Using an Extracurricular Honors Program to Engage Future Physicians Into Scientific Research in Early Stages of Medical Training
Using an Extracurricular Honors Program to Engage Future Physicians Into Scientific Research in Early Stages of Medical Training
Belinda W. C. Ommering 0 1 2 3
Peter J. van den Elsen 0 1 2 3
Jolanda van der Zee 0 1 2 3
Carolina R. Jost 0 1 2 3
Friedo W. Dekker 0 1 2 3
0 Department of Molecular Cell Biology, Leiden University Medical Center , Leiden , the Netherlands
1 Department of Immunohematology and Blood Transfusion, Leiden University Medical Center , Leiden , the Netherlands
2 Center for Innovation in Medical Education, Leiden University Medical Center , Zone V7-P, PO Box 9600, 2300 RC Leiden , the Netherlands
3 Department of Clinical Epidemiology, Leiden University Medical Center , Leiden , the Netherlands
Physician-scientists are urgently needed to make progress in the dynamic world of medical healthcare. Currently, there is a worldwide shortage in physicians pursuing a scientific career. Actively engaging students in research in early stages of medical training could help to direct students towards a scientific career and contribute to creating the next generation of physicianscientists. Leiden University Medical Center (LUMC) implemented an extracurricular Honors program with a fundamental orientation towards research. The program starts in the second year of medical training and is comprised of four different tracks in order to attract multiple types of students with different interests. All four tracks offer students scholarly experiences, but differ in content and amount of provided structure. The LUMC Honors program has a clear goal to develop future physician-scientists, and combined with its unique multiple-track model, the program accommodates about 70 students (25%) each year. The number of students in the program has grown and students' experiences are positive.
Honors; Extracurricular research program; Physician-scientists; Scholarly concentration
The Canadian Medical Education Directives for Specialists
(CanMEDS) distinguishes being able to use and being able
to conduct research as two core competencies of a scholar [
A common belief in the medical field is that all physicians
should be able to use research, which is important in forming
evidence-based decisions and making a grounded diagnosis
]. In order to integrate scientific knowledge in clinical
decisions and to ensure that patients receive the best
possible healthcare, physicians should be aware of the latest
developments in medicine. Being able to critically appraise
scientific literature is key in the process of using research in
daily clinical practice .
However, besides all physicians using research, physicians
who actually conduct research are needed as well. These
physicians are needed because it is important to create new
knowledge to make progress in the demanding world of medical
3, 4, 6, 7
]. Physicians combining clinical work
with doing research in the medical context are called
physician-scientists. Physician-scientists offer an opportunity to
bridge the gap between science and clinical practice [
They have the opportunity to identify clinical problems in
daily practice, which can be translated into research questions
and designs [
]. Subsequently, physician-scientists can
translate research outcomes into clinical practice [
Currently, there is a global shortage in the number of
physician-scientists, with too few physicians pursuing a scientific
2, 8, 10, 13, 14
]. A decline in interest for research
among physicians in Canada, the USA, and Europe has been
documented . How physicians can be directed towards a
scientific career is still a topic of debate, although early
engagement of medical students in research is mentioned as a
possible solution [
2, 6, 7, 15–18
]. Engaging students in
research in early stages of medical education could help to
identify a possible scientific career path for these future
physicians, as it could trigger enthusiasm and motivation for
doing research [
]. This view is shared internationally, as is
reflected in the growing amount of curricular and
extracurricular courses to engage students in research [
Some medical schools have designed and implemented
mandatory courses in the curriculum with the goal to get
students acquainted with research, for instance Duke University
implemented a mandatory period of research into the third
year of the medical curriculum, and Stanford University
integrated mandatory research experiences for medical students
through all years of medical training [
University Medical Center (LUMC) implemented a
curriculum change in 2012, integrating mandatory research courses
in undergraduate medical training with the purpose to engage
students in research in early phases of medical training by
providing them with active learning experiences .
Besides mandatory courses in the curriculum, a trend is
evolving in which medical schools design and implement
extracurricular research programs with the aim to involve
students in research. These research-based programs occur in
very different ways and under different names, but share a
mutual goal to expose students to in-depth inquiry and
research experiences with capstone projects like writing a thesis
or a publishable article. Such extracurricular research
programs occur as, for instance, MD/PhD programs, scholarly
concentration programs, Capstone programs, Summer
Research programs, and Honors programs [
19, 22, 23
Leiden University Medical Center designed and implemented
an extracurricular research-based Honors program to engage
students in research. The aim of this monograph is to provide a
detailed description of the LUMC Honors program to act as
reference or inspiration for other medical schools exploring
options to implement an extracurricular research-based
The Medical Honors Program of the LUMC
As a faculty that is part of a research intensive university, the
LUMC emphasizes the importance of research and educating
future physician-scientists. Therefore, one of the goals of
medical training is to stimulate students to become familiar
with and engage in research. Students of the LUMC follow
mandatory courses throughout all years of medical training, in
which the students are actively engaged in doing small-scale
research projects [
21, 24, 25
]. Next to these mandatory
courses, the LUMC offers an extracurricular Honors program
for bachelor students with a fundamental orientation towards
The medical Honors program of the LUMC differs from
traditional Honors programs in its design and main goal, as the
program originated from a point of view that future
physicianscientists are needed. Hence, the program is largely devoted to
make the first step to cultivate the next generation of
physician-scientists. The LUMC program can be seen as an
extracurricular research program, internationally similar to earlier
mentioned ‘scholarly concentration programs’ [
LUMC Honors program has a relatively large capacity to
accommodate students and focuses on providing them with
scholarly experiences. It is an extracurricular two-year
program and it has a minimum of 30 ECTS (ECTS = European
Credit Transfer and Accumulation System), which means that
students have to invest 30 × 28 h of active study. The program
gives students the opportunity to experience research in an
authentic learning situation by actually designing and
implementing their own research in one of the departments
of the LUMC.
The program starts with an optional orientation phase in the
first year of the medical study. All first-year medical students
are invited to participate in this orientation phase, which is
already unique, as most Honors programs only target so called
‘excellent’ students [
]. The orientation phase consists of
multiple expert lectures covering the different (bio)medical
research areas of the LUMC. These lectures are given by
highly experienced physician-scientists. This allows students
to become familiar with and inspired by research and
research-related work, and to get to know the career
opportunities as future physician-scientists. The number of students
who use this opportunity and are actively involved in the
orientation phase differs every lecture, ranging from 30 to
150 out of approximately 300 students in total. Students
participating in the orientation phase are provided with a
possibility to earn some credits for the actual Honors program, prior
to the official start in the second year of medical training.
Students participating in the orientation phase can choose to
submit written reports of the expert lectures (in English),
summarizing their content and adding new knowledge from recent
literature. The reports are graded by educators specialized in
academic writing, scoring students both on content and
academic English. If students receive a passing grade for at least
four of the meetings, they already earn two credits (2 ECTS)
for the Honors program, before the official program has even
started. After this, students can choose to earn another credit
(1 ECTS) by interviewing one or more post-docs and/or PhD
students. Students are asked to make a scientific report on the
content and outcomes of the interviews, which again will be
graded by educators specialized in academic writing. These
interviews provide the students with an even better impression
of the ins and outs of performing research.
The orientation phase starts in November and ends in June
of the first year of medical study. Students are not obligated to
actively participate in the orientation phase; they can still
participate in the actual Honors program regardless. By and large,
the main goal of the orientation phase is to offer students the
possibility to get acquainted with research and the program,
and to help students decide if the Honors program seems to be
a good fit for them as an extracurricular activity during
During the summer break between the first and the second
year of medical training students need to decide whether they
would like to participate in the actual Honors program starting
in September. They can officially apply during the summer
months. The selection for the program is largely based on
selfselection of the student, as three of the four tracks are open to
different types of students without having institutional
selection criteria. The MD/PhD track is the only track with limited
availability, resulting in institutional selection focusing on
high grades. Although the selection of the MD/PhD track is
comparable to most regular Honors programs, the
selfselection of students in the other three tracks is a second factor
distinguishing this program from regular Honors programs.
Four-Track Model of the Honors Program
The Honors program at the LUMC provides four different
tracks to attract multiple types of students with different
interests. At the start of the program, the student can choose
between one of the following four tracks: the MD/PhD track,
the Journey into Biomedical Sciences track, the Clinical
Research/Epidemiology track, and the Free Research track.
The four tracks are different in content and approach, but they
share a fundamental orientation towards research. The
distribution of students among the four tracks at the start of the
program in the years 2013–2016 is illustrated in Table 1.
The MD/PhD track prepares the student for, and could be
the beginning of, a future PhD project. Although every track
can be a foundation for a future PhD project, the MD/PhD
track explicitly acknowledges this as its main goal. The track
has a limited capacity, accommodating only ten students every
year. Students are selected by the institution, thus in this
regard the track is comparable to regular Honors programs.
Students are selected based on academic performance,
curriculum vitae, and motivation. The selected students are free to
choose a department, and autonomous in choosing their
research topic. The coordinator of the Honors program and the
supervisor from the department assist the student in making
these choices. The department coaches the student in the same
way as it would coach a regular PhD candidate. Next to their
bachelor studies, students have the opportunity to perform
research and to write at least two scientific papers for their
future PhD thesis.
The Journey into Biomedical Sciences track is a program
for students who would like to acquire a deeper understanding
of biomedical sciences and it offers an opportunity to follow a
program with a fundamental orientation towards biomedical
research. Both the first and second year of this track focuses
on theory and laboratory skills, and upon completion gives the
student the opportunity to combine the Medicine master and
the Biomedical Sciences master in Leiden. Main subjects of
this track are cellular communication, medical genetics and
immunology in the first year, and Molecular Biology and
Oncology, communication in science, writing a review, and
acquiring and application of laboratory skills in the second
The Clinical Research/Epidemiology track offers both the
opportunity to participate in courses about clinical
epidemiology and statistics, and the possibility to do a clinical research
project. Students can choose what kind of clinical research
they would like to do and are mentored by a senior researcher
of the department. An example of a course in this track is
‘Introduction in Clinical Scientific Research’, where students
get to know the different departments of the LUMC. This is a
popular course and it helps students with the orientation
towards a specific department, where they could possibly do
their research. Another course of this track gives an
introduction in epidemiology by discussing the book of Kenneth
Rothman (‘Epidemiology, an introduction’) [
Clinical Research/Epidemiology track also offers an
opportunity to follow a 5-day masterclass course in clinical
epidemiology, in which students are educated in content identical to
the education of PhD candidates and clinical researchers. In
both the first and the second year of this track, the student will
actively participate in doing research.
The last track is the Free Research track, which offers
students the possibility to do a research project in a department
of their own choice. This track seems suitable for two types of
students. First, this track appeals to students who are eager to
do research, but who are not yet ready for long-term
commitment, as they are still curious to find out which type of
research and (bio)medical research area suits them best. Second,
this track is also attractive for students who already decided
what kind of research they want to do and at what department,
committed to doing their own research in one particular area.
The Free Research track offers these students the possibility to
devote their Honors program to conducting their own research
at one department.
In contrast to the MD/PhD track, the other tracks are mostly
self-selected. Notably, the Honors program of the LUMC is
designed with maximum flexibility for the participating
students. If students come up with an individualized plan to
earn their 30 credit points, they can approach the Honors
coordinator to discuss the possibilities. Additionally to earning
credits in any of the four tracks or from the alternative
propositions, all students are required to follow at least one Honors
Class of 5 ECTS offered by the University of Leiden. The
Honors Classes of all Leiden Faculties are coordinated by
the Honors Academy Leiden, and are always interdisciplinary
by nature. Most of the Honors Classes are in English, and are
aimed at broadening students’ intellectual horizon. There is a
great variation in the offered Honors Classes and the students
are free to choose whether they prefer to follow an Honors
Class in their second or third year.
Summing up, to receive an Honors Certificate students
need to have earned 30 ECTS, followed an Honors Class,
and passed all the courses in the regular curriculum.
Outcomes of the LUMC Honors Program
The LUMC Honors program is fundamentally orientated
towards research and has the clear goal to develop future
physician-scientists. The relative large capacity, self-selection,
and four different tracks to address different types of students
contribute to the uniqueness of the program as compared to
other, more traditional, Honors programs. Designing an
Honors program in this way seems to be attractive for
students, as is reflected in the increasing number of participating
students over the last few years. From the program’s inception
with about 20 students participating in 2010, nowadays,
the program provides extracurricular research activities for
81 medical students in 2016 (Table 1). This number represents
27.1% of one yearly cohort. Most of the extracurricular
Honors programs provide only places for few students, so
having 27.1% of all students in a year participating in an
extracurricular program is truly exceptional.
Students of the LUMC Honors program were surveyed
in 2016 to evaluate the program and its four different tracks
(n = 97). A total of 136 Honors students were approached, of
whom 97 students participated (71.3%) and anonymously
filled out a digital questionnaire regarding their experiences
in the program. Students from both years of the program and
all four different tracks were included. The sample consisted
out of 22 students from the MD/PhD track, 18 students from
the Journey into Biomedical Sciences track, 20 students from
the Clinical Research/Epidemiology track, and 30 students
from the Free Research track. From the other seven students,
data regarding the track in which they participated was
missing. The evaluation showed that 92.9% of the students were
satisfied with the way the goals and opportunities of the
program were communicated. Overall, the evaluation indicated
that the Honors program offered by the LUMC is well
appreciated by the participating medical students because it allows
flexible implementation of the offered tracks and the
possibility to propose alternative plans. The four tracks of the program
differ regarding their provided structure; therefore, the Honors
program as a whole may appeal to different types of students.
A tailor made program that suits students’ individual needs
and aspirations may be the key to success. We believe this
contributes to the large amount of students participating every
year. Moreover, most students who follow the LUMC Honors
program would recommend the program to their fellow
Additionally, students who recently started the Honors
program were interviewed (n = 6). The students were approached
during an Honors meeting and asked if they wanted to
participate in orientating interviews. Participation was voluntary
and interviews were conducted by the first author. The aim
of the interviews was to provide insights into reasons students
have to participate in the Honors program. Curiosity in
combination with a need for extra challenge seemed to be the most
important reason to participate in the program, as one student
said: ‘Challenge is the biggest reason and also, I want to
discover new things. I want to understand why something
works and not only that it works. That is something I miss in
my study’. Another motive is that students want to learn more
about doing research because of their interest in a research
oriented career, one student stated: ‘I really want to be a
researcher. So the sooner [to start with doing research] the
better’. Students also discussed the benefits of doing
extracurricular research for possible future choices. One student
mentioned research being ‘very good for your resume’ and another
student said ‘if you want to be a specialist, it is self-evident to
follow a PhD first. I don’t know what kind of specialist I want
to be, if I want to specialize at all, but I want to keep my
options open. So it seems good that when I do know what I
would like to do, I have extra possibilities to do it. That is why
it seems good to become familiar with research and that is
why I chose the Honors program as extra activity’. Finally,
students mentioned that participating in the Honors program
was a ‘perfect way to build a network’.
An extracurricular Honors program, aimed at directing more
students towards a scientific career as physician-scientists,
appears to be an effective tool to actively engage
undergraduate students in research. By offering the program to more
students than only the obviously highly talented ones, and
by providing different tracks of interest, the program clearly
reaches more students. The long-term effects of this program
still need to be evaluated by analyzing the actual career
choices our students make, number and impact of
publications, scientific presentations and research-related advanced
degrees like a PhD. However, initial experiences of students
seem positive already, as is reflected in both the outcomes of
the evaluation and the growing number of students
participating in the Honors program.
Acknowledgments The authors would like to acknowledge and thank
John O’Sullivan for his critical appraisal of the manuscript.
Furthermore, the authors would like to thank Lars Bosman for his help
in gathering data.
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of
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