The standard structure of the MD/PhD program begins with the first two years devoted to medical school and the summer between devoted to graduate school. Students are supported financially during the two years of medical school by the medical school tuition scholarship or by personal funds and loans. During the summer term between these two years of medical school, students are considered graduate students, register for graduate school coursework, and complete two lab rotations to identify their PhD faculty mentor. Students are supported during this summer term by the PhD stipend and graduate school tuition scholarship. If a student accepts entry into the MD/PhD program early enough (i.e., before the beginning of the summer term prior to the first year of medical school), the student may opt to complete the two lab rotations and summer graduate coursework in that summer. However, this is not mandatory or necessary for timely completion of the program.
Upon completing the second year of medical school, MD/PhD students spend several weeks preparing for and taking Step I of the United States Medical Licensing Examination (USMLE). Following completion of this exam, students re-enter the graduate school to either immediately join the lab of their previously identified PhD faculty mentor to begin their dissertation studies or, if a mentor was not identified, may do additional lab rotation(s).
MD/PhD students are allowed to apply 26 credits of their medical school coursework towards the requirements for the PhD which minimizes the number of graduate courses MD/PhD students must take and frees up time for dissertation research. Students are strongly encouraged to complete and defend their PhD dissertation prior to returning to medical school for the final two years of clinical training. Students also participate in clinical training during their graduate school years to ensure continuity with their preclinical training and to help smooth the transition back to medical school for the clinical clerkships. This training is also discussed below. The focus of training shifts between medical and graduate education as students complete the MD/PhD program. However, medical and graduate studies are integrated at every stage during the course of study.
For their graduate studies and dissertation research, MD/PhD students will belong to one of four "tracks" or majors. These interdisciplinary programs are aligned with disease processes. Each track is affiliated with university department as follows:
Cancer Biology (Dept. of Biochemistry and Cancer Biology)
Cardiovascular and Metabolic Diseases (Dept. of Physiology and Pharmacology)
Infection, Immunity, and Transplantation (Dept. of Medical Microbiology and Immunology)
Neurosciences and Neurological Disorders (Dept. of Neurosciences)
PhD Training in Biomedical Engineering and Other Options
The majority of MD/PhD students will conduct their dissertation research under the guidance of faculty who are closely affiliated with one of the above four tracks. However, students sometimes have interest in the research program of a faculty who is not a member of one of these tracks and who is outside the Biomedical Science program, for example a faculty from Biomedical Engineering. In such cases, it may be possible to pair that faculty member with a faculty member who has mentoring status within the program and who will serve as the student’s official advisor for the program.
Laboratory Rotations and Identifying a PhD Mentor
Two lab rotations are required for MD/PhD students. The purposes of the rotations are for students to “try out” a laboratory and potential PhD mentor as well as for the faculty mentor to consider the potential student. During the rotations, the student should design and perform laboratory experiments under the guidance of the potential mentor and participate in lab meetings and other laboratory activities in the same manner as if the student was an official member of the lab. The student should strive to work hard and contribute to the research program of the laboratory since this is the opportunity for the student to impress the potential mentor.
Students have the option to begin the MD/PhD program as graduate students during the summer prior to their first year of medical school and complete the two required laboratory rotations in that term. However, most students begin the combined degree in the fall as first year medical school students. These students then enter graduate school during the summer between their first and second year of medical school and complete the laboratory rotations.
Upon completion of the two rotations, the student typically will join one of the two labs s/he rotated in. Occasionally a "good fit" is not found and additional rotations are necessary. Upon joining a lab, however, the student will complete the graduate school and track course requirements as well as undertake research towards the dissertation.
Preclinical Medical School Coursework
MD/PhD students take all of the same preclinical medical school courses and electives during medical school years 1 and 2 as other medical students. During the first two years of medical school, students are encouraged to interact with the graduate school faculty and attend basic science seminars in the area in which they plan to do their dissertation research.
The medical school curriculum and course structure is a systems based approach to learning medicine. UTCOMLS is committed to developing physicians with a broad range of knowledge, skills, attitudes and understanding, allowing them to pursue careers in primary care or any medical or surgical specialty.
The first year of medical school includes the following courses:
Cellular and Molecular Biology. This course includes integrated topics from Biochemistry, Physiology, Microanatomy, Pharmacology and Pathology.
Human Structure and Development. This course includes integrated topics from Gross Anatomy, Microanatomy and Embryology.
Neuroscience. This course integrates neuroanatomy, neurohistology, neuroembryology, neurophysiology, neuropathology, and neuroradiology.
Behavioral Science. This course presents basic human behavior and the processes of emotional, social, cognitive and moral development from infancy to old age.
Clinical Decision Making I. This course provides medical students with fundamental knowledge and skills for clinical decision making. Includes a problem-based learning (PBL) course that combines independent study with small group discussion under the guidance of faculty facilitators.
Basic Life Support. The Basic Life Support Healthcare Provider course is designed to teach CPR, artificial ventilation, use of an automated external defibrillator, etc.
The second year of medical school includes the following courses:
Immunity and Infection. This course includes Immunology, Bacteriology, Virology, Mycology, Parasitology and Molecular Basis of Infectious Diseases.
Organ Systems. This course covers the physiology, pharmacology and pathology of each organ system: Cardiovascular and Autonomics; Neurological Disease; Respiratory; Renal and Electrolytes; Hematopoietic; Gastrointestinal and Hepatic; Endocrine; Reproductive; Skin and Skeletal.
Clinical Decision Making II. This is a year-long course that develops concepts and skills related to providing medical care within the health care system. Includes a PBL course that combines independent study with small group discussion under the guidance of faculty facilitators.
The USMLE Examination, Step I
After completion of the second year of medical school, students generally take several weeks to prepare for ”Step I” of the United States Medical Licensing Examination (USMLE). This is a comprehensive examination covering all of the material presented in the first two years of medical school. Students should schedule the examination prior to July 1 to allow sufficient time for lab rotation(s) during the remainder of the summer if rotation(s) are necessary. Students must achieve a Pass score on Step 1 in order to transition into Graduate School. The Pass score is defined by the USMLE each year. If a failure is achieved, the student must plan to re-take the exam. Information regarding the examination and scheduling can be found at http://www.usmle.org/apply/.
After taking Step 1 of the USMLE, students will reenter graduate school to take graduate school courses, additional laboratory rotations, if needed, and move on to undertake their dissertation research.
Graduate School Requirements
Students must meet all of the requirements for both the MD and PhD degrees, i.e., ten semesters/terms of medical education and a minimum of 90 graduate semester credits. The time limitation for completion of both MD and PhD degrees is 10 years. The additional specific requirements for the PhD degree can be found in the Graduate Student Handbook for the year in which the student entered the MD/PhD program via this link. Information on the specific medical school requirements for graduation can be found here.
The Biomedical Sciences PhD program has a common first-year core curriculum for PhD students (listed below), but much of this curriculum is covered in medical school. Therefore, MD/PhD students are allowed to apply medical school course credit towards their PhD degree and are excused from most of the core curriculum requirements. This also accelerates the entering of the student into the lab and the completion of their dissertation research.
Of the PhD core curriculum, MD/PhD students are required to take only the following:
- On Being a Scientist (INDI 6020/8020) - an ethics and professionalism course for developing scientists
- Two lab rotations (Mentored Research, BMSP 6390/8390) - discussed above
- Methods in Biomedical Science (BMSP 6380/8380) - an introduction to many of the methodologies used in modern biomedical science research
- Statistical Methods (PUBH 5320) – an introduction to basic statistical analyses; this course can be waived if the student has had an equivalent course
- Required track-specific courses and journal clubs – students should consult with their Major Advisor, Track Director, and track websites:
MD/PhD students are strongly recommended to also take the following courses since the courses will help them in their research endeavors:.
• Public Health Epidemiology (PUBH 6010)
• Grant Writing Workshop (BMSP 6250/8250)
MD/PhD students are also required to pass a Qualifying Examination (QE) during their first full year in graduate school. The purpose of the QE is to evaluate the student's knowledge and ability to analyze information in her/his area of concentration and to apply that to the solution of a research problem. The QE consists of the student writing an NIH R21 style grant proposal on a subject determined by the student's faculty Dissertation Committee then orally presenting and defending the proposal to the committee. The oral portion of the exam includes questions that probe the breadth and depth of basic knowledge and critical thinking skills of the student. Upon successful passage of the QE, the student is eligible to register for Dissertation Research credit and will continue working intensively on their dissertation research project.
Writing and Defending the Dissertation
Typically after three years of intensive research activity, the MD/PhD student has accumulated enough data to write the dissertation in preparation of its defense and completion of the PhD side of the program. The go-ahead to write and defend the dissertation is determined by the Dissertation Committee. Upon completion of writing the dissertation, the student will present and defend it by an oral presentation open to the university community.
Clinical Training during Graduate School
During the years of graduate training, students will also participate in required clinical electives to reinforce their preclinical education in pathophysiology, pharmacology, and other areas while beginning to develop the clinical skills they will need as third year clinical clerks. Prior to taking these electives, students are required to attend the one week Bridge Course during the last week of June. The Bridge Course introduces pre-clinical students to life in the hospital and clinics and expectations for students participating in clinical rotations (see below, “Re-entry into Medical School”). It should be noted that the student will participate in the Bridge Course two times. The first time will be immediately following the second year of medical school, prior to entering graduate school. During this week, the student will not be registering for the course but will be attending all of the required components. The second time the student participates in the Bridge Course will be when they re-enter medical school as a third year student. At the beginning of the third year they will be registered for the course and it is at this time that they will receive credit for the course.
Re-entry into Medical School
Planning for the 3rd year clerkships begins more than 6 months prior to the start of the third year. Students are expected to finish their PhD course requirements, qualifying exam, dissertation, and oral dissertation defense before reentering medical school for the third and fourth year clerkships.
The third year clerkships include five 10-week blocks. Each 10 week block consists of either one 10-week or two 5-week clerkships. The 10-week clerkships are Internal Medicine and Surgery. The paired 5-week clerkships are Obstetrics/Gynecology plus Pediatrics, Neurology plus Psychiatry, and Family Medicine plus a 4-week elective with 1 week of flex time. After completing these required rotations, students will take Step 2 of the USMLE.
The fourth year consists of 40 weeks: 32 weeks of electives and 8 weeks of FLEX time. Students are required to complete 24 weeks of Clinical Electives and a maximum of 8 weeks of basic science electives. A minimum of twelve weeks of Electives must be at the The University of Toledo and its associated teaching institutions. Independent Study electives can not be used to satisfy this requirement. Four weeks of the Clinical Electives must be a UT Acting Internship. The remainder of the fourth year of medical school electives can be completed at any medical school in the United States or Canada with the approval of a sponsoring department at The University of Toledo. In addition, students can participate in international clerkships if they are approved by a sponsoring department at The University of Toledo's College of Medicine and the COMLS Global Health Committee.
Area Health Education Centers (AHEC)
During the third and fourth years of medical school, each student is required to complete eight weeks of clinical experience in the Area Health Education Centers (AHEC) of The University of Toledo. These clerkships are at outlying hospitals or clinical practices, and provide students with unique practical experiences in smaller communities in a one-on-one structured relationship with physicians in the community.