This application will support and renew the Medical Scientist Training Program (MSTP) at Stanford University School of Medicine. In 47 years of continuous NIH funding, 321 trainees have graduated from this program, many of whom have become leaders in their fields of academic medicine and biomedical research. Our program provides a superb environment and unique advantages for fulfilling our mission ?to train pioneering physician-scientists dedicated to a lifetime of biomedical discovery that improves human health through innovation.? Dual degree pre-doctoral training in the Stanford MSTP has durably produced successful outcomes in our trainees, based on several metrics used to compare MD- PhD programs nationally, including low attrition and time to degree conferral, publication record, and high retention of graduates in biomedical research careers. This proposal describes important changes in the Stanford MSTP. Program enhancements include a significantly increased level of institutional support, reflected in increased staffing and faculty effort to direct the MSTP; increased financial support for student training by the School of Medicine; creation of an MSTP Advisory Committee; implementation of MSTP-specific innovative courses and teaching programs; improved mentoring and monitoring mechanisms for students throughout their training; increased faculty participation; and enhanced integration of MD-only trainees in MSTP activities. Together, the increased institutional support, increased effort by School of Medicine faculty and leadership, dedicated program enhancements, and integration of clinical and graduate training have changed, expanded and improved the Stanford MSTP. Support through this proposal, heavily leveraged with School of Medicine and University resources, will support continuing innovation in training physician scientists at Stanford devoted to improving human health through a lifetime of biomedical research.