Academic Psychiatry 25:48-56, March 2001
© 2001 Academic Psychiatry
Summer Research Institute
Enhancing Research Career Development in Geriatric Psychiatry
Maureen C. Halpain, M.S.,
Dilip V. Jeste, M.D.,
Ira R. Katz, M.D., Ph.D.,
Charles F. Reynolds III, M.D.,
Gary W. Small, M.D.,
Soo Borson, M.D. and
Barry D. Lebowitz, Ph.D.
Dr. Jeste is Professor of Psychiatry and Neurosciences and Chief, Geriatric Psychiatry Division, University of California, San Diego. Address reprint requests to Dr. Jeste, VA San Diego Healthcare System, 116A-1, 3350 La Jolla Village Drive, San Diego, CA 92161. e-mail: djeste{at}ucsd.edu
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ABSTRACT
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We currently need to train a sizeable group of researchers and academicians in geriatric psychiatry in order to prepare for the upcoming increase in the number of elderly mentally ill persons. The Summer Research Institute (SRI) is an annual week-long research training program followed by ongoing mentorship for about 25 selected fellows and junior faculty. Sessions cover topics such as scientific integrity, recruitment of subjects, grant mechanisms, and balancing life and work. About 90% of the 123 attendees have presented and written publishable papers within a year of attendance, and over 50% have received grant funding within 18 months of the SRI. The 3-year cumulative proportion remaining in full-time academics is 78%. The SRI offers a model for training junior investigators in a manner that is useful both to them and to the field as a whole.
Key Words: Research Issues • Career Development
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INTRODUCTION
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The number of mentally ill adults over age 65 in the United States is estimated to grow from about 4 million in 1970 to approximately 15 million in 2030 (1). An important challenge for geriatric psychiatry is to develop in short order a sizeable group of well-trained junior researchers and academicians in geriatric psychiatry.
Of about 35,000 psychiatrists in the United States, approximately 5,000 list geriatric psychiatry as one of their three primary interests (2). Yet only 2,360 psychiatrists nationwide have passed the American Board of Psychiatry and Neurology examination for subspecialty certification in Geriatric Psychiatry. Moreover, the 1-year PGY-V geriatric residency required by the Accreditation Council for Graduate Medical Education for eligibility for this Board examination focuses on clinical rather than research training. A survey by Siu et al. conducted in 1989 (3) found that among former geriatric medicine or geriatric psychiatry fellows, only one-third reported spending more than 10% of their time in research, and 44% reported doing no research at all. Forty-three percent of the 1985–86 graduates had not authored or co-authored any paper during the previous 2 years, and 30% had only one or two papers. Siu et al. (3) as well as Hazzard (4) concluded that the fellowship programs were not achieving the goal of producing academicians and recommended extra years of training to develop research skills. To our knowledge, there is no evidence of a noticeable improvement in research training in this field over the past decade. In a survey of the members of the American Association for Geriatric Psychiatry (AAGP), Jeste et al. (5) found that the most common obstacle for research was reported to be a lack of research training during the general-psychiatry residency.
Of about 76,000 clinically active psychologists in the country (6), fewer than 1,000 would have qualified as "geropsychologists" (i.e., they devoted at least one-half or more of their practice to older adults and their families) as of 1990 (7–9). No specific projections exist regarding the numbers of pharmacists or psychopharmacologists that will be required to meet the increasing geriatric psychopharmacology need (10).
A survey of full-time, salaried, doctoral-level faculty in departments of psychiatry affiliated with accredited medical schools in the United States (11) found that the mean number of years between the end of research training and the first grant was 4.2. Fewer than 40% of all full-time faculty, and only one-quarter of those with M.D. degrees, had spent at least 20% of their professional time in research activity and also authored or co-authored an original research paper during the previous 2 years. Most of the research activities and research training were concentrated in a relatively small number of institutions.
Outstanding research fellowship programs in geriatric psychiatry are currently available at a few major centers. Yet the total number of trainees in such programs is very small, and low stipends prevent many interested and promising candidates from undertaking fellowships. Furthermore, it is rare for individuals who have completed a clinical geropsychiatry fellowship and been offered a junior faculty position to decide instead to do a research fellowship.
For junior faculty members, it is critical to have skills for surviving in an increasingly competitive research and academic environment (12,13). Many highly promising young researchers have left academics to become full-time clinicians or administrators after facing initial frustrations in completing their research projects, in publishing papers in peer-reviewed journals, or in getting funding for continuing their investigations. With growing pressure on the faculty as well as the departments to generate clinical incomes, even the full-time academic faculty members are required to engage in increasing amounts of clinical activity. This makes it harder for junior faculty to pursue their research interests and to obtain independent funding. The result is a vicious cycle for young faculty members in which difficulties in securing funding lead to a need to undertake additional clinical or other non-research–related activities, thereby further diminishing the chances of developing into independent researchers because of a lack of time to focus on research.
In this article, we present a model for training a sizeable number of junior investigators in a selected discipline. Although the present model is, by choice, restricted to geriatric psychiatry, it could be similarly applied to other specialties and subspecialties.
The Summer Research Institute (SRI) in Geriatric Psychiatry is an annual, week-long academic research training program. The SRI, which began in 1995, focuses on giving trainees the tools needed to begin, remain on, and succeed in an academic research career path. The SRI is designed primarily for promising post-residency (M.D. or D.O.) and post-doctoral (Ph.D., Pharm.D.) fellows and junior faculty persons interested in a research career in geriatric psychiatry. The week-long Institute is followed up by continued communication between SRI trainees and mentors with whom they started building a relationship during the Institute.
The goals of the SRI are 1) to increase the number of new researchers from diverse institutions and disciplines who will promote scientific excellence and provide academic leadership; 2) to shorten the time interval between the end of these investigators' research training period and the receipt of their first extramural grant support; and 3) to foster young investigators' relationships with established researchers who can serve as mentors or consultants and among their cohort group of developing investigators to facilitate peer support and collaborative research.
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METHODS
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The first SRI was held in July 1995 at the University of California, San Diego (14). Three SRIs have been held subsequently (at the University of Pennsylvania in 1996, the University of California, Los Angeles, in 1997, and the University of Pittsburgh in 1998). The SRI is administered by an Executive Committee, which comprises the authors of this article.
Site Selection
The criteria for the selection of SRI sites are as follows: 1) The local Program Director and the faculty must have a strong history of training junior investigators and fellows, including women and ethnic minorities, in geriatric psychiatry and must be committed to the concept of the SRI; 2) The faculty must include individuals with a successful track record in securing federal and non-federal funding for research in geriatric psychiatry; 3) Expertise in training about scientific ethics and integrity must be available; and 4) The site must have available resources to conduct the SRI successfully, for example, meeting facilities and low-cost housing accommodations.
Several steps have been taken to minimize the possible disadvantages of site rotation: 1) The Executive Committee is ultimately responsible for all the SRIs; in order to ensure uniformity in training at different sites, the members of the Executive Committee attend every SRI; 2) Sites are selected as discussed above, 18 months in advance, to ensure that the local staff and faculty can participate and observe in detail the organization of the SRI before taking responsibility for one; and 3) The local Program Director from the future site is added to the Executive Committee so that there is knowledge at each site about the evolving experience and history of the program.
Faculty Selection
The Program Director at each site works with the rest of the Executive Committee in selecting appropriate local faculty. Faculty members are chosen on the basis of their expertise in a given area relevant to research in geriatric psychiatry. Also, strong efforts are made to include junior faculty at each site as presenters; they offer a valuable perspective to the trainees attending the Institute. The junior faculty often have recent first-hand experience with issues such as negotiation of an academic position, making use of local resources, etc., and it may be easier for the trainees to identify with junior faculty. Faculty are also often recruited from other nearby universities and centers, including some smaller programs, without their own critical mass of geriatric psychiatrists, to give trainees an idea of how one can have a successful academic career even in institutions that do not have large resources.
Trainee Selection
Post-doctoral fellows (or residents) and junior faculty members apply by submitting their curriculum vitae, a 500-word personal statement about their research career goals, and one letter of recommendation. Applications are reviewed by the Executive Committee. To date, there have been many more applicants than the trainee positions available. The group size is limited, not by budget, but by choice. A group of 25–30 attendees can have diversity without being diffuse and provides a comfortable level of "intimacy" for trainees and faculty to develop closer mentoring relationships. In the first year of the SRI, 38 participants were selected. This group was felt to be too large, particularly to offer the one-on-one mentoring that is an integral part of the Institute. Table 1 gives a breakdown of the participant characteristics. Only three participants had federal grant support at the time they attended the SRI.
Careful attention has been paid to the development of a balanced group of attendees. Nearly half of the participants in the SRI have been women, and 27% have been members of ethnic minority groups. Also, trainees from diverse professional backgrounds (i.e., psychiatrists, psychologists, neuropsychologists, pharmacists, etc.) have been recruited. A geographically well-distributed group has also been an important goal, so that no one institution or group of institutions is strongly over-represented.
The travel and lodging expenses of the trainees and the faculty are covered by grant support, but there is no honorarium for the faculty.
Program Development
The curriculum for the SRI (available to interested readers) includes a number of components that are fixed and offered each year across sites and some 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 semiformal or informal, as active participation of the trainees is encouraged during the presentations. Lectures are not allowed, and slide presentations are discouraged. The task of the faculty is to offer pointers, techniques, and methods from their own experiences that could be of value to developing researchers. Visits to local laboratories present opportunities for the trainees to meet successful researchers and to observe the workings of mature programs of research at the host sites. The aforementioned activities are geared toward providing the trainees with a better understanding of the pragmatics of research in their current workplaces. The goal is not to have every trainee develop a large "research center"-type program, but one that is appropriate to his or her abilities and milieu.
Table 2A and Table 2B summarize the content of "core" sessions for each SRI. Below, we provide a brief description of some of the main sessions.
Scientific integrity.
A core series relates to the responsible conduct of research. Issues such as the ethical treatment of human and animal subjects, Institutional Review Boards, authorship, and peer review are included. Some of the leading authorities on scientific integrity and ethics (not only in geriatric psychiatry, but also general psychiatry and biomedical research) have provided input on these critical areas as part of the SRI. Also, faculty play a critical role in transmitting to the trainees the high value placed on scientific integrity, through their teaching and, even more importantly, through role-modeling during the SRI and as distant mentors after the SRI is over. The host departments for the SRI discuss their policies on research integrity. This provides the trainees with some notion of how a specific institution handles these issues and offers them potential resources (e.g., suggestions about where to look in their own institution for information as well as experts from the host university whom the trainees may contact after the SRI) when they return to their own site.
Scientific autobiographies.
Several investigators are selected each year to present the history of their own career development. The purpose of these sessions is to indicate how different individuals demonstrate varied creativity in achieving academic success. Efforts are made to have representation of women, ethnic minorities, and academics from diverse fields in these sessions.
Peer career guidance.
A session with current junior faculty members is offered at each site; these sessions are not attended by the members of the Executive Committee. This exclusion allows for frank discussion of issues related to career development between the local junior faculty members and the trainees. Issues such as appropriate selection of mentors, negotiations for academic positions, and balancing life and work are discussed, often with personal anecdotes provided.
Grants, papers, and presentations.
Some of the most popular sessions have been on available grant mechanisms for junior investigators, common mistakes in preparing grant applications, publishing papers in peer-reviewed journals, and giving scientific presentations. The SRI helps the attendees learn about these critical issues from senior as well as mid-level faculty members' experiences, instead of learning through trial-and-error, as most of the investigators do. One uniformly appreciated session is the "mock study section," at which several attendees present their research proposals, which are then formally reviewed by several senior faculty members in the format of a study section. We have found that most of the attendees have had little previous understanding of the way study sections review grant proposals. Other sessions include journal editors (on writing and reviewing manuscripts) and scientists known for their excellent presentations (on the art and skills involved in giving scientific talks).
Recruitment and retention of research subjects.
A strong focus on appropriate subject recruitment occurs throughout many of the sessions. One area of emphasis is the recruitment and retention of women and ethnic minorities for research studies.
Research administration.
This session with research administrators focuses on critical administrative issues, such as working with institutional entities responsible for preparing contracts and grants, budgets, human resources, etc.
Balancing life and work.
This session is intended to discuss the issues involved in making choices related to both personal and professional development. For example, many of the trainees are struggling with raising young families while trying to launch their academic careers. The faculty who lead this session provide the trainees with varied examples of setting priorities.
Individual mentoring.
Opportunities for one-to-one mentoring are facilitated throughout the week. Trainees meet with each member of the Executive Committee on a one-to-one basis. Also, trainees are afforded the opportunity to meet with faculty at the host institution. They can request to meet with specific faculty members, and every attempt is made to accommodate these requests. During these mentoring sessions, the faculty members review the trainees' curriculum vitaes and offer suggestions on how to proceed in research careers. The faculty may also offer specific advice on grant proposals, publications, research hypotheses, and/or methodology. Many attendees have stated that they have never had such personal mentoring in the past and that they found these meetings extremely valuable.
Follow-up.
One week of research training is of little use unless it is followed by ongoing mentorship over a long period of time. For this purpose, the Executive Committee, as well as the SRI manager, maintain a relationship with the trainees. In addition to the regular communication among individual trainees and mentors (see Table 2A and Table 2B, Questions 9 and 10), the alumni meet at the annual conference of the AAGP, where many of them present their work and give an update on their career progress. Some of the alumni have been selected as faculty for subsequent SRIs.
Evaluation.
Within a month of the SRI, all attendees are asked to complete an anonymous evaluation of the usefulness of different components of the SRI.
Structured follow-up occurs annually. A survey is sent to all the SRI alumni in order to gather information on their current activities and research productivity each year. Data are gathered on grants submitted, grants funded, publications, presentations, awards, job changes, etc. Also, we solicit feedback on the usefulness of specific activities related to the SRI. The response rate for this annual survey has been greater than 90%.
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RESULTS
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Subjective Evaluation
On average, the attendees have given a rating of 9.2–9.5 (on a 1–10 scale, with 10 being outstanding) for the usefulness of the SRI in terms of providing them with strategies for surviving in academics, grant-writing, and developing a professional network. This evaluation is completed within a month of the SRI.
One-Year Follow-Up
Table 3 shows results of 1-year surveys. There is remarkably little difference among the classes in terms of their post-SRI academic productivity. During the year after the SRI, most attendees have authored or co-authored a paper and made a scientific presentation at a professional meeting. Approximately one-third have obtained, and a similar proportion have applied for, federal or non-federal grant support. Most alumni maintain contact with other SRI participants.
Longer-Term Follow-Up
The class of 1995 has now been queried on three separate occasions (1996, 1997, and 1998), and that of 1996 has so far been queried on two occasions (1997 and 1998). There has been relatively little change in productivity in terms of papers, presentations, and grants from one year to the next. There is no "control group" of non-SRI participants with which to compare the results. Nonetheless, we have anecdotal data from some trainees who could serve as their own controls. These individuals were candidates who were either not selected or could not attend the SRI for personal reasons at the time of their initial application but did so in a subsequent year. The productivity of these trainees in the post-SRI year has been markedly better than during the preceding year.
We have looked specifically at the "survival rates" of SRI alumni in full-time academics. Life-table survival analysis (15) determines the cumulative proportions surviving in academics (with 95% confidence intervals) as follows: 12 months, 92.2% (89.4%–95.0%); 24 months, 82.0% (78.0%–86.0%); and 36 months, 77.8% (73.3%–82.3%). There was no significant gender difference in the "academic survival" rates (P=0.51, Peto-Prentice test). The cumulative 3-year survival rate was 74.4% (67.7%–81.1%) for men and 81.5% (75.6%–87.4%) for women. The number of trainees from different ethnic minority groups was not large enough to allow a meaningful statistical comparison.
A number of the attendees have received honors or grant awards since the SRI, including 23 NIMH grants (including 14 Career Development Awards, 3 FIRST Awards, 4 ROI- and 2 RO3-type grants), and 26 awards from foundations (e.g., National Alliance for Research on Schizophrenia and Affective Disorders or NARSAD Young Investigator Awards) or national organizations (e.g., American Psychiatric Association Young Investigator Awards). In addition, a number of alumni have received academic promotions since participating. Several attendees have become active participants in local or national professional organizations such as the American Association for Geriatric Psychiatry (AAGP).
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DISCUSSION
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There continues to be a marked discrepancy between the supply and the demand for academicians and investigators in geriatric psychiatry (2,10,16). This problem is only going to worsen over the coming decades (1). Different types of solutions are needed to tackle the crisis in recruitment and ensure retention of talented junior investigators in the field. The SRI offers one such strategy. The short-term results indicate that it has been successful.
We should acknowledge several limitations of this project. There was no control group to ascertain to what degree the SRI itself was responsible for the productivity of the trainees. The individuals were chosen for participation because of their apparent interest and potential to succeed in an academic career, thus biasing the group toward success on the selected follow-up criteria. The SRI has not been funded to be a controlled study of the efficacy of the training intervention. The anecdotal experiences of the SRI trainees who were not able to attend the SRI on their first attempt support the validity of its contribution to their careers. The observed mean cumulative percentage of the SRI trainees (who were selected with an emphasis on diversity) still in full-time academics was 78% after 3 years. This suggests that long-term academic survival of SRI alumni is likely to compare favorably with the historical record of academic medical subspecialties such as endocrinology, in which more than two fellows need to be trained (for 2 years) in order to develop one long-term faculty member (4). One other limitation of the present work pertains to the outcome measures. We have used self-reports and quantitative aspects of some of the research activities rather than external evaluations of the quality of scientific accomplishments. The SRI may also be criticized for apparent superficiality (or naivete) in relying on training in the mechanics of grantsmanship or paper-writing rather than developing "true scientists" in search of knowledge. A large proportion of talented young investigators leave academics within a few years because of difficulties in obtaining funding support, at least partly because of a lack of necessary mentorship. The SRI is aimed at keeping these promising junior investigators in research careers. Financial pressures, along with initial frustrations in surviving in academics, have driven considerable talent away. The SRI offers one model for helping check this trend.
The rationale for a number of methodologic aspects needs to be clarified. The SRI is offered to trainees at the fellowship and junior-faculty level. This is done primarily because individuals at these levels have already decided on a career in geriatric psychiatry. Offering the SRI to predoctoral candidates or medical students or junior residents is likely to be less helpful overall, because many of them may not choose to go into psychiatry/psychology or geriatrics.
The SRI has been held at several academic centers of excellence on a rotating basis, as opposed to being based in a single university. The latter option might, over time, facilitate the refinement of the program's logistics through practice effects. The rotation of sites is, however, important for several reasons: 1) A multi-site program facilitates the recruitment of trainees from the broadest and most diverse base of academic institutions; 2) The scientific leadership of geriatric psychiatry throughout the country has expressed and demonstrated a sense of citizenship and a commitment to this program; the widespread enthusiasm for the program (both at each site and nationally) is an important benefit; and 3) Rotation of the program and spreading the load of training activities facilitate the development of relationships between faculty and trainees that could lead to ongoing mentorship after trainees return to their home institutions. The Executive Committee ensures uniformity of training by establishing a "core curriculum" common to all sites.
A great deal of information is conveyed to the trainees in a very short period of time. The objective is to at least make the participants aware of the various issues so that they can, if necessary, explore them further on their own. The SRI attempts to clarify research and whet the appetites of the participants for a career in research. This can be accomplished by providing a broad notion of what research involves and by offering ongoing support through continued networking with both senior faculty and peers.
The real success of the SRI can only be judged by long-term follow-up of the alumni. The SRI is not meant as a substitute for a research fellowship. One week of training, even when followed by ongoing communication and mentorship, is clearly inadequate in comparison to a multi-year research fellowship. Nonetheless, the SRI offers a model for training a sizeable number of interested and qualified post-doctoral candidates.
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REFERENCES
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- Jeste DV, Alexopoulos GS, Bartels SJ, et al: Consensus statement on the upcoming crisis in geriatric mental health: research agenda for the next two decades. Arch Gen Psychiatry 1999; 56:848-853[Abstract/Free Full Text]
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- Center for Mental Health Services: Mental Health: 1996. U.S. Department of Health and Human Services, Rockville, MD, p 201
- National Institute on Aging: Personnel for Health Needs of the Elderly Through the Year 2020 (NIH Publication 87-2950), Washington, DC, U.S. Government Printing Office, 1987
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ABSTRACT
INTRODUCTION
