phd medical condition

Everything you need to know about pursuing a Ph.D. in Medical Science

Blog Summary

Ph.D. in medical sciences is a vast field of study that equips MBBS graduates with the skills and knowledge base required to diagnose and treat medical conditions in the human body. A medical professional takes a patient through an entire journey of treating a disease, right from its consultation, identification, diagnosis, treatment, and surgery (if required). The subspecialties available in the program are many and can be preferred according to each student’s career interest. The subdisciplines include Public Health, Biomedicine, Dentistry, Nursing, Nutrition, Health Management, Veterinary Science, and many more. A Ph.D. in medicine degree will teach you to identify diseases and treat them promptly. 

Ph.D. in Medicine

Many might wonder what is a Doctorate in Medical Sciences. A Ph.D. in Medicine is crucially designed and structured in a way most suitable for aspiring doctors inclined toward research and academia. The subspecialties from which one can choose to do a doctorate are vast, and it purely depends on the interests and preferences of the students. The curriculum of each may vary on the specialization chosen and may include clinical research, independent study, group work, and lab work. The varied focus areas may include microbiology, immunology, pharmacology, reproductive issues, brain disorders, genetics, orthopedics, development disorders, etc. 

A Ph.D. in medical science means that the student gets exposure to other skills besides academic knowledge, like analytical skills, lateral thinking, technological abilities, accuracy, and attention to detail that will significantly help them in their career life. This Doctorate in Medicine, when obtained from Texila American University in academic partnership with the University of Central Nicaragua, helps students gain a comprehensive view of the subject wherein all the major components of medical science are covered. 

The program is offered for three years and may extend to five years, depending on the specialization chosen. It is aimed at individuals who have a zeal for expertise and conduct research in the field of medicine. It helps them gain 360-degree knowledge and a broader perspective of the science involved. Along with the academic skills, the students get the opportunity to polish their research and analytical and innovative skills that will significantly help them in their research work.

Why consider a Ph.D. in Medical Sciences?

One might have heard the saying, “Jack of all Trades, but Master of None.” A Ph.D. in medicine means the other way around. You get to master expertise in the field of medical science. It is meticulously designed to cover all the primary and essential criteria involved in medicine and seamlessly puts you on the path of research, dissertation, and thesis. It includes all the clinical and non-clinical streams, including neurology, genetics, and epidemics. Ultimately the students of the program get to choose their field of specialization in the third year of study upon completion of successful clinical work study in the initial years. 

The program aims to deliver the students with core competencies required to show excellence in research and development. The industrial demand for doctors who have completed a doctorate in medical sciences is very compelling in hospitals, pharmacies, research & development, biomedical, and pharmacology. The ultimatum is to equip the students with the requisite communicative, analytical, and competent skills for the amicable completion of the research work.

Career Opportunities after completion of PhD

The profession of being a doctor is a tough and engaging one; however, the profile is advantageous and satisfactory. Doctors with academic knowledge are expected to have empathy, passion, good communication, and cooperation with patients and their peers. Graduates get lucrative opportunities in research & development, scientific study, the biomedical industry, and government-aided and initiated schemes for medical health.

Doctors who complete the doctorate program can become one of the below-mentioned career profiles based on their area of interest and focus of study.

• Diagnostic molecular scientist
• Epidemiologist
• Biostatistician
• Biomedical chemist
• Health information specialist
• Allied health manager
• Pediatrician
• Health psychologist
• Orthopedist
• Radiologist
• Occupational therapist

Ph.D. program overview

A Ph.D. in medical sciences program envisions its students transforming into competent physicians and skilled scientists. Becoming a successful doctor after completing the program depends on various factors:

• Clinical requirements
• Progress of your research work
• Time is taken to mold yourself into an independent investigator and
• Other Ph.D. requirements

The initial years of the course cover mastering basic sciences, followed by an intense and rigorous Ph.D. and clinical training period. A typical Ph.D. training involves the completion of coursework, performing dissertation research, completing comprehensive exams, and thesis defense. In this course, you will be expected to conduct a lot of research and thesis writing. It will also offer networking opportunities through workshops, seminars, discussion sessions, and student retreats. 

The curriculum has balanced coverage of theory and practical projects, resulting in the best understanding of the courseware. The subjects mainly involve the study of:

• Research Methodology
• Advances in Physiology and Microbiology
• Advances in Medicines
• Advances in Pharmacology and Anatomy
• Stem Cells and Regeneration
• Hospital Waste and Disposal management
• Biochemistry 
• Application of medical sciences 
• Research Thesis

Ph.D. in Medicine Eligibility Requirements

A student who wants to pursue a Ph.D. doctorate has to complete the following requirements:

• Candidates must have completed an MD/ MS with a decent score from a university recognized and approved by the Medical Council of India.
• Candidates who have secured a Diploma in National Board (DNB) in any subject related to medical science are also eligible for admission.
• Candidates who have graduated with a PG degree like an M. Optometry or M. Sc from any recognized university with the streams of pharmacology, microbiology, anatomy, physiology, biochemistry, or any related stream are considered eligible for admission.
• Candidates may also be required to be registered with the Medical Council of their locality.
• Candidates must possess work experience in their specialty after completing their PG degree.

Ph.D. in Medicine Enrollment

A medical Ph.D. program is gaining more recognition for the convenience it offers with the perfect blend of knowledge. You must successfully clear the All-India Entrance examination that tests applicants’ research and medical science skills. Upon passing the test, you will have to impress the panel of judges who will interview you based on your research interest and medical specialty. Once you are through with the program’s eligibility requirements, you can proceed with the admission process to start a fast-paced and rewarding career. 

Best ways to get admission to the Ph.D. program

• Gain substantive research experience by doing quality research. The thesis and research projects you worked on will impress your interview committee to know why you chose to do a Ph.D.
• Avail of considerable clinical experience in the research and medicine field you choose to pursue. Clinical exposure and lab technicality knowledge is a must-haves to prove your efficiency in handling the Ph.D. courseware and curriculum.
• Shadowing experience is requisite that can be effectively done by passively observing a doctor who does clinical practice. This will help you gain knowledge that can later be put to great use while doing your research work.

When you choose to do a Ph.D. in Medical Sciences , you are about to get a chance to be part of one of the most demanded and compelling career choices globally. Join the team that holds the platform for medical exploration, scientific discovery, and medical intervention. It will land you in a career that blends research and medicine. It also implies that you will gain extensive research experience, contribute widely to publications, be mentored by industry experts, and gain valuable shadowing experience. Register with Texila American University in academic partnership with the University of Central Nicaragua for your Ph.D. in medical sciences and experience your career reaching maximum heights.

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About the PhD in Global Disease Epidemiology and Control Program

The PhD program in Global Disease Epidemiology and Control, International Health is more applied, multidisciplinary, and internationally oriented than standard infectious disease epidemiology programs. It prepares students to take leadership positions in important global public health settings with strong research components. 

This is a  STEM designated program . Eligible F-1 visa students can receive an additional 24 months of work authorization, beyond the initial 12 months of post-completion Optional Practical Training (OPT).

PhD in Global Disease Epidemiology and Control Program Highlights

Students will learn to use epidemiologic, immunologic, laboratory and statistical methods to design, implement, and evaluate disease control interventions for diseases of public health importance to underserved populations.

GLOBAL NETWORK

Research opportunities around the world

APPLIED LEARNING

Training in epidemiologic and biostatistical methods

Vaccine Training

From clinical trials to implementation

STEM DESIGNATED

Eligibility for a 24-month STEM OPT extension

What Can You Do With a Graduate Degree in Global Disease Epidemiology and Control

Visit the  Graduate Employment Outcomes Dashboard to learn about Bloomberg School graduates' employment status, sector, and salaries.

Centers for Disease Control and Prevention

• Coordinator for Prescription Drug Overdose Response, National Center for Injury Prevention and Control
• Epidemic Intelligence Service Officer

Interactive Research and Development

• Director, Child Health & Vaccines Program, Pakistan Country Office

International Rescue Committee

• Technical Advisor for Research

National Institutes of Health

• Research Fellow, Division of International Epidemiology and Population Studies, ​Fogarty International Center

Universidad Peruana Cayetano Heredia

• Assistant Professor of Biochemistry, Department of Biochemistry and Molecular Biology

World Health Organization

• Scientist, Initiative for Vaccine Research

Curriculum for the PhD in Global Disease Epidemiology and Control

Students acquire a broad understanding of the methods needed to design studies and gain hands-on experience in the design, conduct and analysis of community and clinical trials and/or laboratory based investigations, including the immunologic and biologic basis of responses to immunizations and other prophylactic or therapeutic interventions.

Browse an overview of the requirements for this PhD program in the JHU  Academic Catalogue , explore all course offerings in the Bloomberg School  Course Directory , and find many more details in the program's  Academic Guides .

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Courses Available in the Following Areas:

• Infectious diseases
• Vaccinology
• Field trials
• Program implementation and evaluation
• Program design

Admissions Requirements

For general admissions requirements, please visit the  How to Apply  page. This specific program also requires:

Prior Graduate Degree

A degree in medicine, veterinary medicine, or dentistry, or a master’s degree or equivalent graduate training in epidemiology, statistics, international health, tropical medicine, microbiology, parasitology, immunology, or virology.

Prior Work Experience

Not required but highly desirable

Standardized Test Scores

Standardized test scores  are required  for this program. This program accepts the following standardized test scores: GRE.  Applications will be reviewed holistically based on all application components.

Program Faculty Spotlight

Melissa A. Marx

Melissa A. Marx, PhD ‘02, MPH ’98, evaluates maternal, child, and infectious disease programs, and has led response efforts for outbreaks including SARS, Ebola, and COVID-19.

Anna P. Durbin

Anna Durbin, MD, studies experimental vaccines for SARS-CoV-2, dengue, West Nile, Zika, malaria, and more in human clinical trials and in controlled human infection studies.

Christine Marie George

Christine Marie George, PhD, is an infectious disease epidemiologist who designs infectious disease control programs to promote health equity and prevent infections globally.

Rupali J. Limaye

Rupali Limaye, PhD ’12, MPH, MA, studies how health information can best be communicated to individuals in different contexts and through different channels.

Per the Collective Bargaining Agreement (CBA) with the JHU PhD Union, the minimum guaranteed 2025-2026 academic year stipend is $50,000 for all PhD students with a 4% increase the following year. Tuition, fees, and medical benefits are provided, including health insurance premiums for PhD student’s children and spouses of international students, depending on visa type. The minimum stipend and tuition coverage is guaranteed for at least the first four years of a BSPH PhD program; specific amounts and the number of years supported, as well as work expectations related to that stipend will vary across departments and funding source. Please refer to the CBA to review specific benefits, compensation, and other terms.

Need-Based Relocation Grants Students who  are admitted to PhD programs at JHU starting in Fall 2023 or beyond can apply to receive a need-based grant to offset the costs of relocating to be able to attend JHU.   These grants provide funding to a portion of incoming students who, without this money, may otherwise not be able to afford to relocate to JHU for their PhD program. This is not a merit-based grant. Applications will be evaluated solely based on financial need.  View more information about the need-based relocation grants for PhD students .

Questions about the program? We're happy to help.

Elisabeth Simmons, MEd Academic Program Administrator [email protected]

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Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020–March 2021

ORIGINAL RESEARCH — Volume 18 — July 1, 2021

Lyudmyla Kompaniyets, PhD 1 ; Audrey F. Pennington, PhD 1 ; Alyson B. Goodman, MD 1 ,2 ; Hannah G. Rosenblum, MD 1 ,3 ; Brook Belay, MD 1 ; Jean Y. Ko, PhD 1 ,2 ; Jennifer R. Chevinsky, MD 1 ,3 ; Lyna Z. Schieber, DPhil, MD 1 ; April D. Summers, MPH 1 ; Amy M. Lavery, PhD 1 ; Leigh Ellyn Preston, DrPH 1 ; Melissa L. Danielson, MSPH 1 ; Zhaohui Cui, PhD 1 ; Gonza Namulanda, DrPH 1 ; Hussain Yusuf, MD 1 ; William R. Mac Kenzie, MD 1 ,2 ; Karen K. Wong, MD 1 ,2 ; James Baggs, PhD 1 ; Tegan K. Boehmer, PhD 1 ,2 ; Adi V. Gundlapalli, MD, PhD 1 ( View author affiliations )

Suggested citation for this article: Kompaniyets L, Pennington AF, Goodman AB, Rosenblum HG, Belay B, Ko JY, et al. Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020–March 2021. Prev Chronic Dis 2021;18:210123. DOI: http://dx.doi.org/10.5888/pcd18.210123 .

PEER REVIEWED

Introduction

Acknowledgments, author information.

What is already known about this topic?

Severe COVID-19 illness in adults has been linked to underlying medical conditions.

What is added by this report?

In this cross-sectional study of 540,667 adult hospitalized patients with COVID-19, 94.9% had at least 1 underlying medical condition. Hypertension and disorders of lipid metabolism were the most frequent, whereas obesity, diabetes with complication, anxiety disorders, and the total number of conditions were the strongest risk factors for severe COVID-19 illness.

What are the implications for public health practice?

Preventing COVID-19 in populations with these underlying conditions and multiple conditions should remain a public health priority, with targeted mitigation efforts and ensuring high uptake of vaccine, when available, in these individuals and their close contacts.

Severe COVID-19 illness in adults has been linked to underlying medical conditions. This study identified frequent underlying conditions and their attributable risk of severe COVID-19 illness.

We used data from more than 800 US hospitals in the Premier Healthcare Database Special COVID-19 Release (PHD-SR) to describe hospitalized patients aged 18 years or older with COVID-19 from March 2020 through March 2021. We used multivariable generalized linear models to estimate adjusted risk of intensive care unit admission, invasive mechanical ventilation, and death associated with frequent conditions and total number of conditions.

Among 4,899,447 hospitalized adults in PHD-SR, 540,667 (11.0%) were patients with COVID-19, of whom 94.9% had at least 1 underlying medical condition. Essential hypertension (50.4%), disorders of lipid metabolism (49.4%), and obesity (33.0%) were the most common. The strongest risk factors for death were obesity (adjusted risk ratio [aRR] = 1.30; 95% CI, 1.27–1.33), anxiety and fear-related disorders (aRR = 1.28; 95% CI, 1.25–1.31), and diabetes with complication (aRR = 1.26; 95% CI, 1.24–1.28), as well as the total number of conditions, with aRRs of death ranging from 1.53 (95% CI, 1.41–1.67) for patients with 1 condition to 3.82 (95% CI, 3.45–4.23) for patients with more than 10 conditions (compared with patients with no conditions).

Certain underlying conditions and the number of conditions were associated with severe COVID-19 illness. Hypertension and disorders of lipid metabolism were the most frequent, whereas obesity, diabetes with complication, and anxiety disorders were the strongest risk factors for severe COVID-19 illness. Careful evaluation and management of underlying conditions among patients with COVID-19 can help stratify risk for severe illness.

As the COVID-19 pandemic continues, a need remains to understand indicators for severe illness, defined as admission to an intensive care unit (ICU) or stepdown unit, invasive mechanical ventilation (IMV), or death (1). Several underlying medical conditions among adults, including diabetes, obesity, chronic kidney disease (CKD), hypertension, and immunosuppression, have been reported to be associated with increased risk for severe illness from COVID-19 (2-4). However, many existing studies are limited in geographic representation, restricted to cases early in the outbreak, or focused on a limited number of preselected conditions and/or severe outcomes (3–5). Finally, few studies have shown the effect of the number of underlying medical conditions on the risk for severe COVID-19 illness (6).

Both the baseline prevalence of a condition and the magnitude of its association with COVID-19 illness help determine the impact of a condition at a population level. This study, based on a large electronic administrative discharge data set, sought to describe the most frequent underlying medical conditions among hospitalized patients with COVID-19 and their associations with severe illness. This information can better inform clinical practice and public health priorities, such as identifying populations for focused prevention efforts and potential vaccine prioritization.

We used the Premier Healthcare Database Special COVID-19 Release (PHD-SR, release date May 11, 2021), a large, US hospital-based, all-payer database (7). The sample included patients aged 18 years or older who had an inpatient encounter with an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis of U07.1 (“COVID-19, virus identified”) from April 1, 2020, through March 31, 2021, or B97.29 (“other coronavirus as the cause of diseases classified elsewhere,” recommended before the April 2020 release of U07.1) from March 1, 2020, through April 30, 2020 (8,9).

We examined 3 indicators of severe COVID-19 illness: admission to an ICU or stepdown unit, IMV, and death. These indicators were not mutually exclusive.

We considered 2 exposures of interest: 1) specific underlying medical conditions and 2) the number of conditions. We captured data on both exposures by using ICD-10-CM diagnosis codes from inpatient or outpatient hospital records in PHD-SR from January 2019 up to and including a patient’s first inpatient encounter for COVID-19. We used 1 encounter with an ICD-10-CM code to establish the presence of an underlying condition because few patients had multiple encounters in this hospital database. We excluded 3 ICD-10-CM codes (ie, oxygen support, dependence on a ventilator, and tracheostomy) listed during the patient’s COVID-19 encounter because they could be part of COVID-19 treatment.

We used a multistep approach to identify underlying medical conditions. First, we used the Chronic Condition Indicator (CCI) to identify chronic ICD-10-CM codes (11,803 of 73,205 total ICD-10-CM codes), which were then aggregated into 314 categories using the Clinical Classifications Software Refined (CCSR) (10,11). To further differentiate underlying conditions from acute complications of COVID-19, a panel of physicians (K.K.W., W.M.K., H.G.R., B.B., N.T.A., J.M.N.) classified the 314 CCSR categories into “likely underlying” (274 categories; eg, asthma); “indeterminate,” which could include underlying or acute complications or both (29 categories; eg, cardiac dysrhythmias); or “likely acute” (11 categories; eg, acute pulmonary embolism). We used the “likely underlying” CCSR categories for our analysis of underlying medical conditions and excluded the “indeterminate” or “likely acute” CCSR categories. People diagnosed with both CCSR categories of “diabetes with complication” and “diabetes without complication” (n = 55,141) were classified as having diabetes with complication. The number of underlying medical conditions was defined as the number of unique CCSR categories associated with each patient (0, 1, 2–5, 6–10, >10).

Statistical analyses

We described the sample by patient and hospital characteristics. Then we selected the most frequent underlying CCSR categories with a prevalence of 10% or more in the sample. We used multivariable generalized linear models with Poisson distribution and log link function to estimate adjusted risk ratios (aRRs) for 3 outcomes of interest among hospitalized patients: ICU admission, IMV, and death (reference was surviving hospitalized patients without that outcome). We performed these estimations by 1) including all frequent CCSR categories in the same model (“full model”) and 2) including 1 CCSR category per statistical model (“restricted model”). We focused our interpretations on the CCSR categories whose direction of association (positive or negative) was consistent between the restricted and the full model. We also conducted a stratified analysis of frequent conditions by age group (frequency ≥10.0% in each age group). Finally, we estimated the association between the number of CCSR categories and the 3 severity outcomes.

All models used robust SEs clustered on hospital identification, and controlled for patient age, sex, race/ethnicity, payer type, hospital urbanicity, US Census region of hospital, admission month, and admission month squared (to account for potential nonlinear unobservable changes in treatment, patient profile, or severity of illness during the pandemic). All analyses were conducted using R version 4.0.2 (The R Foundation) and Stata version 15.1 (StataCorp LLC).

We performed 2 sensitivity analyses using all chronic CCSR categories, including those determined by the clinician panel to be “likely underlying,” “indeterminate,” and “likely acute.” We performed 1 sensitivity analysis in the main sample and another that was limited to encounters that preceded the first COVID-19 inpatient encounter. These analyses were used to validate the associations found in the main analysis, as well as to examine the conditions excluded from the main analysis after clinical review.

This activity was reviewed by the Centers for Disease Control and Prevention (CDC) and was conducted according to applicable federal law and CDC policy.

Among 4,899,447 hospitalized patients in PHD-SR, 540,667 (11.0%) patients met the study inclusion criteria for COVID-19 ( Table 1 ). Of patients hospitalized with COVID-19, 94.9% had at least 1 documented underlying CCSR condition, 249,522 (46.2%) had an ICU admission, 76,680 (14.2%) received IMV, and 80,174 (14.8%) died. The study sample included 261,078 (48.3%) female patients, 94,670 (17.5%) non-Hispanic Black patients, and 93,171 (17.2%) Hispanic or Latino patients. The median age was 66 years, and the most common insurance types were Medicare (292,978 [54.2%]) and commercial (130,995 [24.2%]). The 863 hospitals visited by patients included in the study were distributed across all US Census regions.

We found 18 underlying CCSR categories with a frequency of 10.0% or more in the sample; the most common were essential hypertension (272,591 [50.4%]), disorders of lipid metabolism (267,057 [49.4%]; top ICD-10-CM code was hyperlipidemia), obesity (178,153 [33.0%]), diabetes with complication (171,727 [31.8%]), and coronary atherosclerosis and other heart disease (134,839 [24.9%]) ( Figure 1 ), .

Relative risk of death in the full model was 30% higher with obesity (95% CI, 27%–33%), 28% higher with anxiety and fear-related disorders (95% CI, 25%–31%), 26% higher with diabetes with complication (95% CI, 24%–28%), 21% higher with CKD (95% CI, 19%–24%), 18% higher with neurocognitive disorders including dementia and Alzheimer’s disease (95% CI, 15%–21%), 18% higher with chronic obstructive pulmonary disease and bronchiectasis (95% CI, 16%–20%), 17% higher with aplastic anemia including anemia in CKD (95% CI, 14%–19%), 14% higher with coronary atherosclerosis and other heart disease (95% CI, 12%–16%), and 4% higher with thyroid disorders including hypothyroidism (95% CI, 2%–6%) ( Table 2 ). These conditions were also associated with a higher risk of IMV and ICU admission.

Diabetes without complication was associated with a 6% lower risk of death (aRR = 0.94; 95% CI, 0.91–0.97), 9% lower risk of IMV (aRR = 0.91; 95% CI, 0.88–0.94), and 2% lower risk of ICU admission (aRR = 0.98; 95% CI, 0.97–0.998). Essential hypertension was associated with an 8% lower risk of death (aRR = 0.92; 95% CI, 0.90–0.93), 6% lower risk of IMV (aRR = 0.94; 95% CI, 0.92–0.95), and a 1% lower risk of ICU admission (aRR = 0.99; 95% CI, 0.97–0.999). Asthma was associated with a 9% lower risk of death (aRR = 0.91; 95% CI, 0.89–0.94) and a 4% lower risk of IMV (aRR = 0.96; 95% CI, 0.94–0.99).

Age-stratified analysis showed that the number of frequent underlying medical conditions (present in ≥10.0% of patients) was higher with older age ( Table 3 ). The most frequent conditions were obesity, diabetes, and essential hypertension among patients younger than 65, and disorders of lipid metabolism, essential hypertension, diabetes, and coronary atherosclerosis among patients aged 65 or older. Among patients aged 18 to 39, essential hypertension was associated with a 26% higher risk of death (95% CI, 10%–44%), 25% higher risk of IMV (95% CI, 17%–35%), and an 11% higher risk of ICU admission (95% CI, 7%–15%). In the same age group, asthma was frequent and was associated with a 9% (95% CI, 5%–13%) higher risk of ICU admission but was not significantly associated with higher risk of IMV or death. Other specified status (CCSR category indicating a need for specific medical support, such as a wheelchair or renal dialysis) was a frequent category among patients aged 40 to 64 and 65 or older and was associated with a 7% (1%–13%) and 4% (1%–6%) higher risk of death, respectively.

We found a dose–response association between the total number of underlying medical conditions and risk of severe COVID-19 illness ( Figure 2 ). Compared with patients with no documented underlying medical conditions, patients’ risk of death was 1.53 times (95% CI, 1.41–1.67) as high if they had 1 condition, 2.55 times (95% CI, 2.32–2.80) as high if they had 2 to 5 conditions, 3.29 times (95% CI, 2.98–3.63) as high if they had 6 to 10 conditions, and 3.82 times (95% CI, 3.45–4.23) as high if they had more than 10 conditions. Adjusted RRs for IMV ranged from 1.57 (95% CI, 1.45–1.70) with 1 condition to 4.47 (95% CI, 4.07–4.90) with more than 10 conditions. Adjusted risk ratios for ICU admission ranged from 1.32 (95% CI =1.27–1.36) for patients with 1 condition to 1.96 (95% CI, 1.82–2.11) for patients with more than 10 conditions .

In the first sensitivity analysis, performed by using all CCSR categories, we identified 6 additional frequent “indeterminate” CCSR categories: cardiac dysrhythmias (n = 124,367 [23.0%]), heart failure (n = 104,858 [19.4%]), other specified nervous system disorders (n = 89,929 [16.6%]; top ICD-10-CM code, metabolic encephalopathy), other specified and unspecified nutritional and metabolic disorders (n = 89,337 [16.5%]; top code, hypomagnesemia), coagulation and hemorrhagic disorders (n = 75,766 [14.0%]), and diseases of white blood cells (n = 57,765 [10.7%]). The risk ratio estimates of most previously found underlying conditions were lower with the inclusion of these 6 conditions in the full models.

In the second sensitivity analysis, which used a subset of 278,215 patients with at least 1 encounter in the PHD-SR before their first COVID-19 hospitalization, diabetes without complication was associated with an 8% (95% CI, 5%–12%) higher risk of death, a 13% (95% CI, 10%–17%) higher risk of IMV, and a 5% (95% CI, 4%–7%) higher risk of ICU admission; sleep–wake disorders were associated with an 8% (95% CI, 5%–11%) higher risk of IMV. Anxiety and fear-related disorders were associated with a 2% (95% CI, 0.4%–4%) higher risk of ICU admission but not with a higher risk of death or IMV, on the basis of the full model.

Among 4,899,447 hospitalized US adults in the PHD-SR, 540,667 (11.0%) were hospitalized with COVID-19. Among patients hospitalized with COVID-19, we found 18 most frequent underlying conditions, of which 9 were associated with severe COVID-19 illness. These 9 conditions were both prevalent in the sample (affecting 81.9% of inpatients with COVID-19) and associated with severe COVID-19 illness, suggesting a high impact at the population level. Essential hypertension and disorders of lipid metabolism were the most frequent conditions, whereas obesity, anxiety and fear-related disorders, diabetes with complication, and CKD were the strongest risk factors for death among hospitalized patients with COVID-19. This analysis builds on 2 previous analyses using data from the PHD-SR (3,5), by including more underlying medical conditions in the frequency analysis (274 CCSR categories), including 9 additional months of data, and examining outcomes other than mortality. The analysis also shows that the total number of underlying conditions is strongly associated with severe COVID-19 illness.

The percentage of the US adult population known to have 2 or more underlying medical conditions ranges from approximately 38% to 64% by state (12). Previous studies demonstrated that patients with medically attended COVID-19 often had multiple underlying medical conditions (6). However, studies have rarely focused on the effect of the number of conditions on severe COVID-19 illness. We found that the risk of death, IMV, and ICU admission was often incrementally higher with a higher number of underlying medical conditions. Our finding that the number of underlying medical conditions is itself a risk factor for severe disease from COVID-19 identifies a population that has not been clearly described in previous literature.

Our results reinforce previous findings of higher risk of severe illness associated with diabetes with complication (13), obesity (4,14), coronary atherosclerosis and other heart disease (4), chronic obstructive pulmonary disease (15), and neurocognitive disorders (3,4). Additionally, we identified several conditions for which little data exist regarding risk for severe COVID-19 illness, such as thyroid disorders (including hypothyroidism) and anxiety and fear-related disorders.

Hypertension and disorders of lipid metabolism (the most prevalent conditions), and obesity and diabetes with complication (strong risk factors for death, IMV, and ICU admission) are associated with well-described hormonal and inflammatory pathways, also previously shown to be risk factors for severe COVID-19 illness (16). High baseline prevalence of obesity and diabetes, combined with their association with severe COVID-19 illness, suggest that these 2 conditions could have an outsized impact on the population with COVID-19. Prevention and treatment of these conditions may be an important strategy that could improve national resilience against chronic threats and acute crises. Essential hypertension, for which evidence is mixed on its association with severe COVID-19 illness (1), was shown in our analysis to be the most prevalent condition. It was found to be associated with a higher risk of severe COVID-19 illness only among patients aged 18 to 39 but with a lower risk of severe COVID-19 illness among older patients and in the full sample. This finding supports a possible link with severe COVID-19 illness and identifies essential hypertension as a risk factor, especially among younger patients.

Uncomplicated diabetes was found to be negatively associated with the risk of death and IMV. A positive association with risk of ICU admission was found only among patients aged 18 to 39. A previous study showed that although type 2 diabetes was a risk factor for mortality from severe COVID-19 illness, patients with diabetes and well-controlled blood glucose had lower mortality than those with diabetes and poorly controlled blood glucose (13). Our sensitivity analysis of a subset of patients with pre-COVID encounters identified a higher relative risk of death associated with uncomplicated diabetes present before the first COVID hospitalization. Coding bias (uncomplicated diabetes may be less frequently coded in hospitalizations with severe outcomes) (17) or reverse causality (diabetes complications arising from COVID-19 illness or treatment) (18) could explain this finding.

Anxiety and fear-related disorders were a prevalent condition in our sample; they were also the second highest risk factor for death among the underlying conditions considered in our study. The reasons for this finding are likely multifactorial and may include a reduced ability to prevent infection among patients with anxiety disorders, the immunomodulatory and/or cardiovascular effects of medications used to treat these disorders, or severe COVID-19 illness exacerbating anxiety disorders (19,20). In a subset of patients with pre-COVID encounters in our study, anxiety diagnosed before COVID-19 was not independently associated with death or IMV during COVID-19 hospitalization and, therefore, it is also plausible that anxiety was diagnosed during COVID-19 illness and may be a resulting sequela of COVID-19 (21). Future studies could explore the temporal and causal associations between anxiety disorders and severe COVID-19 illness.

Our finding of a positive association of CKD and coronary atherosclerosis and other heart disease with severe COVID-19 illness has been well described at the epidemiologic level (22). We also found that people with neurocognitive disorders (including dementia and Alzheimer’s disease) were at a higher risk of severe COVID-19 illness, which could be associated with difficulties in access to care and difficulties in following safeguarding procedures (23). Our finding of an association of anemia (specifically, anemia in CKD) with severe COVID-19 illness may be driven by a reduced capacity to respond to acute infections in people with this condition (24).

Asthma diagnosis was present among 10.5% of hospitalized patients with COVID-19 in PHD-SR, which is higher than the 8.0% national prevalence of asthma in 2019 (25). At the same time, we found asthma to be associated with a lower risk of death in the full sample; a positive association with ICU admission was found only among patients younger than 40. This finding supports the mixed evidence on asthma as a risk factor for severe COVID-19 illness (1), although the association between asthma and severe COVID-19 illness could differ by the degree of asthma severity (26).

A sensitivity analysis revealed 6 “indeterminate” conditions (such as coagulation and hemorrhagic disorders, cardiac dysrhythmias, and heart failure) that were both frequent and associated with at least 1 severe COVID-19 illness outcome. Without better information on the temporality of these 6 conditions relative to the COVID-19 illness, we were unable to determine whether these were truly underlying conditions (27,28). Our second sensitivity analysis, restricted to 278,215 patients with encounters that preceded the first COVID-19 encounter, found a positive association of sleep–wake disorders and uncomplicated diabetes with severe COVID-19 illness. Weaker associations of other frequent conditions with COVID-19 illness in this analysis (compared with the main results) could be due to under-ascertainment of certain conditions that resulted from using data only for pre-COVID encounters.

Our study has limitations. First, using ICD-10-CM diagnostic codes to identify COVID-19 cases might result in misclassification, although COVID-19 codes in PHD-SR showed high sensitivity and specificity with SARS-CoV-2 test results (29). Second, ICU risk estimates could be biased if ICU admission reflected factors other than severity of COVID-19, such as anticipation of future severity among health care professionals. Third, because our data were observational, we could not establish causal associations between the underlying conditions and severe COVID-19 illness. Fourth, relying on ICD-10-CM codes to identify underlying medical conditions may have underestimated their prevalence. For example, obesity was diagnosed in 33.0% of the patients, which is possibly an underestimate of this condition, given the national prevalence of 42.4% in 2017–2018 (30) and the prevalence of 50.8% among patients with available height and weight data in PHD-SR (14). Fifth, prior literature shows evidence of both increased documentation (31) and underdiagnosis of certain chronic conditions among patients with more severe illness (17). Sixth, the interrelation of the conditions made it difficult to obtain independent associations, which could explain why certain conditions (disorders of lipid metabolism, sleep–wake disorders, esophageal disorders, and depressive disorders) had a positive association with COVID-19 illness when not adjusted for other conditions and a negative association when adjusted for other conditions. These differences could be explained by 1) confounding in the restricted model, 2) lack of independent effects in the full model, or 3) potential overadjustment in the full model by including variables that were on the causal pathway between the condition of interest and the outcome. Seventh, we were unable to assess the associations of current treatment modalities or medications for underlying medical conditions and severe COVID-19 illness because that information was not available in detail. Finally, including only the most frequent underlying medical conditions in the estimations of risk could have caused us to miss less prevalent risk factors of severity; however, conditions of any frequency were accounted for in the “number of conditions” predictor.

Our study found that 9 of 18 frequent underlying medical conditions among adults hospitalized with COVID-19 were associated with severe illness. Combined with the high prevalence of these conditions (affecting 81.9% of hospitalized patients with COVID-19 in PHD-SR), this finding suggests a potentially high impact at the population level. The highest risk of severe COVID-19 illness was associated with obesity, anxiety and fear-related disorders, diabetes with complication, CKD, and neurocognitive disorders. Among patients younger than 40, essential hypertension was also a risk factor for death. The total number of underlying medical conditions was a strong risk factor of severe COVID-19 illness. Preventing COVID-19 in populations with these conditions and multiple conditions should remain a public health priority, along with targeted mitigation efforts and ensuring high uptake of vaccine, when available, in these people and their close contacts.

The following additional information is available from the corresponding author upon request: a figure showing the distribution of the number of underlying medical conditions among adults hospitalized with COVID-19 in PHD-SR; a table showing the most frequent underlying medical conditions among hospitalized adults in PHD-SR with a COVID-19 visit, by severity of COVID-19 illness; and 4 tables showing detailed results of the 2 sensitivity analyses.

The authors thank Sachin Agnihotri, MS, Indira Srinivasan, MS, David Nitschke, BS, and Kimberly Riggle, BBA, of the CDC COVID-19 Response Data, Analytics, and Visualization Task Force; and John House, MS, (Premier Inc.) for facilitating access to these data. We thank Jennifer M. Nelson, MD, and Nickolas T. Agathis, MD, of the CDC COVID-19 Community Interventions and Critical Populations Task Force for contributing to the clinical review of underlying medical conditions. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of CDC or the US Public Health Service. The authors have no funding to disclose. No copyrighted materials were used in this article.

Corresponding Author: Lyudmyla Kompaniyets, PhD, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S107-5, Atlanta GA 30341. Telephone: 404-498-0611. Email: [email protected] .

Author Affiliations: 1 COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia. 2 US Public Health Service Commissioned Corps, Rockville, Maryland. 3 Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Abbreviation: IQR, interquartile range. a Some categories may not add up to 100% because of rounding. b Columns are not mutually exclusive. c Underlying medical conditions were defined by 1) using Chronic Condition Indicator to identify chronic International Classification of Diseases, Tenth Revision, Clinical Modification codes; 2) aggregating the codes into a smaller number of meaningful categories using the Clinical Classifications Software Refined (CCSR); 3) a clinical review of CCSR categories that classified the CCSR codes as “likely underlying,” “indeterminate,” and “likely acute”; and 4) including only “likely underlying” CCSR categories and excluding “indeterminate” and “likely acute” CCSR categories.

Abbreviations: ICU, intensive care unit; IMV, invasive mechanical ventilation; CCSR, Clinical Classifications Software Refined. a Underlying medical conditions were defined by 1) using Chronic Condition Indicator to identify chronic International Classification of Diseases, Tenth Revision, Clinical Modification codes; 2) aggregating the codes into a smaller number of meaningful categories by using the CCSR; 3) a clinical review of CCSR categories that classified the CCSR codes as “likely underlying,” “indeterminate,” and “likely acute”; and 4) including only “likely underlying” CCSR categories and excluding “indeterminate” and “likely acute” CCSR categories. b The reference category for each condition is the absence of that condition; the reference category for diabetes with complication and diabetes without complication is the absence of diabetes. c Full model: Each column includes the results of a single generalized linear model (with Poisson distribution and log link function) that includes all 18 of the most frequent underlying medical conditions (reference: absence of the condition), age group, sex, race/ethnicity, payer type, hospital urbanicity, US Census region of hospital, admission month, and admission month squared. d Restricted model: Each column includes the results of 18 general linear models (with Poisson distribution and log link function), each including only the underlying medical condition (reference: absence of the condition), age group, sex, race/ethnicity, payer type, hospital urbanicity, US Census region of hospital, admission month, and admission month squared. Patients who died without using ICU care or IMV were excluded from the sample when estimating the model with the outcome of ICU care or IMV, respectively. e Based on the results from the full model.

Abbreviations: ICU, intensive care unit; IMV, invasive mechanical ventilation; CCSR, Clinical Classifications Software Refined. a Underlying medical conditions were defined by 1) using Chronic Condition Indicator to identify chronic International Classification of Diseases, Tenth Revision, Clinical Modification codes; 2) aggregating the codes into a smaller number of meaningful categories by using the CCSR; 3) a clinical review of CCSR categories that classified the CCSR codes as “likely underlying,” “indeterminate,” and “likely acute”; 4) including only “likely underlying” CCSR categories and excluding “indeterminate” and “likely acute” CCSR categories. b The reference category for each condition is the absence of that condition; the reference category for diabetes with complication and diabetes without complication is the absence of diabetes. c Each column includes the results of a generalized linear model (with Poisson distribution and log link function), stratified by age group (18–39, 40–64, ≥65) that includes frequent (present in ≥10.0% of patients) underlying medical conditions, age, sex, race/ethnicity, payer type, hospital urbanicity, US Census region of hospital, admission month, and admission month squared. Patients who died without using ICU care or IMV were excluded from the sample when estimating the model with the outcome of ICU care or IMV, respectively.

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

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At Mayo Clinic Graduate School of Biomedical Sciences, you’ll discover a unique research training environment of academic inquiry and scientific discovery, combined with exceptional intellectual and technological resources designed to help you achieve your highest scientific career goals.

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The hallmark of research at Mayo Clinic is the highly collaborative interaction that occurs between investigators in basic science and clinical areas. While each investigator has a competitively funded independent lab, collaboration with graduate students and staff across the institution is common. As a Ph.D. student, you’re free to select any Mayo mentor, regardless of which track you choose.

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Our Ph.D. program in Medical Sciences provides advanced training with the goal of preparing you for a research-based career.

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Areas of in-depth study are driven by faculty research and encompass clinically related fields such as diabetes mellitus, obesity, immunology and infectious disease, oncology, and other chronic health conditions.

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The Doctor of Philosophy in Medical Sciences requires a minimum of 43 credits including 9 credits of dissertation. The program is designed to be completed in 4 to 5 years. Program educational goals and courses can be viewed in the Course Catalog .

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•  MMSC800 Preparing Research Proposals (2 cr)
• MMSC650 Medical Biochemistry (4 cr)
• MMSC691 Human Medical Genetics (3 cr)
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A preliminary exam is taken at end of year 1 that tests the student’s general knowledge base in Medical Sciences and their ability to critically evaluate scientific literature. The preliminary examination includes a written component followed by an oral component on a separate day.

A candidacy exam is taken at the end of year 2. The student will prepare a written and oral proposal for dissertation research that meets the requirements for an external grant proposal. The oral proposal meeting will include both a defense of the student's proposed research and an in-depth examination of the student's knowledge of their research specialization.

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When the dissertation research is complete, all Medical Sciences faculty and students will be invited to attend the oral dissertation defense meetings. Following the oral presentation and questions from faculty in attendance, the Dissertation Committee will meet separately and vote on the outcome. The outcome will be presented to the student, along with any conditions or requirements for proposal or dissertation revisions. 

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• v.5; Jan-Dec 2018

How to Conceptualize and Implement a PhD Program in Health Sciences—The Basel Approach

Franziska keller.

1 Institute of Nursing Science, University of Basel, Basel, Switzerland

Suzanne Dhaini

Matthias briel.

2 Basel Institute for Clinical Epidemiology & Biostatistics and Department of Clinical Research, University of Basel, Basel, Switzerland

Sina Henrichs

3 Vice President’s Office for Research, Graduate Center, University of Basel, Basel, Switzerland

Christoph Höchsmann

4 Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland

Daniel Kalbermatten

5 Division of Plastic, Reconstructive & Aesthetic Surgery and Hand Surgery, University Hospital Basel, Basel, Switzerland

Nino Künzli

6 Swiss Tropical and Public Health Institute (Swiss TPH) and University of Basel, Basel, Switzerland

Annette Mollet

7 Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland

Christian Puelacher

8 Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel and University of Basel, Basel, Switzerland

Arno Schmidt-Trucksäss

Belinda von niederhäusern.

9 Clinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland

Sabina De Geest

10 Department of Public Health, University of Basel, Basel, Switzerland

Objectives:

Over the past decade, several excellent guidelines have been published on how to enhance the quality of PhD education in Europe. Aimed primarily at preparing students for innovative roles in their fields, they include variously structured approaches to curricular offerings, as well as other program components applicable across specialties (eg: supervisor support, scientific conduct, transferable skills). Since 2012, the interdisciplinary PhD Program in Health Sciences (PPHS) at the Faculty of Medicine of the University of Basel in Switzerland has focused on translating these guidelines into a 21st-century health sciences PhD program.

The PPHS started in 2012 based on the European Union (EU) guidelines for PhD education. This article describes the resulting interdisciplinary PhD program’s conceptual underpinnings, rationale, structures, and 10 building blocks, like student portfolios, thematic training, interdisciplinary research seminars, student-initiated interdisciplinary activities, financial support of course participation, top-up and extension stipends, PhD supervision, research integrity, alumni follow-up network, and promotional tools including a dedicated website. Students enter from Clinical Research, Medicine Development, Nursing Science, Epidemiology and Public Health including Insurance Medicine, Sport Science (all from the Faculty of Medicine), and Epidemiology (Faculty of Science).

Discussion and Conclusion:

The Basel PPHS exemplifies state-of-the-art PhD education in Health Sciences based on European guidelines and offers guidance to other groups from conceptualization to rollout of an interdisciplinary health sciences PhD program.

Introduction

Health science research is critical for societal health. 1 The current health care delivery and service paradigm demand that researchers use state-of-the-art skills to find innovative solutions to problems inside and outside of academic settings. As a result, over the past 25 years, both in North America and in Europe, the education and resources allocated for future researchers, mainly through PhD programs, has become a focus of much academic policy. 2 , 3

In North America, the bachelor’s/master’s/doctoral scheme and a transferable credit system have been in place for more than a century 4 ; in Europe, they are a very recent development. In addition, North American PhD education has a strong curricular component, whereas European programs are more research-based, with students engaging in research from the start in addition to course work.

In Europe, both the Bologna Declaration of 1999 5 and the Lisbon Strategy of 2000 2 affected the conceptualization of doctoral education and training. Both began with the premise that more and better-trained researchers were needed to make Europe the world’s most competitive knowledge-based economy. 2 , 6 - 11 From that perspective, policy makers have examined doctoral education and requested that universities develop institutional strategies 2 to train young researchers by and through original research. 12

In 2005, the Salzburg Principles confirmed that research institutions need flexible regulations to create the structures and instruments necessary to advance doctoral training. 13 Since then, the education of competent junior scientists at European universities has become a strategic goal to secure Europe’s position in the global knowledge economy. 1 Furthermore, to meet the expanding employment market needs, the May 2005 Ministerial Conference in Bergen 12 urged universities to promote interdisciplinary doctoral training and the development of transferable skills. In that context, several European Union (EU) forces driving PhD education have emerged, including the Organization for PhD Education in Biomedicine and Health Sciences in the European System (ORPHEUS), which includes around 80 European biomedical and health science faculties and institutions, and the League of European Research Universities (LERU). Working together, these groups safeguard the reputation of the PhD as a research degree, strengthen career opportunities for PhD graduates, and advocate the promotion of research at European universities.

In Switzerland, the Rectors’ Conference of the Swiss Universities 14 has developed a joint position paper on the doctorate acknowledging that their institutions’ common objectives and structures are in line with the European positions. The Rectors’ Conference 14 provides no details regarding PhD education, and each Swiss university structures, designs, and confers its own doctorates. This decentralized education mirrors the Swiss Confederation’s small-scale federalist political system. 15 In fact, along with the Swiss National Science Foundation, the main health science funding agency, the advancement of scientific research is primarily the federal government’s responsibility. 15 , 16

The University of Basel, Switzerland, is a publicly funded university founded in 1460. It currently serves almost 13 000 students, of whom 16% are PhD students. 14 Due to strong collaboration with the pharmaceutical and chemical industries, the University of Basel has become a cluster for health sciences. Its 7 faculties offer numerous PhD programs and establish regulations for the implementation and monitoring of doctoral training. 17 From that perspective, the Faculty of Medicine established the PhD Program in Health Sciences (PPHS) 18 in 2012, following a call by the University Rectorate for funding to stimulate and support the development of doctoral programs. The PPHS was launched as an interdisciplinary, inter-professional PhD training platform for students from 6 health-related PhD disciplines offered by 2 faculties: Clinical Research, Medicine Development, Nursing Science, Epidemiology and Public Health including Insurance Medicine, Sport Science (all from the Faculty of Medicine), and Epidemiology (Faculty of Science).

Thus, the PPHS is a support system for PhD education to optimize students’ scientific, professional, and personal development. The program’s mandate reflects the call to increase inter-professionality at the national and international levels and allows maximum networking across health science disciplines that share methodological and statistical approaches.

The PPHS’s governance is headed by a steering committee consisting of 1 representative professor from each of the 5 participating departments, 3 PhD student representatives, and the program coordinator. Guided by national and international guidelines as well as evidence, contextual factors, and university regulations, they decide on program strategies, operationalize the instruments necessary to roll out those strategies, evaluate the quality of proposed initiatives, and continuously optimize their approaches.

Their aim is that each PhD student is fully integrated into a research group and complies with mandatory university PhD regulations regarding publications and European Credit Transfer System (ECTS) credits. The PhD students are selected by the supervisors. Following the PhD regulations of the Faculty of Medicine of the University of Basel, they require a degree from the University of Basel or other acknowledged institution, usually in form of a master’s degree in the field relevant to the planned area of study. Acceptance to the PhD program and progress (toward completion) are monitored by an interdisciplinary PhD board at the level of the Faculty of Medicine. Main criteria for acceptance are the professional background of the candidate, the fit with the supervisor, the subject of the PhD thesis, the quality of the proposal—in particular the adequacy of the methods—and the fulfillment of the financial guarantee for the whole PhD. A personal PhD committee directly supervises each student’s PhD. The program is thus composed primarily of research-based training, complemented by structured training activities provided through the PPHS’s educational infrastructure. The PPHS has no direct supervisory role.

The PPHS is evaluated by the Rectorate of the University of Basel at the end of a financial period. The evaluation is based on the general academic objectives, the organizational structure, the appointment procedure of the students, the structure and content of the training, the activities of the doctoral students within the program, the supervision concept, the mobility of the students, the internationality of experts, the quality of assurance and reporting, the existing collaborations, and the adequate use of funds. PPHS evaluates each course offering and makes regular surveys among its member students.

As an educational platform, the PPHS’s goal is to enable students to become qualified researchers with a comprehensive knowledge base specific to their discipline, to acquire advanced training, and to enhance their research dissemination skills. And as an example of current innovations in European PhD education in health sciences, we describe the conceptualization, implementation, and primary outcomes of the PPHS at the University of Basel.

The PhD Program in Numbers

Although the PPHS started in late 2012, only in 2015 the PhD students had to register and we can track them. Before 2015, all the PhD students of the included disciplines were automatically members. The number of registered PhD students is growing (2015: 65, 2018: 94). Therefore, we have only very few graduates. The mean time to degree lies between 3 and 4 years. Some graduates continue in the academic world, in their specialized formation as doctor or go to the private sector ( Figure 1 ).

Number of PhD students enrolled in PPHS. PPHS indicates PhD Program in Health Sciences.

The PPHS: Description of its 10 Building Blocks

The PPHS has been conceptually guided by the Salzburg II recommendations, 13 the LERU guidelines for PhD education, 19 good practice in doctoral training, 20 and the ORPHEUS standards 21 ( Table 1 ). It consists of 10 building blocks, all guided by interdisciplinary competencies and supported by a coordination office as well as the transferable skills offerings at the University of Basel (see Figure 2 ).

Eight fundamental recommendations for a PhD program derived from the Salzburg II recommendations, 13 the LERU guidelines for PhD education, 19 good practice, 20 and the standards of ORPHEUS. 21

Abbreviations: LERU, League of European Research Universities; ORPHEUS, Organization for PhD Education in Biomedicine and Health Sciences in the European System.

The PPHS and its 10 building blocks.

Interdisciplinary competencies as defined by the PPHS

The PPHS competency framework ( Table 2 ) outlines the minimum competencies to be acquired by each student for completion of a health sciences PhD. In addition to assessing existing and lacking competencies, it guides students and supervisors regarding individual training needs. It anticipates and adjusts for the large variability in new students’ methodological and statistical skills. To ensure up-to-date information and meet current and future needs, this framework is continuously revised and adapted.

Interdisciplinary competency framework as defined by the PhD Program Health Sciences.

Abbreviations: CRF, Conditional Random Field; RCT, Randomized Controlled Trial; SOP, Standard Operating Procedure.

The PhD students obtain 3 sets of interdisciplinary competencies during their PhD training ( Table 2 ):

• Knowledge and scientific competencies : research methods, information literacy, scientific writing, professional conduct, ethics and integrity, and awareness of interdisciplinary contexts.
• Organization and management competencies : project management, self-management, and teaching.
• Leadership and personal competencies : communication and leadership.

All PhD students have to submit a Learning Agreement together with a full research proposal of their PhD project after the first 6 months of admission at the University of Basel. The Learning Agreement describes how they plan to fulfill the mandatory 18 ECTS. The PhD Board of the Medical Faculty provides written approval or feedback on the yearly Progress Reports and the Learning Agreement.

PPHS’ 10 building blocks

The PPHS consists of 10 building blocks (see Figure 2 ), chosen both to reflect the principles of doctoral education ( Table 1 ) and to optimize students’ professional development in view of the 3 sets of competencies ( Table 2 ).

Student portfolio

Each PhD student’s PhD track is individually developed within the framework of the applicable PhD regulations and the PPHS—taking into consideration the student’s professional background, needed competencies, and chosen research type. All also obtain ECTS credits in the 3 competency domains. They report their research in a cumulative dissertation of at least 3 papers. This makes PhD education “highly individual and by definition original” 13 and fundamentally different from bachelor- or master-level studies. The individual PhD track is reflected in an individually compiled student portfolio comprising information on course work as well as the PhD project’s aims and timetable. During the program, each portfolio also contains an overview of the student’s plans regarding attendance of workshops and courses (totaling a minimum of 18 ECTS credits [1 ECTS credit requires 25-30 hours of work]), national and international conferences, teaching activities, and publications. The student portfolio is individualized and tailored to the students’ needs of statistical and other methodological skills as well as competencies specifically required for the proposed PhD studies (see also Interdisciplinary competencies as defined by the PPHS).

Throughout the PhD program, the portfolio not only provides orientation and structure but also serves as a tool to assess progress. 24 - 26 Based on its content, each student is required to write an annual self-assessment for discussion with his or her PhD committee and for submission to the PhD board of the Faculty of Medicine. At this level, the PhD committee and the PhD board will take action to deal with any significant issues such as potential delays and related financial discussions or problems in the supervision of a PhD project. PhD students appreciate this regular written feedback on their performance.

PhD supervision

In line with university regulations, each PhD student is supervised by a specially chosen PhD committee. 27 Each committee meets at least once yearly to discuss the student’s annual self-assessment.

The ORPHEUS network 21 has established best-practice indicators for high-quality PhD supervision, certifying supervisors to mentor students, and to recognize and react to barriers to PhD students’ success. 28 , 29 In addition, an annual PPHS workshop helps senior researchers to promote the quality of their supervisory skills. Fully booked since their implementation, these workshops are highly appreciated by the supervisors.

Thematic training

One key change in PhD education in recent years has been the introduction of a wide range of professional development courses. 20 As students enter the PhD program with widely varying skills, training is available from basic to advanced levels. As all health sciences specialties employ comparable methodological approaches (eg, quantitative, qualitative, mixed methods, implementation science), these form the core content of PPHS training. Therefore, the PPHS offers health science–specific courses valuable across specializations:

• “Proposal Writing in Health Sciences,”
• “Good Scientific Conduct in Health Sciences,”
• “Academic Writing in Health Sciences, “
• “Essentials in Health Research Methodology,”
• “Walking in the Editors’ Shoes: Peer reviewing and journal editing for young researchers in health sciences,”
• “How to prepare a job application inside or outside of academia.”

All courses are optional and there is no defined course sequence. However, the first 4 mentioned courses are more suitable for PhD students in their first year and the 2 courses at the end of the list above are more suitable for advanced PhD students. A new agreement with the structured Swiss School of Public Health PhD Program in Public Health provides free access to further set of methodological and advanced courses.

For all the courses, Learning Outcomes are defined which reflect the competencies framework of PPHS. At the end of each course, students have to take an examination (mandatory) to evaluate if the PhD students have reached the Learning outcomes and hence acquired the necessary competencies.

Various international guidelines underpin the importance of training transferable skills (see also Table 1 ). 20 , 23 The trans-faculty Transferable Skills Program organized by the University of Basel Graduate Center offers a wealth of courses for all PhD students, enabling skill set enhancement through individualized selections of courses. Students in the Faculty of Medicine can also acquire ECTS credits through participation in these courses, further enhancing cross-discipline networking. This approach follows the European Commission’s Directorate General for Research and Innovation 23 recommendation that “doctoral training must be embedded in an open research environment and culture to ensure that any appropriate opportunities for cross-fertilization between the disciplines can foster the necessary breadth and interdisciplinary approach.”

Financial support for course participation

The PhD students must have the possibility to go to other universities. 28 PPHS financial support is available to all member students to attend external (including online) courses that complement their PhD education. Students can apply for up to 2000 CHF per PhD study in financial support to participate in courses not offered at the University of Basel. To be eligible, courses must be linked to the student’s portfolio, award ECTS credits, and cover competencies essential to the student’s PhD studies.

Interdisciplinary research seminars

Reflecting the European Commission’s 23 promotion of interdisciplinary cross-fertilization in research, PPHS interdisciplinary research seminars encourage networking and stimulate the exchange of diverse scientific perspectives and approaches, contributing to a creative and productive research environment. In this regard, the monthly meetings of the “Methods in Health Sciences” PhD Journal Club offer opportunities for members from all disciplines to present research manuscripts and receive critical feedback in an interdisciplinary peer review environment. In addition to their direct educational value, these presentations promote professional communication skills among peers. Following the peer review and discussion segments, a “meet and greet” period allows students to network and share experiences.

Student initiated interdisciplinary activities

International doctoral education should support bottom-up initiatives, also called student-initiated activities, 28 (p19) as “the ability to drive initiatives is part of a doctoral candidate’s process of becoming an independent researcher”; hence the annual PPHS call for student-initiated activities. Under the “Invite your expert” competition, which awarded 4 students in 2016, PPHS gives the opportunity to invite an international expert to deliver a lecture at the University of Basel. This encourages the participants to initiate activities autonomously, build transferable skills, and develop independent organizational skills.

Top-up and extension stipends

For students to benefit fully from their programs, their funding must be sufficient “to nurture an open and investigative research mindset.” 28 To allow excellent PhD students the opportunity to deepen their research experience, competitive PPHS top-up and extension stipends are available. Top-up stipends support unplanned and newly emerged projects during the PhD program; extension stipends allow the analysis and publication of additional material at the end. As a PhD’s financing must be guaranteed for 3 years at registration, these instruments add value and research resources beyond the program’s primary scope. In 2015, 10 stipends led to 16 additional publications.

Research integrity

In concordance with the 2015 ORPHEUS conference message 30 that knowledge and awareness of research integrity are central to the career development of all PhD students, starting in 2018, several PPHS courses will focus on good scientific conduct. Given the PPHS program’s interdisciplinary approach, best scientific conduct practices will soon be established across all the participating disciplines. Students are made aware of the University of Basel’s Code for Good Practice in Research 31 as well as the Swiss Academies of Arts and Sciences brochure, “Integrity in Scientific Research.” 32

Alumni follow-up network

Alumni networks help PhD students and the PPHS with career orientation information and feedback regarding the program’s quality. 23 , 33 Regular meetings with alumni expand the PPHS network and facilitate continuous assessment of its career development support. 34

Website and other promotional tools

For profile-raising, networking, and dissemination purposes, an interactive website is the most important PPHS promotional tool ( www.pphs.unibas.ch ). Offering a group identity in an interdisciplinary framework, 35 it includes links to the social media where current events are regularly posted. In addition, PPHS activities include welcome events for all new PhD students during their first year, a PhD day, and annual PPHS updates via faculty meetings (reaching out to supervisors), all of which raise PPHS awareness among PhD members and their supervisors. Student feedback is collected after each activity via a short questionnaire, and observations are constantly integrated for quality control and improvement.

PPHS coordination

The coordination of a PhD program is an overarching theme and not one of the building blocks ( Figure 2 ). According to Pifer and Baker, 24 PhD program administrators play key roles in establishing and fulfilling the missions, purposes, and processes of PhD education. University management should ensure that relevant staff members have pertinent competences to handle all day-to-day business. 28 The coordinator should be a research professional, normally holding a PhD. He or she must implement, monitor, and execute the designed strategy and activities decided by the PPHS Steering Committee, which comprises the second PPHS operational component.

The annual PPHS budget is 175 000 CHF, of which one-third is allocated to personnel costs. The remainder funds the activities of the 10 building blocks. The PhD students are paid by their supervisors.

Sustainability of the PPHS depends on continuous funding. Discussions are underway to integrate it within a larger Swiss interdisciplinary structure’s PhD Program in Public Health (Swiss School of Public Health+, SSPH+). 36 , 37 If the plan is adopted, the public health infrastructure will be combined with that of clinical research. Hopefully, such a mix will provide a model that will successfully bolster the academic public health work force. 38

This article describes the conceptualization and development, based on European guidelines and international evidence on PhD education, 20 , 28 of the PPHS, an interdisciplinary health sciences PhD program at the University of Basel, Switzerland. As the European Union is showing an increased interest and investment in developing forward-oriented PhD programs, awareness of this program can help universities to reflect on their own initiatives. For those introducing PhD programs, it will help to operationalize the various guidelines. A vibrant and highly functional interdisciplinary program, the PPHS promotes all the ideals put forward on the topic by the Directorate General for Research and Innovation of the European Commission. 23

As a single-faculty project, 39 the PPHS initially grew out of informal collaboration between staff from various health science disciplines. Admittedly, the competitive funding for PhD programs provided by the University Rectorate was crucial for the program’s launch. In countries with fewer resources available, 40 , 41 the PPHS remains relevant, as the program concept and building blocks can be adapted to the resources available. Where budgets are severely limited, the core components to be considered are the student portfolio and supervisor training.

The University of Basel’s individualized PhD tracks, including 18 ECTS points and involving research throughout the 3 years of the PhD, contrasts strongly to US-based PhD programs, which begin with course work, leading to qualifying examinations, followed by a research project. 2 It is beyond the scope of this article to evaluate the pros and cons of both models: both models have clearly emerged from distinct educational and societal contexts. Highly structured PhD programs with large formal course work components 2 are certainly an improvement on the loosely organized PhD tracks formerly common in Europe. The PPHS is a flexible educational platform that allows students and supervisors to plan PhD tracks while ensuring compliance with PhD requirements, course offerings, and other useful instruments. Considering the ultimate goal of optimizing the PhD experience, supervisors of PhD students also receive ample attention 27 ; supervisor courses have been booked out quickly clearly, indicating a strong need for this type of support as well as a willingness to improve supervision.

This article demonstrates that some principles drawn from international guidelines are easily transferred into practice. Others, such as transparent international recruitment of PhD students ( Table 1 ), are more difficult to implement, as they require close collaboration and homogenization of participating institutions’ processes. However, continuous monitoring of international guidelines helps to improve critical structures continuously.

The PPHS needs to be interpreted in the context of a policy that provides major incentives for PhD education. Active integration of national and local programs such as the PPHS into national structures would add further value for PhD students seeking interdisciplinary training and networking beyond those available through their universities.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author Contributions: FK, SD and SDG took the lead in writing the manuscript. All authors provided critical and substantial feedback and helped shape the manuscript. MB, NK, AS, and SDG conceived the original idea. SDG supervised the whole project.

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Everything You Need to Know About MD-PhD Programs

Posted in: Applying to Medical School

Table of Contents

MD-PhD programs are dual-degree programs for pre-medical students who want to both practice medicine and conduct extensive research.

In an MD-PhD program, the medical education of the MD program is combined with the in-depth research training of a PhD program. Students learn to practice medicine, diagnosing and treating patients all while gaining research experience to investigate medical conditions and diseases.

These programs are more intense than standard medical school. Students take additional coursework, typically in the biomedical sciences, graduate training, rotations in different laboratories, and intensive research.

The extra education gives students the tools to advance in the medical field after graduation. If you are interested in investigating diseases as you treat patients and developing innovative ways to provide care, an MD-PhD path may be for you!

What are MD-PhD programs?

MD-PhD programs are unique dual-degree programs designed for students who have an interest in both patient care and research. In these programs, students complete both a medical degree (MD) and a doctorate (PhD). This prepares graduates to function as physician-scientists, seamlessly bridging the gap between the laboratory and the clinical setting.

What is the difference between an MD and an MD-PhD? The difference between MD and MD-PhD graduates is that while both degrees are conferred to medical doctors, MD programs focus on clinical practice. MD-PhD programs, on the other hand, combine medical education with extensive biomedical research training. 

Is MD-PhD easier than MD? MD-PhD programs are not easier than MD programs. They require a longer time commitment, but in the end, provide graduates with a broader skill set to pursue careers that integrate medicine and scientific research.

How rare is an MD-PhD? Only about 3% of students that enroll in medical school are in MD-PhD programs. There are 122 MD-PhD programs in the U.S. and 13 in Canada listed on the AAMC MD-PhD Degree Programs by State directory .

Graduate programs aren’t confined to a specific area of study. Each school with this type of program has its own options for its PhD degree. PhD students commonly choose to specialize in topics such as:

• Cell biology
• Biochemistry
• Pharmacology
• Neuroscience
• Biomedical engineering

Upon completion of an MD-PhD program, graduates are awarded the dual degree for their proficiency in both clinical practice and research. 

MD-PhD Program Duration

A significant commitment of time is necessary to complete an MD-PhD program, but the career path is rewarding and well-compensated. 

How many years are MD-PhD programs ? Students can expect to spend 7-8 years total between graduate school and med school, but there is no strict timeline for completing an MD-PhD. Some students complete their programs in as little as six years, and others take as long as 10.

Students usually start with the first year to two years of medical school, followed by 3-5 years of research, then finish with another two years of medical training and clinicals. Current students entering into MD-PhD programs are older , on average, than when these programs first began, and many take longer to complete their studies.

How much does an MD-PhD program cost?

Most MD-PhD programs offer enrolled students tuition-free training and a stipend to cover living expenses.

The cost of an MD-PhD program varies widely depending on the institution, but the stipend and tuition-free training makes many of these programs significantly less burdensome financially compared to standalone MD or PhD programs.

Financial support is available through the Medical Scientist Training Program (MSTP) funded by the National Institutes of Health (NIH). Scholarships are offered that cover tuition and provide a stipend for living expenses, making these intensive dual degree programs more attainable.

Not all MD-PhD programs are funded by the MSTP, but some schools offer similar financial support to their MD-PhD students. For any school you plan to apply to, double-check their program website or call an admissions counselor to see if there are options for financial aid. 

MD-PhD Residencies

MD-PhD residencies provide a unique opportunity to bridge the gap between patient care and research. Graduates often enter residency programs to acquire hands-on training in a particular medical specialty. Some even opt for a fellowship in a subspecialty after that. This training phase can range from 3 -7 years, depending on the specialty.

Although they can enter any medical specialty, they frequently gravitate towards specialties with a strong research component. Here are a few common residencies that MD-PhDs typically enter:

• Internal Medicine: This field covers a broad range of diseases in adults and often involves solving complex medical problems. It’s a popular choice for MD-PhD graduates because of the diversity of patients and conditions, which provides many opportunities for research.
• Neurology: The complexity and the largely untapped understanding of the nervous system provide abundant research opportunities. Advances in neuroimaging, AI , and genetics also offer tools for physician-scientists to explore the nervous system in unprecedented ways.
• Psychiatry: Studying the pathophysiology of mental disorders, exploring new therapeutic interventions, and examining the genetic basis of psychiatric conditions are just a sample of the ways an MD-PhD can continue research in this specialty.
• Pathology: Pathologists often work behind the scenes in medicine, studying the causes and effects of diseases. This field is deeply rooted in medical research, which makes it a good fit for many MD-PhD graduates.
• Pediatrics : Pediatric physician-scientists research a wide array of topics, including childhood diseases, growth and development, pediatric therapies, and many other areas related to child health.

The choice of residency program should align with each graduate’s clinical interests, research interests, and career goals. There is great flexibility in the MD-PhD pathway, and physician-scientists span all specialties in medicine.

MD-PhD Career Path & Salary

Careers for MD-PhD’s often sit at the intersection of healthcare, academic medicine, and industry. Roles vary from practicing physicians, medical researchers, educators, and policy advisors to leaders in biotech and pharmaceutical companies.

After completing their residency, MD-PhDs typically divide their professional time between research and clinical practice. They often work in academic medical centers or research institutions where they can see patients and conduct research. Their research may be basic, translational, or clinical, depending on their interests and training.

MD-PhDs may also grow to take on teaching roles, educating the next generation of physicians and scientists. This path can bring them to leadership roles such as department chair, dean of a medical college, or even hospital CEO with their unique understanding of both medicine and research.

The salary for MD-PhDs does vary depending on the chosen career path. Earning potential is generally high due to the advanced and specialized nature of their training.

On average, physician-scientists in the US earn a median salary that is well above the national average for all occupations. According to Doximity’s 2023 Physician’s Compensation Report , the average salary for physicians in the Pharmaceutical/Industry employment setting is highest at $392,534.

Those working in academia or research may have different salary scales. These salaries are frequently dependent on research grants, but still typically fall within a comfortable range.

An MD-PhD opens up a wide range of career options, particularly in the intersecting areas of healthcare and research. Below are careers someone with an MD-PhD might pursue:

• Academic Physician: They divide their time between seeing patients, conducting research, and teaching students and residents. These professionals usually work at medical schools or teaching hospitals.
• Biomedical Researcher: MD-PhDs often find employment as researchers in the field of biomedical sciences. They can work in research institutions, pharmaceutical companies, or government organizations such as the NIH.
• Clinical Investigator: These are physicians who conduct research involving human subjects (clinical trials). They develop and implement studies to understand the effects of new drugs or therapeutic strategies.
• Pharmaceutical/Biotech Industry Professional : Many MD-PhDs work in the pharmaceutical or biotechnology industry. They may be involved in drug development, clinical trials, regulatory affairs, or medical affairs.
• Medical Director: In this role, an individual would oversee the medical aspect of a healthcare facility, biotech company, or department in a hospital. This position often requires both a medical and research background.
• Science Policy Analyst/Advisor: They can work in government or nonprofit organizations, helping to shape policies that affect scientific research and healthcare.
• Public Health Official: Some MD-PhDs choose to work in the public sector, addressing health issues at the population level. They may work for entities like the Centers for Disease Control and Prevention (CDC) or World Health Organization (WHO).
• Medical Science Liaison: This role often involves serving as a bridge between pharmaceutical companies and healthcare professionals, explaining new therapies and scientific findings to physicians, researchers, and other stakeholders.
• Medical Educator: MD-PhDs are uniquely qualified to educate future doctors and researchers, teaching in areas such as pharmacology, pathology, genetics, or any other medical specialty. They may design and implement courses, advise students, and contribute to the educational mission of their institution.

These are just a few of the potential career paths. A career choice often depends on an individual’s specific interests, such as which medical specialties they are drawn to, whether they prefer working with patients or in a laboratory, and how they want to contribute to advancing medical science.

Medical Science Training Programs

Some MD-PhD programs in the United States are funded by the National Institutes of Health (NIH) through the Medical Scientist Training Program (MSTP). This means that students receive full tuition remission, health insurance, and a living stipend throughout their training.

Because of this financial support, admission to an MSTP is very competitive. Many schools have financial support available to MD-PhD students even if they are not part of the Medical Scientist Training Program to allow them to focus on their studies and research.

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4 Benefits of Becoming an MD-PhD

Earning dual degrees in medicine and research is an ambitious endeavor, but the impacts you can make on patient care and scientific research are significant and valuable to public health. An MD-PhD degree comes with some great benefits.

1. Interdisciplinary Perspective

The duality of the MD-PhD training allows graduates the ability to translate clinical observations into research questions, then taking research findings to enhance patient care. You will essentially be a bridge to the gap between the laboratory and the clinic.

2. Career Flexibility

Graduates can become practicing physicians, medical researchers, educators, and/or policy advisors. They may also take on leadership roles within academic institutions, hospitals, biotech companies, or pharmaceutical firms. 

The wide range of possible careers allows the flexibility to pursue a path that aligns with your passion.

3. Influential Impact 

The rigorous training in MD-PhD programs allows graduates to drive innovation in healthcare and medical science. This advanced education will have you asking critical questions and finding answers that can change the course of medical treatment and patient care. 

The potential to make significant contributions to the field of medicine is a rewarding and prestigious aspect of this career path.

4. Community and Mentorship

During their training, MD-PhD students join a tight-knit community of fellow dual-degree students, mentors, and faculty. This network can provide valuable support, guidance, and camaraderie during the demanding years of study. 

Post-graduation, this network continues to serve as a resource for collaboration, mentorship, and career advancement.

Are MD-PhD programs more competitive than MD programs?

In general, yes, MD-PhD programs are more competitive than MD programs. 

The statistics here can be a little confusing, though. 10% of applicants are accepted to an MD-PhD program, which is higher than the 3% that get accepted into MD programs. Acceptance rates are nearly the same as traditional medical programs, too.

But the quality of application for MD-PhD programs is inherently higher than traditional pre-meds. Your GPA and MCAT need to be higher, with well-developed extracurricular experiences and glowing letters of recommendation to have a chance at an MD-PhD program. 

Learn more about how we can help you boost your MCAT score.

Preparing to Apply to MD-PhD Programs

Applying for an MD-PhD program is done through AMCAS, just like MD programs. Preparation is key in the application process .

Being proactive, getting relevant experiences, understanding the requirements, and applying to multiple programs will significantly enhance your chances of success in securing a spot in an MD-PhD program. Applicants must be prepared to showcase themselves as doctor material and make a case for their desire to take part in research.

Here are a few tips for increasing your chances at acceptance.

Make sure you have the right extracurriculars under your belt.

Gaining relevant experiences beyond the classroom is crucial to showcase your commitment to a career in medical research. Admissions committees are looking for candidates with experience in research projects. 

It is absolutely necessary to have taken part in research to have a chance at getting into an MD-PhD program.

Check application requirements well in advance.

You’ll be required to meet all the AMCAS application requirements of MD programs. This includes the prerequisite coursework, your MCAT score and GPA, letters of evaluation, and personal statement . 

There are also two additional essays that are required on MD-PhD applications, which we’ll cover later.

We advise checking with each specific medical school on the requirements for their applications . Non-medical graduate programs may ask for your GRE scores. You want to make sure you’ve taken this test well in advance of the AMCAS open date. 

Our advisors can help you craft a personal statement for your MD-PhD that will stand out.

Apply to several programs.

Because of the limited number of programs and the competitive nature of MD-PhD programs, you should apply to multiple programs. Students who have gotten into these programs report applying to as many as 30 programs for the best chance to be accepted. 

Along with MD-PhD programs, we also recommend applying to some MD programs as well. On your AMCAS application, you can easily designate as an MD candidate or MD-PhD candidate.

Even if you don’t make it into the MD-PhD program of a medical school, you will still have the opportunity to be considered for their MD program.

MD-PhD Application Timeline

Get your medical school application in early — the same goes for MD-PhD applications. In fact, it’s even more important to have your primary application in as soon as possible to give yourself plenty of time to write your secondary essays. 

The MD-PhD application process follows the AMCAS application timeline :

• May: AMCAS application opens. You’ll receive your secondary application shortly after you submit your primary. 
• July-August: Submit your supplemental application within two weeks.
• October-March: Prepare for and attend all scheduled interviews.
• December-March: Application committees make final decisions. For schools with rolling admissions, this may happen shortly after an interview. Other institutions wait until after all interviews are complete to make decisions.
• March-April: Applicant decisions are made.
• June-August: Your MD-PhD begins.

Additional Essays in the MD-PhD Application

The MD-PhD application process includes two additional essays that showcase your commitment to a career as a physician-scientist. 

MD-PhD Essay

The MD-PhD Essay is your opportunity to express why you have chosen the dual-degree path and how it aligns with your career goals. Discuss your motivation for pursuing the ambitious MD-PhD degree. You should explain why both clinical practice and research are integral to your career vision and share personal experiences that ignite your interest in this path.

Describe your career goals and how integrating clinical practice and scientific research will allow you to achieve those goals. If you’re interested in a particular field, discuss how the blend of clinical and research training in the MD-PhD program will enhance your contributions to this field.

Significant Research Experience Essay

This essay is your chance to elaborate on your research experiences and demonstrate your scientific curiosity, perseverance, and ability to work independently. You’ll explain the objectives of the research project you have been involved in, your role in achieving these objectives, and the significance of the research.

You can also write about instances where you faced challenges and had to use your problem-solving skills, perseverance, and critical thinking to overcome them. Highlight your ability to learn from others, like your mentors, how you can collaborate, and contribute to a team-oriented goal.

If your work led to any significant findings, presentations, or publications, be sure to include this. Use this opportunity to communicate your passion for research and how these experiences have prepared you for a career that combines patient care and scientific investigation.

MD-PhD: The career path that moves medicine forward.

MD-PhD candidates have a commitment to both medical practice and research on this path. The journey is long and at times challenging, but for those driven by a passion for both clinical medicine and biomedical research, the reward lies in the unique ability to contribute to the advancement of healthcare as a physician-scientist.

Speak with a member of our enrollment team who can help you prepare your MD-PhD application.

Kachiu Lee, MD

Dr. Lee specializes in BS/MD admissions. She was accepted into seven combined bachelor-medical degree programs. She graduated Summa Cum Laude from Northwestern University and proceeded to Northwestern University’s Feinberg School of Medicine in Chicago, IL. After completing a dermatology residency at Brown University, Dr. Lee pursued a fellowship in Photomedicine, Lasers, and Cosmetics at Massachusetts General Hospital and was a Clinical Fellow at Harvard Medical School. Academically, she has over 100 peer-reviewed publications and lectures internationally.

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Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020-March 2021

Affiliations.

• 1 COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.
• 2 Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S107-5, Atlanta GA 30341. Email: [email protected].
• 3 US Public Health Service Commissioned Corps, Rockville, Maryland.
• 4 Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia.
• PMID: 34197283
• PMCID: PMC8269743
• DOI: 10.5888/pcd18.210123

Introduction: Severe COVID-19 illness in adults has been linked to underlying medical conditions. This study identified frequent underlying conditions and their attributable risk of severe COVID-19 illness.

Methods: We used data from more than 800 US hospitals in the Premier Healthcare Database Special COVID-19 Release (PHD-SR) to describe hospitalized patients aged 18 years or older with COVID-19 from March 2020 through March 2021. We used multivariable generalized linear models to estimate adjusted risk of intensive care unit admission, invasive mechanical ventilation, and death associated with frequent conditions and total number of conditions.

Results: Among 4,899,447 hospitalized adults in PHD-SR, 540,667 (11.0%) were patients with COVID-19, of whom 94.9% had at least 1 underlying medical condition. Essential hypertension (50.4%), disorders of lipid metabolism (49.4%), and obesity (33.0%) were the most common. The strongest risk factors for death were obesity (adjusted risk ratio [aRR] = 1.30; 95% CI, 1.27-1.33), anxiety and fear-related disorders (aRR = 1.28; 95% CI, 1.25-1.31), and diabetes with complication (aRR = 1.26; 95% CI, 1.24-1.28), as well as the total number of conditions, with aRRs of death ranging from 1.53 (95% CI, 1.41-1.67) for patients with 1 condition to 3.82 (95% CI, 3.45-4.23) for patients with more than 10 conditions (compared with patients with no conditions).

Conclusion: Certain underlying conditions and the number of conditions were associated with severe COVID-19 illness. Hypertension and disorders of lipid metabolism were the most frequent, whereas obesity, diabetes with complication, and anxiety disorders were the strongest risk factors for severe COVID-19 illness. Careful evaluation and management of underlying conditions among patients with COVID-19 can help stratify risk for severe illness.

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• Association of Abnormal Cardiac Biomarkers and Cardiovascular Complications, with Mortality in Patients with SARS-CoV-2 Infection in Latin America. Gómez-Mesa JE, Escalante M, Muñoz-Ordoñez JA, Azcárate-Rodriguez V, Peláez-Martínez JD, Arteaga-Tobar AA, León-Giraldo H, Valencia-Orozco A, Perna ER, Romero A, Mendoza I, Wyss F, Barisani JL, Speranza M, Alarco W, Herrera C, Lugo-Peña J, Cárdenas-Aldaz LP, Rossel V, Sierra D; CARDIO COVID 19-20 Research Team. Gómez-Mesa JE, et al. J Cardiovasc Dev Dis. 2024 Jun 30;11(7):205. doi: 10.3390/jcdd11070205. J Cardiovasc Dev Dis. 2024. PMID: 39057625 Free PMC article.
• Real-world effectiveness of sotrovimab in preventing hospitalization and mortality in high-risk patients with COVID-19 in the United States: A cohort study from the Mayo Clinic electronic health records. Bell CF, Gibbons DC, Drysdale M, Birch HJ, Lloyd EJ, Patel V, Carpenter C, Carlson K, Calay ES, Puranik A, Wagner TE, O'Horo JC, Razonable RR. Bell CF, et al. PLoS One. 2024 Jul 16;19(7):e0304822. doi: 10.1371/journal.pone.0304822. eCollection 2024. PLoS One. 2024. PMID: 39012863 Free PMC article.
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Graduate School

Ph.d. requirements.

• Academics & Research
• Programs & Requirements

Brown University awards more than 200 doctor of philosophy degrees annually.

The Brown Ph.D. is primarily a research degree. Teaching is an important part of many doctoral programs, and many departments require candidates for the Ph.D. to have teaching experience.

Brown University offers substantial financial support to doctoral students. All incoming doctoral students are guaranteed five years of support, which includes a stipend, full tuition remission, health-services fee, and a health-insurance subsidy. Doctoral students in the Humanities and Social Sciences are guaranteed six years of support. All promises of student support are subject to students making satisfactory academic progress, as determined by their programs of study. Please see related links for additional details regarding the University's commitment to doctoral education.

Ph.D. Funding

Funding guarantee, four general requirements for the doctor of philosophy.

The candidate must be formally admitted to his or her degree program.

The normal residency requirement is the equivalent of three Academic Years of full-time study beyond the bachelor's degree. Students who enter a PhD program at Brown already holding a master’s degree in a related field have a residency requirement equivalent to two Academic Years of full-time study upon entering the PhD program at Brown. Use of a previously earned master’s degree to reduce PhD residency requirements is contingent upon approval of the program Director of Graduate Study. Graduate work done at other institutions and not used in fulfillment of the requirements for any doctoral degree elsewhere may, on the approval of the program Director of Graduate Study, be counted in fulfillment of up to, but not exceeding, one year of the residency requirement. A student who desires credit for work done elsewhere should file a timely application with the program Director of Graduate Study; transfer credit forms are available through the  Office of the Registrar .

A student is advanced to candidacy for the Ph.D. when he or she has completed satisfactorily all the requirements, departmental and general, requisite to beginning work on the dissertation. Candidacy is determined by the department or program of study and certified by the Registrar. Most departments require a preliminary examination before advancing any student to candidacy. Most departments also require a final examination or defense. The examination is conducted by professors in the department and by such other members of the faculty as may be appointed.

The candidate must present a dissertation on a topic related to his or her area of specialization that presents the results of original research and gives evidence of excellent scholarship. The dissertation must be approved by the professor or committee under whose direction it is written and by the Graduate Council. All requirements for the Ph.D. must be completed within five years after advancement to candidacy.

Faculty Member Leaves Brown

If a faculty member working with a doctoral student leaves Brown for any reason before that student has completed his or her degree requirements, it may not always be possible for that faculty member to continue working with the student as an advisor. In such cases, departments will work with students to help them locate a new advisor.

Additional Requirements

Individual departments and programs may have additional requirements regarding the number of courses to be taken, proficiency in foreign languages, special examinations, and theses. The department should be consulted for specific information.

Doctoral Degrees

Doctor of public health (drph) program.

A doctoral degree for those who want to translate knowledge into powerful results as the leader of a public health organization:

Doctor of Public Health

Doctor of Philosophy (PhD) programs

All PhD programs at Harvard University are administered by the Harvard Kenneth C. Griffin Graduate School of Arts and Sciences (Harvard Griffin GSAS), and applications are processed through the Harvard Griffin GSAS online application system .

The following three PhD programs are based at the Harvard T.H. Chan School of Public Health, designed for students seeking specialized scientific and technical expertise to propel an academic or research career:

PhD in Biological Sciences in Public Health PhD in Biostatistics PhD in Population Health Sciences

Harvard PhD program in Health Policy The PhD in Health Policy is a collaborative program among six Harvard University schools, including the Harvard T.H. Chan School of Public Health.

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