Attracting and educating new investigators is a critical priority for psychiatry in general and geriatric psychiatry in particular. The number of people over age 65 with chronic mental illnesses is expected to more than double during the next three decades (1, 2). Consequently, there will be a markedly increased need for academic and health care professionals in geriatric psychiatry (3—6). The President’s New Freedom Commission on Mental Health (7) reported that significant shortages exist for mental health providers who serve children as well as older Americans.
Early experience is needed to stimulate interest and ultimately impact recruitment in the field of geriatric psychiatry (6, 8, 9). It is essential to identify potential scientists as early as possible in the career pipeline and to offer them opportunities for exposure to the field (10, 11). The Aging Research Consortium of the National Institute of Mental Health (NIMH) has specified a pressing need for training programs that would extend the pipeline of potential future researchers in geriatric mental health (12).
Several studies have shown that early intensive research experiences can be a successful mechanism to attract students to a career in research (10, 13, 14). A retrospective examination of data indicated that individuals with doctoral degrees who had received predoctoral research support were more likely to hold tenure-track faculty appointments, serve in research career positions, receive federal peer-reviewed grant support, and have greater numbers of publications and citations than comparable individuals with doctorates who received no predoctoral research support (13). Another report analyzed data from 22 undergraduates who participated in an intensive research program during which they worked full-time with an investigator to develop and conduct a research project (14). On a follow up telephone survey, program participants reported a greater positive change in their research skills, higher research productivity, and a stronger interest in research as a career choice than 21 undergraduate student comparison subjects. Two other programs that focused on facilitating and enhancing medical students’ research training (15, 16) concluded that medical students could be motivated to carry out research with appropriate encouragement from the administration and the faculty, as a part of an effort to reverse a troubling national trend.
One model of national-level research training intended for promising postresidency and postdoctoral fellows as well as junior faculty members is the Summer Research Institute (SRI) in Geriatric Psychiatry, an NIMH-funded program (17, 18). The SRI has served to bridge and shorten the transition period from fellowship to first research funding. However, we did not find any formal national-level research training programs in geriatric mental health targeting undergraduates, predoctoral students, or medical students.
Below we describe our first-year experience with the development and implementation of a new national-level program for intensive short-term training in research related to geriatric mental health for undergraduate, graduate, and medical students—viz., Summer Training in Aging Research Topics in Mental Health (START-MH). This program was supported by the NIMH. Students were selected for a Summer research experience in geriatric mental health in which they had to complete a small project, prepare a scientific poster, and present it at a scientific workshop in early August.
An Executive Committee was formed, comprised of several senior and junior investigator-mentors in geriatric psychiatry along with student and administrator representatives. The task of this Committee was to design and oversee implementation of the program. Outside investigator-mentors were consulted as needed. In designing this program, central emphasis was placed on pairing students with established mentors in the field. Having a mentor has been consistently linked with academic and professional success (8, 9).
It was decided that competitively selected students (undergraduate, graduate, and medical) would be offered an opportunity to work in the research labs of established investigators in geriatric mental health for 10 weeks during Summer. The grant paid stipends to the trainees ($5,000 for undergraduate, and $6,250 for graduate and medical students) so that they would not need to work at other Summer jobs during the period of research training.
Criteria were established for who could serve as a mentor. Mentors were required to have an established track record in training students as well as in geriatric mental health research as demonstrated by having obtained independent peer-reviewed grants and published peer-reviewed papers in areas relevant to geriatric mental health.
Outcome measures included formal and informal evaluations to assess the effectiveness of the training program from both the mentors’ and trainees’ perspectives, challenges in program implementation, and improvements necessary to attain the training objectives. Trainees were asked to evaluate the program, the final workshop, and their mentor. Mentors were asked to rate both the program and their trainees. Participants will be followed annually to determine how many continue to be active in research.
Application and Selection
Informational brochures about the START-MH program for potential trainees and for mentors were prepared and mailed to all principal investigators with NIMH grants related to aging, and to members of the American Association for Geriatric Psychiatry, the American Psychiatric Association, the American Psychological Association Divisions 12 and 20, the Gerontological Society of America, and the National Association of Social Workers. A website was developed to attract and inform applicants (both students and mentors) to the program (http://startmh.ucsd.edu). The website included information regarding the program, the application process, program requirements, mentor roles/responsibilities, a list of available mentors, benefits of program participation, and frequently asked questions and answers. The website also enabled students and mentors to access program brochures and application forms on-line. This website was widely used; it had 4,129 unique "hits" from November 2002 to January 2003. We made a concerted effort to recruit a diverse pool of applicants by advertising through mechanisms such as the American Psychiatric Association Minority Research Training Program.
The student application consisted of an application form, a personal statement of career goals (up to 500 words), a current transcript, and a letter of recommendation. The mentor application consisted of a completed mentor interest form and an NIH-format biographical sketch. In a 6-week period, we received 85 student applications. Of the applicants, 75% were women and 32% belonged to ethnic minority groups. Students and mentors could apply individually or as a student/mentor pair. Nearly two-thirds of the students applied without a mentor, indicating that they did not have access to or contact with an established investigator in the field.
A form for trainee selection criteria was developed. The candidates were rated on a Likert scale in different categories including academic qualifications, level of interest in aging and mental health, letter of reference, quality of mentor (if applicable), and an overall rating. The student applications and rating forms were sent out to a Selection Committee comprised of 11 geriatric mental health researchers not affiliated with the UCSD. Thirty trainees from 22 institutions were selected to participate. A demographic breakdown of the student applicants and selected trainees appears in t1. Of the 30 trainees selected, 83% were women, and 33% came from ethnic minority groups.
Thirty-eight mentor applications were received. Some mentors applied with a student while others applied with hopes of being matched to a student. Mentor applications were also forwarded to the Selection Committee. Mentors were evaluated based on their track records in terms of peer-reviewed publications and federal grant support, particularly in the field of geriatric mental health. Junior faculty members were encouraged to co-mentor with a more established researcher. Thirty-four mentors from 21 different institutions were selected. In five instances, students had two mentors—typically a junior/senior mentor pair. Of the mentors, 59% were women; 65% were M.D.s, 29% Ph.D.s, and the rest had other degrees. About one-third were Professors, 35% Associate Professors, 21% Assistant Professors, and 9% had other faculty titles. Final selection of the students and of the mentors was done by the Executive Committee, based on rankings from the Selection Committee, fair representation of gender and minorities, geographic distribution, and availability of an appropriate mentor/student match.
Placement Data and Information
Members of the Executive Committee reviewed applications of trainees needing mentors as well as the applications of potential mentors in order to determine potential matches. Factors taken into consideration for matching included stated research interests (garnered through applications and telephone interviews) as well as geographic limitations and resources available.
Once the potential matches were identified, the START-MH staff coordinated phone or in-person interviews with trainees and potential mentors in order to confirm the suitability of the pairing. The trainee and her or his mentor were asked to discuss with each other (usually on the phone) important topic areas such as what the trainee’s role in the laboratory would be during the course of the training, how they would meet the program’s requirements, and what expectations each had of the other. The trainee and mentor were then asked to report back to the START-MH staff about whether they felt they could establish a joint commitment to the trainee’s successful research experience. The program was able to match all of the selected students who had applied without a mentor with an established investigator, sometimes after multiple interviews.
Seventeen students trained in their "home" institution, and 13 elsewhere. All the placements were 10 weeks long and occurred between May 1 and September 12, 2003. To provide program guidelines and suggestions, two manuals were developed and distributed: "Effective Mentoring" developed for mentors and a "Guidelines and Expectations" handbook for the trainees. These guidelines were developed after a detailed review of many existing training manuals and websites (http://www.mentoring.org/; http://www.beamentor.org/; http://www.uscg.mil/hq/g-w/g-wt/g-wtl/mentoring.htm). The Executive Committee reviewed the materials as they were being developed, and approved the final manuals.
The START-MH Program defined what was expected during the course of the 10 weeks, and the mentors decided how to meet those expectations based on the structure of their own labs as well as the level of the student trainee. Each of the selected mentors participated in a 1-hour conference call with the authors of this article to discuss potential problems in implementation of the program and to ensure agreement on all essential elements. We believed that it was absolutely critical that each student be not only mentored but also be "plugged into" a successful research program. One of the reasons we required the mentors to have grant funding was to ensure that the students would be able to work under the scope of an existing project. It is nearly impossible to conceptualize, initiate, conduct, and complete a clinical research project, including IRB approval, subject recruitment, data collection, and data analysis in a 10-week time period. Established labs have a greater ability to plug students into ongoing research activities, allowing the trainees to complete their specific subprojects optimally. The day-to-day structure of the research training was left largely to the individual mentors. Aspects that were common to each site were: 1) students would complete any required local training (e.g., ethics, HIPAA, or animal use training); 2) an abstract and time frame of the specific project to be completed by the student would be submitted to the START-MH Program office by the end of the second week of the placement; 3) mentors would have frequent and regular interactions with their trainees; 4) trainees and mentors would complete all the required evaluations; and 5) students would present posters at the START-MH workshop at UCSD scheduled for August 2003.
As a majority of the students (70% of undergraduate, 62% of graduate, and 25% of medical students) had never presented a poster in the past, all the trainees were sent guidelines on how to prepare a poster in advance of the meeting. The areas of research covered in the posters presented at the workshop ranged from basic neuroscience to translational research to clinical, epidemiological, interventions, ethics-related, and services research. Examples of projects included: HPA axis response to cholinergic stimulation in young and old rats, basal cortisol levels in geriatric psychiatry inpatients, hormone replacement therapy and sex differences in brain structure in elderly depressed patients, and daytime sleepiness in Alzheimer’s patients.
A weekend workshop for the START-MH students was held at UCSD on August 1—3, 2003. The workshop afforded the trainees, for many of whom this was the first experience attending a "professional meeting," an opportunity to present their own research, network with their peers and with leaders in the field, and get exposure to an array of other research topics in the field of geriatric mental health.
The first event of the program was an informal dinner on Friday evening. Saturday offered both didactic and interactive learning opportunities. In the morning, the students heard talks about the future of geriatric psychiatry research from Drs. Floyd Bloom, Richard Nakamura, Barry Lebowitz, and Dilip Jeste. During lunch, the students were divided into three "affinity groups." They were seated at tables according to their student status (undergraduate, graduate, or medical). The faculty led informal discussions on topics such as how to apply to graduate school (for undergraduates), how to find an appropriate postdoctoral fellowship (for graduate students), and how to select a suitable residency training program (for medical students).
The main focus of the workshop centered around the trainees’ poster presentations. For this purpose, two teaching poster sessions were held on Saturday afternoon. In each session, half of the students stood by and explained their posters, while the other half visited those posters. The goal was not only to have the trainee present her or his research to peers and faculty without a fear of harsh criticism but also to learn about how to "read" posters presented by others. Preselected groups, each comprised of two to three students and a faculty member, visited each poster and discussed how to review and constructively critique scientific posters. These sessions also gave the trainees an opportunity to network with different faculty members.
The final formal session on Saturday was a discussion with a panel comprised of a community social worker and a caregiver of a spouse with Alzheimer disease. For many trainees, this was the first time they had heard about the day-to-day life of seriously mentally ill older adults.
Sunday morning was designed to illustrate the various career paths that students may choose in the field of geriatric mental health. Four junior faculty members from the UCSD presented their career development stories and answered trainees’ questions about academic choices. Finally, the trainees provided verbal feedback to the program staff and completed anonymous written evaluations of the program.
Common reasons for participating in the program included: interest in geriatric mental health research, the stipend, the length of the fellowship training, and having a mentor (t2). About a third of the trainees had considered other Summer programs, but their interest in geriatric mental health persuaded them to participate in the START-MH. The trainees rated the different components of the START-MH program highly. They also reported that, because of the program, they were "highly likely" or "likely" to pursue a career in geriatric mental health. Of note, 70% of the students indicated that the length of the training was just right, whereas 30% reported that the program was too short.
A number of trainees subsequently presented their research findings at national or regional conferences including the Western Student Medical Research Forum, the Society for Neuroscience, the Gerontological Society of America, the West Coast College of Biological Psychiatry, and the American Association for Geriatric Psychiatry. Some of these presentations have eventually evolved into manuscripts that are presently under review in peer-reviewed journals, and a couple have already been accepted for publication.
On a 0 (poor) to 4 (outstanding) scale, the mean rating for the response to "How well prepared academically was your mentee for the research project?" was 3.8. The mean rating on the response to each of the other three questions (How would you rate your mentee’s enthusiasm for the research topic?; If you were matched with your mentee, how would you rate the match?; and How would you rate your overall satisfaction with the START-MH program?) was 4.0.
Whereas 53% of the mentors believed that the length of the fellowship was just right, the rest reported that the training period was too short. Without exception, all of the mentors indicated that their trainees showed promise and enthusiasm for a career in geriatric mental health research and that they would be willing to participate as mentors for future trainees.
There is a pressing need to attract new trainees to careers in geriatric mental health research (4, 9). The initial experience with the new START-MH program for undergraduate, graduate, and medical students was overwhelmingly positive, as judged by evaluations by student participants and mentors as well as by the breadth and quality of research poster presentations.
One limitation of the evaluation of START-MH is that there is no comparison group of students who are otherwise similar to the START-MH trainees but do not participate in this program. However, the primary goal of this program is not to conduct a randomized controlled trial of a training method but to find out if the START-MH is administratively feasible, acceptable to the trainees and mentors, and useful at least in the short run based on reviews by the participants. Longitudinal follow up is planned to track the training experiences of the participants to determine what proportion of the alumni pursue a career in geriatric mental health research.
There are both strengths and weaknesses of short-term intensive research training. The main advantage is its feasibility for students whose principal goal is to complete their undergraduate, graduate, or medical training, and thus have a limited amount of time to devote to research. A Summer program is also less expensive than a year-long program. Finally, the immediate goal of this program is not to convert students into full-fledged investigators but rather to get them interested in a research career in geriatric mental health. Nonetheless, we were essentially trying to interest the trainees in two different areas: research and geriatric mental health. Different people make their career choices at different stages. Thus, some trainees may decide to go into geriatric mental health at an early stage of their careers, whereas others may not decide about pursuing geriatric psychiatry until the last part of their psychiatry residency (or postdoctoral training). The same applies to the choice of a research career. Our hope is that early exposure to research in geriatric psychiatry will increase the odds that the trainees will choose to pursue a career in one or both of these areas. The limitations of a Summer program are that the long-term yield is likely to be lower than a program of longer duration. On the other hand, the number of students who can and will opt for a longer commitment at an early stage of career is quite small. It will take considerable time to measure the outcomes of this program in that many students, especially the undergraduates, are at such an early career stage that they will not be making their final career choice for years to come. A number of other happenings in the intervening period could impact the eventual outcome. The hope is that many of the START-MH alumni will later choose longer and more sustained research training further down the career pipeline. A notable feature of the program was mentors’ work with the trainees without financial compensation.
The number of medical student applicants was low in the first year of the START-MH. Problems in recruiting medical students into psychiatry in general and academic psychiatry in particular are well known (10, 19). Most second- and third-year medical students have clinical rotations during the Summer, and therefore only the first-year medical students can devote the entire Summer to other activities. Financial pressures due to loans force many medical students to pursue higher paying jobs during Summer. Typically, only a small proportion of medical students are interested in psychiatry. Finally, the short time frame (6 weeks) available for advertising and the lateness of the announcements (November-December) for a new program made it harder to reach medical students before they had made other commitments for the Summer. More concentrated efforts specifically directed toward medical students were warranted.
Overall, the experience with the first year of START-MH, including evaluations by trainees and mentors, suggests that this program offers clear promise as a possible model to attract early-pipeline trainees to geriatric mental health research. The real success of the program will only become apparent after a number of years of follow up to determine if the START-MH alumni choose research careers in geriatric mental health.
We were disappointed with the initial year’s response of medical students to the START-MH program. For the 2004 START-MH Program (which is underway at the time of this writing), we started advertising earlier than we did in the previous year and engaged in a concerted effort to reach medical school student affairs offices/research offices at various medical colleges, making repeated contacts with them. As a result, there was a dramatic improvement in the numbers of medical student applicants in the second year of recruitment. We received a total of 159 applications vs. 85 in 2003. More significantly, the number of medical student applicants increased from 6 in 2003 to 43 in 2004 (a greater than 600% increase). These applications came from schools across the country and included a substantial proportion of applicants from ethnic minority groups. This suggests that it is possible to recruit medical students into geriatric mental health research programs with a well-focused effort.