The increasing complexity of research literature and scientific advancement puts great demands on psychiatrists. Moreover, in recent years, the field of psychiatry has evolved from theory-based standard practices to evidence-based practice (1). At the same time, the number of psychiatrists conducting investigative research has declined (2). While there is a clear need for comprehensive research training in psychiatric residency programs, there is insufficient funding for resident research, mentorship, and psychiatry training infrastructure (3, 4). Currently, less than one-third of residency programs offer a formal research track (5).
This article describes a comprehensive, cost-effective program that has been developed in the Department of Psychiatry at Beth Israel Medical Center in New York to address these needs. We have developed a residency research curriculum that is independent of both our clinical and didactic programs, and emphasizes mastering core competencies of research (6) by teaching research as a stand-alone discipline through all 4 years of residency training. Our approach offers a model that may be useful for other programs to follow, as it does not require governmental funding or external research support.
Given the complexity and volume of published scientific findings, research literacy is of ever-increasing importance (4, 7). In order for practitioners to utilize research findings in a way that enhances patient care, training in research literacy must be provided during residency (4, 8). This will allow future practitioners to read and understand the current literature and research findings as part of practice-based learning. Furthermore, the average practitioner must be able to critically evaluate information provided by pharmaceutical companies, since this information often quotes scientific studies. Accordingly, ensuring research competency for all psychiatrists is essential to the provision of the best evidence-based care (1).
The National Institute of Mental Health (NIMH) has noted a precipitous decline—more rapid than any other branch of medicine—in the number of psychiatrist-investigators (1, 9). Moreover, the authors of an NIMH-commissioned report (4) noted that residency training appears to be a critical time period in which to attract psychiatrists to the possibilities of a career in research. For example surgical residency graduates at UCLA were twice as likely to track to an academic position if they had completed 2 years of residency-based laboratory experience (10).
A similar trend has been noted in family medicine. Attraction to practice-based research has been found to be more prevalent in residency programs in which most of the residents had completed a research project and in which opportunities for research incorporated a research curriculum and program director support (4, 11).
The available literature offers limited practical guidance on how residency training programs can educate psychiatrists to be competent researchers (8). In its requirements for residency training in psychiatry, the Accreditation Council for Graduate Medical Education (ACGME) outlines that residents must be educated in the design and interpretation of research studies, and that opportunities must be provided for residents with an interest in conducting psychiatric research.
Nonetheless, research training during residency has frequently been limited in practice, and encouraging research among residents, particularly in specialty areas such as child psychiatry, forensic psychiatry, and geriatric psychiatry, remains a problem (8). Many prospective psychiatric researchers “are lost to our field because they lack a few basic skills necessary for scientific exploration” (13). The present shortage of psychiatric researchers suggests that brief research experiences and didactic seminars alone are not sufficient for the creation of competent researchers (4, 13).
The NIMH-commissioned report (4) noted significant barriers to the incorporation of research experiences into residency training. Among the barriers noted in the report were insufficient funding of resident research and psychiatry training infrastructure, disjointed research opportunities for residents, the absence of research education mechanisms, the scarcity of researcher involvement in training, insufficient resources to advance programs to higher levels of competency and efficiency, under-utilization of residents’ talent; and the lack of a centralized research training track for all psychiatric residents (3, 4).
The Psychiatrists Acquiring Research Training (PART) program at Beth Israel differs from the research components of most psychiatric residency programs. The program is based on the conclusion that didactic seminars and brief research experiences are insufficient to produce competent researchers (13). The principle of our program is to treat research training as a discipline in itself (rather than simply incorporating aspects of it into other academic courses). In doing this, we emphasize learning by both academic and experiential knowledge. Residents are exposed to all aspects of ongoing research and develop mentoring relationships with research faculty. Overall, the program aims to train residents to become critical consumers of scientific research while simultaneously creating an opportunity for future psychiatric researchers to learn the basics of the research process.
The program is administered jointly by the department’s Associate Chairman for Research and Associate Chairman for Education. Both of these individuals actively mentor and encourage residents in their research endeavors. Each resident presents his or her progress on a yearly basis at one of the monthly departmental research committee meetings, which is attended by the Associate Chairman for Research, the Associate Chairman for Education, and the resident’s mentor.
Finding protected time for residents in their second postgraduate year (PGY-2) and in PGY-3 is always a challenge. Due to the administrative support for the program, there is a general understanding among faculty that residents may be excused from clinical activities in order to further their research or attend research meetings. The key to research success has been the active collaboration between residents, faculty, and other research personnel. This makes productive research possible for residents.
The program has a book fund for residents and provides funding for residents to attend national meetings early in residency, even if they do not present. Beyond the cost of travel to academic meetings, the main cost of the program is the faculty time required for active mentoring. Faculty members are not paid to mentor; however, as they are expected to be academically productive, the involvement of residents in research and the time spent mentoring is generally viewed as a net-plus for faculty members (Table 1).
The program incorporates the following innovations in providing longitudinal research training (9) for all residents:
1. Research competency and the development of a research project is required for all residents, rather than being limited to those on a “research track.” This has two major benefits, including that all residents will be competent in critical analysis of the growing body of psychiatric literature and scientific advancement, and residents may discover a previously unnoticed aptitude or interest in research during their training.
2. Research competency is taught as a discipline in itself, separate from other academic courses. This enables students to become adept at thinking critically about research methodology and design. In this way, residents begin to think about investigative inquiry as a tool for acquiring and critically evaluating knowledge in all disciplines, as well as becoming knowledgeable consumers of research data.
3. Research training is included for the entire length of the residency program. This allows residents to consider the integration of research science into clinical practice from the start of their careers as psychiatrists, and to complete a project over the course of several training years. Residents are exposed to the ongoing research of the department and are encouraged to develop their own research projects early in their training (a detailed overview of the program is provided in Table 1). Weekly ongoing 90-minute research seminars are offered in the first year. In PGY-2, all residents attend a research course in the summer and fall in which they are formally taught research design and officially declare their supervised research. The residents present their work at grand rounds at the end of PGY-4, and are encouraged to disseminate their results through national meetings and publications.
4. Research training is made practical. Residents gain hands-on experience by initiating and completing a research project. The summer-fall training course also includes training on Good Clinical Practice (an international ethical and scientific quality standard for designing, recording, and reporting trials that involve the participation of human subjects), psychometrics, study design, and data analysis. Residents then choose a mentor (see item 8) and have more than 2 years’ worth of practical research experience. Our department has also successfully recruited research volunteers (students looking for research experience prior to application for graduate school) who assist residents and mentors with all aspects of scholarly projects. The residents receive supervision on presentation of their findings both at grand rounds in PGY-4, and at national or specialty scientific meetings (see item 7). In this way, they gain an opportunity to learn about all aspects of the research cycle first-hand, under the supervision of a mentor.
5. There is a systematic, program-wide approach to research mentorship. Dedicated mentors are a crucial component of research training (9). In order to ensure high quality research mentorship, the number of residents who faculty members can mentor is limited. This limit encourages faculty members, not only the most active researchers, to serve as mentors and raises the overall academic level of the department. Although they do not select a research project until the fall of PGY-2, residents actively approach faculty to discuss their research interests and to see if they connect with potential mentors on a personal level. In our experience, the residents’ research experience is better when they choose their own mentors.
6. Training is provided in how to prepare and give national meeting professional presentations and how to be able to answer questions from the audience. All residents gain presentation experience at grand rounds in PGY-4. Many go on to present their research at local and national scientific meetings.
7. Residents are encouraged to publish the results of their research in peer-reviewed publications. Mentors collaborate on the preparation of manuscripts, and manuscripts in progress are discussed in a roundtable format at the weekly departmental research meeting. Submission strategies and the process of responding to reviewers’ comments are also discussed in this format.
8. The Psychiatrists Acquiring Research Training (PART) program can be replicated in any academic setting as it does not require government funding or major financial support. Our program represents a cost-effective way to meet the need for the integration of research training into psychiatric residency.
We reviewed all resident publications, presentations, and research awards in the psychiatry department at Beth Israel Medical Center from 2002 to 2007. We found that scholarly activities and accomplishments had steadily increased since the inception of the mandatory research program.
The 89 residents followed over 5 academic years co-authored 32 publications (see Figure 1). Excluding Beth Israel Grand Rounds, residents in the psychiatry program gave a total of 56 presentations during 2002–2006 to local, national, and international audiences, including New York District Branch APA, APA Annual Meeting, the American Association for Geriatric Psychiatry Annual Meeting, the Society for Psychotherapy Research Annual Meeting, and the World Congress of Psychiatry Annual Meeting. Additionally, residents in the program have received prestigious honors ranging from local awards to national awards and NIMH Fellowships (see Table 2).
Table 3 shows all of the research projects conducted by residents graduating in the last 3 years (2006–2008). The vast majority of studies consisted of institutional review board-approved clinical research, in which residents were actively involved in data collection, data analysis, and synthesis. We generally discourage residents from limiting their projects to case reports. Literature reviews may be acceptable when the work warrants submission for publication.
As can be seen in Table 2 and Table 3, involvement in research has significantly increased in our program over a short period of time. This success has been a direct product of our decision to require that all residents achieve research competency and our effort to encourage selected residents to pursue intensive research endeavors.
The Psychiatrists Acquiring Research Training (PART) program is designed to function without major funding and to be replicable at other institutions. We did, however, encounter limitations in the implementation of PART. For example, both residents and research mentors are subject to competing demands on their time, and may have difficulty devoting “protected” time to research in departments without an already-established program. Our comprehensive research course (Table 1) currently assists mentors by ensuring that residents have basic training in research design, data analysis, and other critical skills before they begin their research work; however, another possible solution could be to create a 1-month research rotation. Moreover, we believe a more general departmental focus on research has helped to convince mentors that even though it can be time-consuming, mentorship can end up reaping dividends for faculty, as residents become productive members of a research team.
We also have learned that management of residents’ passage through the program requires administrative institutional support. While we realize that this may present some additional costs, these costs would be a wise investment for programs that are not able to obtain externally funded research track programs for residents. Moreover, the cost should be weighed against the fundamental needs of research training for residents.
A possible outcome measure of the PART program could be to follow up with residents completing the residency program (12). Our program has recently begun giving a Resident Satisfaction Questionnaire to residents in PGY-3 and PGY-4 to evaluate the helpfulness of PART.
In summation, integrating research into clinical training can enhance research skills and foster the development of adept clinicians and competent scientists. Adapting a research-focused science model can help address the pervasive deficiency in the availability and depth of research training for psychiatric residents (4). Our novel program offers a viable, cost-effective way to meet the pressing need for research training in psychiatric residency.