Honorary fellowship awards are given each year by professional organizations in recognition of the significant achievements and future promise of trainees in the field of psychiatry. Personal anecdotes and narratives suggest that honorary fellowship awards are important in professional development of trainees and early-career psychiatrists, and yet no empirical data are published on the qualities and impact of these awards. Do fellowship awards actually help to establish mentor relationships, to build research or education careers, and to foster involvement with organizational psychiatry, as the awards are intended? What characteristics do honorary fellowships reward or encourage (e.g., scholarly accomplishments, cultural diversity in psychiatry, educational skill, and leadership)? How do award recipients assess their experiences in various fellowship award programs, and how do recipients recommend that these programs be improved to reach their goals more fully?
The lack of empirical evidence to answer such questions merits attention, especially in light of the substantial expenditure of financial resources and organizational effort represented in these award programs. While the exact figure is unknown, we estimate that pharmaceutical companies have provided hundreds of thousands of dollars in educational grants in recent years to support fellowship awards in psychiatry in the United States. In addition, the administration of each fellowship program entails ongoing effort and attention by the individual professional organizations. Based on our experience related to one such fellowship program, as many as 300 hours of psychiatrist and staff time may be expended annually by each organization in preparing and announcing their respective award programs, coordinating selection activities, facilitating travel and financial arrangements, interacting with recipients, and providing mentorship and guidance. Taken together, honorary fellowship awards given by professional organizations in psychiatry represent a significant investment in the development of trainees and early-career psychiatrists. The issue that remains, then, is whether and how these awards make a difference in the eyes of recipients.
To better understand the perceived value and possible enduring effects of honorary fellowship awards given by professional organizations in psychiatry, we conducted a survey in 1997—1998 of award recipients from six professional psychiatric organizations over the past 22 years. Based on the medical education literature (1—4) and on our direct experience with fellowship awards, we tested four main hypotheses: 1) overall, fellowship award experiences would be viewed by recipients as having a positive influence on their professional development; 2) the perceived importance of various fellowship experiences and activities would be greater for some organizations than others; 3) women recipients would place greater importance upon fellowship experiences than men recipients; and 4) the expected impact of fellowship awards would be less than their perceived actual effects on individual professional development.
A team of five multidisciplinary professionals with experience with fellowship awards and professional medical education developed a five-page written survey (available from the authors). Respondents reported up to three awards that they had received, and then dichotomous items assessed the activities entailed by these awards (8 items), the roles of the people who nominated the recipients (5 items), and subsequent organizational involvement by recipients (7 items). Respondents also used 7-point Likert scales to rate their expectations at the time of reception of the importance of nine aspects of the award, and the respondents then rated their perceptions of the actual importance of the same nine aspects of the award to their professional development since reception (9 items). Recipients then rated the helpfulness of award experiences in advancing six dimensions of their professional work. Finally, respondents were asked to provide qualitative responses to five issues about their awards: 1) what was most valuable, 2) what fostered whatever was valued, 3) any negative experiences, 4) suggestions for improvement of awards, and 5) how the recipients would participate in the programs differently based on their experiences to date. Award recipients reported their age, gender, and ethnicity, as well as six characteristics of their training and professional experience. This project used a confidential method and was approved by the Institutional Review Board at the University of New Mexico School of Medicine.
The names of all fellowship award recipients over the past 22 years were obtained from six professional organizations in psychiatry: the American Association for Geriatric Psychiatry (AAGP), the Association for Academic Psychiatry (AAP), the American College of Neuropsychopharmacology (ACNP), the American College of Psychiatrists (ACP), the Academy of Psychosomatic Medicine (APM), and the American Psychiatric Association (APA). These national organizations were selected so that the sample would have diverse representation of professional mission, fellowship structure, and award selection processes. We estimate that these programs constitute one-third to one-quarter of psychiatric fellowship award programs in the country. All award recipients from the AAP, ACNP, APM, and AAGP were invited to participate in our study. Because of their larger number of awardees, we randomly selected one-half of the fellowship recipients from the ACP and one-third of the fellowship recipients from the APA for inclusion in the study sample. Nonphysician award recipients, present only in the ACNP, were excluded to retain the focus on psychiatry.
The written, number-coded survey was sent with a self-addressed stamped return envelope to prospective participants. A signed cover letter described the aims of the project and its confidential method. Three mailings were performed to increase participation.
Data were entered into a Statistical Package for the Social Sciences database without identifying the respondents. Frequencies of responses to the dichotomous items were reported and compared by using χ2 tests. Responses to these items were compared for various demographic and professional characteristics. Likert-scaled items were subjected to factorial repeated measures multivariate analyses of variance (MANOVA) by using Organization and Gender as between-subjects independent variables and Item and Time (when appropriate) as within-subjects variables. When main effects or interaction effects were statistically significant (P<0.05), individual means were contrasted by using Fisher's Least Significant Difference (LSD) test (P<0.05).
Fifty-five percent of fellowship award recipients invited to participate responded to the survey (N=182). Because only four individuals who received APM awards responded, their surveys were excluded from further analyses because of concerns about representativeness and unreliability. Response rates from the remaining five organizations did not significantly differ (range: 46%—71%, P>0.10) (see t1). For these organizations, more respondents were men (60%) than women (40%) (P<0.01), and the AAGP had significantly more women respondents (75%) and the ACNP significantly fewer women (14%) than the other three organizations (mean=43%) (P<0.001). The respondents' mean age was 41 years (range: 28—64, SD=6.7), a result that did not differ by gender, but the AAGP respondents were significantly younger than those from other organizations (P<0.01). Most respondents (82%) were white, a finding that did not differ by organization or gender.
Overall, 77% of the respondents reported that they were board-certified in psychiatry, and certification varied by organization (range: 25%—89%; P<0.0001) but not by gender. An additional 6% reported board certification in an area other than psychiatry. More white respondents reported certification than did other groups (81% vs. 56%, P<0.01). Almost half (49%) of the award recipients received more than one fellowship award, and this characteristic varied by organization (range: 19%—68%, P<0.001). More men than women received at least two awards (56% vs. 42%, P<0.07), and fewer whites than other groups received multiple fellowships (46% vs. 76%, P<0.01).The respondents also reported the percentage of professional time that they were involved in clinical work (mean=49%), research (mean=22%), administration (mean=15%), academia/teaching (mean=13%), or other activities (mean=2%). A repeated measures MANOVA [Activity(Within Subjects)(5) × Organization(Between Subjects)(5) × Gender(B)(2)] was performed on these measures, and as expected, the main effect for Activity showed that more time was devoted to clinical work than any other activity (P<0.0001). The Activity by Organization interaction (P<0.003) showed that the time devoted to activities varied across organizations. For example, the recipients from ACNP reported only about one-fifth of their time was devoted to clinical activities, but those in other organizations reported from one-half to almost two-thirds of their time (P<0.001). Similarly, the ACNP respondents reported over two-fifths of their time devoted to research, but those from other organizations only about one-tenth to one-quarter (P<0.001).
The respondents indicated whether their award entailed any of seven specified activities (see t2). Most recipients reported engaging in small group discussions (66%, range by organization: 36%—77%, P<0.01); attending more than one professional meeting (58%, range 18%—92%, P<0.0001); and becoming involved with the awarding organization (55%, range: 30%—100%, P<0.0001). A large minority (40%, range: 2%—65%, P<0.0001) reported giving a formal presentation or paper, and about one-fourth (28%, range: 7%—51%, P<0.0001) became involved with a mentor or adviser from the awarding organization. Few reported giving an informal paper or presentation (13%, range: 7%—32%, P<0.05) or other activities (7%, range: 0%—11%, P>0.10). Thus, all activities—except "other activities"—showed significant variation by the awarding organization.
Importance of Fellowship Experiences
The award recipients rated (on a scale from 1="not important" to 7="very important") nine aspects of their fellowship experience. The recipients made two ratings of each aspect—the first, "how important you expected the aspects to be at the time of receiving the award," and the second, "how important the aspects actually were in your professional development since receiving the award." Thus, two factors were repeated within each respondent [Time: "at the time of" vs. "since receiving" and Aspect (9 items)]. These measures were analyzed by performing a 4-factor repeated measures MANOVA: Gender(B)(2) × Organization(B)(5) × Time(W)(2)×Experience(W)(9). The effects involving Time or Aspect were of primary interest.
First, the main effect for Experience (multivariate F(8,146)=16.70, P<0.0001) revealed that the fellowship recipients discriminated among the relative importance of the nine kinds of experience (see t3 or t4). "Attending a conference" and "meeting leaders in psychiatry" were both rated moderately high (means≥5.10). "Professional recognition" and "meeting other recipients" were rated above the scale's midpoint but somewhat lower (means>4.70), and "learning about helpful resources," "meeting with potential collaborators," and "meeting with potential mentors" were rated even more moderately (means>4.30). Finally, "support from the nominating institution or individual" was rated moderately important (mean=4.16), but "gifts or funds given with the award" was rated rather unimportant (mean=2.78). Although the effect size for the range of rated importance of the various aspects was quite large (d=1.51) (5), the overall means extended over only about one-half the range of the rating scale. That is, the respondents did not rate elements of fellowship experience at either extreme on the scale of importance.
Second, the main effect for Time (F(1,153)=9.38, P=0.003) showed that the respondents reported expecting the aspects of their fellowship experience to be more important at the time of receiving the award than they perceived them to have actually been in their professional development since receiving the award (see t3). Although the average effect size for Time was small (d=0.28), the effect was consistently in the same direction across all nine items for both men and women. The only Time interaction to approach significance was Time × Organization (P<0.08), indicating a tendency for the general time effect to be larger in some organizations than in others, irrespective of the aspect.
Third, the Experience by Organization interaction (F(32,540)=3.04, P<0.0001) indicated that the nine aspects of experience were evaluated by the recipients differently, depending upon the nominating organization (see t4). The ACP recipients rated "attending a conference" lower than the other organizations. "Meeting leaders in psychiatry" was evaluated most important by the AAGP recipients and least important by the APA respondents. The ACNP recipients rated "professional recognition" much more importantly than the others did. The APA and AAGP recipients rated "meeting other recipients" as more important than did the others, particularly those from the ACNP and ACP. The AAGP respondents believed "learning about helpful resources" was more important than others, and the ACP recipients believed it was less important. The ACP respondents also rated "meeting with potential collaborators" and "with potential mentors" as less important than did others (all P<0.05). Finally, the AAGP and ACNP recipients rated "gifts or funds given with the award" as moderately important (means>4.00), but the others rated this aspect as rather unimportant (means<2.50, P<0.001). Most of these contrasts were in the order of half a standard deviation difference, but some approached a full standard deviation, a very large effect size (5).
No other effects reached significance, although the Gender × Item interaction was marginal (P<0.09), and the main effects for Gender and for Organization were also (P<0.08). However, two subanalyses were performed to illuminate the organization and gender effects. First, an Experience(W)(9) × Time(W)(2) × Gender(B)(2) repeated measures MANOVA was performed to examine the differences between the male and female responses more closely (see t3). In that analysis, the Experience by Gender interaction was significant at P<0.003, but the main effect for Gender was not (P=0.13). Thus, the women rated some experiences more positively than the men but not others, and this tendency occurred in collapsing over (i.e., ignoring) the Time variable. The most prominent gender differences were that the female recipients evaluated "attending an educational or research conference" and "learning about helpful resources" as more important than did the male recipients. Second, an Experience(W)(9) × Time(W)(2) × Organization(B)(5) repeated measures MANOVA was performed to examine the differences between the the awarding organizations. The Experience by Organization interaction was significant at P<0.001, indicating that perceived importance of the different experiences varied by the particular organization (see t4). In addition, the Organization main effect (P<0.04) showed that some organizations produced higher ratings of importance overall than others (mean range: 4.16—4.93, maximum d=0.45). Finally, the Time by Organization interaction (P<0.02) showed that the tendency to rate actual importance lower than expected importance was stronger for some organizations than for others.
Contributions of Experiences to Professional Development
The award recipients also rated the helpfulness (on a scale of from 1="not helpful" to 7="very helpful") of their fellowship experiences to six elements of their professional development (see t5). A 3factor repeated measures MANOVA was performed: Aspects(W)(6) × Gender(B)(2) × Organization(B)(5). The main effect for Aspects (P<0.0001) showed that the respondents discriminated among the importance attributed to the contributions of fellowship experiences to different aspects of their professional development. "Overall professional development" (mean=5.02) was rated the most important. "Building a network of colleagues in psychiatry," "advancing other aspects of work," and "advancing scholarly work" were rated somewhat lower, just above the midpoint of the scale. "Advancing clinical work" was rated a bit below the middle of the scale, and "building a relationship with a mentor" was rated the lowest (mean=3.20) of all aspects. Thus, as with previous ratings, the items were rated moderately on the scale.
Again, a 4-factor repeated measures multivariate analysis of variance was performed on these measures: Gender(B)(2) × Organization(B)(5) × Time(W)(2) × Experience(W)(9). The main effect for Aspect of professional development (F(5,156)=30.99, P<0.0001) showed that the respondents discriminated among the items. The Gender by Aspect interaction (F(5,156)=2.59, P<0.03) showed that the women rated some items as more important than did the men, and the Organization by Aspect interaction (F(20,636)=1.98, P<0.01) revealed that items were rated higher for some organizations than others. However, these two-way interactions were both qualified by the Gender by Organization by Aspect interaction (F(20,636)=1.72, P<0.03), which indicated a complex pattern of effects, wherein gender differences among importance attributed to different aspects varied, depending upon the particular organization (see t5 for contrasts among the individual cell means).
Subsequent Organizational Involvement
Finally, the respondents indicated whether they had performed any of seven activities after receiving their fellowship that reflected increased involvement with the awarding or other professional organizations (see t6). Over two-thirds (71%) reported "attending later meetings of the awarding organization." About half (45%—53%) of the recipients reported "becoming more involved with other organizations," "helping in the nomination process of other colleagues," "becoming more involved with the awarding organization," or "becoming a member of the awarding organization." About a third (31%) indicated that they "assumed a leadership role in other organizations," and about one-fifth (18%) said that they "assumed a leadership role in the awarding organization."
Four activities showed differences by awarding organization. The AAGP awardees (91%) were more likely to "become a member of the awarding organization" than those from other organizations (range: 66%—32%, P<0.01). The ACNP recipients were more likely to "attend later meetings of the awarding organization" (92% vs. 65% for others, P<0.01). The APA respondents were less likely to "help in the nomination process of other colleagues" (34% vs. 58%, P<0.05). The AAGP recipients were more likely (75%) and the ACP (40%) and the APA recipients (38%) less likely to "become more involved with the awarding organization" than those from the AAP (59%) or the ACNP (62%) (all P<0.05).
Qualitative Responses to Fellowship Experiences
Five narrative questions asked about overall fellowship experiences. Almost all (94%, n=71) responded to the question, "In retrospect, what about your fellowship experiences has been most valuable to you in your professional development?" Of those responding, meeting colleagues or other fellowship recipients was valued most highly by 23%; meeting leaders, experts, or mentors in academic psychiatry by 22%; the prestige and recognition that comes from receiving an award from a well-known organization by 20%; networking with colleagues or leaders in the field by 16%; and, learning about academic psychiatry and organizational medicine by 14%.
The question, "How did the organization, structure, or activities associated with the fellowship award(s) help to foster this?" had an 88% response rate (n=161). The largest number of the respondents (37%) felt that the organizational milieu was most important in supporting professional development. This included factors such as a relaxed atmosphere; encouragement of committee involvement; efforts to foster, motivate, and reinforce professional growth of fellows and organization members; greater identification with a diverse group of psychiatrists; and provision of a small, informal group setting for closer interaction.
Eighty-four percent (n=152) of the participants responded to the question, "Describe any negative experiences in association with a fellowship award in psychiatry." A vast majority (75%) felt that there were no negative experiences, but 5% felt that the fellowship awards were too exclusive. However, of the 75% (n=137) who responded to the question, "How might fellowship award experiences be improved?" 39% felt that there should be increased structured time with mentors, more opportunities to meet mentors in small group settings, more active preparation on the part of the organization to match mentors with award recipients, and better follow-up with mentors and with the organization as a whole after the initial meeting. A fourth of recipients felt that there was no need for program improvement.
Finally, when asked, "Describe any aspects of your fellowship experiences that you would perform differently, given what you know now," 50% of the 72% (n=131) responding felt that they would do nothing differently. Some (16%) felt that they would be "less shy" or "more aggressive" about talking more and networking more effectively with peers, mentors, and the professional organization as a whole.
This retrospective survey study documents the impressions and self-described career development experiences of honorary fellowship award recipients from five professional organizations in psychiatry. These programs are generally well received by participants who endorse their helpfulness in overall professional development, in building a network of colleagues in psychiatry, and in advancing their scholarly and other work. Individual fellowship programs are viewed as possessing certain strengths, though they differ in terms of their mission, characteristics of their participants, and their formal activities. The programs also vary with respect to their perceived professional outcomes, such as the self-reported importance of fellowship participation in meeting peers, collaborators, mentors, and leaders in psychiatry; garnering support and professional recognition through fellowship awards; attending meetings and conferences; becoming involved in the leadership activities of national psychiatry organizations; and subsequent work duties and rates of board certification. The women and men in our study differ—in general and across organizations—in their expectations and assessments of the professional impact of their fellowship awards. Comments of recipients indicate that cultivating more opportunities for mentor relationships would improve fellowship experiences, but one-quarter of the respondents feel that there was "no need for improvement," and three-quarters of the respondents have no negative experiences associated with their awards.
To our knowledge, no empirical data on honorary professional awards in medicine exist. These findings may offer some insight into the poorly understood influence of specific training-related and early-career interventions upon physicians' professional development. Now we will describe our findings' implications for honorary fellowship award programs of professional psychiatric organizations. We briefly outline the limitations of our study and conclude with areas for future inquiry.
The intent of this study was not to assess the relative merits of the different fellowship programs from which the recipients were sampled because each organization has its unique characteristics, goals, and professional outcomes. For instance, the AAP places value on supporting the development of fellows as psychiatric educators, the ACNP places relative emphasis on research career development, and the AAGP focuses more on clinical practice and research growth in this subspecialty area. However, our findings have several key general implications for professional psychiatric organizations that sustain honorary fellowship award programs. The first relates to the selection of award recipients. It is striking that nearly half of all respondents in our study received more than one award, and minority recipients are especially likely to have been honored by more than one organization. Moreover, compared with data derived from the 1996 National Survey of Psychiatric Practice (n=961) in the United States, a greater percentage of awardees are women; report being board-certified; and report spending more time in research, administration, and academic activities than other, more clinically focused psychiatrists (6). These findings suggest that the award selection criteria for psychiatric trainees and early career psychiatrists reflect similar core values across organizations and that awardees tend to pursue professional activities beyond clinical service.
Second, all of the fellowship programs are assessed favorably by the award recipients, and every program had relative strengths revealed with both quantitative and qualitative measures. Nevertheless, differences clearly exist across organizations in terms of their fellowship activities and structure, perceived relative importance of overall fellowship experiences, reported impact in advancing certain aspects of professional development, and subsequent organizational involvement. These differences in responses generally range from neutral to positive, and they should be viewed in light of the widely varying attributes and missions of the parent organizations. For instance, meeting leaders in psychiatry is more difficult in larger professional groups such as the APA and ACP than it is in smaller organizations such as the AAP and AAGP. Similarly, organizations such as the AAP and ACNP that seek to support academic work were perceived as relatively effective in these areas but should not be viewed as superior overall to other programs that have different emphases. Program leaders may wish to use these findings to review the purpose, structure, and perceived effects of their honorary fellowships within the context of their larger organizations.
Third, fostering mentor relationships in medicine is widely recognized as an important avenue for professional growth (1—4). Mentor relationships have been shown to enhance collegiality, vitality, intellectual growth, and psychosocial support; increase overall career satisfaction and job retention in clinical, administrative, and research positions; and improve investigative skills and productivity among young academic medical faculty (1—4,7—9). Key elements of successful mentor relationships include fostering a commitment and interest in the careers of others, developing the ability to motivate others, acquiring methodological and research skills, and establishing extensive contacts and networking abilities (1). Strong mentor-protégé dyads identify "goodness-of-fit" in their relationships with both cognitive and noncognitive dimensions of their work styles and personalities (2,4). Early studies have not substantiated the need to pair one's gender or minority group in mentor relationships (1,7), although many authors have noted that women may more greatly value their mentor experiences in their career development—an observation that served as the basis of our third hypothesis (1). Our findings suggest that honorary fellowship award programs create a context in which one-on-one guidance, encouragement, and support may occur but perhaps are not sufficiently pursued by organizational leaders and potential mentors. This finding may be especially relevant for organizations that seek to enhance the involvement of women in psychiatry. The recipients' narrative comments indicated that the current level of mentoring represents a "missed opportunity" in the professional development of fellowship recipients.
Fourth, the effects of gender and time that we found were unexpected and merit further study. Specifically, we hypothesized that women would place greater importance on and perceive more positive effects of fellowship experiences. Beyond the issue of mentor relationships, the data proved to be much more mixed. Indeed, gender effects appear to vary by organization, by activity, and by aspect of professional development. In addition, the time effects were the reverse of what was predicted—that is, we hypothesized that the career impact would be underestimated by awardees at the time of receiving their fellowship honors, but their self-reports revealed the opposite. In fact, despite positive assessments of effects upon professional development for each fellowship program, a consistent pattern of less-than-expected ratings ("at the time of" vs. "since" mean comparisons) emerged across items and organizations. A prospective study of award recipients would clarify the effects of time.
Finally, honorary fellowship involvement appears to inspire significant subsequent integration in professional organizational psychiatry, and this result represents an important "outcome" of fellowship programs for their parent organizations. A majority of our study's participants report that they attend later meetings of their awarding organizations, become more involved with other professional groups, and help in the nomination process of other award candidates. A large minority become more involved with, a member of, or a leader in their awarding organization. Nearly one-third assume a leadership role in another group. Honorary fellowship award programs thus appear to communicate the importance and value of participating actively in professional groups in the field of psychiatry.
Strengths and Limitations of the Study
This initial study examines a neglected educational and professional development phenomenon in psychiatry. It includes award recipients from five organizations over a span of more than two decades, but its interpretation is limited by the self-report, retrospective method. In particular, because of our reliance on memory, our findings on the effect of time may not be valid. The response rates in the five organizations range from 46% to 71%, figures that are high given a confidential but not anonymous mail survey using address lists that often were several years old. Nevertheless, the actual respondents in each organization range in number from 12 to 57, making the power for some statistical comparisons (e.g., ethnicity) very low. In addition, our design did not include a comparison of awardees vs. nonawardees, so the true impact of the fellowship awards upon individual careers was not evaluated. Furthermore, the views of mentors and of organizational leaders are not considered in this study, and the objective characteristics of fellowship programs are not assessed. Finally, our measures place greater emphasis on academic rather than clinical career outcomes; therefore, our findings for more clinically focused organizations should be interpreted with caution. Ideally, future work should include an ongoing, prospective study with larger samples of participants, both awardees and nonawardees, and multiple independently verifiable measures to assess career milestones and the objective impact of honorary fellowship award involvement.
Honorary fellowship award recipients are a widely accomplished group of psychiatrists who report that fellowship award experiences overall are beneficial to their career development. Perceived differences across fellowship programs should be interpreted in light of their varying goals, composition, and structures. Greater efforts to mentor awardees should be pursued by fellowship programs, and further prospective research is needed to understand the effects on adult professional development of honorary fellowship award programs in psychiatry.