There continues to be a critical need for increasing the number of researchers in psychiatry, including its subspecialties, such as geriatric psychiatry (1–4). Many of the federally as well as privately funded research training programs focus on post-doctoral-level trainees and involve several years of hands-on research experience with mentors at major universities. Though this is the well-trodden way of developing independent investigators, it is severely limited in at least three ways in its ability to capture a large proportion of people who could become scientists in the field.
Only a very small proportion of those with an early potential for a research career in geriatric psychiatry go on to complete psychiatry residency or doctoral-level training; the remainder either have chosen other fields or have opted to become clinicians or administrators instead of researchers. A subspecialty that has to fight the dual stigma of aging and mental illness is at a particular disadvantage and may have greater difficulty attracting many talented individuals to a research career. Potential scientists need to be identified as early as possible in the career pipeline and be provided with a rewarding exposure to the field (4–6). Early intensive research experience has been found to be successful in attracting students to a research career (4, 7, 8).
The long duration of training required following completion of a long graduate program or a residency, coupled with financial pressures of large loans, especially when one may be starting a family, makes the research fellowship unappealing even to those with interest in the field.
By restricting the training to a few major universities, there is little opportunity to recruit candidates from large parts of the country, which also results in a lack of development of comprehensive research training programs in geriatric psychiatry in settings of high public health need, such as rural areas and areas with large ethnic minority populations.
Possible solutions to these problems include “catching” people at an early stage of their careers before they choose other lines of work, shortening the period of training, and/or shifting the recruitment of candidates to a national effort rather than local. Obviously, there are limitations to these approaches, too. It may be argued that precious resources may be wasted on the development of early research experiences, as many of those who participate in such training may later be attracted to other fields. The earlier in the pipeline the trainees are (e.g., high school versus graduate or medical students), the larger the pool of potential trainees, but also the lower the percent yield in terms of long-term retention in the field. A focus on short-term training is also clearly inadequate for developing independent investigators.
Although these objections are valid, they are not insurmountable. Continued long-term follow-up with research mentors in the field is critical and feasible in helping to retain a sizable proportion of such trainees in academic psychiatry. In designing national-level programs for short-term research training, a number of issues must be considered that can affect program success. These include selection criteria for and number of trainees, site(s) of training, length and content of training (experiential versus didactic, flexible versus standardized), type of faculty, duration of follow-up, evaluation of outcomes, and future sustainability of the program.
Below we describe three federally funded, short-term research training programs (all taking place during the summer) for trainees from across the United States: 1) Summer Training on Aging Research Topics–Mental Health (START-MH) for undergraduate, graduate, and medical students; 2) Stein Institute for Research on Aging (SIRA) Medical Student Training in Aging Research (MSTAR); and 3) Summer Research Institute (SRI) in Geriatric Psychiatry for postdoctoral fellows and junior faculty. We compare salient characteristics of these programs, illustrating similarities as well as differences, and discuss their limitations along with plans for the future. Early experiences with two of these programs (START-MH and SRI) have been reported previously (9–11).
The Summer Training on Aging Research Topics—Mental Health (START-MH) program, established in 2003, competitively selects 25 to 30 students (undergraduate, graduate, and medical) per year from across the country to work in the research labs of established investigators in geriatric mental health for 10 weeks during the summer. All selected trainees are paid a stipend. The trainee can apply with a chosen mentor or can be matched with a mentor by the START-MH program staff. Mentors are required to have an established track record in training students as well as in geriatric mental health research in terms of independent peer-reviewed grants and published peer-reviewed papers. At the end of the summer experience, all students present their work at a workshop, and they, in conjunction with their mentors, are encouraged to submit the results of their research as an abstract to a professional meeting and also as a paper for submission to a peer-reviewed publication.
The program has demonstrated excellent success in recruiting high-quality applicants. In 2003, the first year of the program, 85 student applications were received; this number increased to 159 the following year. The most dramatic changes were a sixfold increase in the number of medical student applicants and a 123% increase in the number of minority applicants. In 2005 and 2006, 132 and 182 applications were received, respectively. A total of 90 students have participated in the START-MH program during its first 3 years (2003 to 2005), with another 30 students accepted for 2006. Nearly 50% have been from ethnic minority groups and approximately 75% have been women.
The total length of the program is 10 weeks. Clear expectations for the course of the START-MH program are defined. The mentors must decide on how to meet these expectations on a day-to-day basis, based on the structure of their own labs as well as on the educational level of the student trainees. Student requirements common to each placement include: 1) completion of any required local training (e.g., ethics, HIPAA, or animal use); 2) submission of an abstract and a time-frame for the research project to be completed and submitted to the START-MH staff by the end of the second week of placement; 3) submission of all program evaluations; and 4) attendance at the START-MH conference in August of that year. Participating mentors are also expected to complete all program evaluations and must provide frequent and regular supervision of their students.
Application and Selection Procedures
Applications are required from both interested students and mentors. The students apply by submitting an application form online, a personal statement of career goals (up to 500 words), a current transcript, and one letter of recommendation. Interested mentors are asked to submit a completed mentor form and an NIH-format biographical sketch. A mentor may apply without a trainee and vice versa. Junior faculty members are encouraged to partner with established faculty in mentoring students.
The student applications and rating forms are sent out to be reviewed and rated by a selection committee comprising geriatric mental health researchers outside of UCSD. Based on a developed trainee selection criteria form, candidates are rated on a scale of 1 (outstanding) to 5 (poor) in the following categories: academic qualifications, level of interest in aging and mental health, letter of reference, and quality of mentor (if applicable). In addition, an overall rating is given. Mentor applications are also reviewed by the selection committee based on their publication and grant track records. The ratings are returned to the START-MH staff for tallying and ranking, followed by a conference call held to discuss the rankings and determine final selection.
Research Training Workshop
As previously mentioned, the day-to-day activities of trainees are determined by the mentors and based on the defined program expectations. A major component of the research training includes the attendance of all trainees at a 2-day weekend workshop held in August on the UCSD campus, beginning on a Friday evening and ending midday on Sunday. Trainees attend talks by senior leaders and researchers in the fields of mental health and aging and also present their own research posters based on the work conducted over the summer. The START-MH conference workshop provides the trainees an opportunity to gain exposure to a broad spectrum of research topics in geriatric psychiatry, as well as to network with fellow students and leaders in the field. For many trainees, this is their first experience attending a “professional meeting” and every effort is made to ensure that trainees have a positive experience.
There are both didactic and interactive learning opportunities, including the presentation of information on the need for additional professionals in the field, as well as exciting research findings and future opportunities. One session consists of a presentation by an elderly consumer of mental health care along with her or his caregiver; most students find this discussion of real-life experiences both illuminating and moving. During the lunch, students are placed at tables according to their student academic level (undergraduate, graduate, or medical student), along with faculty members who share a similar academic background. The faculty members lead relevant discussions, including how to prepare for and apply to graduate school (with undergraduate students), how to select an appropriate residency training program (with medical students), or how to find an appropriate postdoctoral fellowship (with graduate students). There are “teaching” poster sessions. Each trainee is expected to present the results of her or his research at this meeting in the posters and is provided guidelines on how to prepare a poster in advance of the meeting. The poster sessions are utilized as teaching sessions where two to three students are assigned to an individual faculty member. The student/faculty group visits each poster and discusses how to review and critique a scientific poster. There is a session designed to illustrate the various career paths that students may pursue in geriatric mental health. Several selected junior investigators from the UCSD faculty present their career development stories and answer questions from the trainees regarding academic choices. Finally, there is a written evaluation of the program by the students and an opportunity for attendees to provide verbal feedback to the program staff.
The initial evaluations of the program by the participants have been very positive. Over 95% have reported an increased knowledge of what a research career involves, and more than 90% asserted that they were “highly likely” or “likely” to pursue a career in geriatric mental health research. A number of students have continued to work with their mentors in order to write up their results as abstracts or manuscripts and have submitted them to national professional conferences and peer-reviewed journals. Several papers with a START-MH student listed as the first author or coauthor have already been published.
The University of California, San Diego (UCSD) Sam and Rose Stein Institute for Research on Aging (SIRA) Medical Student Training in Aging Research (MSTAR) program, established in 2005, focuses on aging well (or on successful or healthy aging) in the context of age-associated diseases and disorders. Funded by a grant sponsored by the National Institute on Aging (NIA) and co-sponsored by the American Federation for Aging Research (AFAR) and the John A. Hartford Foundation, the SMART program provides support for up to 18 medical students from across the country selected for training experiences of 8 to 12 consecutive weeks full-time during summer. All trainees are paired with experienced scientists from UCSD, who have outstanding track records in research as well as research training. Areas of interest for the faculty range from basic and molecular biology to clinical, epidemiological, and therapeutic research on aging and age-related disorders, such as Alzheimer’s disease, cancer, cardiovascular diseases, depression, and schizophrenia.
Trainees are provided an opportunity to conduct hands-on research with their selected mentors. Trainees may also opt to be paired with scientists from three neighboring institutions, the Burnham Institute, the Salk Institute, and the Scripps Research Institute. The program is specifically tailored to medical students who have some clinical knowledge and academic interest but limited prior research experience. The students selected receive a stipend during their training. At the conclusion of the training program, it is expected that all trainees will, at a minimum, have developed an abstract and a draft of a poster, with guidance from their mentor, with travel support provided to the students to present their poster at the American Geriatrics Society’s annual meeting. Mentors are strongly encouraged to assist their students in developing a publishable article for submission to a peer-reviewed journal within a year. In addition to the hands-on research experience and the formation of a valuable mentoring relationship, a combination of didactics and workshops is provided to reinforce the skills learned in the direct research experience.
A total of up to 18 medical students are selected each year. All trainees must have successfully completed at least 1 year at a U.S. school of medicine or osteopathy prior to beginning their research training. During the first year of the program, 16 students were selected locally from the UCSD School of Medicine, along with three additional local students, funded separately through another program. (Due to time constraints, national recruitment did not occur.) Two-thirds of the program participants selected were from minority racial/ethnic groups, with equal numbers of men and women. The recruitment and selection of students for the training awards during subsequent years of the program will include the use of a common electronic process developed by AFAR in conjunction with additional program-awarded institutions from across the country. Initial recruitment for the second year of the program has resulted in a total of 26 student applicants requesting UCSD as their first or second choice to conduct their research training.
All students are required to spend 8 to 12 consecutive weeks training full-time during the summer. Students may apply to participate in the program for more than 1 year (i.e., during two or more consecutive summers). Selected students and their faculty mentors are expected to develop their summer research projects well in advance, prior to the students’ arrival. Projects are designed to allow the student to complete his or her work while learning research during the stipulated program period. It is expected that the relationship fostered between the mentor and student will continue long-term. In addition to the research training received in conjunction with the selected mentors, students also participate in a series of didactics throughout the summer, along with an all-day conference/retreat.
Application and Selection Procedures
The student application and selection process was developed in concert with the program-sponsor staff from NIA and AFAR. A common electronic application process has been developed by AFAR, which requires students to apply to a central site and indicate their preference for different schools participating in the program. Applications are solicited nationally. Selection criteria include: 1) the student’s ability and potential as demonstrated by past academic performance, statement of purpose in the proposed program, and letter of support from a faculty sponsor at the student’s home institution; 2) interest in geriatric issues suggested by course work, research studies, and volunteer activity; 3) interest in and promise for a successful academic career; and 4) the student’s background and potential for helping diversify the pool of physician researchers in aging. The national selection committee is formed by AFAR and is composed of experts in aging research.
All trainees are paired with experienced scientists from UCSD or one of three neighboring institutions, the Burnham Institute, the Salk Institute, and the Scripps Research Institute. The selected mentors are senior faculty with an excellent track record of NIA and other federal funding and of research training of medical students. Students are provided an opportunity to conduct hands-on research by pursuing basic science, clinical, or health services research projects in geriatrics or gerontology with their selected mentor. The area of focus for a particular student is determined based on his or her expressed interests and the expertise of the faculty available. The daily activities of the students are determined in conjunction with their mentor, with the expectation that they will, at a minimum, have developed an abstract and a draft of a poster by the end of the summer. Mentors are also strongly encouraged to assist their students in developing a publishable article for submission to a peer-reviewed journal within a year of completion of the program. In addition to the individual research training, students collectively participate in a series of didactics designed to complement their research experience.
Didactic sessions focus on content areas, such as healthy aging, bioethics, and biostatistics, as well as process aspects, such as publication strategies, effective presentations, clinical case conferences, journal clubs, and scientific autobiographies by selected scientists representing diverse backgrounds (in terms of discipline, gender, ethnicity, seniority, etc.). There are also “social hours” designed to further enhance informal interactions among students, faculty, and program staff.
Near the end of the summer program, a 1-day conference is organized to bring together all of the participating students, as well as many of the faculty mentors. The content of the conference includes talks by senior faculty on successful aging, the future of aging research, life after medical school, and a session with consumers and caregivers. Based on feedback, an effort is being made to ensure the time spent by students in didactics is balanced with their research training requirements. In addition, greater emphasis is being sought on an interactive versus lecture-type format.
Participating students and mentors must complete a formal evaluation 2 weeks after the start and at the conclusion of the training program. Results from the first year of the program show that a vast majority of the students strongly agreed that their research work was of interest and relevance and that the time spent with their mentors was valuable to their learning. A majority of faculty mentors gave the highest rating for “overall satisfaction with the program.” Although the MSTAR program is in its infancy, the career paths for all student participants will be followed in the years to come to determine the long-term outcomes.
The Summer Research Institute (SRI) in Geriatric Psychiatry is designed for promising postresidency (M.D. or D.O.) and postdoctoral (Ph.D., Psy.D., or Pharm.D.) fellows and junior faculty persons who are clearly interested in developing a research career in geriatric mental health. The SRI, which is now in its thirteenth year, is geared toward training investigators in clinical, basic, treatment, services, or translational research. The weeklong Institute is followed up with mechanisms for continued communication between trainees and mentors. There is a heavy emphasis on career mentoring and experiential learning. Thus, there are discussions of topics, such as academic survival and success, publication strategies, grant writing, and balancing life and career. In addition, every trainee submits a draft of a research grant or a synopsis of a research plan; this research proposal is reviewed by senior faculty members and provides a hands-on basis and context for discussions on developing fundable research ideas, grant writing, the review and revision process, and longer-term goals. Many of these ideas have developed, in substantially modified form, into research proposals funded by NIMH (including K awards, small grants or R03s, or even regular research grants or R01s) and other sources (NIA, VA, and private foundations such as NARSAD and the Alzheimer’s Association).
Between 25 and 30 trainees are selected each year from a pool of over 70 applicants. Whereas the exact proportions vary across the years, overall, half of the attendees have been women, and a quarter have come from ethnic minority groups. Similar proportions (about 43%) have been either Ph.D. or M.D., with the rest being Pharm.D. or M.D. plus Ph.D. Approximately 50% have been fellows, another third, assistant professors; the rest have had other faculty positions. Trainees have come from over 40 different states. The research interests of the attendees have ranged from basic to translational to clinical to services research.
The Institute itself is 1 week long and is scheduled during the last full week of July. Although UCSD staff coordinate the SRI each year, it has been held at different universities that have major geriatric psychiatry programs, for example, Cornell, Duke, Penn, Pittsburgh, Rochester, Stanford, UCLA, UCSD, and the University of Washington.
Application and Selection Process
An annual call for applications is made in early November. Advertising occurs through a number of means, including the SRI Web site and appropriate newsletters (e.g., American Association for Geriatric Psychiatry, American Psychiatric and Psychological Associations, American Association for Geriatric Psychiatry). In addition, a brochure is mailed to every chair of the psychiatry, psychology, and neurology departments and to all psychiatry and geriatric psychiatry residency program directors in the United States. The brochure is also sent to all SRI alumni for distribution to appropriate candidates.
Each applicant must submit 1) a current curriculum vitae; 2) a 500-word description of personal interest in a research career related to mental health and aging; and 3) two letters of recommendation. Completed applications must be submitted by around March 15th each year. These are then forwarded to and ranked by the Institute’s executive committee. Each application is ranked on a scale of 1 to 5 (similar to an NIH grant review committee) with weight being given to the applicants’ prior accomplishments (curriculum vitae and two letters of recommendation), as well as their interest in and potential for a successful career in academics (personal statement). The main criterion for the selection of candidates is the perceived likelihood of their successfully pursuing an academic career. The rankings are tabulated and distributed to the SRI executive committee for discussion and final selection (via conference call).
The Institute involves a week of intensive workshops. The curriculum includes many components that are fixed and offered each year across sites and a few that are variable and designed to utilize the unique resources of each site. The core program consists of elements designed to provide career guidance as well as didactic components offering basic knowledge about subjects such as research methods. Most sessions in the SRI are intentionally open-ended and informal. Examples of the topics for main sessions include grant mechanisms and grant writing, giving scientific presentations, publishing papers in peer-reviewed journals, responsible conduct of research, a session with current junior faculty members, scientific autobiographies, and balancing life and work. Details of the schedule have been described previously (9, 10).
When the program first began in 1995, it was somewhat more didactic than pragmatic in nature—that is, the focus was as much on content (e.g., diagnosis and treatment of alcohol dependence in the elderly) as on process (e.g., how to recruit subjects for a research project on alcohol dependence in the elderly). It became apparent early on that most trainees had ready access to content but were in much greater need of process training. Thus, the curriculum of the SRI was changed to encompass that need—the faculty now addresses the nuts and bolts of research. Similarly, it was found that individualized grant preparation was particularly unique and valued, so the emphasis on each participant’s presentation of research ideas (or early draft grant submissions), with feedback from the senior SRI faculty, was increased.
Some sessions include discussions of state-of-the-art methodology in the field and laboratory programs that highlight the major strengths of the host sites. These present opportunities for trainees to meet successful researchers as well as observe the operation of mature programs of research. All of the aforementioned activities are geared toward the trainees, with an understanding of their current workplaces. The goal of the Institute is to have each trainee develop his or her own research that is appropriate to individual background, interests, and abilities.
A critical part of the SRI is the follow-up communication between SRI alumni and faculty. This takes place formally at the annual meetings of the American Association for Geriatric Psychiatry and informally throughout the year via phone, e-mail, and in-person visits.
Since its inception in 1995, over 300 trainees have attended the SRIs. The cumulative “survival rate,” measured as staying in full-time academics for over an average of 3.5 years of follow-up, has been 75%. There are no significant differences between M.D.s and Ph.D.s or between men and women in terms of the academic survival rates. Of the SRI alumni followed, more than half have received federal grants as principal investigator (mostly K awards, R03s, and R01s), while more than a quarter have obtained other competitive national-level peer-reviewed grants (e.g., NARSAD, Stanley Foundation, Alzheimer’s Association). Almost every SRI alumnus has published peer-reviewed papers.
The SRI provides a useful model for an approach to bridging and shortening the transition period from fellowship to first research funding and of ensuring a continued flow of new faculty-level investigators in geriatric psychiatry.
Appendix 1 compares the salient characteristics of the three programs described above. They share several common features, such as being NIH-funded, short-term (summer) research training programs that recruit trainees from across the United States, involve dedicated volunteer mentors (i.e., not paid for their mentorship), are primarily nondidactic in nature, encourage follow-up research with mentors, and emphasize peer-reviewed publications as an important outcome measure. They all help the trainees understand that an academic research career involves such steps as establishing a relationship with a mentor and building networks that benefit their academic and career advancement. Each program has its own executive committee to help the principal investigator develop the specifics of the program according to its unique needs and provide ongoing oversight and a manager who is responsible for administrative details.
These three programs also differ from one another in several ways. Two of them (START-MH and MSTAR) aim at expanding the pipeline for new researchers by providing early opportunities and exposure to research for undergraduate, graduate, and/or medical students and involve 8 to 12 weeks of hands-on research, whereas the SRI targets postdoctoral fellows or junior faculty and involves workshops and discussions of individual research projects over the course of 1 week. The START-MH and MSTAR programs pay stipends to the students, providing them with the ability to devote their summer to research and limiting their need to seek additional employment. The MSTAR program encompasses research in aging as a whole, while the other two programs focus specifically on geriatric mental health.
The evaluations of the programs by the trainees as well as the mentors have been mostly very positive. More importantly, the SRI and START-MH have been quite successful on the objective measure of peer-reviewed publications by trainees. (The MSTAR program has been operating for less than 1 year.) In the case of the SRI, “academic survival” as well as competitive grant funding by the trainees confirms its value. We must add that there are no true control groups. This should not be surprising as these programs were funded for research training and not as randomized, controlled trials of specific educational interventions. Also, it will take several years to measure the true impact of early pipeline programs such as the START-MH and MSTAR in terms of their value in expanding the pool of researchers. It is gratifying to note that the proportions of women trainees and those from ethnic minority groups have been substantial.
An overarching goal of the research training programs described in the current article is to attract and retain individuals in research careers in geriatric psychiatry. However, measuring this outcome requires long-term follow-up for at least several years. The “academic survival rate” among the SRI alumni has been 75% after an average follow-up period of 3.5 years. This rate seems to be higher than what would be expected in a diverse group of fellows and junior faculty from across the country. This type of long-term data is not yet available with the START-MH and the MSTAR programs, but we hope to have such data available in the near future. In the short term, the success of the programs may be evaluated on the basis of trainees’ and mentors’ satisfaction with the programs. It is worth noting that the initial experience with the SRI that we had reported (9) was restricted to positive evaluations of the program by the trainees and the mentors. The prediction of long-term success with the SRI based on the initial results has been borne out in our follow-up. We believe the same will be true for the START-MH and MSTAR programs too.
In conclusion, our experience to date shows that short-term research training programs hold great promise for future development of new researchers in chosen fields. Future plans include long-term follow-up evaluating the career choices of trainees. We also plan to expand these programs to even earlier stages of the pipeline by designing programs for high-school students, especially those from ethnic minority groups. Finally, modifications will be necessary as one seeks to apply them to different fields within and outside of psychiatry.