Combined residencies in clinical medicine and research change the future of pediatrics

The road to innovation in child health begins with people who choose to follow a long, hard path.

Some physicians choose to focus on clinical care. Others concentrate on research into childhood disease. Then there are the few who choose the dual path of pediatric clinician-scientist.

“Our goal for the past several years has been to accelerate our recruitment and development of clinician-scientists,” says John Bissler, MD, an associate director of the Residency Training Program at Cincinnati Children’s. “This offers great hope for developing better understanding of pediatric disease, and discovering better treatments.”

Years of rapid research growth at Cincinnati Children’s have made the medical center more attractive to would-be researchers, which leads to more funded projects, which in turn creates demand for specialized research talent.

The Residency-Research Training Track at Cincinnati Children’s is a highly competitive program that blends medical residency training with a post-graduate research fellowship. The six-year program provides a setting for people who have obtained MD-PhDs to continue working with one foot in clinical care and the other in the laboratory.

“Medical training is designed to help people think of the correct treatment. Clinician-scientists try to come up with better treatments,” Bissler says.

Growing program, growing impact

National interest in research training at Cincinnati Children’s has grown significantly. In the early 2000s, the medical center was receiving two or three applicants a year for the residency-research track and in some years, the program accepted only one candidate. Now, four to six MD-PhDs join the program each year, selected from more than 35 applications.

“As we’ve grown, we have developed and recruited a number of leaders in their fields. We are seeing more interest from students who seek these leaders as mentors,” Bissler says.

For more than a decade, post-graduate education programs at Cincinnati Children’s were focused on building the medical center’s in-house clinical and research capacity. More recently, Cincinnati Children’s has become an exporter of scientific talent, Bissler says.

“We serve as a feeder to our own fellowship programs and to fellowships at other institutions. As these people go out and their colleagues see how well-trained and successful they are, that helps with our recruiting,” he says. “More importantly, it helps children who are depending on the expertise of these scientists.”

The Residency-Research Training Track involves three years of medical residency training plus three years in a research-focused fellowship. About 30 people are currently “in the pipeline” at Cincinnati Children’s, Bissler says.

Recent graduates include Jonathan Howell, MD, PhD, a research fellow in the Division of Endocrinology who studies human intestinal enteroendocrine cell development. Howell is part of the laboratory team for James Wells, PhD, director for basic research, Division of Developmental Biology. Wells’ team, along with colleagues from several other divisions at Cincinnati Children’s, recently became the first to successfully generate functioning human intestinal tissue from pluripotent stem cells.

“We expect our trainees to help develop innovative new treatments,” Bissler says. “But that’s not the full breadth of their impact.”

Living in two worlds

Clinician-scientists play a central role in Cincinnati Children’s growing emphasis on translational research. By spending time in both the hospital and the laboratory, they strengthen the connections between current practice and the future of medicine.

“If you have someone who’s dually trained in clinical medicine and science, they will give a much more detailed explanation of the disease process,” Bissler says. “So the discussions with residents, medical students, even with faculty, are taken to a new level. By asking ‘Why is this happening?’ it helps foster discovery and improvement.”

Susanne Wells, PhD, is director of the Epithelial Carcinogenesis and Stem Cell Program at the Cancer and Blood Diseases Institute. Her laboratory is one of many here that illustrates the close ties between clinical care, research and education at Cincinnati Children’s.

The laboratory examines the roles human papillomavirus (HPV) infection can play in causing cancer, and employs two post-doc fellows, two to four graduate students and at least one undergraduate student each year. A variety of other students spend four-week rotations in Wells’ laboratory as they decide upon their research interests.

Wells says many people overlook the vital roles that students play in medical research.

“These people are the workhorses of science. While I’m devoting time to writing grants, they’re working long hours, nights and weekends to keep the experiments going.”

For many institutions, the recent slow-down in federal funding for pediatric research and the proposed budget cuts for graduate education make it harder to support laboratory teams. Wells and Bissler say Cincinnati Children’s has been unusual in its commitment to continue research training.

Curiosity driven by purpose

“We believe in advancing the science of pediatric medicine even when the economy is tough,” Bissler says. “The culture here is collegial and forward-moving. We all know we are here to help sick children. So we help each other.”

Cincinnati Children’s goes to great lengths to connect its research work to its clinical programs. That connection is reflected in its education programs.

“When I started in this field, some people liked to say we get paid to play with proteins and DNA,” Wells says. “But that’s not so much the culture anymore. It is one thing to study how genetic tests can determine how predisposed a person might be to head and neck cancer. It’s quite another thing to meet those patients in person.”