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Academic Psychiatry 25:4-8, March 2001
© 2001 Academic Psychiatry

Commentary

Preparing the Next Generation of Psychiatric Researchers

A Story of Obstacles and Optimism

Laura Weiss Roberts, M.D. and Michael P. Bogenschutz, M.D.

Dr. Roberts is Associate Professor and Director, Empirical Ethics Group, Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico. Dr. Bogenschutz is Associate Professor, Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico. Address reprint requests to Dr. Roberts, Department of Psychiatry, University of New Mexico School of Medicine, 2400 Tucker NE, Albuquerque, NM 87131. e-mail: Lroberts{at}Salud.unm.edu

Key Words: Research Training • Residency Training • Commentaries

Academic departments of psychiatry are entrusted with the responsibility of preparing the next generation of clinicians, educators, and researchers, who, in turn, will dedicate their professional lives to advancing the care, teaching, and scientific understanding of mental illness. This set of tasks will require that future psychiatrists have a rich, multidisciplinary knowledge base and a sophisticated skill set. It will also require that future psychiatrists possess the ethical sensitivity, professionalism, and tenacity to thrive in the milieu that they will soon encounter.

This context is one in which mental illness is recognized for its prevalence and profound impact, in which innovative clinical treatments with great promise are being introduced each day, and in which unimagined progress in the neurosciences is becoming almost commonplace. Yet, ironically, it is also a milieu in which the traditional foundation of academic psychiatric research is undergoing significant revision (1,2). Although federally funded mental illness research has dramatically increased, the locus of research has shifted toward private industry. Academic institutions and health care systems with the capacity to conduct research and to help people with mental illness are undergoing extraordinary systemic stresses (1–4). The time, mentoring, infrastructure supports, and pilot-research dollars available to early-career researchers to perform original studies are all diminishing (4). For these reasons, fewer psychiatrists are choosing to become academic investigators, and key leaders in our field have expressed concern that psychiatric trainees are not adequately prepared for the research tasks ahead (1,5,6).

In light of these issues, this special issue of Academic Psychiatry centers on the status of research training in postgraduate psychiatric education. Through this collection of papers, we sought to explore several questions: What is the current status of research training in psychiatry? What wisdom can we gather from the insights and experiences of our colleagues who are accomplished senior, mid-level, and junior researchers? What challenges are currently faced by faculty in teaching and by trainees in learning about mental illness research? What specific methods and programs may be valuable for the teaching in this area? What is important about the continued sustenance of psychiatric research, from the perspectives of people with mental illness and of academic psychiatrists? What we found is a story characterized by both obstacles and optimism.

Obstacles
The pressures driving talented early-career psychiatrists away from academic medicine are considerable, and the obstacles in preparing the next generation of psychiatric researchers are many (1,2,4). First, as noted by Dr. Harold Pincus in his commentary (6), although the opportunities for research careers are continuing to expand, the past decade has seen a decline in the number of medical students selecting the field of psychiatry and the percentage of medical students expressing interest in research (7). Second, increased clinical demands on both trainees and faculty, due primarily to financial stresses on academic medical institutions, has resulted in less time and fewer opportunities for research. Compensation for academic positions remains relatively poor, and protected scholarly time for junior faculty is a rarity (8). A corollary to this is that access to scientific mentors is limited because of the trend toward greater concentration of senior researchers in a few departments nationally (9).

Third, many forms of psychiatric research, including clinical and epidemiological, as well as basic research, have become increasingly technical and entail greater multidisciplinary collaboration, expertise, and resources. This translates into the need for more substantial preparation and training for the psychiatric researcher (10,11). Fourth, industry-funded research in psychiatry has expanded dramatically and has outpaced NIMH-funded research growth. Industry support may be crucial for the survival of many academic departments of psychiatry and can be a strong positive force for scientific progress, particularly in drug discovery and development. Some believe, however, that a disproportionate emphasis on research in these areas, rather than on original independent research in multiple arenas, may erode the intellectual foundation of academic medicine (12). Mismanagement of conflicts of interest and financial incentives, as publicized by the media, has raised further questions about the potential negative impact of industry-based research (13).

The final obstacle that we wish to highlight relates to the underdevelopment of research education in psychiatry residencies nationally. The findings of the survey studies performed by Balon and Singh (14) and by Fitz-Gerald et al. (15) in this volume indicate that relatively little curricular attention has been focused on this area for psychiatric residents. Resident participation in research was required in fewer than half of the training programs represented in these surveys. It is uncommon for residents to write their own protocol or initiate a project of their own. The imperative for greater research-ethics training, in particular, was documented in a study performed by one of us (LR), as well (16). In this survey study, involving 181 residents from 10 psychiatry training programs, we found that 92.3% of respondents felt that ethics training was helpful in responding to ethical dilemmas and that 49% (55% women, 45% men) would prefer greater curricular attention to the topic of the ethics of psychiatric research involving human subjects. As noted in the commentary by Dr. David Shore and colleagues (11), the NIMH has recognized the need for intensive research-skills education and for ethics training as a key component of this process. The NIH has placed priority on the development of fellowship and career development programs and funding mechanisms encompassing these areas.

Emerging Optimism
Despite the obstacles, we see the future of psychiatric research as one of optimism for several reasons. On a societal level, awareness and acceptance of mental illnesses has grown over the past 20 years (17,18). Advocacy groups such as the National Alliance for the Mentally Ill (NAMI) have pushed for the recognition of psychiatric disorders as serious, treatable medical conditions, and their efforts have helped to reduce the stigma and suffering experienced by countless mentally ill individuals and their families (19). In his article in this volume, Dr. Rex Cowdry of NAMI emphasizes the strong support of the consumer and family movement for clinically relevant research in this country (20). The Surgeon General's report on mental illness in 1999 also underscored the importance of mental illness and psychiatric treatment (21). Many states have passed parity legislation requiring equal insurance coverage for mental illness (22). Health economists have recognized the adverse effect of untreated mental illness on total healthcare costs for our country and throughout the world (23). Although public understanding of substance use disorders has lagged behind, there has also been increased acceptance of these disorders as biologically-based illnesses that are diagnosable and do improve with treatment (24).

Second, new methods and technological advances have created unprecedented opportunities in biomedical research. For psychiatry, innovation in neuroimaging (e.g., MRI, MRS, SPECT, PET), molecular genetics, automated drug discovery, and powerful computational models of data analysis have opened up unprecedented avenues for scientific work. Also, integration of social-scientific methods has created new opportunities for rigorous services research, clinical ethics investigation, and educational scholarship in psychiatry (25).

Third, another fortuitous circumstance is that increased research funding is available from a number of sources. Research funding for the national institutes such as the NIMH, NIDA, and NIAAA has enlarged greatly in the past 15 years and continues to grow. The NIMH budget for fiscal year 2001 is $1.03 billion, a 47% increase from 1997. NIDA and NIAAA funding levels have also increased dramatically, and they now receive almost three-quarters of a billion dollars annually. This amount includes specific grant mechanisms for career development such as the K awards described in the article by Shore et al. in this volume (11). Highly dedicated private foundations have seen psychiatric research as an important philanthropic focus. Since 1987, the National Alliance for Research on Schizophrenia and Depression alone has invested $99 million to fund 2,403 research grants to 1,236 scientists, the majority of whom have received Young Investigator Awards (26); and although it represents a small portion of their overall research, pharmaceutical companies are also gradually transitioning to provide support for investigator-initiated studies (2).

Fourth, in spite of the many adversities facing psychiatric investigators as a whole, the inspiring professional-development paths of Dr. Jeffrey Lieberman (27) and Dr. Constantine Lyketsos (28) suggest that mental illness researchers can thrive and make substantial contributions to psychiatric science in the current environment. Both stories of these special colleagues demonstrate the value of immersion in a culture supportive of research time, collaboration and mentorship, tenacity, and vision.

Finally, it is highly encouraging that the call for papers for this special issue was met with papers describing several different and innovative approaches to research training. There are two related goals in psychiatric research education. On the one hand, we must address the shortage of psychiatric researchers by providing the specialized training necessary to allow psychiatrists to become competent as independent researchers; on the other hand, it is vital that all clinical psychiatrists be knowledgeable enough about research to be able to interpret and apply the results of psychiatric research in their clinical practice. The articles in this issue include examples of programs aimed at these two distinct goals. Balon and Kuhn (29) describe a structured, intensive research training program that is open to medical students, residents, and fellows, and can lead to a Masters of Science degree in psychiatry. Halpain et al. (30) describe a research program in geriatric psychiatry that combines an intensive week-long summer program with ongoing mentorship. Both of these programs are clearly intended for trainees who are making a commitment to academic psychiatry. The remaining models provide research training to residents as part of their general psychiatric residency. Clayton and Sheldon-Keller (31) describe a year-long weekly seminar during which a group of residents writes a clinical research proposal and submits it to the Institutional Review Board. Pato and Pato (32) describe a 12-session seminar series, including the experience of writing and submitting a letter to the editor of a journal. El-Mallakh (33) describes a brief (7–10 session) but intensive seminar in which a group of residents designs and completes a simple research project. These curriculum models are interesting and valuable, although further data are needed to help clarify what constitutes effective research training. Intuitions and experienced individual judgment aside, it is important to assess the factors that make a critical difference in transforming a bright early-career psychiatrist into a researcher who makes real scientific contributions. Educators who seek to enlarge the research skill of residents will need to consider and develop teaching methods that are most appropriate to this special educational goal, drawing on advances in other areas of medical education (34–36). Didactic sessions alone may be sufficient to prepare residents to become "critical readers" of the scientific literature, for example, but are unlikely to provide adequate grounding for psychiatric trainees to become independent investigators. Measuring the effects of particular educational interventions is an important next step, as noted in Dr. Joel Yager's commentary (37), which outlines the salient issues in education research and describes how such studies can be designed and funded.

Conclusion
Preparing the next generation of psychiatric researchers for the future involves a genuine commitment in the present. Postgraduate medical education should foster the intellectual curiosity and build the scientific skills of the subset of residents who may become gifted psychiatric researchers. This training period must also prepare all residents to understand the basics of ethical research conduct, scientific method, study design, statistics, and critical thinking.

These are not easy tasks, particularly in the intensely pressured milieu of most residency training programs. Nevertheless, with the increased pace of advances in psychiatric inquiry, these skills are more vital than ever for all psychiatrists to be able to assess research findings and apply them to clinical practice. Trainees will need to develop a working understanding of a number of content areas that are either new or of vastly increased importance, including the genetics of behavioral disorders; related special areas of pharmacology, such as ethnopharmacology, the ethics of research with special populations; and the use of information technology in research and clinical practice. As the readership of Academic Psychiatry understands, educational research, itself, should be developed as a field and applied to the study of research training, so that psychiatric faculty will have an empirical basis on which to choose training methods that meet the particular needs of their students.

Taken together, these issues suggest that guarded optimism about the future of psychiatric research is well founded. Ultimately, the outcome will depend on how successful we are in addressing the concerns that have been raised; incorporating the lessons learned from the experience of successful researchers; using the technological and financial resources that are available; and validating, incorporating, and further developing effective methods of research training.

ACKNOWLEDGMENTS

Thanks to Dr. Cindy Geppert and Ms. Megan Smithpeter for their assistance with this work.

Dr. Roberts is supported in part by a grant from the National Institute of Mental Health (1K02AI01738-01).

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