Mellon Foundation's Program Triples M.D.-Ph.D. Students' Options

While an undergraduate at Princeton University, Darren Orbach found himself faced with a dilemma. He had always envisioned being a physician, yet at Princeton he had also become fascinated by theories about the mind, which led him to an interest in investigating the workings of the brain's visual cortex. But how was he to pursue a career in basic research and be a physician, too? Like many aspiring researchers who feel a pull in the clinical direction, Orbach chose to enter a joint M.D.-Ph.D. program, applying to Cornell University. Typically, students accepted into an M.D.-Ph.D. program are committed from the start to one particular institution for their doctoral work. But thanks to a $1 million grant from the New York-based Andrew W. Mellon Foundation to Cornell, Orbach has a choice of three institutions, in essence tripling the advantages of an M.D.-Ph.D. program. Using the Mellon funds, Cornell teamed up with Rockefeller University and the Sloan-Kettering Institute for Cancer Research in March of this year to establish a course of study known as the Tri-institutional Medical Scientist Training Program. All three institutions are contiguously located on York Avenue on Manhattan's East Side. The new program, which supports three M.D.-Ph.D. students a year for each of the next six years, provides not only a wide range of resources for the students, but also time for them to decide how to make the best use of those resources. Orbach and the other Mellon fellows can take two years of general medical studies and two summers of laboratory experience--before the first and second years of med school--at any of the three institutions to develop their interests and ideas before deciding where they will spend the next three years pursuing their Ph.D.'s. When the thesis work is completed, all M.D.-Ph.D. students return to Cornell Medical College for one year of clinical clerkships. "Basically, what [the new program] gives me is more options," says Orbach. Although he is currently planning to do his thesis research in one of two labs investigating the visual cortex at Rockefeller University, "it's always nice in the back of my mind to know that I'm not committed," he says. "It keeps open the possibility [that] if Cornell were to get some superstar in my field, I'd be able to work with that person." The considerable resources of the medical complex formed by the three research institutions and Cornell Medical College are complemented by four hospitals--the Rockefeller University Hospital, the Memorial Sloan-Kettering Cancer Center, and the New York Hospital and the Hospital for Special Surgery, both associated with Cornell. The tri-institutional program promotes interaction among all the research and clinical components of the medical complex, which benefits not only the students, but also the institutions themselves, administrators say. "For example," says Bernard L. Horecker, dean of the Cornell University Graduate School of Medical Sciences, "there may be some new instrumentation that is available at a laboratory at one institution and not at another... And we're already generating new courses that are taught by faculty from all three institutions, so there's more interaction at that level, too." He adds that the program will "permit us eventually to unify all of our information-gathering facilities." Mary Rifkin, associate dean of graduate studies at Rockefeller University, believes that the M.D.-Ph.D. students themselves form an important means of interaction among the institutions. "The students have a terrific network," she says. "And I think it brings the institutions closer." The program represents somewhat of an alteration in policy for the Mellon Foundation, a nonprofit corporation that makes grants to institutions supporting higher education, population studies, the arts, conservation and the environment, and public affairs. In 1989, the foundation gave $32 million to higher education, out of a total of $71 million it awarded. Although the foundation has provided significant funds over the years to support teaching and research opportunities for young faculty members in the biomedical sciences, the foundation does not currently focus on medical research and is, in fact, cutting back on its medical research grants. "We simply don't have enough money to make a difference in that field," explains William Robertson, program director at Mellon. But because the tri-institutional proposal "seemed like such a reasonable opportunity," Robertson says, the foundation decided to make an exception and provide funds to set up the program. "We do make some exceptions to our usual program guidelines for New York institutions," Robertson says. "And here we had three New York institutions, it was linked to a previous program, and it seemed like a good idea. So we swallowed hard and said, `Okay, we'll [fund] one more [medical research program].'" The Mellon program extends an idea that has been at work at Cornell's New York City medical campus, Rockefeller, and Sloan-Kettering since the early 1970s. A joint M.D.-Ph.D. program was established in 1972, allowing students to pursue a medical degree at Cornell Medical College and a Ph.D. at Rockefeller University. First funded by the National Institutes of Health in l974 and renewed continuously since then, the "Cornell-Rockefeller" program provides support for five students a year. In 1981, Cornell University and the Sloan-Kettering Institute for Cancer Research cooperated to create a similar program, but one in which students receive an M.D. from the Cornell Medical College and a doctorate from the Cornell Graduate School of Medical Sciences (the "Cornell-Cornell" program). Sloan-Kettering scientists are on the faculty at the Cornell graduate school. A total of six students this year began the Cornell-Cornell M.D.-Ph.D. program (which includes the faculty and resources of Sloan-Kettering). Until recently, the Cornell graduate school had two divisions. An M.D.-Ph.D. student accepted into Sloan-Kettering was committed to doing his thesis research on that campus, while students admitted by the Cornell graduate school had to work at Cornell labs. But two years ago, the two divisions were unified. Now students admitted by either institution can work on either campus for their doctoral research. Sloan-Kettering continues to award its Ph.D.'s through the Cornell graduate school, as it always has. Funded over the years by the institutions themselves, the program has received support from NIH for two students a year since July 1990. Horecker explains that the new program funded by Mellon takes the concept of flexibility represented by the unification of the Cornell graduate school and spreads it to all three research institutions, including Rockefeller. Now, students can choose a primary lab at one school and a secondary lab at another. The tri-institutional program is expected to pave the way for a future program that will fully integrate all the M.D.-Ph.D. programs at the three institutions. According to Robertson, the $1 million from Mellon gives Cornell, Rockefeller, and Sloan-Kettering administrators "the chance to start the program and convince NIH that this is the way NIH ought to do it...and whatever other funders they might want to attract." The three Mellon fellows increase to 13 the total number of M.D.-Ph.D. students entering this year in all three programs at the three institutions. One reason Orbach wants both an M.D. and a Ph.D. is that he sees the gap closing between basic research and clinical application in his area of interest. "Right now neuroscience is still pretty far from neurology, at least the direction I'm going in, but the two are coming closer and closer together all the time," says Orbach, who hopes one day to discover neurobiological correlates for the theory of neural networks, a computational theory of learning and memory. Could Orbach get away with only a medical degree and still be a top-notch researcher? "There is no way you can come out of medical school and do good science," says Rifkin. Horecker agrees. "The M.D. doesn't really include the kind of rigorous training that we feel is necessary for high-quality laboratory research," he says. "There are certain things you learn in the graduate school that are not part of the medical school curriculum." On the other hand, the medical degree presents certain advantages to the researcher. "A student who goes only for the Ph.D. may never be aware of the possible, potential applications of the work they're involved in," says Horecker, adding that a researcher with an M.D. can take projects to the clinic himself. "Almost everyone I've spoken to from different faculties at different places has told me that having the M.D. will open doors in terms of getting a position," says Orbach. Orbach did not actually make an application to the tri-institutional M.D.-Ph.D. program. It was not advertised this year because word of the funding by Mellon did not arrive until after the acceptances for the other M.D.-Ph.D. programs had been sent out. The three Mellon fellows were selected from the pool of students who were acceptable to both the Cornell-Rockefeller and the Cornell-Cornell programs. Orbach had applied to both. When asked by program officials if he'd like to switch to the tri-institutional program, Orbach readily agreed. "The program has been terrific so far," he says. "People seem to be interested in having M.D.-Ph.D.'s around, and everyone's willing to talk about their research. It's been a congenial atmosphere." For more information about the Tri-institutional Medical Scientist Training Program, write to Cornell University Medical College Admissions Office, Room C118, 1300 York Ave., New York, N.Y. 10021. Bruce Silver is a freelance writer based in Philadelphia.

Mellon Foundation's Program Triples M.D.-Ph.D. Students' Options

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