Research Training in Psychiatry Residency Strategies for Reform (2003) / Chapter Skim
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1 Introduction
1 Introduction
Pages 21-36
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From page 21... ...
Millions of Americans experience the debilitating and sometimes deadly consequences of mental illness: 10 million suffer from a major depressive disorder (National Institute of Mental Health [NIMH]
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All of the above reports detail the extraordinary gains that have been made in mental health care, including advances in integrative neuroscience and health services research. Yet they also point to substantial gaps in basic and clinical scientific knowledge related to the treatment and prevention of mental diseases, gaps that must be filled by the efforts of a sophisticated workforce consisting of physicians, epidemiologists, psychologists, and neuroscientists.
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From page 23... ...
The importance of researchers with credentials in psychiatry is predicated on the logic that they have a valuable and unique set of skills and perspectives encompassing the clinical neurosciences, psychopharmacology, psychotherapy, mental illness diagnostics, and integrative human physiology (Andreasen, 20011. These skills place psychiatrists trained in research methods in an excellent position to assess the broad clinical needs of individuals with mental disorders and to frame questions that are relevant to improving patient care.
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Kendler, a psychiatrist at Virginia Commonwealth University. These two authors published "Lifetime and 12-month prevalence of DSM-lIl-R psychiatric disorders in the United States: Results from the National Comorbidity Survey" in 1994, in addition to more than 30 other high-impact papers during the 8-year period assessed (IST Thomson, 20031.
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From page 25... ...
principal investigators (data courtesy of NIMH, Office of Science Policy and Program Policy, February 21, 2003~. It is therefore cause for considerable concern that NIMH officials, along with other prominent leaders in psychiatry, believe the training of psychiatristresearchers is not keeping pace with needs in patient-oriented mental health research (Fenton, 2002; Hyman, 2001; 2002b; Hyman and Fenton, 2003; Kupfer et al., 2002; Shore et al., 2001~.
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, Section for Institutional and Faculty Studies, July 2003~. The fact that only 2 percent of practicing psychiatrists spend more than 50 percent of their time engaged in research compares poorly with analogous research involvement rates for several other disciplines of medicine (see Table 1-~)
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These sources reveal unequivocally that at best only about one in five practicing psychiatrists engages in any research activity, and that if the figures are the same as they were in 1989, only about one in four psychiatrists at U.S. medical schools spends more than 1 day a week adding to the knowledge base of the profession.
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From page 29... ...
Study Charge Given the unparalleled opportunities and needs that exist in mental health research and the apparent decline in the number of psychiatrists entering the research workforce, NIMH commissioned the TOM to acidress the following four tasks: 1. Review the goals and objectives of training for adult and child psychiatry residents with an emphasis on both core research training and training trajectories to facilitate patient-oriented research career development.
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From page 30... ...
The committee also gathered information through numerous personal contacts, two commissioned papers, outreach mailings to members of the American Association of Directors of Psychiatric Residency Training, literature reviews, and I6ternet searches. Appendix A offers additional detail on the study sources and methods.
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Adfult Psychiatry, SubspeciaZists, and Nonpsychiatrists The study charge directed the committee to consider specifically both adult and child psychiatry residencies. Technically, adfult psychiatry residents are nonentities as all psychiatry residents receive marginal child and adolescent training,6 thereby affording them the designation of general psychiatrists.
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From page 32... ...
was paid to child and adolescent psychiatrists.8 The especially Tow numbers for child psychiatrist-researchers thus support their special consideration in this report on research training. Although this report emphasizes broad psychiatric training by focusing on both adult and child and adolescent training, this emphasis is not intended to minimize the importance of patient-oriented research training for psychiatric subspecialists not explicitly noted in the study charge (i.e., geriatrics, addiction, forensics, pain management)
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Instead, the focus on psychiatrists is aimed at careful analysis of the state of one readily definable sector of the mental health workforce. Patient-Orientedt Research According to a 1999 NIH program announcement, patient-oriented research is "...conducted with human subjects (or on material of human origin such as tissues, specimens, and cognitive phenomena)
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In that chapter, residency is placed in the context of a broader career continuum that includes medical school and fellowship training. The chapter begins by `describing the benefits of incorporating research training into residency.
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The chapter begins by describing the idiosyncrasies and challenges associated with the funding of graduate medical education, and then turns to leadership and mentoring issues. The chapter concludes with a review of local and national program strategies (e.g., curricula)
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