EMPIRICAL REPORT

Promoting Careers in Academic Research to Psychiatry Residents

Sotirios Posporelis & Akira Sawa & Gwenn S. Smith &

Maxine L. Stitzer & Constantine G. Lyketsos &

Margaret S. Chisolm

Received: 10 September 2013 /Accepted: 9 January 2014# Academic Psychiatry 2014

AbstractObjective With the shift of interest in psychiatry towardspatient-oriented research with clinically relevant outcomes,there is a critical need for well-trained psychiatrist–scientists.The authors report on two developmentally tailored, longitu-dinal research training curricula designed to use peermentoring to bridge the gap between physicians and scientistsand to promote careers in academic research.Methods The authors instituted two independent researchtraining curricula, one for first-year and one for second-to-fourth-year psychiatry residents, spanning two campuses ofone institutional residency training program. Each curriculum’sparticipants included psychiatry residents and peer scientificinvestigators, and both were attended by senior scientists anddepartmental leaders. The authors developed and administeredan anonymous survey at the end of the first cycle of the first-year resident curriculum to assess participant attitudes.Results The first-year and second-to-fourth-year resident cur-ricula have been implemented for 3 and 2 years, respectively.The authors observed overall participant satisfaction with thefirst-year curricula, independent of trainee status. Furthermore,first-year psychiatry residents reported increased interest inacademic research careers after exposure to the curricula.

Conclusions Results suggest that it is possible to encourageacademic research careers using peer mentoring, an innovativeapproach that requires minimal funding, causes little disruptionto the residents’ schedule and engages the gamut of individualsinvolved in psychiatry care and research: psychiatrists-in-training and young non-clinician scientists-in-training.

Keywords Research training curricula . Peer mentoring .

Psychiatry residents

Psychiatry is one of the most vibrant and exciting specialtiesin medicine, offering the opportunity to be part of an ever-growing, innovative, and fast-paced field aimed at alleviatingthe suffering of millions of individuals and their families/caregivers. Given the limited, mechanistic knowledge of de-finitive etiology and pathophysiology of almost all psychiatricdisorders and limited effective treatments, psychiatry is afertile specialty for groundbreaking research. Psychiatric in-vestigators emerge from a diverse range of scientific fieldsincluding neuroscience, pharmacology, genetics, biology, ep-idemiology, sociology, psychology, clinical psychiatry, andother clinical medical specialties. With the shift of interesttoward the translational aspect of researchwithmore clinicallyrelevant, patient-oriented outcomes, there is an increasinglyhigh demand for well-trained physician–scientists.

Concerns exist not only about the paucity of new physician–scientists in general [1, 2] but about the lack of psychiatrist–researchers in particular [3]. The National Institute of MentalHealth has noted a decline in the number of psychiatrist–re-searchers disproportionate to other medical specialties [4, 5].Regulatory, institutional, and personal reasons have been iden-tified behind these falling numbers [6]. In an attempt to high-light potential discrepancies between physician investigatorsand their nonphysician peers, Dickler et al. [1] gathered datafrom NIH’s Consolidated Grant Applicant File between 1964

S. Posporelis :A. Sawa :G. S. Smith :M. L. Stitzer :C. G. Lyketsos :M. S. ChisolmJohns Hopkins University School of Medicine,Baltimore, MD, USA

S. Posporelis (*)South London and Maudsley NHS Foundation Trust,London, UKe-mail: sotiris.posporelis@slam.nhs.uk

G. S. Smith :M. L. Stitzer :C. G. Lyketsos :M. S. ChisolmJohns Hopkins Bayview Medical Center,Baltimore, MD, USA

Acad PsychiatryDOI 10.1007/s40596-014-0037-7

and 2004 and analyzed trends in the annual number of first-timeapplicants for NIH R01 grants. The number of physician inves-tigators showed little net change during this period.

Realizing the need for research-competent clinicians andresearch-literate psychiatry residents, many academic psychi-atric departments have taken action by adjusting their curric-ulum and developing new strategies to implement these goals.Beth Israel Medical Center developed a residency researchcurriculum (PART: Psychiatrists Acquiring Research Train-ing) that is independent of both their clinical and didacticprograms, with an emphasis on core competencies of research.Research is taught as a stand-alone discipline through all 4years of residency training and scholarly activities, and ac-complishments had steadily risen since the inception of PART[7]. The Medical University of South Carolina launched a 2-year NIH-funded research track in 2006 called DART (DrugAbuse Research Training) to address the barriers to researchtraining during residency [8]. DART encompasses the final 2years of psychiatry residency training (PGY-3 and PGY-4),and its alumni are being followed for 10 years in order toassess relevant outcomes (e.g., manuscripts, abstracts, fundingproposals) [8]. Different, yet successful, approaches havefollowed. One, by the University of California, San Diego,coordinates three federally funded summer programs focusedon geriatric psychiatry-related research [9]. Another, by theU.S. Department of Veterans Affairs South Central MentalIllness Research Education and Clinical Center, establishedthe Training Residents in Psychiatry Scholarship Program[10]. Specific to the needs of geriatric mental health researchis the Advanced Research Institute. The objective of thisinnovative program is to promote the transition to indepen-dence for junior faculty by providing focused mentoring [11].

In light of these optimistic findings and as a first steptoward attracting more young psychiatrists to academic re-search careers, the authors developed and implemented twodevelopmentally tailored, longitudinal research training cur-ricula designed to use peer mentoring to bridge the gap be-tween clinicians and scientists and to encourage careers inacademic research. The aim of this report is to describe theseresearch training curricula and to provide qualitative andquantitative information regarding participant attitudes.

Methods

Program Description

The Johns Hopkins University School of Medicine (JHUSOM)has been offering training in general psychiatry since 1913.Psychiatry residents enter the training program in the internshipyear at the Johns Hopkins Bayview Medical Center (JHBMC).After their first year, they move to the Johns Hopkins Hospital(JHH) for the second through fourth years of their training. Six

months of the fourth year is spent pursuing elective clinical and/or research activities.

As the site of the first year of psychiatry residency trainingand multiple postdoctoral psychiatry research fellowships,JHBMC was deemed as the ideal place to initially developand implement a curriculum to promote academic researchcareers to psychiatry residents. In 2009, a committeeconsisting of four of the coauthors (two physician scientists[CL, MC] and two nonphysician PhD scientists [GS, MS])developed such a career development curriculum. In an at-tempt to ensure early resident exposure to their peer investi-gators, all postdoctoral psychiatry trainees at JHBMC wereinvited to participate (i.e., was open to first-year psychiatryresidents, not just postdoctoral fellows as is typically done insuch programs [12]). Initially named the “All-Trainee Lunch,”the curriculum was designed to use peer mentoring to bridgethe gap between clinicians and scientists and to encouragepsychiatry residents to pursue careers in academic research.The “All-Trainee Lunch” curriculum was piloted as a quarter-ly program for the 2009–2010 academic year. Based on par-ticipant feedback, the curriculum was refined to a monthlyprogram beginning in the 2010–2011 academic year. The“All-Trainee Lunch” is designed as a 2-year curriculum spe-cifically to balance the educational needs of the postdoctoralfellows who are at the training site for 2 years (thus, there is noredundancy of content) while still providing a rich educationalexperience for the PGY-1s who are exposed to the curriculumat this site for 1 year only. Spanning the whole length of theacademic year, the curriculum now maintains a longitudinaland fresh exposure to research training for all participants.Length (1 h), frequency (monthly), timing (12–1 pm), andprovision of free lunch during the seminars ensure higher ratesof attendance and smooth integration into the first-year resi-dents’ busy clinical schedule, without being overwhelming.Now in its third full year of implementation, the curriculum’sseries of seminars cover a diverse set of topics, all of whichserve as an appropriate introduction to psychiatric researchwith a hands-on approach. These topics’ general themes aresummarized below:

& Introduction to Perspectives of Psychiatry approach. Partic-ipants are presented with an alternative approach to theDSM and biopsychosocial models for the understandingand treatment of patients with psychiatric conditions, whichwas originally articulated at the JHUSOM and forms theconceptual core of its residency training program [13].

& Mentorship. The development and fostering of mentoringrelationships are crucial steps forward for residents inter-ested in a research career [14, 15]. After an introduction onthe scope of the curriculum, participants are introduced tothe idea of mentorship, mostly in its developmental form,as a source of general and practical information related topsychiatric research [16]. In addition to peer mentoring,

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they are encouraged to identify faculty memberswith similar research interests and compatibility ona personal level, qualities that could maintain theserelationships [17, 18].

& Academic promotion within the institution. The promo-tion process at JHUSOM is discussed in detail, giving aclear timeline of a research career path in the actualacademic environment in which the participants work.

& Facilitation by senior investigators and departmentalleaders. Common misconceptions about a researcher’scareer path and/or lifestyle, identified as deterrents in thedecision to follow a physician–scientist career path, areclarified by senior researchers and/or faculty memberswith a rich research history [19].

& Clinical case presentations. Discussion of clinical casespresented by the first-year residents provides an excellentfocus of discussion among residents and their peer PhDinvestigators. The residents gain presentation and teachingexperience as they guide their peer researchers through thecase, and the postdoctoral researchers gain similar experi-ence as they guide the residents in developing clinicallyrelevant research questions generated by the case presen-tation and discussion.

& Junior physician faculty career path presentations. Led bypsychiatrists who have recently completed the residencytraining and are close in age and career level to the first-year residents, these presentations encourage the residentsto consider the achievability of research career paths.

& Junior PhD trainee (i.e., peer) and faculty career path pre-sentations. Led by nonphysicians, these presentations offerinsights on a variety of topics, including the components ofan interprofessional research team and collaborations withmembers outside the clinical field, such as statisticians.

A similar research curriculum was subsequently institutedat JHH, the site of the second-to-fourth years of the JHUSOMpsychiatry residency training program. Recognizing the needfor an increased number of psychiatrist–researchers and foreffective communication between psychiatrists and nonphy-sician psychiatric researchers, a monthly workshop seminarseries was established, under the intuitive name: “Mind theGap: Aspiring to bring clinicians and scientists together.” Thecurriculum is sponsored by the Johns Hopkins SchizophreniaCenter. “Mind the Gap” is open to medical students, second-to-fourth year psychiatry residents, postdoctoral physicians,PhD scientists, and physician/PhD trainees, supported byfaculty investigators and department leaders. Following face-to-face interviews with more than 20 scientists and cliniciansof all levels, a list of seminar topics was assembled aroundthemes that include:

& Mental status examination, psychopathology, and scien-tific explanations

& An introduction to the classification of mentalhealth disorders

& Neuropsychology and treatment of schizophrenia& Psychosocial implications of mental illness& Transcultural psychiatry& Schizophrenia symptomatology in other diseases

In addition, one of the seminars was devoted to understand-ing better how psychotic symptoms are experienced by apatient, as well as the impact of the illness on an individual’slife. To accomplish this, a patient diagnosed with schizophre-nia was invited, and, following a structured interview by oneof the psychiatry residents, seminar participants had thechance to ask the patient questions.

In order to optimize seminar participation, the followingmethods have been used:

& Weekly e-mails to an extensive database comprised ofpsychiatry residents, psychiatry faculty members, post-doctoral fellows, research assistants, and lab technicians.A final e-mail is sent out on the day of the workshop.

& Design of a dedicated webpage, part of the Johns HopkinsSchizophrenia Center website, where a list with dates,topics, and speakers can be found. http://www.hopkinsmedicine.org/psychiatry/specialty_areas/schizophrenia/mind_gap.html

& Posting of an announcement with every upcoming work-shop on the Johns Hopkins Science Calendar (a webpagelisting all events sponsored by Johns Hopkins Medicineand other Hopkins-affiliated institutions).

& Posters placed in strategic JHH locations, mainly focusingon the building in which the Psychiatry department islocated, outside laboratories that conduct relevant re-search, and various JHU cafeterias.

& Provision of coffee and cookies to all participants.

Each of the curriculum’s seminars lasts approximately 1 hand is organized by one of the authors (SP) who, as a residentphysician–scientist from the Maudsley Hospital, recentlycompleted a postdoctoral research fellowship in the JohnsHopkins Schizophrenia Center. Discussion facilitators, whomake short presentations to initiate the discussions, are mainlysecond-to-fourth year residents based at JHH. Other psychia-try residents are present as participants, in addition to medicalstudents, postdoctoral fellows, doctoral students, and facultyfrom a variety of backgrounds all relevant to psychiatry (e.g.,biology, biochemistry, neurobiology, immunology, genetics,epidemiology, neuropsychology, and neuroscience).

In its first year of implementation, “Mind the Gap” hasestablished itself as a common ground for psychiatry residentsand nonphysician researchers to meet and exchange ideas. It isan excellent networking opportunity for residents to meetsimilar-age peers who are pursuing a career in research.

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Bidirectional discussion between residents and nonphysicianscientists is encouraged and helps clarify misconceptions heldfrom both sides [20] as well as facilitates translation frombedside to bench and the reverse. Residents gain insight inthe biological mechanisms underlying psychopathology,adding to their understanding of mental health disorders,making scientifically based treatment decisions, and optimiz-ing care delivery. Nonphysician scientists are helped to askmore clinically relevant questions, enhancing the translationalsignificance of their work. Initial observations revealed evi-dence of the “gap” that exists between residents and re-searchers, with respect to clinical practice and research (e.g.,use of phrases such as “WE do this, but YOU do that”), whichthis curriculum is hoping to close, since academic psychia-trists and nonphysician researchers ultimately have the samegoal, a better future for people suffering from a psychiatricdisorder, for which they will need to work together to achieve.

The authors believe that it is only through close collaborationand sharing of information between clinicians and scientists thatadvances in neuroscience can happen and both research-trainingcurricula provide a platform where this is possible (Table 1).

Results

To evaluate the “All-Trainee” curriculum, an anonymous sur-vey was developed and administered at the end of the pilotphase to all participants (N=11). The survey comprised of 12items assessing (1) overall satisfaction with the seminars fromall participants, e.g., “Meetings were helpful in achieving theoverall goal of exposure to psychiatric research (for interns)and clinical care (for other trainees)”; (2) academic researchcareer attitudes of all participants; and (3) reflections on theuniqueness of the curriculum by first-year psychiatry resi-dents. The survey had four additional items targeting thisspecial subgroup, including one on the impact of the curricu-lum on their academic career interest (e.g., “I am more inter-ested in an academic research career”). The survey also

provided a prompt for free narrative comments of all trainees,as well as an open discussion about the curriculum for whichcomments of all trainees were recorded by one of the courseinstructors (MC). Respondents were asked to evaluate thesurvey items on a Likert-type scale, with gradual increase instrength of agreement from 1 to 5.

Overall curriculum satisfaction for all trainees ranged from3.6 to 4.6 [mean=4.1, standard deviation (SD)=0.3]. An addi-tional aim of the survey was to compare attitudes toward thecurriculum between first-year psychiatry residents (n=5) andpostdoctoral fellows (n=6). It was hypothesized that first-yearpsychiatry residents would be as satisfied with the curriculumas the postdoctoral fellows. Mean satisfaction for first-yearresidents and postdoctoral fellows was 4.2 (SD=0.3) and 4.0(SD=0.3), respectively. Satisfaction was not dependent ontrainee status: there was no significant difference betweenfirst-year psychiatry residents’ satisfaction with the form andcontent of the curriculum compared to postdoctoral fellows(p=0.93). The curriculum aspired to endorse increased interestin academic research careers, and this was also assessed by thissurvey. Report of increased interest in an academic researchcareer after exposure to the curriculum for the first-year psy-chiatry residents ranged from 3.3 to 5.0 with a mean of 4.0(SD=0.8). On the free narrative section of the survey, a post-doctoral fellow provided additional written comments: “I reallyappreciate the effort that is being put into this training experi-ence. I feel very fortunate to have this opportunity.” The opengroup discussion generated several additional comments, in-cluding one by a resident who valued “seeing the researchquestions that can be generated from clinical care.” The major-ity of the attendees found the curriculum inspiring.

Discussion

The “All-Trainee Lunch” and “Mind the Gap” curricula rep-resent a combined effort early in training to attract morephysician trainees to an academic research career path and

Table 1 Summary of “Mind the Gap” curriculum’s contributions

Nonphysician scientists Clinicians

• Promote holistic view of mental health illness • Establish a channel of communication with nonphysician scientists

• Deepen understanding of psychopathology • Foster awareness of current departmental research projects

• Introduce to the practice of psychiatry in a clinical setting • Encourage active participation in ongoing research projects

• Enhance effective use of diagnostic criteria in mental health disorders • Support evidence-based clinical practice

• Strengthen use of rigorous study inclusion/exclusion criteria • Reinforce how research impacts daily clinical practice

• Encourage development of clinically relevant animal models and behavioraloutcome measures

• Encourage formulation of scientifically sound research questions

• Support development of translational aspects of research

• Promote design of studies with focus on enhancing/transforming clinical care

• Foster mindfulness of the human presence/factor in illness

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bridge the gap between psychiatrists and nonphysician re-searchers. Both programs were designed to function withminimal funding and with little disruption to the busy clinicalschedule of psychiatry residents.

The curricula are innovative in that they are: (1) Longitu-dinal: the combined curricula include psychiatry residentsfrom all levels. By engaging residents in their first year, theopportunity to consider the academic path early on in theircareers is given; (2) Inclusive: the combined curricula includeall residents regardless of previous experience in research.This ensures exposure to recent advances in research and hasthe potential to spark a new interest; and (3) Engaging ofsimilar-age peers as mentors: the combined curricula includeresearch trainees from nonphysician backgrounds, affordingpeer mentoring between psychiatry residents and nonphysi-cian–scientists, which is essential for the future of psychiatricpractice and research. The lack of the hierarchical dimension ina peer-mentoring relationship might make it easier to achievecommunication, mutual support, and collaboration than itwould be in a faculty–trainee mentoring relationship [21].

The results from a survey conducted following the com-pletion of the pilot of the “All-Trainee Lunch” curriculumsuggest that such endeavors are appealing to all psychiatrytrainees, regardless of background, career stage, degree, and/or path. It was encouraging to see that the curriculum had apositive impact on young physicians’ interest in academicresearch careers. These results will assist in the refinement ofboth clinical curricula and in the development of further re-search curricula within the JHUSOM psychiatry residencytraining program. They may also serve as a practical guide forother departments and institutions interested in creating aca-demic research curricula for residents and postdoctoral fellows.

The project also provides a background for further investi-gations of effective graduate medical education interventionsfor increasing physician interest in academic research careers.Finally, although there are advantages of a residency trainingprogram that has no separate clinical and research tracks (e.g.,no second-class citizen status, rigorous clinical training), thereis a relative lack of protected time for residents to engage inpurely research-related activities.

There are several limitations of this current study that futureevaluation of the curricula will address: (1) small sample size;(2) relative lack of data on immediate knowledge, attitudes,and practice outcomes; and (3) lack of data on longitudinaloutcomes, including posttraining career choice and academicproductivity. In addition, results may represent an under-representation of the program’s impact as satisfaction datawere based on the pilot (quarterly) phase of the program.

Future curricular implementation and evaluation plans in-clude (1) expansion of the topic list with inclusion of work-shops on research literacy and grant writing; (2) short presen-tations of the same topic by both a clinician and a scientist; (3)“The Link”: based on the principles of peer mentoring, upon

entry to JHUSOM psychiatry residency training program,each resident will be linked with a young scientist at anequivalent stage of his career with similar research interests.The scientist would most likely be a postdoctoral fellow froma relevant department (e.g., neuroscience, neurology, psychi-atry). “The Link” aspires to strengthen the bonds betweenpsychiatry residents and scientists by enhancing communica-tion and promoting future research collaborations; (4) expand-ed evaluation of immediate and longitudinal outcomes from agreater number of participants; and (5) multisite (beyondJHUSOM) implementation and evaluation.

As equal parts of a longitudinal research training curricu-lum, the “All-Trainee Lunch” and “Mind the Gap” curriculaare two novel, successful attempts to introduce JHUSOMpsychiatry residents of all levels to academic research andfoster closer communication with scientists. Simple structureand cost effectiveness suggest that it could be easily imple-mented in other departments and institutions as well.

Implications for Educators

• Given the need for physician–scientists, psychiatric residency trainingprograms are developing, implementing, and evaluating curricula inresearch

• Research curricula can be developed for first-year psychiatry residentsand postdoctoral fellows that engage both groups of trainees

• Research curricula can be implemented with little disruption to thebusy clinical schedule of psychiatry residents

• Research curricula can allow residents and nonphysician scientists toserve as peer mentors for one another

Implications for Academic Leaders

• Close collaboration and sharing of information between clinicians andscientists will foster clinically relevant advances in both clinical andbasic science

• Research curricula can be developed that engage both residents andnonphysician scientists to advance collaboration and facilitatetranslation from bedside to bench and the reverse

• Research curricula can be implemented with minimal funding andminimal disruption of the clinical care mission

• Interprofessional research curricula is an innovative approach that willplace the institution at the cutting edge of translational science andpractice improvement.

Disclosure On behalf of all authors, the corresponding author states thatthere is no conflict of interest.

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