideal for someone who wants to contribute to translational research while caring for patients. The program gives you the opportunity to develop meaningful questions from clinical experiences and take them back to the lab. It is wonderful to be able to do both,” she added.
As a member of the program’s admissions committee, Dr. Boyd said the goal is not only to have strong applicants but also to have a diverse group of students. “We are in the perfect location to train the next generation of health care providers and researchers.”
Dr. Boyd is exemplary of the diverse backgrounds these MD/PhD students come from, and how their unique perspectives are changing medical research one patient at a time.