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Regular Article | March 01, 2001

Psychiatry Residents' Participation in Research: A Survey of Attitudes and Experience

Mary Jo Fitz-Gerald, M.D.; Anita Kablinger, M.D.; Barbara Manno, Ph.D.; O. S. Carter, M.D.; Gloria Caldito, Ph.D.; Stacy Smith, B.A.

Academic Psychiatry 2001;25:42-47. 10.1176/appi.ap.25.1.42

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Research TrainingResidency TrainingResidency Surveys

Dr. Fitz-Gerald is Professor of Clinical Psychiatry, Louisiana State University Health Sciences Center—Shreveport. Address correspondence to Dr. Fitz-Gerald, Department of Psychiatry, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130-3932. e-mail: Mfitzg@lsuhsc.edu

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Abstract

The authors surveyed members of the American Association of Directors of Psychiatric Residency Training (AADPRT) and chief residents of training programs in 1999. (The Residency Review Committee [RRC] requires research training in psychiatry.) The survey gathered information on faculty and resident participation in research, attitudes, presentations and/or publications. The total response rate was 49%. Faculty and residents showed no significant difference in their residency training in research offerings/requirements; however, current residents showed greater access to more programs offering research. Ninety-eight percent of respondents indicated that research training should be offered to residents, but only 32% thought that research should be a requirement. Psychiatry residencies continue to require strong leadership in clearly defining acceptable components of strong research programs.

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The Special Requirements for Residency Training in Psychiatry, effective January 1, 1995, emphasize that residents must be taught the basics of research methodology. The primary focus of the Guidelines is directed toward providing the structure for strengthening the resident's ability to critically read and critique the psychiatry literature. The anticipated outcome is that this will serve as the foundation for the introduction of residents to possible research participation. The Guidelines, however, do not incorporate a formal research requirement (1).

Although the majority of psychiatrists enter clinical psychiatry practice upon completion of their formal training, the obvious questions that should be asked are "Is research valuable to psychiatry residents?" and "Why is research valuable to residents?" Most residency programs have a journal club where the residents critically review current literature and comment on the validity of the work discussed. The expectation is that residents will learn to critique the literature, thus providing better preparation for responsible decision-making as they complete the residency. Although journal clubs are one way to meet this objective, literature searches and participation in research projects enable the resident to gain practical experience concerning the details of psychiatric research and problem-solving. Active research participation assists in the development of lifelong scholarly inquiry in their chosen specialty. Other advantages include training in the preparation of manuscripts and experience in public speaking. Also, research activities allow the resident to explore the practice of research as a career opportunity (2—5). Residents themselves place research highest overall in terms of learning value, compared with other residency training components (6).

In 1992, when the psychiatry faculty developed the residency program at the Louisiana State University Health Sciences Center in Shreveport, all agreed that the residents would be required to perform a research project or write a paper for each year PGY II—IV. Most trainees perform literature searches on selected topics or case reports. Residents prepare the manuscript according to the "Instructions to Authors" of The American Journal of Psychiatry and submit the information to faculty for critique. Supervisors allow the resident to present a detailed research proposal including a hypothesis, background information, and experimental design one year, followed by a written report of their findings at the end of the next year. Departmental mentors encourage residents to participate in the preparation and presentation of case reports for submission for publication. Residents also participate in psychopharmacology drug trials during their tenure in the program. Finally, the residents attend and present at the Annual Southern Association for Research in Psychiatry (SARP) meeting, where their presentations are critiqued by faculty-level attendees.

In 1980, Strauss et al. reported that only 15% of psychiatry residency training programs surveyed required a research paper before graduation, and only 5% required any research experience (7). Reports are available that describe research requirements for critical care fellowships, radiology, obstetrics and gynecology, pediatrics, and rehabilitation medicine residency training programs (8—12). In 1995, Pincus described the postdoctoral research training of psychiatry faculty, however, there are no recently published reports on research in general psychiatry residency training programs (13).

The purpose of this survey was to assess the extent to which research has been a requirement in most residency training programs. We also hoped to discover whether a difference in attitude between faculty and residents existed concerning the necessity of research in training programs. Another purpose was to discover whether residents participating in research published their work and whether they felt research was a benefit to their career.

RESEARCH DESIGN AND STATISTICS

Survey Questionnaire

We developed a questionnaire (see Appendix 1) concerning research in psychiatry residency programs. The survey consisted of 27 questions, identifying respondents as resident or faculty, and reviewing whether research was offered or required during their residency programs. The survey also solicited opinions about whether research should be offered or required during residency training. The survey queried respondents regarding the nature of their research participation, their autonomy, sense of faculty assistance and support, and the location of their presentations or publications, if applicable. We also asked respondents to answer the questionnaire on the basis of their past or current experience as residents.

Two copies of the questionnaire were mailed to a sample (N=815) of residents and faculty members (residency training directors, assistant residency training directors, and fellowship training directors) obtained from the American Association of Directors of Psychiatric Residency Training (AADPRT) 1998—1999 Membership Directory. The Training Director was requested to give the second copy of the survey to the Chief Resident for completion. A second letter and survey was sent to the initial contact person, encouraging their participation.

Statistical Analysis

Each question in the survey was subjected to statistical analysis to compare frequencies or proportions of response (Yes/No) with each type of respondent (Resident/Faculty); we used chi-square analysis to determine significant differences in frequencies or proportions of response. For 2 × 2 tables with small expected cell frequencies (5), the Fisher's exact test was used (14). Sample numbers (n) correspond to the number of responses within the categories of resident and faculty. TN refers to the total number of responses to any given question.

RESULTS

A total of 399 of the 815 survey questionnaires (49%) were completed and returned; however, not all respondents provided answers to all 27 questions. Two respondents did not indicate their status; that is, resident or faculty. Because status was critical to the survey analysis, the data from these two surveys were not included in the final data analysis. Table 1 provides a summary of those questions where significant differences were found between resident and faculty responses. For ease of discussion, the survey questions subsequently were placed into three focus groups to facilitate discussion of the data. The groups are 1) Residency Research Requirement and Attitudes; 2) Faculty and Resident Interaction; and 3) Publications and Presentations.

Residency Research Requirement and Attitudes

A total of 232 respondents identified themselves as faculty (58%) and 165 (42%) as residents. Over 90% of those surveyed reported that research was offered in their respective residency programs, although a larger proportion of residents reported a research requirement than did faculty (P<0.047). There was no significant difference between faculty's (Yes: 22%; n=50; No: 78%; n=181) and residents' responses (Yes: 27%; n=45; No: 73%; n=120) regarding the research requirement of their programs; 42% of the total response (n=396) indicated that there was a research requirement in training. No significant difference was observed between resident and faculty attitudes on questions concerning research as an option vs. a program requirement and whether research is or was important to them personally. Attitudes based on total responses (TN=397) showed that 98% of the respondents expressed the opinion that research should be an option, whereas only 32% (of TN=395) said that research should be required.

Faculty's response was more positive (P<0.01; Yes: 80%; TN=220) than residents' (Yes: 68%; TN=155) with regard to the issue of research providing help in their practice. Again, faculty and residents responded similarly when asked whether research was important to them personally; however, 59% (Yes: 227; TN=384) indicated that research was valuable to them personally. Finally, 76% of all responders (TN=370) included "continuation of research" in their future career plans. Faculty indicated a more significant likelihood of including research ([85%]; P<0.001; Yes: 188; n=221) in their future plans than did residents ([64%]; Yes: 95; n=149).

Resident and Faculty Interaction

No significant differences were found between resident and faculty replies on the subject of faculty interaction. However, of those individuals who participated in research during their residency program, over 82% (TN=362) indicated that they were given the latitude to select their own research topic. Sixty-four percent (TN=371) participated in ongoing research with faculty members, whereas slightly over half of the respondents were originators of their own research projects during their training. Overall, the general opinion of survey participants was that they had found faculty supportive ([88%]; TN=387) and helpful ([78%]; TN=379).

Nature of Research, Publications, and Presentations

Faculty reported significantly more case reports ([55%]; P<0.012; Yes: 104; No: 85) than did residents ([40%]; Yes: 47; No: 70). Other categories of participants' research took the form of a review of the literature ([61%]; TN=306) and clinical trials ([44%]; TN=306). Neither of these two categories was determined to demonstrate a significant difference between residents' and faculty's replies.

Fifty-two percent of those surveyed acknowledged presentation of their research results during residency, but only 42% (n=364) had published their work. There was no significant difference between residents and faculty in publication and/or presentation of their research results. The majority of presentations occurred at the national level (in half of the respondents; [53%]; TN=369), followed by local presentations ([30%]; TN=326) and regional meetings ([18%]; TN=325). There was no significant difference between residents ([24%]; Yes: 31; No: 76) and faculty ([34%]; Yes: 66; No: 130) at the local meeting level. However, regional and national presentations tended to be more common for faculty (P<0.001). When the results of a research project were published, the overwhelming majority were published in a national journal, with faculty accomplishing this task more often than residents (P<0.001).

DISCUSSION

Of the 49% of the 815 survey recipients who returned the survey, faculty (58%) comprised the majority of the respondents. Respondents acknowledged that more programs offered research than required research during training, consistent with the lack of formal research requirements in psychiatry. Faculty and residents perceived research during their training somewhat differently. Although most subjects had autonomy in selecting their research topic, almost two-thirds of the individuals worked with faculty. Both faculty and residents presented and published their research projects, primarily at a national level. The nature of the research participation varied, suggesting that trainees had the ability to select a broad spectrum of projects. The vast majority of those surveyed agreed that faculty were both supportive and helpful. Research was noted to be important personally and professionally, Unfortunately, only faculty were significantly more likely to continue research endeavors.

Many respondents agreed with making research a requirement, especially if they had not been offered research in the past. Not surprisingly, respondents opting or required to perform research during residency were more likely to present and publish their results during residency. Individuals required to do research as trainees were less likely to find faculty supportive or express the idea that research helped them personally, compared with those opting to do research during training. However, respondents required to perform research during residency were more likely to state that research helped them in their practice. It may be that residents do not perceive their residency years as anything more than a broad training experience, rather than an actual practice.

Although the authors sent the survey questionnaire twice, the response rate was only 49%. Our findings are consistent with the 50% reported response of Strauss et al. in 1980 (7). Although the response rate appears low, it is higher than the 25%—33% commonly cited (15—17). Most of the surveys done previously that involve residency research requirements followed the initial mail contact with a telephone call. This may be an additional way to increase the response rate.

Both copies of the survey were sent to the Training Director, requesting that they give the second copy of the survey to the Chief Resident for completion. If the Training Director did not want to complete the survey, he or she may have been unlikely to give the survey to the Chief Resident, thus negatively influencing the response rate. Also, the Chief Resident was the only resident to complete the survey. Chief Residents may already be showing initiative and interest in an academic psychiatry career and thus may have been the most likely resident to participate in research. Sending the survey to more residents may have resulted in a better sampling of resident perceptions.

Responses from some of the Training Directors indicate confusion regarding the questions. For example, one respondent said he didn't know if he should answer the question for when he was a resident or in regard to the current training program, where he serves as Training Director. It should have been intuitively clear to the participant Training Director that if he or she answered on the basis of the same program as the Chief Resident, the total number of responses would be artificially inflated. Thus, the data would lose significance. The intent of the question was to apply to the Training Director's own experience as a resident. Having a separate questionnaire may clarify this discrepancy. However, this approach may produce more uncertainty because of possible differences in question content and format. In retrospect, we can say that more detailed instructions to guide the participants would be of benefit.

The population of Psychiatry Training Directors selected as participants was selected from the AADPRT Membership Directory. Retrospectively speaking, there are limitations to the selection process. Not all Training Directors may belong to this professional organization, and there may have been some turnover in Training Directors since publication of the directory. Academic centers may account for a greater proportion of returned surveys and therefore would be expected to demonstrate greater research activity (10). There is no differentiation between academic, private, and state-funded institutions in the directory. We suggest that future study population be drawn from Psychiatry Residency Programs recognized by the American Committee on Graduate Medical Education (ACGME). This would include programs in the United States and Puerto Rico, consisting of 186 programs, with 110 university affiliations (1).

A more confounding issue appears to be the definition of research. This is apparent in the Requirements for Residency Training (1). Does the terminology used in the Requirements and in the survey only apply to Journal Club? Does the term research include literature reviews, case reports, and letters to the editor? Research, for some people, may mean only bench research. Others may discount drug trials financed by pharmaceutical companies and consider only government-sponsored basic clinical research as true research. If the long-term objective is to learn critical appraisal skills, then research shows that journal clubs may not accomplish this goal (18).

Training Directors must answer these research-related questions for the educational benefit of residents. Most residents who attempt research do so with faculty guidance and support. If faculty do not encourage scholarly inquiries, residents may feel that research is for academic psychiatrists only. The resident may falsely believe that the private clinical psychiatrist has little to contribute to the field through case reports or letters to the editor. Likewise, residents may not have the mentorship for the sheer enjoyment of research that many psychiatrists demonstrate. Another big question that has yet to be answered is whether or not research during residency training actually increases knowledge.

This study has shown that were no differences between faculty and residents who were required to do research in their residency training, but a significant number of current residents now enjoy the luxury of being in programs that offer research opportunities. There was no significant difference between the groups on the questions addressing whether research should be offered or should be required. However, although 98% of respondents stated that research should be offered, only 32% expressed the attitude that research should be a requirement. Both residents and faculty equally feel that research is personally important to their careers, but faculty recognizes the significance of its help in their practice of psychiatry. Unfortunately, significantly fewer residents plan to incorporate research into their future career plans than do faculty; however, the total group response indicated that it is given positive consideration in their future plans.

Psychiatry encompasses diversity in many different areas. Research is a dynamic endeavor. As the push for clinical productivity increases in both the academic and private (clinical) sectors, the term research must be more clearly defined. As a variety of barriers to research proliferate, the term may also undergo evolution. There is a distinct need for Training Directors to take the lead in encouraging future psychiatrists to contribute to all areas of research, improving attitudes and career choices for those involved.

ACKNOWLEDGMENTS

This work was done in the Department of Psychiatry at Louisiana State University Health Sciences Center, Shreveport, LA.

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Appendix:

TABLE 1. Summary of survey questions yielding significant results

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References

Accreditation Council for Graduate Medical Education: Graduate Medical Education Directory, 1999-2000. Chicago, IL, American Medical Association, 1999

Cummings CW: Research training for residents. Arch Otolaryngol 1982; 108:640-642

Fletcher RH: Faculty training and fellowships in research in general medicine. J Gen Intern Med 1986; 1(suppl4):S50-S55

Markert RJ: A research methods and statistics journal club for residents. Acad Med 1989; 64:223-224[PubMed][CrossRef]

Neinstein LS, MacKenzie RG: Prior training and recommendations for future training of clinical research faculty members. Acad Med 1989; 64:32-35[PubMed][CrossRef]

Hayward RA, Taweel F: Data and the internal medicine house-officer: alumni's views of the educational value of a residency program's research requirement. J Gen Intern Med 1993; 8:140-142[PubMed][CrossRef]

Strauss GD, Yager J, Offer D: Research training in psychiatry: a survey of current practices. Am J Psychiatry 1980; 137:727-729[PubMed]

Powner DJ, Thomas EA: Research curricula in critical care fellowships: a survey. Crit Care Med 1996; 24:1079-1082[PubMed][CrossRef]

McGuire CW, Heberman HB: Research in radiology residency programs: a survey. Acad Radiol 1998; 5:698-700[PubMed][CrossRef]

Sulak PJ, Croop JA, Hillis A, et al: Resident research in obstetrics and gynecology: development of a program with comparison to a national survey of residency programs. Am J Obstet Gynecol 1992; 167:498-502[PubMed]

Brouhard BH, Doyle W, Aceves J, et al: Research in pediatric residency programs. Pediatrics 1996; 97:71-73[PubMed]

Taniguchi MH, Johnson PD: Rehabilitation resident academic productivity: Report on 1993 Graduates. Am J Phys Med Rehabil 1994; 73:240-244 [PubMed][CrossRef]

Pincus HA, Haviland MG, Dial TH, et al: The relationship of postdoctoral research training to current research activities of faculty in academic departments of psychiatry. Am J Psychiatry 1995; 152:596-601[PubMed]

Fleiss JL: Statistical Methods for Rates and Proportions, 2nd Edition. New York, Wiley, 1981

Streiner DL, Norman GR: Health Measurement Scales: A Practical Guide to Their Development and Use, 2nd Edition. Oxford, UK, Oxford University Press, 1995

Veney JE, Kaluzny AD: Evaluation and Decision-Making for Health Services, 2nd Edition. Ann Arbor, MI, Health Administration, 1991

Welch S, Comer J: Quantitative methods for public administration. Chicago, IL, Dorsey, 1989

Fu CH, Hodges B, Regehr G, et al: Is a journal club effective for teaching critical appraisal skills? Acad Psychiatry 1999; 23:205-209

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Appendix