Appendix A
Data Sources and Methods

To respond to the study charge, the committee took several steps to review research training and psychiatry residency training. Sources of data and information included the expertise of the committee members, literature reviews and Internet searches of principal concepts (e.g., research training, program curricula, personal characteristics, funding mechanisms), informal and semistructured interviews, two commissioned works, hosting of a public workshop, and other invited presentations.

STUDY COMMITTEE

The 12-member committee that conducted this study broadly represented psychiatry (adult and child and adolescent psychiatry, from both small and large programs), other biological and cognitive– behavioral disciplines (neurology, psychology, neuroscience), mental health economics, and other branches of medicine (pathology and pediatrics). The committee included members with expertise in either training of biomedical researchers or graduate medical education, biomedical researchers, two psychiatry department chairs, a medical school dean, and a director of a children’s hospital research foundation. The committee convened for one 3-day and four 2-day meetings on April 12–13, 2002; June 18–20, 2002; July 30–31, 2002; September 26–27, 2002; and March 17–18, 2003. In addition, a public workshop was held on June 19, 2002. Biographies of individual committee members appear in Appendix D.



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Research Training in Psychiatry Residency: Strategies for Reform Appendix A Data Sources and Methods To respond to the study charge, the committee took several steps to review research training and psychiatry residency training. Sources of data and information included the expertise of the committee members, literature reviews and Internet searches of principal concepts (e.g., research training, program curricula, personal characteristics, funding mechanisms), informal and semistructured interviews, two commissioned works, hosting of a public workshop, and other invited presentations. STUDY COMMITTEE The 12-member committee that conducted this study broadly represented psychiatry (adult and child and adolescent psychiatry, from both small and large programs), other biological and cognitive– behavioral disciplines (neurology, psychology, neuroscience), mental health economics, and other branches of medicine (pathology and pediatrics). The committee included members with expertise in either training of biomedical researchers or graduate medical education, biomedical researchers, two psychiatry department chairs, a medical school dean, and a director of a children’s hospital research foundation. The committee convened for one 3-day and four 2-day meetings on April 12–13, 2002; June 18–20, 2002; July 30–31, 2002; September 26–27, 2002; and March 17–18, 2003. In addition, a public workshop was held on June 19, 2002. Biographies of individual committee members appear in Appendix D.

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Research Training in Psychiatry Residency: Strategies for Reform LITERATURE REVIEW AND INTERNET SEARCHES The committee conducted extensive literature reviews and Internet searches regarding research training during residency and factors that either promote or inhibit such activity. In particular, Institute of Medicine (IOM) staff used in-house databases, including Academic Search Premier, PubMed, and PsychInfo, to identify peer-reviewed literature using a combination of the following keywords: Psychiatry Research Residency Education Graduate medical education Research training Training Internal medicine Allergy and immunology Neurology Pulmonary disease and critical care International medical graduates Minority physicians Women physicians Furthermore, the committee reviewed residency training requirements and certification requirements for psychiatrists in two ways. First, we reviewed the Accreditation Council for Graduate Medical Education (ACGME) requirements for different specialties, including psychiatry, neurology, internal medicine, and allergy and immunology, to determine key similarities and differences among residency training programs. Second, we reviewed certification requirements established by the American Board of Psychiatry and Neurology (ABPN) for psychiatrists. INTERVIEWS AND OUTREACH In addition to the above literature reviews and extensive Internet searches, the committee conducted a number of interviews and outreach activities to understand organizational and individual perspectives as they relate to research training during residency. In an effort to further understand local factors that influence residency-based research training and the factors that influence individual psychiatrists to pursue research, IOM staff conducted outreach in three ways:

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Research Training in Psychiatry Residency: Strategies for Reform IOM staff interviewed 8 chairs whose departments were considered emerging with respect to interdepartmental research. Chairs were asked a series of questions relating to research activities of residents and faculty, innovative strategies to encourage research within the department, and obstacles to training (see Chapter 4 for further discussion). Seven psychiatrist-investigators who had received mentored career (K) awards within the past 5 years (see Chapter 2 for further discussion) were interviewed. Members of the American Association of Directors of Psychiatric Residency Training (AADPRT) were solicited via mass mailing to provide programmatic information regarding research programs, as well as data on residents who have tracked to careers in research. Summary information on programmatic characteristics appears in Appendix C, and outcome data on research training efforts at selected institutions appear in Chapter 4. IOM staff also conducted personal communications with numerous individuals outside of the committee, including but not limited to the following: Virginia Anthony, American Academy of Child and Adolescent Psychiatry (May 3, 2002) Richard Balon, Wayne State University (March 26, 2003) Barbara Barzansky, American Medical Association Council on Medical Education (October 22, 2002) James Bentley, American Hospital Association (October 25, 2002) Eugene Beresin, Massachusetts General Hospital/McLean Hospital (May 16, 2002) Patricia Davidson, American Academy of Child and Adolescent Psychiatry (January 31, 2003) Leon Eisenberg, Harvard University (January 30, 2002) Karen Fisher, Association of American Medical Colleges Division of Health Care Affairs (July 11, 2002) David Folks, University of Nebraska (November 18, 2002)* Richard G. Frank, Harvard University; Institute of Medicine Board on Neuroscience and Behavioral Health (March 3, 2003) Lawrence Friedman, National Heart, Lung, and Blood Institute, Division of Epidemiology and Clinical Applications (April 17, 2003) Gregory Fritz, Brown University (February 10, 2003) John C. Gienapp, University of Washington (July 2, 2003)

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Research Training in Psychiatry Residency: Strategies for Reform J. Christian Gillin, University of California, San Diego (January 8, 2002; February 1, 2002) Walter Goldschmidts, National Institute of Mental Health (April 4, 2002; December 12, 2002; February 11, 2003) Gary Gottlieb, Brigham and Women’s Hospital; Harvard University (June 21, 2002) Linda Greco-Sanders, University of Colorado (August 7, 2003) John Greden, American Psychiatric Association Council on Research (July 26, 2003) Ernesto Guerra, American Psychiatric Association (December 4, 2002; July 15, 2003; July 25, 2003) Gretchen Haas, Western Psychiatric Institute and Clinic (April 18, 2003) Deborah Hales, American Psychiatric Association (June 13, 2002) Jeanne K. Heard, University of Arkansas College of Medicine (June 2003) Leighton Huey, University of Connecticut (October 3, 2002) Barry Kaplan, National Institutes of Mental Health (July 29, 2002) Patricia Kapur, American Board of Anesthesiology (April 15, 2003) Martin Keller, Brown University (November 20, 2002)* James Leckman, Yale University (April 4, 2003) Theodore Marmor, Yale University (August 22, 2002) Christopher McDougal, Indiana University (November 4, 2002)* Judith G. Miller, National Board of Medical Examiners (July 15, 2003) Robert Moore, National Institutes of Health, Office of Reports and Analysis (July 11, 2002) David Mrazek, Mayo Clinic (March 24, 2003) Henry Nasrallah, Veterans Administration Medical Center (July 29, 2002) Charles Nemeroff, Emory University (November 21, 2002)* Eric Nestler, University of Texas at Southwestern (November 7, 2002)* Jason T. Olin, National Institute of Mental Health, Aging Research Consortium (November 13, 2002) John C. Peirce, Good Samaritan Regional Medical Center (June 24, 2003) Alicia Permell, National Institute of Mental Health (December 12, 2002) Darrel Reiger, American Psychiatric Association (June 7, 2002) Mark Rieder, Mayo Clinic (April 10, 2003) Ronald Rieder, Columbia University (March 29, 2003)

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Research Training in Psychiatry Residency: Strategies for Reform Robert Rosencheck, Yale University (August 22, 2002) Eugene Rubin, Washington University (May 28, 2002) Neal Ryan, Western Psychiatric Institute and Clinic (April 17, 2003) Walter Schaffer, National Institutes of Health, Office of Extramural Research (July 11, 2002; September 16, 2003) Stephen Scheiber, American Board of Psychiatry and Neurology, (April 5, 2003) Bert Shapiro, National Institutes of Health (December 30, 2002) Charles Schulz, University of Minnesota (November 22, 2002)* Anne L. Shuster, Robert Wood Johnson Clinical Scholars Program (June 12, 2002) Joel Silverman, Virginia Commonwealth University (November 5, 2002)* G. Richard Smith, Jr., University of Arkansas (December 5, 2002)* Cheryl Sroka, Emory University (April 21, 2003) Larry Sulton, ACGME (August 6, 2002) Fred Taylor, National Institutes of Health, National Center for Research Resources (April 10, 2003) G. Warren Teeter, Administrators in Academic Psychiatry (July 19, 2002) Linda Thorsen, ACGME (October 15, 2002) Glenn Treisman, Johns Hopkins University (May 15, 2002) Farris Tuma, National Institute of Mental Health (June 4, 2002) Benedetto Vitiello, National Institute of Mental Health, Division of Services and Intervention Research (November 14, 2002) Debra F. Weinstein, Massachusetts General Hospital (July 3, 2002) Dan Winstead, Tulane University (July 16, 2002) Sunny Yoder, Association of American Medical Colleges (June 18, 2003) James R. Zaidan, Emory University (June 27, 2003) Steven Zalcman, National Institute of Mental Health (April 8, 2002) *   = One of 8 chairs interviewed per outreach noted on page 120. COMMISSIONED PAPERS The committee commissioned the work of historian Joel T. Braslow of the University of California at Los Angeles and economist Douglas D.

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Research Training in Psychiatry Residency: Strategies for Reform Schwalm of Louisiana State University. Braslow was commissioned to write a paper considering the unique history of psychiatric practice and how that history influenced the emergence of research activity within the field. The paper focuses on the late twentieth century. Braslow’s work was important for the preparation of the section on pscyhodynamics that appears in Chapter 3. Schwalm used data from the American Psychiatric Association to consider the income differences that exist between psychiatrists who are and are not engaged in research activity. Schwalm’s analysis additionally controlled for gender, race, practice venue, and experience. Schwalm’s results are cited and used throughout the report, especially in Chapter 5. PUBLIC WORKSHOP As noted above, the committee convened for five 2-day meetings and a separate 1-day public workshop. The workshop focused on obstacles to research training in psychiatry. Most of the invited speakers were experts in adult or child and adolescent psychiatry, although experts in economics, neurology, and clinical research also presented their views. A list of speakers and participants who attended the open sessions of the committee meetings and the workshop is presented below.

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Research Training in Psychiatry Residency: Strategies for Reform   Open Session for Committee Meeting #1 April 12–13, 2002 The National Academies Washington, DC 1:00 p.m.–2:15 p.m. Sponsor Presentation of Study Genesis and Charge Richard K. Nakamura, Acting Director, National Institute of Mental Health Wayne S. Fenton, Acting Deputy Director, National Institute of Mental Health 2:15 p.m.–3:15 p.m. The Psychiatry Residency Paths Sheldon I. Miller, Chair, Psychiatry Department, Northwestern University; Past Chair, Psychiatry Residency Review Committee 3:30 p.m.–4:15 p.m. The Internal Medicine and Allergy and Immunology Residency Paths Stephen I. Wasserman, Professor of Medicine, University of California at San Diego; Past Chair, American Board of Allergy and Immunology   Open Session for Committee Meeting #2 Tuesday, June 18, 2002 The National Academies Washington, DC 10:00 a.m.–10:50 a.m. Obstacles to Residency-based Research Training in Psychiatry Herbert Pardes, M.D., President and CEO, New York-Presbyterian Hospital; Former Director, National Institute of Mental Health 11:30 a.m.–12:20 p.m. Obstacles to Residency-based Research Training in Psychiatry Steven E. Hyman, M.D., Provost, Harvard University; Former Director, National Institute of Mental Health 4:00 p.m.–4:50 p.m. Obstacles to Residency-based Research Training in Psychiatry Harold A. Pincus, M.D., Professor and Executive Vice-Chairman, Department of Psychiatry, University of Pittsburgh, School of Medicine, Western Psychiatric Institute and Clinic; Senior Scientist and Director, RAND– University of Pittsburgh Health Institute

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Research Training in Psychiatry Residency: Strategies for Reform   Open Session for Committee Meeting #3 July 30–31, 2002 The National Academies Washington, DC 1:00 p.m.–2:00 p.m. Review of Strategies Used by Pediatrics James A. Stockman III, M.D., President, American Board of Pediatrics   Open Session for Committee Meeting #4 September 26–27 2002 J. Erik Jonsson Center Woods Hole, Massachusetts 9:00 a.m.–10:00 a.m. Daniel K. Winstead, M.D. Chair, Department of Psychiatry and Neurology, Tulane University Health Sciences Center; Chair, Psychiatry Residency Review Committee; ACGME President; American Association of Chairs in Psychiatry 10:15 a.m.–11:15 a.m. Joel T. Braslow, M.D., Ph.D. Associate Professor, Departments of Psychiatry and Biobehavioral Sciences and History, University of California at Los Angeles Invited Discussant: Gerald N. Grob, Ph.D. Henry E. Sigerist Professor of History of Medicine Emeritus, Rutgers University 11:15 a.m.–12:00 p.m. Douglas D. Schwalm, Ph.D. Assistant Professor, Department of Economics, Louisiana State University   Public Workshop on Obstacles to the Incorporation of Research into Psychiatry Residency Training Wednesday, June 19, 2002 The National Academies Washington, DC 8:30 a.m.–8:50 a.m. Ensuring the Future of Clinical Research Across Medical Specialties Roger E. Meyer, M.D., Senior Consultant for Clinical Research, Association of American Medical Colleges 8:50 a.m.–9:10 a.m. Questions and Discussion

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Research Training in Psychiatry Residency: Strategies for Reform 9:10 a.m.–9:30 a.m. Personal Economics and Other Factors Influencing Specialty Selection Sean M. Nicholson, Ph.D., Assistant Professor of Health Care Systems, The Wharton School of the University of Pennsylvania 9:30 a.m.–9:50 a.m. Questions and Discussion 10:05 a.m.–10:25 a.m. Mentoring Residents Interested in Research James H. Meador-Woodruff, M.D., Associate Chair for Research Training and Faculty Development, Department of Psychiatry, and Senior Associate Research Scientist, Mental Health Research Institute, University of Michigan 10:25 a.m.–10:45 a.m. Questions and Discussion 10:45 a.m.–11:00 a.m. Child Psychiatry’s Perspective, Part I David Shaffer, F.R.C.P., F.R.C.Psych., Director of Child Psychiatry, Columbia University, New York State Psychiatric Institute 11:00 a.m.–11:15 a.m. Child Psychiatry’s Perspective, Part II John S. March, M.D., Director of Programs in Child and Adolescent Anxiety Disorders and Developmental Psychopharmacology, Duke University 11:15 a.m.–11:35 a.m. Questions and Discussion 12:35 p.m.–12:50 p.m. Leadership Perspectives: From the Executive’s Perch Steven M. Mirin, M.D., Medical Director, American Psychiatric Association; Former President and Psychiatrist-in-Chief, McLean Hospital 12:50 p.m.–1:05 p.m. Leadership Perspectives: Where the Chair Sits, Part I Paula J. Clayton, M.D., Professor of Psychiatry, University of New Mexico; Professor Emeritus of Psychiatry and Former Chair, Department of Psychiatry, University of Minnesota 1:05 p.m.–1:20 p.m. Leadership Perspectives: Where the Chair Sits, Part II Henry A. Nasrallah, M.D., Professor of Psychiatry, Neurology and Internal Medicine, University

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Research Training in Psychiatry Residency: Strategies for Reform     of Mississippi School of Medicine, and Chief, Mental Health Services, VA Medical Center, Jackson, Mississippi; Former Chair, Department of Psychiatry, Ohio State University 1:20 p.m.–1:40 p.m. Questions and Discussion 1:40 p.m.–2:00 p.m. Recruitment, Development, and Retention of Clinical Neuroscientists in Residency Training: Neurology’s Perspective Robert C. Griggs, M.D., Chair of Neurology, University of Rochester; Editor-in-Chief, Neurology 2:00 p.m.–2:20 p.m. Questions and Discussion 2:20 p.m.–2:35 p.m. Sociocultural and Policy Issues in Psychiatry Residency Training Howard H. Goldman, M.D., Ph.D., Director of Mental Health Policy Studies, University of Maryland, Baltimore 2:35 p.m.–2:50 p.m. Questions and Discussion 3:05 p.m.–4:05 p.m. Reflections/Comments from Current and Former Training Directors Martin J. Drell, M.D., Louisiana State University Christopher R. Thomas, M.D., The University of Texas Medical Branch at Galveston Karon Dawkins, M.D., University of North Carolina, Chapel Hill Lisa B. Dixon, M.D., Department of Psychiatry, University of Maryland, Baltimore Anthony L. Rostain, M.D., University of Pennsylvania