Académie royale de Médecine de Belgique

|

Résumé de Emile Boulpaep

MEDICAL RESEARCH BY PHYSICIAN-SCIENTISTS

par Emile BOULPAEP (Department of Cellular and Molecular Physiology, Yale School of Medicine, USA), membre étranger.     

Physician-scientists occupy the interface between the biological/physical sciences and clinical practice. They perform several types of research: basic research, disease-oriented research, patient-oriented research, population-oriented research, and prevention-oriented research. The physician-scientist fills the gap between the art and the science of medicine.

Physician-scientists bring a unique perspective to medical research that is not provided by PhD scientists without clinical training/ experience. The participation of physicians is essential to bring information from bedside to bench and conversely from bench to bedside. Such two-way exchange requires a practitioner who is well-acquainted with both the clinical picture and the advanced biology of disease at the cellular and molecular level. Medical algorithms in healthcare treatment drawn from big outcome data are increasingly dictating medical decision making. Health-related applications of artificial intelligence are forthcoming and may reduce the physician to a technical intermediary. Only physicians familiar with statistics and computer science can critically evaluate the gradually imposed “rules” of health care.

The pool of physician-scientists is dwindling among young MDs since about 30 years such that the concept of “the vanishing physician-scientist” has been coined in the medical literature. Barriers to engage in a physician-scientist career can be personal, related to the medical curriculum, or institutional. Corrective measures, e.g. by the National Institutes of Health in the U.S. have not adequately remediated the dearth of this special class of physicians.

Persuading medical students, residents, clinical fellows to do research is often an exercise of too little too late. We develop the thesis that early exposure to research is the essential condition to promote the making of physician-scientists. Using the framework of U.S. educational levels we consider the specific set of circumstances that lead to participation in medical research at each of the following stages: the Bachelor-Student as researcher, the Post-Bac Student as researcher, the MD Student as researcher, the MD/PhD Student as researcher, and the MD postgraduate as researcher. The current medical curricula in Europe as reformed along the Bologna agreements are not conducive for young medical students to find their destiny in biomedical research.