Department of Rheumatology, Division of Immunity and Infection, The Medical School, The University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
Correspondence to:
C. Gordon.
![]() |
Introduction |
---|
![]() ![]() ![]() ![]() ![]() |
---|
Here we discuss the role and respective merits of different postgraduate degrees available to medical graduates and the timing of the research period, a factor that plays a significant part in the long-term success of the venture.
![]() |
Which degree? |
---|
![]() ![]() ![]() ![]() ![]() |
---|
Traditionally, MD projects have been more clinically orientated than PhD projects, although this is not necessarily the case. Some MD studies are purely laboratory-based and some PhD projects are in clinical research. The value of MD research time both for the individual and for the body of scientific and medical knowledge has been extremely variable. Some projects have been well-thought out, supervised and successful both as training in scientific methodology and increasing understanding about certain subjects. Unfortunately, many projects have not been. Some people have spent 2 or even 3 yr `studying' a subject in a totally unproductive way, often with little or no guidance. Not infrequently the person was not really interested in doing the research anyway but saw it as a fast track to a good consultancy.
Many universities until recently did not require projects to be discussed with a supervisor nor require submission of the title for approval in advance of doing the work. Some individuals got very little advice during the project and when writing up, as the MD was often considered an unsupervised degree, although this has now changed in most universities. Needless to say the value of unsupervised work was often poor, certainly for training in scientific methods and the results were often unpublishable. Even more structured projects with a named active supervisor were not always successful, as not all supervisors have been adequately trained in relevant scientific methods and in how to train someone else in research techniques. If the trainee has obtained a peer-reviewed grant to fund the research this should not occur, but the problem is not necessarily avoided, and in the past many MD research projects have been funded out of `soft' money from pharmaceutical company trials. Thus, the trainee has not always obtained useful training, a justified degree and worthwhile publications. Even if the person does not get publishable results, it is to be hoped that they will have learnt something useful from the process of research and writing up a thesis that will be of value in their future career. After all, most become practising rheumatologists who will have little time for research thereafter, although some will be more academically minded and continue active research in the clinic and/or laboratory themselves or through collaboration. However, all rheumatologists need to be able to assess the literature and to decide whether and how to apply research developments to their clinical practice. Some understanding of research methodology and statistics is essential to do this properly.
PhD
This has become increasingly favoured as the research degree for all academically minded trainees over the last 10 yr. It is, however, often looked on less favourably by non-academic consultants in district general hospitals (as they may see PhD graduates as rather threatening superspecialists). PhDs have always been supervised (although with varying success) and usually take 3 yr to complete (sometimes more to write up and submit) compared with the 2 yr usually taken for MD research projects. In general they are laboratory-based research projects, but more clinically based PhDs are on the increase. They are more likely to be funded by peer-reviewed grants, to provide more structured research training and to be more `complete' and original research projects than MDs (the latter probably explains why funding is now easier to obtain for PhD rather than MD projects). However, in the UK, unlike many European countries and the USA, there is no requirement for formal teaching and course work during the PhD in most universities. Although supervised, the PhD trainee is expected to develop their research in a more original and independent manner than for MDs. After completing the PhD they should be able to plan future research effectively and be in a position to obtain further grant funding.
As with MD projects, the success of a PhD training programme depends on the personality, ability and commitment of the individual, as well as that of the supervisor and others in the research institution or elsewhere, who act as collaborators and advisors. These factors are usually more important than the details of the research project. The problems often lie in the difficulty of deciding whether 3 yr dedicated research in a fairly specialized area is what the trainee wants and needs for their future career, and whether the trainee is going to be suitable for the research work and training. The amount of research experience prior to a planned PhD is often very limited and neither the trainee nor the trainer may be sure at the outset. Moving between a PhD and MD, or vice versa, has become increasingly difficult, although some universities require a qualifying MPhil (short research thesis) at the end of the first year before allowing someone to register for a PhD, as a way of ensuring that they have the relevant skills. The timing of the PhD in the career structure is debatable but may be critical for the individual (see below). The amount of `routine' clinical work should be limited to one session per week in most cases and is usually arranged with local rheumatologists, even when the research project is undertaken in a basic science laboratory (e.g. immunology or biochemistry). This is sufficient to maintain clinical skills and may allow some exposure to different types of clinical practice than the trainee has experienced previously. This may promote increased awareness of the important questions in clinical medicine that require integration of basic and clinical science to answer.
MSc
This is a more structured postgraduate degree with less emphasis on doing research. The courses are very variable, some generic to a variety of medical specialities and some more specific for rheumatology. The courses are often modular, allowing some choice of subject matter, and include formal teaching and some independent course work for the trainees. This may include short research projects or dissertations. MSc courses are often undertaken part-time and are usually equivalent to a 1 yr postgraduate degree course. The emphasis of many of the MSc courses is to provide some background in research methodology and application of statistics, as well as more traditional topic teaching in specific diseases or the provision of health services. Some are designed to supplement the new Calman training schemes and others are more for doctors from abroad than for British graduates. Many have been set up recently as the new Calman training schemes for rheumatology have not included time for research thesis work (MD or PhD), and it appears that many future rheumatologists will have gone from general medical training at senior house officer (SHO) level, to rheumatology specialist registrar (SpR) posts and then consultant posts without obtaining any postgraduate degrees. It is not clear when people who want to do research will do it (see below), but for some who are wondering whether or not to take `time out' from the `normal' scheme, this may provide an opportunity to assess whether they like and are suited to more detailed study and research than the standard hospital training schemes provide (alternatively many may decide this `on the job' by getting involved in research projects). For others who definitely do not want to do much research but do want more comprehensive training or an opportunity to be different (and appear `better trained' on their CV or at interviews), the MSc provides a mechanism for achieving this without departing from the normal training scheme. The value of the MSc schemes is very debatable and has yet to be evaluated (not that formal evaluation of MD or PhD training has been undertaken, and there is known to be considerable variation in the quantity and quality of both as there are no standards).
![]() |
So when should someone do a postgraduate degree, if ever? |
---|
![]() ![]() ![]() ![]() ![]() |
---|
Integrate with undergraduate medical studies
This has been proposed for PhDs only, particularly for candidates who look like potential high-flying academics of the future. Most universities operate a system of combined BSc with medical studies for selected candidates (all at Oxford and Cambridge) and this is used to provide some introduction to more detailed study and research than a normal medical degree provides. Some universities offer a PhD place to those that do well in their BSc but some have now introduced PhD research programmes directly into the medical undergraduate course for selected individuals.
Advantages.
Early introduction to detailed research study: 1. may get the person involved at an early stage and commit to an academic career; 2. may prevent them getting bored with standard medical curriculum and from leaving before they find their niche; and 3. will provide valuable training in research methodology whatever the later career path of the individual.
Disadvantages.
After general medical training: after SHO posts and before SpR training
This applies equally to MD or PhD (funded by a fellowship grant or departmental funds as in the past) and could be a time for a full-time MSc, if funding was available (but this is unlikely so savings would have to be used or a fellowship obtained for study abroad).
Advantages.
Disadvantages.
As `time out' during SpR training
This applies predominantly to MD or PhD programmes; MSc studies are usually done in parallel with SpR posts and so much of this discussion is not relevant to MSc programmes.
Advantages.
Disadvantages.
After SpR training has been completed
This particularly applies to MD/PhD programmes and some comments apply to MSc courses.
Advantages.
Disadvantages.
![]() |
Conclusion |
---|
![]() ![]() ![]() ![]() ![]() |
---|
Submitted 25 February 1999;
revised version accepted 23 April 1999.