Pathways to Clinician-Scientist Identity among Medical PhD Candidates: A Multi-Case Ideal-Typical Analysis

Background : Clinician-scientists are widely regarded as critical for translational medicine, yet many systems struggle to sustain a stable clinician-scientist workforce. Existing research often assumes a single linear identity pipeline and focuses on Western MD-PhD programs, with limited attention to heterogeneous trajectories in other high-intensity contexts. In China, rapid expansion of dual-role PhD programs in elite “Double First-Class” medical universities has created dense expectations in both clinical service and research. How medical PhD candidates position themselves within these dual demands, and how distinct clinician-scientist identity pathways emerge, remains insufficiently understood. Methods : A qualitative multi-case study was conducted with 30 medical PhD candidates from 30 top-tier medical universities in North and East China. All participants held a medical degree and were engaged in both clinical and research training. Semi-structured interviews explored motivations, professional self-definition, experiences of dual-role conflict, perceptions of evaluation systems, mentorship arrangements, and access to institutional support. Transcripts were analyzed through inductive coding followed by ideal-typical analysis to construct comparative pathways of clinician-scientist identity development. Results : Four ideal-typical pathways were identified. The Integrated Dual-Identity type described clinical and research roles as mutually informative and actively sought synergy across settings. The Clinician-First type regarded the PhD primarily as an instrument for clinical career advancement and tended to meet only minimum research requirements. The Research-First type oriented mainly toward a scientific career and substantially reduced clinical engagement during training. The Ambivalent type reported persistent tension between domains, oscillating commitments, and marked psychological strain. Evaluation criteria, mentor configurations, organization of clinical and research time, and availability of institutional resources systematically steered trainees toward particular pathways and rendered some trajectories more fragile than others. Conclusions : Clinician-scientist identity formation among medical PhD candidates is plural rather than uniform. The four ideal types provide an analytic framework for understanding how local structures channel trainees toward integrated dual identities, single-role orientations, or sustained ambivalence. Programs that combine flexible evaluation systems, coordinated clinical and research mentorship, structured protection of time for both roles, and targeted support for ambivalent trainees may strengthen the clinician-scientist pipeline in China and offer transferable design principles for similar high-pressure training environments worldwide.