Almost all educators consider research to be an essential part of the training of young physicians. Research training is thought to help develop critical thinking. Some feel that research in psychiatry is vital to the stability and continuing growth of the discipline's scientific basis (R219431). McGuire and Fairbanks (R219432) stated that, in their view, the purpose of research training in a general program of psychiatric clinical education is to provide trainees with an understanding of the style and procedure of research and to develop (or facilitate) an ability to think critically about research findings. Pato (R219433) felt that research advances the field, contributes to better care of patients, advances one's career, gains one the respect of colleagues and peers, and, most importantly, ensures that treatment is based on proven effective interventions instead of tradition or anecdote. Education in and about research clearly is and should be an important part of a psychiatrist's training and development. Several texts discuss the development of a researcher in a primarily academic environment (R219432—R219436), and some specifically address the subject of research training (R219432,R219433). There is clearly need for research training during residency experience.
However, it is not very clear under what conditions, and how, research skills are taught around the country. It is also not clear what constitutes a research mentor and who should be teaching and educating trainees about research around the country. Research training is a serious interest of relatively few teaching faculty (R219432), and most psychiatric research is conducted in only a handful of departments of psychiatry. According to Pincus and colleagues (R219437,R219438), half of all psychiatric researchers are concentrated in 15 departments of psychiatry, and only a small percentage of residency training programs attempt to develop research skills from the beginning of training and to polish them during training (R219432). Also, the demands on teaching faculty to provide clinical services have been growing while the resources have been shrinking. Appelbaum and colleagues (R219439) suggested in 1978 that research training was, at best, the stepchild of most psychiatric residency training programs. They also felt that the low priority assigned to the research aspect of training may deflect most residents from becoming involved in research.
It is also not clear what constitutes research training and what training techniques are effective in research training (R219432). For instance, almost every program in the survey of research training practices in the late 1970s (R219431) had a journal club in which recent literature was discussed. Journal clubs focused on recent research findings, study designs, and statistics should also be a part of good research training. However, discussion of recent literature does not necessarily constitute research training. The range of research training opportunities for residents includes a critical appraisal of new findings, using the scientific method of inquiry and evaluation in one's own clinical practice, and finally carrying out a supervised, independent research study.
The importance of research training for the "continued growth of the discipline's scientific basis" (R219431) has been emphasized repeatedly. However, it seems plausible to assume that, for various reasons, the research training in most departments of psychiatry, university-based or not, is probably carried out only because of Residency Review Committee (RRC) requirements. Information about the current status of research training is lacking; the last survey of research training in psychiatry was done almost a quarter-century ago. We felt that it might be useful to get information about the current status of research training in departments of psychiatry. This could constitute a starting-point of a discussion about the further development of the research training. Thus, we decided to conduct a survey of research training in psychiatry in the United States and Canada. Trainees are psychiatry's most important resource, and the old adage says that one practices mostly what one learned in residency training. Thus, we focused primarily on the research training of actual trainees and not on junior faculty members.
In January 2000 we mailed a 30-item questionnaire (Appendix 1A and Appendix 1B) addressing various issues pertaining to research training to chairs of 126 departments of psychiatry in the United States and Canada. The questions were constructed to assess the availability, quality, funding, incentives, faculty, and nature of research training for psychiatric residents and medical students. The mailing also included an information sheet containing all the standard components of an informed consent. Thus, filling out and returning the questionnaire implied informed consent. The names and addresses for mailing were obtained from the recent AACDP Membership Directory and the Directory of Graduate Medical Education Programs. Finally, the mailing included a self-addressed, stamped return envelope. Neither the envelopes nor the questionnaires was coded, so as to ensure the anonymity and confidentiality of responders. The analysis of data was done in a strictly anonymous fashion.
The study was approved by the Wayne State University (WSU) Human Investigation Committee.
After a single mailing, 74 questionnaires were returned, a response rate of 58.7%. For various reasons, four questionnaires could not be used (e.g., invalid answers, or less than 20% of questions answered). Thus, the final analysis included 70 questionnaires. Because the discussion of medical student research training is beyond the scope and focus of this report, we did not include the data on medical student research training.
Results are summarized in t1a and t1b.
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Research Training of Residents
Only about one-third of the programs offer a research track, and most of them offer it also during the first and second year of residency training. However, 52% of these programs report that fewer than 10% of their residents had joined a research track in the last 5 years, and 87% of programs report that fewer than 25% of residents had joined these tracks. Interestingly, in the survey by Strauss et al. (R219431), it was also found that only about one-third of programs offered research training tracks (2% required, 29% available).
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Research requirements and opportunities/electives.
Fewer than half of programs require all trainees to participate in some research activity. Forty-four percent of these programs require this activity in PGY-IV, and no programs require it in PGY-I. About 80% of programs do not require that residents in their program present a detailed research protocol. Those that require submission of a research protocol do so mostly during the PGY-IV year. Twenty years ago (R219431), 50% of programs offered practice in drafting research protocols (2% required, 48% available), and 22% offered courses in scientific writing.
Fewer than half of the programs in our study offer a research fellowship.
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Research didactic education.
Even though most programs offer didactic lectures and seminars on the "know-how" of research, only an average of 5.7% of the total time of all didactics in programs is devoted to research. Also, fewer than one-third of programs teach their residents about research design. In the study by Strauss et al. (R219431), 73% of programs offered seminars on research methodology, experimental design, and data analysis.
About half of the programs offer some incentive for undertaking research, mostly in the form of cash or travel money if research is accepted for presentation at a conference.
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Research training faculty.
Most programs (83.8%) stated that their trainees are assigned a mentor for research activities. This is substantially more than the 53% of programs offering a faculty research preceptor 20 years ago. In some departments, research is taught solely by researchers, or solely by clinicians, which may not be the best strategy. Interestingly, most departments (66.%) do not invite outside faculty to teach research.
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Character of trainees' research.
Most programs reported that they encourage their trainees to engage in research projects of their own. This is similar to the percentage—94%—reported by Strauss et al. (R219431). However, 52% of the programs stated that fewer than 10% of their trainees started any research project of their own during the past 5 years. Almost all programs (95.5%; [Strauss et al. (R219431): 91%]) provide trainees with an opportunity to participate in ongoing research projects; however, in most programs, fewer than 25% of trainees joined these projects.
Fifty-two percent of programs have seen the number of publications by trainees rise during the last 5 years. Two programs stated that they had no publications by residents at all during this period. In the report by Strauss et al. (R219431), 20% of programs reported no publications from residents in the previous 5 years.
Most departments (83.8%) designated more than one source of their research funding, if any (e.g., combination of NIMH and pharmaceutical companies and/or VA funding).
Over two decades ago, Strauss and colleagues (R219431) suggested that, as a profession, we fell short in guaranteeing research exposure to all residents. The situation does not seem to be much different in the year 2000. Trainees' exposure to psychiatric research remains very low. Speculating about the results of our survey, we identify six possible major problems/suggestions in research training around the country:
However, it is important to note that it is not clear whether programs with research tracks provide better training to the residents other than those who take part in the actual research tracks.
Our study also had some limitations. Only about 60% of chairs returned the questionnaire. However, this response rate is higher than the response rate in similar studies (e.g., Strauss et al. (R219431): 50%), and is fairly high for a single mailing. Various factors, such as vacant chair positions (estimate: over 10 around the country) may have contributed to this response rate. Our questionnaire was also not very detailed (30 items), but we felt that a more detailed questionnaire would probably lead to a further drop in the response rate. Our questionnaire did not ask for the absolute number of residents, only for percentages. We also did not ask about the journal clubs, as Strauss et al. (R219431) did. As we pointed out, we are not convinced that journal clubs in most programs truly constitute a part of research training. There may be also a further bias in the data, because only those curriculums that have a reasonable training program in psychiatric research would respond to this questionnaire. Thus, the actual state of training in research might be worse than reflected by this survey. Given that the responses were anonymous, we also do not know if the institutions that did not respond were academic or non-academic ones. Finally, we did not address the university vs. non-university research training issue. Strauss et al. (R219431) pointed out that there are better research opportunities in the university-based programs. It is plausible that this has not changed. Actually, the gap between the university and non-university programs has probably widened.
Our findings about the lack of research experiences and research training at the departments of psychiatry around the United States and Canada is similar to that of Strauss and colleagues (R219431) and Appelbaum et al. (R219439) over two decades ago. It seems that not much has changed, and there continues to be a lack of attention to developing the research skills that academic or practicing psychiatrists will need throughout their careers. There seems to be a lack of clarity on how best to train residents in research. The resources for research training, especially the number of academic staff to mentor and/or train residents, are limited.
Strauss et al. (R219431) predicted a shortage of psychiatric manpower, especially in the area of research. In spite of managed-care projections, predictions, and pressures on the overall manpower in psychiatry, the shortage of psychiatric researchers, especially clinical ones, is a sad reality. We believe that the lack of research training in many departments and deficiencies in the concept of research training are, at least partially, to be blamed.
We propose that the concept of research training should be reconsidered and reconceptualized on the national level. Research experience should be offered, or probably be mandatory, to all trainees very early in their residency training and should be longitudinal. Trainees should be required to submit a research proposal (equivalent of a thesis proposal in other disciplines) and should attempt to realize their own research project instead of joining someone else's project. The research-training didactic lectures and seminars should be expanded and should always include discussion of formulating the hypothesis, study design, data collecting and processing, statistics, technical issues (informed consent, the role of the Institutional Review Board, training in use of research instruments, structured interviews, rating scales, etc.), writing the paper (literature search, structure of the paper), and ethical issues related to research.