Most theses are lucky to be read once, but Edwin Anderson’s sits in a place of honor. The 21-year-old Yale medical student didn’t write on anything glamorous — kidney stones that enter the bladder — and his work didn’t even make a lasting impression on that field. But Anderson wrote his thesis in 1837, making it one of the earliest surviving examples of an enduring tradition at the Yale School of Medicine.
A thesis, nothing new to undergraduates, is rarely part of a medical school education. But Yale has required one since 1839, by far the oldest such requirement among medical schools. Alumni praise it as the crowning achievement in their medical school educations, administrators and faculty see it as the cornerstone to the Yale system of medical education, and students find it often dominates their medical school experience.
But a thesis requirement is no longer unique to Yale. Other schools are adopting new areas of concentration or thesis requirements for medical students to allow them to build up specialities early in their careers, though administrators at Yale said such policies have come and gone at other schools before.
Yale’s future doctors can study any topic they choose in their thesis, in sharp contrast with the rest of the strictly-regimented medical school curriculum, School of Medicine Dean Robert Alpern said.
“I think it really is one of the things that defines Yale,” he said. “Typically at medical school you’re just spoon-fed. Having to be creative does something to you.”
While students delve deeply into individual research projects, the topics chosen span everything from HIV research in Kenya to transplant immunology to tobacco policy. About half of the 100 medical student theses each year focus on clinical research, said Dr. John Forrest, director of the Office of Student Research. Another 35 percent of students spend their time on lab-based research, about 10 percent carry out their original research projects abroad and the rest study connections between medicine and the humanities: law, ethics, or history of medicine.
Students are expected to spend a minimum of 12 to 16 weeks collecting data for their projects, according to the guide to the requirement. But about half of each graduating class choose to spend a fifth year at Yale — one more than usual for a medical degree — to finish their research.
The University does not charge tuition during this fifth year, but students still pay a fee and must find housing, Associate Dean of Student Affairs Nancy Angoff said. About 20 students usually receive outside grants worth about $20,000 to $28,000 for their fifth year, though this year 30 stipends were awarded, Forrest said.
Yale’s financial support also extends to those who choose to finish all their requirements in four years. Medical students take no classes the summer after their first year, and Forrest said many choose to start research then, when they can earn a stipend of about five thousand dollars.
That extra time spent on research shapes physicians’ careers far into the future, Forrest said, even if they do not end up pursuing academic medicine.
“[Students’] ability to think and to analyze data and to come to a reasonable judgment is extremely important, whether they are going to be a practitioner in a group practice or a small practitioner in a rural town, whether they’re going to be a medical school dean, a physician-scientist,” Forrest said. “The ability to interpret data and to know the limitations of data, to have a skeptical mind, is probably never developed fully unless you’ve done original research yourself.”
Despite its long-term value, the prospect of finishing a thesis in addition to the regular medical school requirements can be daunting, some students said. Dr. Michael Reel MED ’06, an OB/GYN resident at Yale-New Haven Hospital, said other people warned him that few students leave Yale in just four years. Reel, who had a career in business before turning to medicine, said he was concerned about having to take an extra year to complete a thesis and falling even farther behind his peers.
“You really have to make an effort,” he said. “I used all of my available time to work on the thesis. If I had a month off from clerkships I would go into the lab.”
Finishing his thesis so quickly came at a price, though. Reel said there were elective clerkships — blocks of time in which medical students are exposed to individual specialties — that he could not take because of the demands of his research. But the advantages outweighed this cost, he said.
“I think it gave me a definite leg up when it came to residency applications,” Reel said.
As important as the thesis is to a physician’s long-term development, several others agreed that it especially helps in the residency match. Angoff said the thesis and the publications that can stem from that research help portray Yale students as “exceptional.”
Krishan Soni MED ’08 SOM ’08 also said increasingly selective residency programs give students an added incentive to do the thesis.
“They want to strengthen residency applications,” he said. “Just doing well in classes isn’t enough anymore.”
But those students who need a leg up in the most competitive application pools for medical residencies also usually need to do a fifth year on their theses.
“It gets harder [to finish in four years] as students are more interested in specialties — such as ophthalmology, radiation oncology and radiology — that take time to know because they are not in the core curriculum,” Angoff said.
A handful of schools besides Yale are now offering — though not requiring — theses or areas of concentration to bring some individual choice to medical education. Dr. Molly Cooke, a clinical medicine professor at the University of California, San Francisco — which offers a thesis but does not require it — cited UCSF, Stanford and the University of Pittsburgh as other examples. At most medical schools, she said, all students take the same classes as everyone else in their year.
“There’s clearly a trend towards trying to individualize medical education,” she said. “In some respects Yale was really a leader in that.”
But David Irby, vice dean for education at UCSF, said a thesis is not the only solution. He said probably only half of students who do such projects benefit from the research, and a significant minority hate it. And a thesis requirement may place too much of an emphasis on academic medicine, he said.
“One of the perhaps unspoken missions of research-intensive medical schools is to produce future academics,” Irby said. “Many schools institute [theses] to socialize students into this.”
Whether or not it is a goal of the thesis program, Yale seems to be successful at placing its students in academic positions. Statistics compiled in 2005 showed that 38 percent of students whose thesis research was supported by a federal grant had gone on to faculty positions.
Though Anderson’s 1837 handwritten essay was one of the first in an unbroken history of nearly 170 years of scholarship, it is a far cry from today’s thesis. Students still turn in bound copies of their work, but they now also submit electronic copies, which the Medical School stores online as part of its new digital thesis project. And unlike Anderson, medical students handing in their thesis now receive a Hershey’s bar in return, one of Forrest’s long-standing traditions.