Research Training in Psychiatry Residency Strategies for Reform (2003) / Chapter Skim
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2 Residency as Part of a Longitudinal Career Continuum
2 Residency as Part of a Longitudinal Career Continuum
Pages 37-60
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From page 37... ...
Strategic considerations involved in providing an integrated, longitudinal research experience are addressed, and brief descriptions of existing mechanisms for serving this purpose are presented. The chapter ends with conclusions and a single recommendation regarding longitudinal research training associated with residency.
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From page 38... ...
needed to increase residency research options. Several logical arguments are advanced below and are summarized in Box 2-1.
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From page 39... ...
In summary, although much of medicine, including psychiatry, has a considerable evidence base supporting practice methods, the committee's strong sense is that residency-based exposure to research theory and
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From page 40... ...
Exposure to research theory and practice in residency has not been assessed as frequently as such training in the context of postresidency fellowship, but there is some evidence that residency-based research training is an antecedent to future research career tracking, albeit from other disciplines. For example, a recent survey of 96 surgical residency graduates from the University of California at Los Angeles (a 65 percent response rate)
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From page 41... ...
From this perspective, residency may represent an untapped opportunity to integrate more research training during a time when career decisions have yet to be completely formed. Accordingly, it appears reasonable to conclude that if fellowship training encourages research career tracking, slightly earlier training might enhance that process, and would be most effective if it simultaneously encouraged residents to pursue research fellowships.
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From page 42... ...
Attracting and Sustaining the Interest of Talented Medical Students Residency training programs that offer research experiences will likely attract medical students with the greatest interest in and ability to pursue research careers. Such students will likely include M.D./Ph.D.'s or equivalently prepared trainees, who traditionally have chosen the more research-intensive specialties, such as internal medicine (institute of Medicine [IOM]
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From page 43... ...
Although the committee can cite no empirical data to support the importance of maintaining research skills and interest through inclusion of research experiences in residency, it appears logical that such training would be both practical and encouraging. It furthermore appears that patient-oriented research training would serve to keep the trainee abreast of new methodologies and important discoveries entirely germane to competent clinical practice.
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From page 44... ...
There are a number of avenues, both formal and informal, through which preresidency trainees can obtain research exposure. Informal Research Experiences Undergraduate and, for medical students, preclinical summer research opportunities in psychiatry departments can foster long-term interests among students majoring in related disciplines (e.g., neuroscience, psychology)
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From page 45... ...
Formal Research Experiences Formal education programs also exist that support research training in the college or medical school years. The NTH R25 grant mechanism provides funding of up to $150,000 a year over 3 to 5 years for the development of research training curriculum.
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From page 46... ...
Since the mid-199Os, three medical students have participated in the program, and all have been first authors of articles and abstracts, made national presentations, and moved on to research-oriented residency training programs; two have attended the American Psychiatric Association's (APA) Research Colloquium (Baron and Kuhn, 20011.
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From page 47... ...
While the federal government funcis a number of initiatives, including the R25 mechanism and the MSTP, foundations also fund preresidency research training. The recently established Dons Duke Clinical Research Fellowship Program offers high-achiev~ng medical students a year of clinical research.
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From page 48... ...
These data can be taken to indicate that postresidency fellowship training is an important segue for many new physicians entering research—one that the trainees themselves recognize as central. Central to the theme of this report is the need to recruit more psychiatrists into research fellowships.
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From page 49... ...
Individuals who wish to pursue extended postdoctoral fellowship training may consider the NIH-funded fellowship (F32) that provides a stipend of at least $34,000 for extended training in biomedical and behavioral research (see Appendix B for further information)
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Young Investigator Award and The Robert Wood Johnson Foundation's Clinical Scholars Program. NARSAD's award provides up to $30,000 for 1 to 2 years for fellows and junior faculty to conduct research pertaining to major mental disorders, including schizophrenia and affective disorders.
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From page 51... ...
(2000) found that physicians do not Lack to additional fellowship training' In part because of lengthened training in preparation for a research career and limited stipends Low financial compensation no doubt offers some explanation for why residents do not pursue fellowships in increasing numbers.
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From page 52... ...
Given that a 5-year K award involves a federal investment that can easily exceed $500,000 per awardee, it is imperative that studies be done to understand why the failure rate in mentored research Raining is so high. One potentially useful way to conduct such studies would be to survey the trainees and mentors who fail at the intended transition of K award to R01, and compare their experiences and attributes with those of the individuals who succeed.
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From page 53... ...
One respondent complained that research time is often taken up by administrative and clinical responsibilities, leaving little time to read, think, and write. Nearly all respondents noted limited protected time for research, low salaries relative to those of full-time clinicians, and general uncertainty about continued fun(ling.
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From page 54... ...
STRATEGIC CONSIDERATIONS Early planning can allow for useful connectivity between residency and fellowship, and then to career awards. In particular, those interested in research-intensive careers should consider research fellowship training as early as possible during residency, since, as noted previously, early research experiences are known to be correlated with research career tracking (Davis and Kelley, 1982; Dial et al., 1990; Dunn et al., 1998; Haviland et al., 1987; Pincus et al., 1 993; Ringel et al., 20011.
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From page 55... ...
Models from Outside of Psychiatry Although pediatrics and internal medicine have far Tom solved their own problems of attracting residents to research careers, these two disciplines have created pathways that link residency training with 2- or 3year research-intensive fellowships. The connection is made by offering TABLE 2-1 Western Psychiatric Institute and Clinic's Developmental Pathway for Psychiatric Researchers Duration of Trammg (years)
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From page 56... ...
The PSDP is a 6- to 7-year pathway that adds 3 to 4 years of research fellowship onto standard residency training. It also offers trainees the possibility of assuming a junior faculty position once they graduate.
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From page 57... ...
TABLE 2-2 Duration in Years of the Two Stages of Pediatric Subspecialty Training Pathways Outlined by the American Board of Pediatrics and the Pediatric Scientist Development Program Pathways for Those with Significant Prior Research Experience (years) Pediatric Sub- Special Scientist Standard Integrated specialty Alternative Development Pathway Research Fast Track Pathway Program Activity (years)
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From page 58... ...
Departments of psychiatry should organize optional research experiences and mandatory research didactics in residency as early steps in research career development pathways, leading from residency to a junior faculty appointment. Federal and private agencies should expand mechanisms that encourage psychiatry trainees to enter and move, without interruption, from residency to a research fellowship to a faculty position, all designed to promote independence as a patient-oriented investigator.
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From page 59... ...
In addition, mandatory research didactic learning (e.g., lectures and reading of epidemiology, study design, clinical consent procedures, grant preparation) for all residents may well have the dual benefit of enhancing evidencebased practice and promoting research interest among some residents who might otherwise not consider research careers.
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