Physician, Educate Thyself

Double exposure: Students in the University’s Medical Scholars program work toward both a medical degree and a doctorate in another field. From left: Katherine Omueti Ayoade, Claudia Winograd, Loren Zech and John Selby.
At Illinois, students inject the study of medicine with other disciplines.

The bioengineer wants to develop a cure for blistering skin disease, and the neuroscience student believes her understanding of how zebra finches learn songs could help combat degenerative neurological ailments. The biochemist dreams of applying her knowledge of the molecular foundation of the immune system to help fight infectious disease. The philosopher hopes to play an important role in teaching medical ethics and even guiding policy.

Each of these students is a University of Illinois Medical Scholar, earning both a medical degree and a doctorate in a field of basic research. Achieving even one of these degrees is hard enough, but to study for both simultaneously? These are students who dream of being physician/scientists, driven by a rare combination of intellectual curiosity and a desire to make a difference in other people’s lives. They can fulfill that dream in the University of Illinois Medical Scholars Program.

Take John Selby ’99 ENG, MS ’01 ENG, PHD ’07 ENG, for example. Selby, whose three Illinois degrees are all in mechanical engineering, is now enrolled in the UI College of Medicine. He says that, except for a joint program between Harvard University and the Massachusetts Institute of Technology, at the time of his enrollment Illinois was the only institution that offered such a combination of studies.

Selby sees his M.D./Ph.D. program as the interface between classic engineering, which takes a reductionist view, where data is broken down to less complex equivalents, and medicine, which is part science and part art.

“I want to do work in an area that is not traditional medicine and not traditional engineering,” he says.

Selby has become intrigued at how cells handle various forces exerted upon them. When he learned of blistering skin disease, in which skin cells cannot stand any kind of friction and babies are born completely blistered as a result of labor, he knew he could use microfabrication techniques to ask and answer basic science questions about how cells handle tension from a mechanical perspective rather than a biological one.

“I fell in love with the idea of doing research, the idea that there is something there is no answer for yet,” says the Quincy native. “New insight is always a good thing.”

Selby also appreciates that this inquisitive process will ultimately help people in medical need.

Medicine + 35 Other Choices
Formal programs that offer both doctoral and medical degrees (known generally as M.D./Ph.D. programs) are not new, but the program at Illinois, which was established more than 30 years ago, is among the oldest and largest in the country. In addition, it is the only school to offer doctoral degrees in one of 35 disciplines, from history or philosophy to engineering or neuroscience. Illinois medical students may also combine their degrees with a juris doctorate or MBA. The breadth of available offerings is one reason Medical Scholars may elect to study medicine and their additional field of interest at the Urbana campus, although all Illinois medical students apply to and are accepted by the University of Illinois at Chicago’s College of Medicine.

As of last fall, more than half of MSP students were enrolled in disciplines traditionally offered in M.D./Ph.D. programs (such as immunology or pharmacology), but 27 percent are in sciences not traditionally offered in other programs, and 16 percent are enrolled in disciplines within the humanities and social sciences, such as community health, communications, history, kinesiology, philosophy or agricultural and consumer economics.

This diversity benefits everyone, says Jim Slauch, a UI microbiology professor who directs the MSP program. “The students learn from each other as much as they do from the faculty,” he says. “You may have a biochemistry Ph.D., but that person next to you has one in neuroscience, and next to them is an engineering or history Ph.D.”

Unlike many Medical Scholars at Illinois, Claudia Winograd had not originally intended to pursue medicine.

“I had always planned on a Ph.D.,” says Winograd, who majored in biology and Spanish and minored in dance. “I wanted to do research, not medicine.”

But as she grew interested in degenerative disorders of the nervous system, Winograd realized she needed to understand how the entire human system worked, both in sickness and in health. Her courses involve medicine and neuroscience, with her research focusing on the molecular basis for how zebra finches learn specific tunes (which can be related to the effect of human diseases on learning and neural connections). On top of that, Winograd became involved in the HeRMES clinic, a free community health center run by MSP students (see sidebar). Like Selby, she gets a different kind of satisfaction in this clinic than she does in the lab.

‘I Wanted a Deeper Understanding’
These physician/scientists can and do bring fresh perspectives from a wide range of fields to address issues of access and cost containment as well as new, more effective, efficient and affordable health care options. For this reason and many more, says Slauch, “People who run residency programs like M.D./Ph.D.s. They want M.D./Ph.D.s on their staff and work hard to attract them and keep them as faculty members.”

Katherine Omueti Ayoade ’00 LAS, PHD ’07 LAS, whose Illinois doctorate is in biochemistry, also finds satisfaction both in the lab and in the clinic. After earning a bachelor’s degree in chemical engineering from Illinois and spending two years at Proctor & Gamble, she yearned to return to the lab. There, she wanted to pursue her longtime interest in pathogenesis and treatment of infectious diseases, like malaria, which is endemic in Nigeria, where she grew up. Ayoade’s thinking was that, while medical doctors can and do conduct research, having a doctorate in an area of the biological sciences would give her the grounding she hopes to apply in medicine. “I wanted a deeper understanding,” she says. “I need to know on a molecular level what is going on.”

As Ayoade describes her work, which elucidates some of the molecular mechanisms involved in human immune responses, the animation in her face makes it clear where her passion lies.

“I fell in love with immunology,” she says of her experience in the lab. “A physician/scientist sees something unique or addresses a given problem from a different direction [than does a traditional medical doctor],” she says. She envisions using the knowledge and tools she learned in the laboratory to investigate and possibly develop new treatments for inflammatory and infectious diseases in dermatology, her chosen medical specialty.

A Rich Environment
One of the most unusual aspects of the Illinois program, says Brad Schwartz ’74 LAS, dean of the College of Medicine, is that MSP students are the majority of medical students at Urbana-Champaign. Most M.D./Ph.D. programs, on the other hand, comprise only between 5 percent to 10 percent of a given medical school class.

“The MSP is defined by the students,” agrees Ramji R. Rajendran, PHD ’03 LAS, MD ’05 (uic), one of the program’s graduates. “They really make the program. They are interested in learning new things, and it provides for a very rich environment. It made me a better physician, scientist, person. It’s a huge intangible.

“Many universities segregate their professional schools from the broader intellectual community, whereas we are located right smack dab in the heart of this great University,” he says.

“By having so many people who have earned dual degrees, you change the intellectual environment, and it really is a remarkable thing,” Schwartz says. “Simply put, when you are surrounded by a bunch of Ph.D.s, people tend to hold each other to higher standards.

Loren Zech, AM ’00 LAS, has embraced that intellectual community by working on a doctorate in philosophy at Illinois, as well as a medical degree. Zech is adept at asking the hard questions – and the deceptively simple ones – and then teasing apart the nuances to get at the heart of the issue. As a graduate student, he became curious about the line between medically therapeutic and non-medical treatments. Fundamentally, Zech realized, he had to ask, “What is disease? Can we define it? And if we can, does that help us determine when a treatment is medically appropriate and when it is extra-therapeutic?”

“Science is not supposed to merely reflect the cultural opinions and norms of our times, but all too often newly proposed models do contain bias and are influenced by prevailing cultural belief,” Zech says. “It can take time to separate that bias from accurate models.”

In order to define disease, Zech decided to first look at what is “normal.” He determined three conceptions, the first being the theoretical norm. The key here, Zech says, is that the more controversial or poorly worked out the model, the less reliable this sense of normal becomes. Then there is the statistical sense of normal, which is derived from measuring hard data. Finally, there is the conventional, culturally relative definition of normal, i.e., it is “normal” for women to have long hair and men to have short hair. Needless to say, cultural norms shift over time.

And so it is when contradictions arise between the first and last definitions of “normal” that the line between disease and health becomes blurry and, sometimes, battle lines are drawn. Is attention-deficit hyperactivity disorder a disease, or are parents and teachers simply wanting kids to calm down? As neuroscientists learn more about how the brain works, the answer with regard to ADHD has become clearer (studies show the brains of children with ADHD differ from those of their peers), but questions regarding other conditions remain.

“Science moves slowly as it builds explanatory models,” says Zech. “Working out the kinks can take decades. Science can’t answer these questions on a policy time scale.”

He finds wrestling with this kind of ambiguity deeply satisfying and can easily envision himself as a full-time clinician at an academic hospital where he might teach and consult on medical ethics, especially as they relate to policy.

Habits of Graduate Education
The program at Illinois is also structured to take maximum advantage of the graduate school experience, says Schwartz. In most programs, students take the first two years of medical school (which encompasses basic sciences) before doing their graduate research and earning a doctorate; then, they return for the last two years of medical school. At Illinois, students begin with the graduate program, which alone can take six to seven years to complete.

“We want our students to acquire the habits you get in graduate education – in which you need to stop, consider what you’re looking at, question it, and be able to drill down where necessary – as their core approach to acquiring and using new knowledge,” says Schwartz. “The other thing is, in graduate education you take established information and use it as a foundation to now project forward and discover new things. We think that is something
students should learn early.”

Peter Rohloff, PHD ’03 VMS, MD ’07 (uic), who has a doctorate in parasitology, embodies this credo. Rohloff founded Wuqu’ Kawoq, a non-governmental organization that delivers health care in native languages to Mayans living in Guatemala. Although almost 75 percent of Guatemala’s population is made up of Mayans who speak one of 20 indigenous languages, health care is provided to them only in Spanish.

It wasn’t until Rohloff had completed his doctorate and was “muddling through” medical school that he first visited Guatemala and became interested in social justice and indigenous rights. The enormous flexibility of the Illinois program allowed Rohloff to take as much time as he needed to pursue his passion.

“My status as an MSP student helped me do things a traditional medical student would not necessarily be allowed to do and played a big role in getting me to where I am now,” he says.

Rohloff regards Illinois’ science resources as outstanding and its access to technology and equipment unparalleled. “Getting an M.D./Ph.D. at Illinois was much more collaborative than one might find at other institutions,” he says.

And the strong research base that characterizes the Illinois Medical Scholars Program will support myriad physician/scientists’ efforts, in both tangible and intangible ways. Whatever the direction selected, those efforts, ultimately, are in service of individual patients. Physician/scientists never lose sight of that.

“In the end, medicine puts a very human face on what you are doing,” says Selby, who has blended engineering with medicine. “Encouraging patients and making them feel better is a totally different kind of reward you never get in the lab.”