Academic Psychiatry 25:61-67, March 2001
© 2001 Academic Psychiatry
Structure vs. Laissez-Faire
Master of Science in Psychiatry Program and Other Aspects of the Detroit Experience
Richard Balon, M.D. and
Thomas W. Kuhn, M.D.
Dr. Balon is at the Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan. Address reprint requests to Dr. Balon, UPC–Jefferson, 2751 E. Jefferson 200, Detroit, MI 48207. e-mail: rbalon{at}wayne.edu
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ABSTRACT
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The authors describe their experience with an innovative model of research training programs, including the Master of Science in Psychiatry Program. The Master of Science in Psychiatry program provides research trainees—medical students, residents, fellows, and possibly junior faculty—with an opportunity to enroll in research-oriented classes and seminars, to realize their own research project under the guidance of research mentors, and finalize it with a thesis defense. The experience with this approach has been successful so far. The authors suggest that their programs may provide a template for other academic departments and that this could be one of the models for preparation of the next generation of psychiatric researchers.
Key Words: M.S. in Psychiatry Program • Structured Approach • Research Training
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INTRODUCTION
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Preparing the next generation of psychiatric researchers is a task closely related to a more daunting goal: preparing the next generation of psychiatrists. It has become clear that the number of United States medical graduates choosing careers in psychiatry is in decline (1). Medical students bring to their medical training a negative view of psychiatry. Two of the "aversive" factors mentioned in a study by Feifel and colleagues (1) are the students' perception that psychiatry lacks a scientific foundation and the idea that psychiatric treatments lack clinical efficacy, or both.
Along with the declining interest in psychiatry as a career choice, there has been a decline in the number of trainees interested in research and academia as a career choice. The pool of physician–researchers applying for clinical research grants has been decreasing (from 40% of all applications about 15 years ago to 25% [2]), partially because of the lack of available training in research for physicians. Possible explanations for the declining interest in research careers could be the increasing difficulty and decreasing possibility of obtaining external funding; increasing demands to generate clinical revenues while continuing to teach and publish (at the risk of loss of promotion), and, last but not least, the lack of adequate training in research. Yet, the new generation of academic physicians may play a crucial role in the survival of psychiatry as a discipline. Their understanding of research and their preparedness to carry on research projects may be a critical factor in translating the vast amount of neuroscience findings into the practice of clinical psychiatry. Presumably, just as a positive clinical experience may lead to a career choice of psychiatry, a positive research experience may lead to a career choice of research and academic psychiatry. As Skeff and Mutha (3) stressed, academic institutions have an obligation to society to produce competent and sensitive clinicians, physician–scientists, physician–teachers, and physician–administrators. On the basis of these considerations, it is clear that providing a positive and effective research experience to trainees is an important role of academic departments of psychiatry.
It may be difficult to define what constitutes a positive and effective research experience. The National Institute of Mental Health (NIMH) and American Psychiatric Association (APA) have developed several well-known research fellowships and research experiences intended to guide trainees toward a successful research career. Several department of psychiatry pathways have been described in the literature. Nemeroff (4) discussed the importance of mentoring: size of the department, choice of the subfield, and responsibilities of the mentor. Lambert and Garver (5) described their experience supervising and collaborating on projects that led to the first publications of several medical students and psychiatric residents. Rather than mandating a research project of all the residents, they emphasized that the faculty at their department focus on the trainees with a sincere interest in writing a scholarly paper. They also describe the procedure of developing a publishing project into manageable steps. The department of psychiatry at Western Psychiatric Institute and Clinics in Pittsburgh (6) developed a fairly structured course on writing grant applications for postdoctoral clinical fellows, using a peer-review process modeled after an NIMH study section.
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THE WAYNE STATEUNIVERSITY EXPERIENCE
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The Department of Psychiatry and Behavioral Neurosciences (DPBN) at Wayne State University (WSU) has historically undertaken various approaches to research training, from almost no training, a few decades ago, to a "laissez-faire" mentorship selection during the 1980s, and, finally, a fairly structured set of training programs developed during the 1990s. During the early 1990s, the leadership of our department felt that formal research training in all aspects of psychiatry—biological, psychological, social, or others—had been somewhat neglected within psychiatry residency training. We had developed the traditional research "tracks" within the residency program. However, these tracks were plagued by the traditional problems: the resistance to a mandatory research project among some uninterested residents, the lack of time due to rotation requirements, the logistical nightmare of balancing the switches from rotation to rotation and research requirements, lack of formal research education beyond "tagging along" with an existing research project, lack of the trainee's own research, and, thus, lack of structure of the research training. There was an increasing need to create a structured program with a stringent set of requirements in research training and guidance in conducting a trainee's own research project from hypothesis to publication. The existence of an increasing number of new clinical research programs within our department (e.g., the new Substance Abuse Research Division) and an existing strong Cellular and Clinical Neurobiology (CCN) Program (consisting of several successful Ph.D. basic-science researchers), created a conducive environment for creating strong research training programs. Thus, we have developed a unique research training program: the Master of Science in Psychiatry Program.
The idea of a research training-oriented Master of Science in Psychiatry program was conceived by one senior faculty member who felt that that a structured and centralized research training program that would force the trainees to write and defend a thesis might be a successful formula for good research training. This faculty member, with substantial help from the CCN faculty members, designed the program and submitted it to the School of Medicine and the Graduate School. The program was approved by all appropriate offices of WSU, and a Director of the program was appointed. For various reasons (e.g., lack of funding, change in the leadership of the department), the program remained dormant for a few years. After the arrival of the new department chair who was strongly interested in research, a transition to an active program began. A more detailed structure (e.g., committees' structure and membership, faculty commitment) was established; funding sources (medical school and department) were identified; and the program began to be marketed (brochures, discussions with residents and students).
The program was originally intended for psychiatry residents and fellows. However, we realized that there is also a strong need to attract medical students to psychiatry and to psychiatric research. Thus, we opened the Master of Science Program to medical students and created further research opportunities for them. As the Master of Science in Psychiatry is a logical continuation of other medical student research programs, we will describe the medical student research program first.
Medical Student Programs
Since 1997, two distinct but related programs have been developed to expose WSU medical students to research in neurosciences.
- The Summer Neuroscience Research Fellowship. Sponsored by funding from the WSU School of Medicine Alumni Association, the Summer Neuroscience Research Fellowship allows medical students to pursue a research project over the summer between their first and second year of medical school. The fellowship lasts 8 to 10 weeks and pays a stipend of $2,000 to $2,400. The program is administered by the research office in the school of medicine. The costs incurred by the department are only those of promoting the program (flyers, etc.) and the time and energy the mentors put in. One might consider the research space allotted to students a cost; however, the cost of space has not become an issue.
In order to be accepted into the program, students must meet with a research mentor, prepare a research proposal, and submit it to the School of Medicine Office of Research. There are six different programs within the Department of Psychiatry and Behavioral Neurosciences: Behavioral Medicine, Brain Imaging, Cellular and Molecular Neurosciences, Child and Adolescent Neuropsychiatry, Molecular Neuropsychiatry, and Substance Abuse Research. In order to be considered eligible to be research mentors, faculty must have substantial external grant funding and must specifically express an interest in participating in the program. To date, nine students have participated in the fellowship. Six intend to pursue careers in academic psychiatry and one in academic neurology. The two students from last summer's program have not yet made a definite career choice. Two of the summer neuroscience research fellows have completed the Master of Science in Psychiatry Program, and a third will enroll in the next academic year.
- Clinical Elective Programs. The Summer Neuroscience Fellowship feeds into the Year 3 and Year 4 elective system. Students may take a 1- or 2-month research elective in Year 3 and/or Year 4. There are four electives specially devoted to research: Research and Practice in Addiction Psychiatry (students in this elective do a small amount of supervised clinical work combined with formal didactics in substance abuse and are mentored by one of the substance-abuse researchers), Cellular and Molecular Neuroscience, Inpatient Research in Psychiatry, and Brain Imaging of Childhood-Onset Neuropsychiatric Disorders (students in this elective spend usually 2 days per week in the Pediatric Anxiety Disorders Clinic and 3 days per week analyzing existing data from various imaging studies). Approximately 20 students have participated in these research electives since 1997.
Master of Science in Psychiatry Program
Successful researchers in clinical psychiatry should have a sound knowledge of clinical psychiatry and neurobiology, should be familiar with the methodology of clinical studies, and also should have an understanding of basic statistics. They should also become familiar with clinical investigational drug trials. All of these areas are not usually thoroughly covered during medical school and residency training in psychiatry. We felt that a master's program was best suited to accomplish these goals in our department of psychiatry. A formal program with clear objectives is more attractive than the elective research tracks previously offered, and the combination of a master's degree and quality training could provide the right incentive for residents, fellows, and medical students interested in research careers.
The Master of Science in Psychiatry offers three research training tracks (which should not be confused with the elective residency tracks discussed previously): one for residents during their training (Years II–IV), one for research fellows, and one for medical students interested in neurosciences who are willing to take a break from their medical school study. We are considering a fourth track for junior faculty members at the present time. So far, the medical students have been the only group successful in graduating from this program (one student graduated; one is graduating). The accomplishments of the program and limitations in attracting residents and fellows are discussed below.
Program description.
An individual curriculum plan is developed for each trainee. The individual curriculum involves research training in classes and seminars and presentation of a thesis on either a clinical or basic research problem. Medical students taking a break from medical school (either between Years 2 and 3 or Years 3 and 4) have an individualized 1-year program developed. Residents enter the program on the PGY-II level and complete the majority of their didactic courses during PGY-II, -III, and -IV (with a commitment of 4 or more hours per week, aside from the regular residency training courses). During Years III and IV of residency, an individual research project is prepared. Residents focus on the realization of this project by writing a thesis during Years IV and V (fellowship). For trainees starting at the PGY-V (research fellows) level, an individual program is developed. For example, the majority of courses are taken during PGY-V, with project preparation upon entering the Master's program, and the majority of research is done during PGY-VI. A program for junior faculty has been considered, but has not yet been established because of some unresolved issues.
Course work recommended for this Master's program has been selected from the existing Ph.D. program offered in CCN in our department and from other existing courses in the DPBN and WSU.
Admission requirements.
Applicants must be medical students in good standing at WSU School of Medicine, DPBN residents or research fellows, or possibly DPBN junior faculty. They must submit a letter stating academic objectives and career plans, a curriculum vitae, and three letters of recommendation. All applications are reviewed by an admission committee. Program requirements are as follows: 1) There is a total of 30 required credits; 2) There are various mandatory (e.g., Neurobiology, Research Seminar, Thesis Preparation; total of 27 credits) and elective courses (e.g., statistics; total of 3 credits); 3) A total of 8 thesis credits is required; 4) An oral thesis defense is required; and 5) Maintenance of a 3.0 GPA is required.
Program policies and procedures.
Program policies conform to the requirements of the WSU Graduate School, the residency training director, and ultimately, the Dean's Council. Students must maintain the minimum grade-point average required by the Graduate School at WSU to continue in the program. Failing of more than one course is cause for dismissal.
Upon entry into the program, trainees are provided with documentation outlining sample curricula and requirements for the degree and thesis. A sample curriculum (medical student) is outlined in Table 1.
Program office and administration.
The office for the Master of Science in Psychiatry is housed and administered within the Department of Psychiatry and Behavioral Neurosciences (DPBN). The director of the program is a board-certified psychiatrist with research and training experience, who is appointed by the Chairperson of the DPBN. The CCN Graduate Committee may advise the Chairperson in the selection of the program director. The program director reports to the Chairperson of the DPBN and to the CCN Graduate Committee.
The program has four formal committees: the Admissions Committee, Program Committee, Thesis Committee (individualized for each student), and Graduate Committee. Faculty and mentors of the program are members of the graduate faculty selected by the director of the program and approved by the Chairperson of the DPBN.
Resources.
The part-time Director of the program and part-time secretary (shared with the CME and Geriatric Fellowship programs) are responsible for the day-to-day administration of the program. Numerous faculty members volunteer their participation on the program's committees and as mentors. Residents/fellows usually do not require extra funding for their projects; however, support has been sought from research funds from within the department and from outside. Medical students who enrolled in the program have been provided salary at the level of research assistant. Funding for one student who finished the program and for one student who will enroll has been secured from the office of the chair and from the office of the Associate Dean for Research (shared). One student obtained external funding from the American Psychiatric Association, another from Blue Cross/Blue Shield of Michigan.
Accomplishments
Since 1997, WSU medical students participating in these programs have been the first authors on over a dozen peer-reviewed articles and published abstracts. They have won numerous awards, including Best Oral Presentation at the WSU School of Medicine Annual Research Symposium, the Psychiatry and Behavioral Sciences Award at the National Research Forum, the American Medical Association Excellence in Clinical Research Award, and a New Investigator Research Award from the New Clinical Drug Evaluation Unit of the National Institute of Mental Health (NIMH). They have also won several competitive fellowships, including a WSU Research Fellowship, two Program in Minority Research Training in Psychiatry Fellowships (American Psychiatric Association), and the James Comer Minority Research Fellowship (American Academy of Child and Adolescent Psychiatry). One Master of Science in Psychiatry program student is the first author on a Priority Communication paper recently published in Biological Psychiatry (7). The second student is in the process of submitting for publication the results of her study on the effect of nicotine on mood, cognition, and performance in non-smoking subjects. She will be the first author. Our students have been also successful in obtaining external funding: one of our Master's graduates obtained a 1-year research stipend from the American Psychiatric Association, and the other was awarded a grant through the Blue Cross/Blue Shield of Michigan Foundation Student Award Program.
To our knowledge, in the 10 years prior to the introduction of our innovative programs, only two WSU medical students had published in the neuroscience literature (both trained in psychiatry at different institutions).
Mentorship
Perhaps the most rewarding aspect of the research training initiative is the ongoing relationship students have developed with their mentors. This year (2000), there are three graduating medical students who intend to pursue careers in academic psychiatry. Two hope to match at WSU and continue their work with their mentors here. The third hopes to match at a nearby program and continue to collaborate with her mentor. The two students who finished the Master of Science program felt that the mentorship was a salient feature of the program. They felt that they would not have finished the program without their mentors' help. They reported being very satisfied with the program and stated that, "Mentorship was extremely important. My mentor felt very positive about me and it was good to know it. He also pushed me all the time, which was very good and important. It was an amazing experience." "The mentorship was great; I would not done the program without it."
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DISCUSSION
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During the last decade, our department has moved from a rather disorganized "laissez-faire" approach to research training of medical trainees to a structured, organized, progressive approach. Our experience with this model has been positive so far. Our trainees have been able to formalize and realize their research hypotheses, finish their projects, and get them published. We feel that the combination of research-oriented classes with preparation and realization of the trainee's own research project, as provided by the Master of Science Program, is the most suitable and "success-guaranteed" approach to research training in an academic department environment. The participation in the Master's program has lead to more trainee ownership of research projects—the "ownership" of the project is actually a requirement (thesis writing and defense). We do not allow trainees enrolled in the Master in Psychiatry program to be inserted as helpers or "modules" into large ongoing projects, which would not fully allow for training in general research skills such as experimental design.
However, it is difficult to asses the long-term success of our approach. We have been able to attract bright trainees to psychiatric research and to provide them with guidance and a successful start. Nevertheless, their ultimate success in research and academia may become obvious only after a long period of time.
As already mentioned, our trainees have had some success obtaining external funding. Despite these successes, it is our opinion that the acquisition of grant-writing skills is an area of relative weakness in the Master of Science program. We are aware that it is usually very difficult to obtain extramural funding by medical students or residents—the main focus of our research training programs. A "research survival skills" course, similar to the one developed at the University of Pittsburgh (6), is being considered.
Our description of these research training programs focused mostly on one of the three salient ingredients of successful research training: the structure and organization of the programs, "the boiler-plate." The other two ingredients, good mentorship and availability of internal funding, are equally important. As noted before, our trainees felt that the mentorship was an extremely important part of their experience and that they would probably not have finished the program without a good mentor. The importance of good mentorship is well-known and is skillfully discussed by Nemeroff (4) and Lambert and Garver (5). We have been fortunate to have several very organized, enthusiastic, and successful mentors among our faculty. But we have also had to keep in mind that, as Nemeroff (4) states, "some fabulously successful scientists and clinicians are notoriously poor mentors." We have also been fortunate to obtain some internal funding from our department and medical school. The availability of internal funding is particularly important for the medical student track. In addition to covering students' living expenses during the year or more spent in the Master of Science program, internal funding could provide start-up money for some of students' own projects. Internal funding could, and usually does, provide start-up money for resident and fellow research projects. A close collaboration of the departments, schools of medicine (Office for Research and the Associate Dean for Research), and universities is very important for allocating internal funding for these purposes. A combination of these three elements—structure, mentorship, and internal funding—is probably necessary for a successful research training program in psychiatry or any other discipline.
However, our efforts in getting trainees interested in research training have had some limitations. To date, participation in the Master of Science program by residents and fellows has been rather low; they are either not interested or do not finish the program. We attribute this to several factors. The WSU psychiatry training program has traditionally focused on clinical psychiatry, and the residents attracted to this program have rarely been interested in research. An attempt to implement a mandatory research project for all residents was so distasteful to this group that the notion of additional training via the Master of Science program was not embraced.
Most of our residents have not been interested in academic/research careers and have not been willing to commit themselves to an extra year of training and a long-term research project. Also, the rigors of the program preclude the participation of any but the most committed and talented trainees. One PGY-V fellow enrolled in the program had to be dismissed because of poor performance/grades in classes.
There may be other reasons for the lack of interest in the program among our residents: 1) the possibility that the brightest WSU students interested in an academic career and/or in staying in Detroit have already enrolled in the Master in Science program during medical school; and 2) our residency training program has not been attracting residents from outside who are interested in academia (low recruitment into psychiatry in general and into the Detroit location, in particular). Our residency training program is considering various recruitment strategies to attract candidates interested in the combination of residency training in psychiatry and the Master of Science in Psychiatry. Also, we anticipate that as some of our medical students who have also graduated from the Master of Science program become residents at WSU DPBN, the residency program will begin to attract applicants (both from WSU and outside) more interested in research and academia.
In conclusion, we feel that our set of structured research training programs, culminating in the Master of Science in Psychiatry, is a suitable model for research training in departments of psychiatry and may be a successful model for preparing the next generation of psychiatric researchers.
We have not systematically evaluated our program's impact. So far, our program has clearly been very successful in recruiting medical students into research-focused psychiatry programs. One could argue that the trainees would have had the same success without the Master of Science Program or our other program experience. We doubt that. We feel that our trainees' records of publications, awards, presentations, and external funding constitute evidence of the efficacy of these programs. Rigorous longitudinal (over a decade or more) measuring of the efficacy of such research programs should be an area for future research.
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REFERENCES
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- Feifel D, Yu Moutier C, Swerdlow NR: Attitudes toward psychiatry as a prospective career among students entering medical school. Am J Psychiatry 1999; 156:1397-1402
- Nathan DG: Clinical research: perceptions, reality, and proposed solutions. JAMA 1998; 280:1427-1431
- Skeff KM, Mutha S: Role models: guiding the future of medicine. New Engl J Med 1998; 339:2015-2017[Free Full Text]
- Nemeroff CB: On mentoring. CNS Spectrum 1998; 3:17,60
- Lambert MT, Garver DL: Mentoring psychiatric trainees' first paper for publication. Acad Psychiatry 1998; 22:47-55[Abstract/Free Full Text]
- Reynolds III CF, Martin C, Brent D, et al: Postdoctoral clinical-research training in psychiatry: a model for teaching grant writing and other research survival skills and for increasing clarity of mentoring expectations. Acad Psychiatry 1998; 22:190-196[Abstract/Free Full Text]
- Dimond-Fitzgerald K, Moore GJ, Paulson LA, et al: Proton spectroscopic imaging of the thalamus in treatment-naive pediatric obsessive-compulsive disorder. Biol Psychiatry 2000; 47:174-182[CrossRef][Medline]
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R. Balon, G. Heninger, and R. Belitsky
Medical School Research Pipeline: Medical Student Research Experience in Psychiatry
Acad Psychiatry,
February 1, 2006;
30(1):
16 - 22.
[Abstract]
[Full Text]
[PDF]
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L. W. Roberts and M. P. Bogenschutz
Preparing the Next Generation of Psychiatric Researchers: A Story of Obstacles and Optimism
Acad Psychiatry,
March 1, 2001;
25(1):
4 - 8.
[Abstract]
[Full Text]
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ABSTRACT
INTRODUCTION
