History of the NACST

The 1990s were a period of major changes in the evolution of MD-PhD training and the MSTP. Lee van Lenten, M.D., retired as NIH Program Director for the MSTP in 1995; he was succeeded by Bert I. Shapiro, Ph.D., who served until 2011. During his tenure, Dr. Shapiro served as advisor and mentor to numerous Program Directors and had input on many of the developments summarized below.

The major changes grew out of the Annual National MD-PhD Student Conferences in Aspen, CO, which since 1986 had been organized by the University of Colorado MSTP to create a forum where students from MD-PhD Programs across the US could present research and network. As the students returned home, they were aware of developments in other programs — more so than many Directors — which motivated an increasing number of Directors to attend the Student Meetings to monitor how their students compared and to exchange ideas about best practices.

By 1994, so many Directors attended the Student Meeting that Peggy Neville and Arthur Gutierrez-Hartmann decided to host a separate Directors' Meeting in 1995 for more extended discussions. The meeting was successful, and George Abraham (Director of the University of Rochester MSTP) sent out an invitation encouraging all Program Directors to attend the 1996 Directors' Meeting. Several dozen directors accepted and voted to form the National Association of MD-PhD Program Directors. This decision was affirmed in 1997, when Paul A. Insel (Director of the UC San Diego MSTP) was chosen as the Association's first president.

Over the next five years, the number of participating programs grew from about 35 to about 70. The driving force was a common interest in training physician-scientists — exchanging information regarding recruitment, admissions, curriculum, programmatic activities, career counseling, and outcomes. Meetings continued to be organized by the Colorado MSTP, where Dr. Gutierrez-Hartmann and Ms. Terri Wood worked with a dedicated Program Committee of Directors and Administrators from other programs.

Beginning in 1998, the Program Administrators began organizing their own meetings — to network and run workshops covering the practical aspects of effective MD-PhD program management. These workshops established the tradition that Bert Shapiro and Marcia L. Hahn (NIGMS Grants Management Analyst) became regular annual presenters: Dr. Shapiro summarized the state of NIH and NIGMS research training; Ms. Hahn conducted tutorials on preparing MSTP applications. Though the number of funded programs increased only modestly (from 33 in 1996 to 39 in 2005), the application process became demystified and expectations became more explicit.

At meetings, Administrators also compiled the matriculation database, which enabled all programs to track where their accepted applicants enrolled — and thus evaluate their admissions and recruiting strategies. Administrators were also instrumental in developing listservs for effective year-round communication among programs, especially during the final weeks of admissions season. Recognizing their growing importance, the Association was renamed the National Association of MD-PhD Programs in 2003.

The Association was a volunteer-driven organization; individual Directors or Administrators spearheaded initiatives deemed important to the community. The first such initiative — collecting data on MD-PhD student performance on the USMLE to petition for relaxation of the Seven-Year Rule — was undertaken by Olaf S. Andersen (Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MSTP) and Paul Insel. The petition was successful, though the relaxation applied only to students pursuing thesis research in the biomedical sciences. Many other important issues — a common MD-PhD application, Traffic Rules for admissions — were beyond the Association's reach due to its voluntary structure.

As the Association grew, the limitations of its structure became increasingly apparent. Though it received some administrative support from AAMC through David Korn, M.D. (Senior Vice President for Biomedical & Health Science Research), it faced two major challenges: lack of recognition as the principal organization with expertise in MD-PhD training, and lack of sufficient infrastructure to undertake key initiatives, including organizing annual meetings as membership grew.

These limitations became clearly visible at the 2003 meeting. Soon after, David Korn proposed that the Association establish closer ties with AAMC — possibly becoming an "entity" within AAMC. A group of Directors, led by Olaf S. Andersen, met with Korn and AAMC staff to discuss options. Though there were concerns about loss of independence, the advantages were compelling: increased administrative support, an AMCAS MD-PhD application enabling better data collection on applicants, and access to AAMC databases for national outcomes studies.

The result: the Association was mapped onto a new MD-PhD Section within the AAMC Group on Research Education and Training (GREAT). The Association would continue to exist independently, allowing it to pursue initiatives that might be difficult as an AAMC entity. The Section was approved at the GREAT Group's 2004 Annual Meeting; its inaugural meeting took place in 2005. The Section's first accomplishment was the long-sought common MD-PhD application on AMCAS — completed in time for the 2005–06 admissions cycle, driven by Nancy Hall (University of Oklahoma) and Brian Sullivan (Washington University). Joint Traffic Rules for admissions were established for the 2009–2010 cycle.

The GREAT Group MD-PhD Section and the National Association of MD-PhD Programs continue to coexist and synergize. The Section and Association share a joint leadership structure: the Section Steering Committee Chair also serves as the Association President, with elections coordinated by the AAMC. This arrangement offers maximum flexibility — the Section uses AAMC programming and resources while the Association takes up matters of training advocacy unique to MD-PhD programs. The community meets in even years together with the GREAT Group and in odd years independently in conferences organized by the Association.