In view of the CME role of tracking dual degree programs, Dr. LaManna
invited Dr. Nilson to present an overview of the Medical Scientist Training Program in
hopes that we could determine ways in which the CME might be of help to the M.S.T.P.
Prior to the CME meeting, Dr. Nilsons PowerPoint slides were
distributed to members and participants to follow along with the presentation. Dr. Nilson elaborated on the following areas: Program Mission, Program Features, Typical Student
Accomplishment, New Students, 1999 Ph.D.s., 1999 Program Graduates, and 2000 Program
The CWRU M.S.T.P. has been NIH-funded for over 20 years. It received an outstanding review at its last site
visit. It is currently funded for 30 slots. Dr. Nilson sits on the Study Section evaluating
all the M.S.T.P. programs and has participated in numerous site visits. These experiences have served to reaffirm his
confidence and pride in our own program. The
program mission is to endow students with the skills necessary for a lifetime of
scholarly accomplishment in medical science. The
M.S.T.P. student chooses to spend an extra four years acquiring a Ph.D. along with earning
Particular attention is paid to getting quality mentorsthe
emphasis is on the quality of each students personal experience. The Five-Deep Mentorship Plan affords students
more than one mentor. Five different mentors
are assigned at different times during the trainees tenure in the program. The number of M.S.T.P. students exerts a limiting
factor on finding a sufficient amount of quality mentors.
Students tend to select from a restricted group of mentors. The M.S.T.P. has been expanding its training base
to include faculty in clinical departments.
The New Clinical Tutorial
was the brainchild of M.S.T.P. student Brian Lestini who, along with the help
of Patient-Based Program Coordinator, Dr. Jay Wish, and Dr. Clark Distelhorst, M.S.T.P.
Co-Director, got it implemented. Leaving
medical school to enter the Ph.D. program and exiting the Ph.D. program to enter the wards
pose difficult transitions. Opting for the
New Clinical tutorial, the Ph.D. student is able to retain some contact with physicians by
working one half-day per week in a clinic during his/her last two years in the lab. The two years of the Clinical Tutorial are
recognized as equivalent to a one-month Type B elective credit.
typical student accomplishments, M.S.T.P.
students have taken on leadership roles in CWRU curriculum redesign and have won research
recognition via the annual Lepow Research Day for Medical Students and at national
meetings. M.S.T.P. students must have at
least one first-authored publication; many have more.
Over the last six years, students graduated with 3.0 first-authored
publications and 5.8 co-authored papers. Greater
than 90% of the M.S.T.P. students achieve their first choice in the match. Approximately 80% of M.S.T.P. graduates remain in
academic medicine; a few have started their own biotech firms. Because of their commitment to research,
most M.S.T.P. graduates select academic positions that afford either 80% research/20%
clinical or the reverse.
The topic of recruitment
was discussed. The M.S.T.P. aims to recruit
10 students annually. Last year, they got 17
students. On the down side,
having such a large group means that 1) more money is needed, and 2) compensating for the
lack of quality mentors to support that many students.
When asked what unique features impressed him during his numerous site
visits to other universities, Dr. Nilson mentioned the following innovations: 1) The University of Chicago uses the pre-summer
for M.S.T.P. students to complete all their gross anatomy, which proves to be a great
bonding experience and frees up more time for other graduate activities. 2) Having one person specifically charged with
helping the M.S.T.P.s get ready to return to the wards is another valuable mechanism. 3) Washington University, which has the premier
M.S.T.P. program in the country, offers a special post-graduate M.D./Ph.D. program for residencies. CWRU
has nothing designed for M.D./Ph.D. graduates in their residencies. We need to do something to enhance training for
the M.S.T.P. graduates and M.D.s with an affinity to do research. With regard to our
strengths, Dr. Nilson pointed out that CWRU is still the leader in integrating basic and
clinical education. When asked to identify detractors to recruiting M.S.T.P.
candidates at CWRU, Dr. Nilson mentioned the need to elevate our graduate programthere are not
enough Ph.D.s and they are not visible enough. He
favors more medical students taking graduate courses and more graduate students taking
medical courses. Dr. Nilson explained that
NIH rankings do not affect our recruiting. However,
the U.S. News and World Report seems to be a
better indicator. We are ranked #17 or 18. Often, students who do not get offers elsewhere
come here. Another negative factor in
attracting students is our physical facilities; we are way behind our competitors,
particularly with respect to education buildings. However,
Dr. Nilson emphasized two factors that attract
students here: 1) our openness, and 2)
our commitment to medical education.
Dr. Wile began by providing a brief history about the roles that the NBME Part I
and Part II examinations took on, starting with
implementation of the different, innovative 1952 Case Western Reserve University
curriculum. The Class of 1956 was required to
the NBME Part I examination at the end of
their third year in June 1955. Senior
students were required to take the NBME
Part II examination in the spring of 1956. Scores
were reported but were not used for promotion or graduation.
With the 1968 curriculum revision, the first two years were basic
science and the third year consisted of five clerkships.
The NBME Part I took on the
official role of the second year comprehensive examination.
Instead of taking the NBME Part II at the end of the fourth year as before,
the NBME Part II was now taken in September
of the fourth year and used to guide students in elective choices.
1975, the NBME Part I was no longer required,
and a CWRU faculty-developed Phase 2 (second year) comprehensive examination became a
requirement for advancement to the third year. Effective
with the Class of 1978, a passing score on the NBME
Part II became a graduation requirement. However,
passing the NBME Part II as a graduation requirement was not always enforced. At this time, most students were taking the FLEX examinations for
licensure (instead of the NBME Parts I, II, and III).
September 1993 marked the last complete FLEX offering to obtain
With the implementation of the USMLE Step 1
in 1992, passage of the USMLE Step 1 became a CWRU requirement, effective with the Class
of 1994. The USMLE Steps 1, 2, and 3 now
became the only
way to obtain licensure. Passage of the USMLE Step 2
became a prerequisite for graduation. At its
November 10, 1994 meeting, the CME reaffirmed a passing score on the USMLE Step 2 as a
requirement for graduation. The Committee on
Students has supported this decision.
Dr. Wile distributed two separate charts providing data for the past
ten years on CWRU first-time test-takers performance on the USMLE Step 1 and the
USMLE Step 2. Each chart can be read
chronologically from right to left. Note
that the NBME
Comprehensive Part I in 1991 served as a transitional exam preceding the USMLE Step 1
in 1992. The NBME
Comprehensive Part II during the 1991-1992 academic year served as a transitional
exam to the USMLE Step 2 beginning during the 1992-1993 academic year.
In 1992, the first time that the USMLE Step 1 was a requirement at CWRU, only 74% of
first-time test-takers in the Class of 1994 passed the exam. These students also had to deal with the
requirement of passing our own second year comprehensive exam. The following year, we provided students with
extra help and review sessions, and the students put together a syllabus. By 1994, the Class of 1996 scored above the
national mean. The chart shows a trend
indicating that the national percentage of first-time test-takers passing the USMLE Step 1
has been increasing.
The USMLE Step 1 was a
paper/pencil exam administered in June and September from 1992-1995 and in June and
October from 1996 to 1998. The electronic format replaced the paper/pencil exam
in 1999, and the electronic version is
available to students all year. With the
paper/pencil format, everyone answered the same questions. Also, the exam was administered at a CWRU test
site. The introduction of the online format
in 1999 produced a one-day exam consisting of eight one-hour blocks. There are 350 questions in the electronic exam,
which is administered at Prometric Sylvan Learning Centers, an unfamiliar environment. Every single online exam is different. While students can take the USMLE Step 1
electronic version anytime, the Registrar will only sign the application to take the exam
if the examination is scheduled after Year II classes have ended (May 22, 2001 for the
2000-2001 academic year). However, students
must take the USMLE Step 1 before July 1, which marks the start of the clerkships. Students
must pass the USMLE Step 1 to stay in the clerkships.
Data reveal that students who remain with the class they start with for two years
and take the USMLE Step 1 after two years have higher passing rates on the USMLE
Step 1 than those students who leave (repeat, LOA) and rejoin another class.
Dr. Wile pointed out that there is a very low
correlation between the MCAT and USMLE Step 1 scores.
There is a higher correlation between
the USMLE Step 1 and the CWRU Year I Comprehensive Examination.
Electronic administration of the USMLE Step 2 also began in 1999. The Class of 2000
scored slightly below the national mean. The
chart prepared by Dr. Wile attests to the generally favorable percentage of CWRU
first-time examinees passing the USMLE Step 2 compared with the national average.
If a student fails, he/she can apply to re-take the exam 60 days
after taking the failed exam. However, it
would be unusual to re-take the exam within 60 days.
A student can only take the USMLE Step 1 or Step 2 three times in one year. There is concern that more CWRU Year IV students
have not taken the Step 2 yet, since it is a graduation requirement. The USMLE Step 2 score is not included in
the Deans Letter. However, this
information is included in the residency application when released by the individual