Hu, Leland S

Abstract M.D.-Ph.D. programs in the United States have traditionally followed a “2- n -2” curricular model, with the graduate phase occurring between the pre-clerkship and clerkship portions of medical training. While well established, this format can limit trainee autonomy in shaping their physician-scientist training trajectories. In response, some programs have introduced a “3- n -1” model, allowing students to complete clerkships before beginning Ph.D. training. Our institution implemented multiple flexible curricula in 2017. Understanding why trainees choose one pathway is important as programs consider implementing more adaptable training structures. To investigate these factors, we surveyed M.D.-Ph.D. students at our institution, which offers multiple flexible curricular alternatives, about contributions to their curricular decisions. Responses supported that trainees weigh considerations across medical education, scientific development, and integrated physician-scientist training domains. Although the traditional pathway was a popular option, most students pursued one of the flexible pathways. Our findings suggest that introducing flexibility in the timing of undergraduate medical education and graduate training can support diverse educational, logistical, and personal priorities while maintaining the rigor of physician-scientist training. Offering multiple pathways empowers trainees to design trajectories that best fit their needs. Continued longitudinal studies are needed to assess the long-term impacts of flexible curricula on physician-scientist career outcomes.

Lay Summary Accurately differentiating actual tumor progression from treatment-related changes, such as pseudoprogression or radiation-induced injury, remains one of the most critical diagnostic challenges in neuro-oncology for both primary and secondary brain tumors. Conventional MRI often lacks specificity because it primarily reflects blood-brain barrier disruption rather than viable tumor tissue. Consequently, advanced techniques like perfusion-weighted MRI and amino acid PET have gained significant attention. While perfusion-weighted MRI provides essential insights into blood flow and is widely available, accumulating evidence suggests that amino acid PET can be more reliable in identifying treatment-related changes. Since both modalities offer complementary information, there is an ongoing debate regarding their relative roles and the optimal way to integrate them into clinical practice. Combining these tools aims to provide more reliable diagnoses, ultimately preventing unnecessary interventions and ensuring that true tumor growth is detected as early as possible.

The Quantitative Imaging Biomarkers Alliance Profile for dynamic susceptibility contrast (DSC) MRI and its longitudinal claims for the precision of a DSC MRI–derived quantitative imaging biomarker to assess the relative cerebral blood volume changes in gliomas are summarized.