Appendix A
Data Sources and Methods
To respond to the study charge, the committee took several steps to review research training and psychiatry residency training. Sources of data and information included the expertise of the committee members, literature reviews and Internet searches of principal concepts (e.g., research training, program curricula, personal characteristics, funding mechanisms), informal and semistructured interviews, two commissioned works, hosting of a public workshop, and other invited presentations.
STUDY COMMITTEE
The 12-member committee that conducted this study broadly represented psychiatry (adult and child and adolescent psychiatry, from both small and large programs), other biological and cognitive– behavioral disciplines (neurology, psychology, neuroscience), mental health economics, and other branches of medicine (pathology and pediatrics). The committee included members with expertise in either training of biomedical researchers or graduate medical education, biomedical researchers, two psychiatry department chairs, a medical school dean, and a director of a children’s hospital research foundation. The committee convened for one 3-day and four 2-day meetings on April 12–13, 2002; June 18–20, 2002; July 30–31, 2002; September 26–27, 2002; and March 17–18, 2003. In addition, a public workshop was held on June 19, 2002. Biographies of individual committee members appear in Appendix D.
LITERATURE REVIEW AND INTERNET SEARCHES
The committee conducted extensive literature reviews and Internet searches regarding research training during residency and factors that either promote or inhibit such activity. In particular, Institute of Medicine (IOM) staff used in-house databases, including Academic Search Premier, PubMed, and PsychInfo, to identify peer-reviewed literature using a combination of the following keywords:
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Psychiatry
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Research
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Residency
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Education
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Graduate medical education
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Research training
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Training
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Internal medicine
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Allergy and immunology
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Neurology
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Pulmonary disease and critical care
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International medical graduates
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Minority physicians
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Women physicians
Furthermore, the committee reviewed residency training requirements and certification requirements for psychiatrists in two ways. First, we reviewed the Accreditation Council for Graduate Medical Education (ACGME) requirements for different specialties, including psychiatry, neurology, internal medicine, and allergy and immunology, to determine key similarities and differences among residency training programs. Second, we reviewed certification requirements established by the American Board of Psychiatry and Neurology (ABPN) for psychiatrists.
INTERVIEWS AND OUTREACH
In addition to the above literature reviews and extensive Internet searches, the committee conducted a number of interviews and outreach activities to understand organizational and individual perspectives as they relate to research training during residency. In an effort to further understand local factors that influence residency-based research training and the factors that influence individual psychiatrists to pursue research, IOM staff conducted outreach in three ways:
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IOM staff interviewed 8 chairs whose departments were considered emerging with respect to interdepartmental research. Chairs were asked a series of questions relating to research activities of residents and faculty, innovative strategies to encourage research within the department, and obstacles to training (see Chapter 4 for further discussion).
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Seven psychiatrist-investigators who had received mentored career (K) awards within the past 5 years (see Chapter 2 for further discussion) were interviewed.
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Members of the American Association of Directors of Psychiatric Residency Training (AADPRT) were solicited via mass mailing to provide programmatic information regarding research programs, as well as data on residents who have tracked to careers in research. Summary information on programmatic characteristics appears in Appendix C, and outcome data on research training efforts at selected institutions appear in Chapter 4.
IOM staff also conducted personal communications with numerous individuals outside of the committee, including but not limited to the following:
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Virginia Anthony, American Academy of Child and Adolescent Psychiatry (May 3, 2002)
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Richard Balon, Wayne State University (March 26, 2003)
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Barbara Barzansky, American Medical Association Council on Medical Education (October 22, 2002)
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James Bentley, American Hospital Association (October 25, 2002)
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Eugene Beresin, Massachusetts General Hospital/McLean Hospital (May 16, 2002)
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Patricia Davidson, American Academy of Child and Adolescent Psychiatry (January 31, 2003)
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Leon Eisenberg, Harvard University (January 30, 2002)
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Karen Fisher, Association of American Medical Colleges Division of Health Care Affairs (July 11, 2002)
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David Folks, University of Nebraska (November 18, 2002)*
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Richard G. Frank, Harvard University; Institute of Medicine Board on Neuroscience and Behavioral Health (March 3, 2003)
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Lawrence Friedman, National Heart, Lung, and Blood Institute, Division of Epidemiology and Clinical Applications (April 17, 2003)
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Gregory Fritz, Brown University (February 10, 2003)
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John C. Gienapp, University of Washington (July 2, 2003)
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J. Christian Gillin, University of California, San Diego (January 8, 2002; February 1, 2002)
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Walter Goldschmidts, National Institute of Mental Health (April 4, 2002; December 12, 2002; February 11, 2003)
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Gary Gottlieb, Brigham and Women’s Hospital; Harvard University (June 21, 2002)
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Linda Greco-Sanders, University of Colorado (August 7, 2003)
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John Greden, American Psychiatric Association Council on Research (July 26, 2003)
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Ernesto Guerra, American Psychiatric Association (December 4, 2002; July 15, 2003; July 25, 2003)
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Gretchen Haas, Western Psychiatric Institute and Clinic (April 18, 2003)
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Deborah Hales, American Psychiatric Association (June 13, 2002)
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Jeanne K. Heard, University of Arkansas College of Medicine (June 2003)
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Leighton Huey, University of Connecticut (October 3, 2002)
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Barry Kaplan, National Institutes of Mental Health (July 29, 2002)
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Patricia Kapur, American Board of Anesthesiology (April 15, 2003)
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Martin Keller, Brown University (November 20, 2002)*
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James Leckman, Yale University (April 4, 2003)
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Theodore Marmor, Yale University (August 22, 2002)
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Christopher McDougal, Indiana University (November 4, 2002)*
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Judith G. Miller, National Board of Medical Examiners (July 15, 2003)
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Robert Moore, National Institutes of Health, Office of Reports and Analysis (July 11, 2002)
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David Mrazek, Mayo Clinic (March 24, 2003)
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Henry Nasrallah, Veterans Administration Medical Center (July 29, 2002)
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Charles Nemeroff, Emory University (November 21, 2002)*
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Eric Nestler, University of Texas at Southwestern (November 7, 2002)*
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Jason T. Olin, National Institute of Mental Health, Aging Research Consortium (November 13, 2002)
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John C. Peirce, Good Samaritan Regional Medical Center (June 24, 2003)
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Alicia Permell, National Institute of Mental Health (December 12, 2002)
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Darrel Reiger, American Psychiatric Association (June 7, 2002)
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Mark Rieder, Mayo Clinic (April 10, 2003)
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Ronald Rieder, Columbia University (March 29, 2003)
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Robert Rosencheck, Yale University (August 22, 2002)
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Eugene Rubin, Washington University (May 28, 2002)
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Neal Ryan, Western Psychiatric Institute and Clinic (April 17, 2003)
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Walter Schaffer, National Institutes of Health, Office of Extramural Research (July 11, 2002; September 16, 2003)
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Stephen Scheiber, American Board of Psychiatry and Neurology, (April 5, 2003)
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Bert Shapiro, National Institutes of Health (December 30, 2002)
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Charles Schulz, University of Minnesota (November 22, 2002)*
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Anne L. Shuster, Robert Wood Johnson Clinical Scholars Program (June 12, 2002)
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Joel Silverman, Virginia Commonwealth University (November 5, 2002)*
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G. Richard Smith, Jr., University of Arkansas (December 5, 2002)*
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Cheryl Sroka, Emory University (April 21, 2003)
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Larry Sulton, ACGME (August 6, 2002)
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Fred Taylor, National Institutes of Health, National Center for Research Resources (April 10, 2003)
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G. Warren Teeter, Administrators in Academic Psychiatry (July 19, 2002)
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Linda Thorsen, ACGME (October 15, 2002)
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Glenn Treisman, Johns Hopkins University (May 15, 2002)
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Farris Tuma, National Institute of Mental Health (June 4, 2002)
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Benedetto Vitiello, National Institute of Mental Health, Division of Services and Intervention Research (November 14, 2002)
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Debra F. Weinstein, Massachusetts General Hospital (July 3, 2002)
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Dan Winstead, Tulane University (July 16, 2002)
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Sunny Yoder, Association of American Medical Colleges (June 18, 2003)
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James R. Zaidan, Emory University (June 27, 2003)
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Steven Zalcman, National Institute of Mental Health (April 8, 2002)
COMMISSIONED PAPERS
The committee commissioned the work of historian Joel T. Braslow of the University of California at Los Angeles and economist Douglas D.
Schwalm of Louisiana State University. Braslow was commissioned to write a paper considering the unique history of psychiatric practice and how that history influenced the emergence of research activity within the field. The paper focuses on the late twentieth century. Braslow’s work was important for the preparation of the section on pscyhodynamics that appears in Chapter 3. Schwalm used data from the American Psychiatric Association to consider the income differences that exist between psychiatrists who are and are not engaged in research activity. Schwalm’s analysis additionally controlled for gender, race, practice venue, and experience. Schwalm’s results are cited and used throughout the report, especially in Chapter 5.
PUBLIC WORKSHOP
As noted above, the committee convened for five 2-day meetings and a separate 1-day public workshop. The workshop focused on obstacles to research training in psychiatry. Most of the invited speakers were experts in adult or child and adolescent psychiatry, although experts in economics, neurology, and clinical research also presented their views. A list of speakers and participants who attended the open sessions of the committee meetings and the workshop is presented below.
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