During the Program
The key to M.D./Ph.D. education, especially at programs that are less organized, is to take an active role. Failure to maintain responsibility for completion of requirements toward graduation will only increase the program duration. In our opinion (though it may contrast with some educators or current students), seven or eight years is long enough. Once you start the program, it is up to you to see that your education progresses in a timely fashion with as much (or as little) integration between the medical and graduate curricula as possible. While some program directors tend to be more forceful than others in terms of laying down the law, no one will be there to hold your hand at every step of the way. Therefore, you have to show the same, if not more, initiative and motivation that you demonstrated during the application process.
A good way to ensure a healthy progression through an M.D./Ph.D. program is to maintain contact with the director(s) and administrator(s). In other words, kiss up to the people in charge. Ok, maybe that is a little excessive. Rather, you should communicate with the director at least once a month and the administrator more often. In some programs, there are seminars, lunches, dinners, or other chances to meet formally. We recommend that you seize these opportunities, if not for the prospect of meaningful discussion of the pertinent issues relating to your education and career goals with people who have considerable experience, then at least for the free food and drinks. Stipend, M.D./Ph.D. prestige, and all, you still are a starving student! Alternatively, you can make appointments or just drop by informally. Although usually very busy, most administrators are more than happy to take a moment and chill with an M.D./Ph.D. student.
We recommend that you start looking for a thesis laboratory early on in your M.D./Ph.D. career. Program administrators frequently will encourage (or even require) you to participate in one or more laboratory rotations during the summers before or after your first year of medical school. Early rotations will allow you to test the waters of the labs in which you are interested. It is to your benefit to decide on a lab as soon as possible, so that you may get started on your thesis project and expedite the Ph.D. phase of your education. Of course, a decision on a thesis advisor should be made with great care, as this is the person that will make or break you in terms of science. Some labs are gigantic empires in which a student may be nothing more than a mere pawn. Others may harbor more nurturing environments for M.D./Ph.D. students. You may have to experience several to determine what will best suit your learning style (i.e. large lab with many resources, small lab with lots of one-on-one interaction, etc). The earlier you can make the decision, the better.
One thing that commonly happens in M.D./Ph.D. programs is that students become lost in the laboratory after the first two medical school years, especially if they haven’t decided on a thesis lab. If you don’t know what you want, don’t expect anyone else to know the answer. Along the lines of the previous self-motivation discussion, we recommend that you be completely up-front concerning your goals and ambitions throughout the program and especially in the laboratory. Some advisors are notorious for keeping students around a long time. As an M.D./Ph.D. student, you don’t want to be hanging around the lab for years, with no end in sight. You always want to keep a “heads-up” on the horizon so that you don’t lose sight of ultimate career goals. This is especially true if you plan to go on to do a medical residency and postdoctoral fellowship. You will have ample time as a fellow or principal investigator to research and explore the questions in which you are most interested. It is important to remind your thesis advisor that you are in the training stage and when you feel you are ready to proceed (and have done the appropriate work toward the thesis), you must do so. Some programs have time tracking procedures in place. For example, UCSF requires a meeting with the thesis advisor every six months, with signed reports stating progress, as well as letters sent after 2.5 and 3.5 years to advisors with response required. These steps help ensure timely progress on the thesis.
After struggling through the long admissions process, perhaps you wish never to see or hear of it again. That is completely within your rights. However, we suggest that it is to your advantage to see how the process works from the inside. Therefore, you might try joining the admissions committee at your school (if they allow students on it). This will allow you to interview and evaluate applicants, interact with faculty and other students on the committee, and perhaps may generate some sympathy for the people on the other side. Do it for yourself. Do it for all the other potential M.D./Ph.D. applicants out there. At least do it for the free food!
Despite the above descriptions of how you can take charge and power through your education, we definitely don’t recommend giving yourself an ulcer. Stop and smell the roses once in a while. Seven to eight years spent in total misery will not do well for your hair color or facial wrinkles. Work hard, but also play hard. Take trips, go places, and enjoy time with friends, students, and significant others. Become part of the community—medical schools have various service projects in which you can make a difference. At many universities and in most cities, there are bountiful opportunities for theatrical, musical, artistic, and cultural enrichment. If that doesn’t float your boat, you could always go for the local bars or clubs. Don’t sit in the classroom or lab all day—get outdoors! Many programs (such as ours) are only a few hours away from natural wonders. Go hiking, camping, rock climbing, skiing, or snowboarding. Put that stipend money to some good use. We don’t have to tell you how to have fun… as a certain shoemaker once said… JUST DO IT!