Choosing a School
 
“The circle is now complete. When I left you, I was but the learner. Now I am the master.”–Darth Vader, Star Wars: A New Hope 

My, how the tables have turned. After surmounting the admissions process and hopefully having been admitted to the program(s) of your choice, you now sit in the driver’s seat as the master of your own fate. If you are one of those people fortunate enough to be in the position of deciding between multiple acceptances, then you will soon be making one of the most important decisions of your education and possibly even your career.

By now you have likely been to several schools on interviews, so you have had at least a brief opportunity to see firsthand the school facilities and to meet faculty and current students. You have probably read at least a portion of the ample literature given out by different programs, including brochures, booklets, and pamphlets. Thus, you should have already developed some idea of where you might see yourself spending the next seven to eight years of your life.

Most programs offer fully-paid return visits that will allow you to see more of the school, interact with current students, meet with additional faculty members, attend medical and graduate school classes, and take part in a variety of other formal and informal activities. Based on our experiences, during these return visits you will most likely get a “gut feeling” of where you fit best.

There are of course many factors that go into making a decision on what school to attend. Just as the admissions committees assessed you based on a host of criteria, we recommend that you approach your decision in a similar manner. M.D./Ph.D. applicants face unique circumstances due to the program length, balance of medical and graduate education, and specific researchers in fields of interest. Thus a combination of factors, influenced by individual preferences, must be taken into account to make a decision that is right for you.
 
 
Location, Location, Location
 
One of the most important aspects of deciding between the various programs actually has nothing to do with the programs whatsoever. Some questions to ask yourself are: where would you most like to live for the next several years of your education? Are you a big-city person? Or do you prefer small-town or rural areas? Most major academic centers (and consequently M.D./Ph.D. programs) are located in substantially populated cities, since in addition to medical education, these institutions provide needed medical care. However, there are many schools located in non-urban areas that provide an excellent educational experience.

What type of weather do you prefer: rain, blizzards, noreasters, tropical paradise, 72-degree year-round temperature, etc? Do you enjoy surveying restaurants, bars, or clubs? You should make yourself aware of the school’s environment, proximity to stores, venues, and recreational facilities. If you enjoy the outdoors, you might look for hiking, rafting, skiing, and other available options. It may seem somewhat surprising, but most M.D./Ph.D. students, while very driven by their goals, also know how to get out and about and have a good time.

Housing arrangements and affordability of living can vary considerably between locations. While the stipend of MSTPs and non-MSTP M.D./Ph.D. programs provides a good level of financial support, how far the money goes will vary greatly depending on your location. Near some schools, students can actually afford to buy property, while at others they are limited to renting out studios, apartments, and flats. Other programs encourage campus housing for its students. How much space do you need to live comfortably and to study? Do you prefer communal-style living or are you more private?

The point of all this is that lifestyle plays a big part in student happiness. You don’t want to be a workaholic during your medical and graduate education, and you’ll likely want to get outside and enjoy life a little. You’ll obviously have to figure out what fits you best. We emphasize that while it may seem that you could potentially “live anywhere” and force yourself through your education, you will be infinitely happier if you choose a place in which you can thrive not only academically, but emotionally as well.
 
 
Strength of the Graduate and Medical Programs
 
Unlike M.D.-only applicants, those pursuing the combined degree programs have an additional component of education to consider. For M.D./Ph.D. admissions, a balance must be struck between the strength of medical education versus graduate training. Some schools provide excellent clinical experience and focus less on basic research. Others are more lopsided toward the research end. You’ll have to investigate the specific programs in which you are interested to determine what best fits your career goals.

You may have specific research interests that will influence your decision on which school to attend. While most of the MSTPs and many non-MSTP M.D./Ph.D. programs offer a wide variety of scientific disciplines, it would be wise to choose a school that has a particularly strong graduate program in your area of interest. If there are specific faculty members with whom you would like to work, that can be an important deciding factor. Often, M.D./Ph.D. programs will provide you with a list of investigators, research summaries, and publications. You probably have already talked with some researchers during interviews. The strengths of the various programs will become fairly obvious with a little exploration on your part.

However, the caveat is that your research interests may change over time, as you are exposed to the medical curriculum. Thus, don’t hang on to your pre-conceived ideas too tightly. However, if the school is particularly well-funded for research, then you should have many options should you change your mind.

The U.S. News medical school rankings, although often quoted, do not take into account the uniqueness of M.D./Ph.D. and other combined programs. Although the rankings can be useful for purposes of comparison, they should be taken with a grain of salt. Conducted by survey, there is the potential for response bias, and the individual components used to measure strength of the medical schools are somewhat dubious. A better way to learn about the strengths of various programs is to do your own research. One way to do this is to ask many different faculty members for their perspectives on the programs in which you are interested.
 
 
Program Integration
 
One of the most formidable challenges of combined degree education is the incorporation of two distinct pathways that have at their root different goals. Thus, it is no surprise that the level of integration between the M.D. and Ph.D. phases varies considerably between M.D./Ph.D. programs.

Some schools offer classes or seminars specifically geared toward M.D./Ph.D. students. A current and popular example is “Molecular Grand Rounds” (at UCSF now called “Medical Sciences Grand Rounds”), in which students and faculty members present clinical cases with relevant basic science material. This gives M.D./Ph.D. students an opportunity to discuss disease-oriented basic research in the context of potential treatments and patient care.

In addition, programs attempt to integrate the M.D. and Ph.D. in other ways. Some encourage students to take graduate classes during the medical years. Others attempt to reduce the overlap between the medical and graduate curricula by allowing students to place out of certain courses. Longitudinal clinical electives provide students with the opportunity to maintain contact with medicine during the graduate years.

Despite these efforts, the medical and graduate portions of M.D./Ph.D. training remain two distinct entities at most schools. In making a decision, program flexibility is important in allowing students to tailor their education to their interests.
 
 
Program Length
 
While the average is seven to eight years, the duration of M.D./Ph.D. programs varies from school to school. Some have a notoriously long average time to graduation (i.e. nine or ten years). Others have administrators that push students out the door. In general, the more flexible programs graduate students in a more timely fashion. The variation usually arises from the length of the Ph.D. phase of the training. Given the small sample size and tremendous variation in research interests of the students graduating at a particular school each year, you should be cautious in interpreting average program length. How much time you take to earn the degrees will depend more on you and your research advisor than on the particular M.D./Ph.D. program.
 
  While we have attempted to highlight some of the factors significant to M.D./Ph.D. applicants, you may find that others not mentioned here are more pertinent to your specific situation. A decision on an M.D./Ph.D. program, like regular medical school admissions, comes down to assessing a range of factors in conjunction with your personal preferences. Chances are that you know yourself best. While input from friends, family, relatives, other applicants, etc. may be useful, you and you alone must make the final decision.