Asian Journal of Psychiatry 13 (2015) 81–82
Contents lists available at ScienceDirect
Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Research by residents: Obstacles and opportunities John Torous a,b,*, Jaya Padmanabhan b,c a
Harvard Longwood Psychiatry Residency Training Program, Boston, MA, United States Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States c McLean Hospital, Boston, MA, United States b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 24 October 2014 Accepted 3 December 2014
As the psychiatric field continues to evolve in a world with nascent mobile technology (Hilty et al., 2014), novel neuroscience and genetic research, and new payment and care models (Fried et al., 2014) it is likely that the psychiatry residents learn today will not match what they will be practicing tomorrow. Residents have the opportunity to help shape that future through conducting research today. While the prospect of research can initially seem daunting to the busy resident, here we examine, from psychiatry residents’ perspective, the common pitfalls and rewards of research during residency. ß 2014 Elsevier B.V. All rights reserved.
Keywords: Residency Education Research
It is important for residents to become involved in research efforts early in their training rather than waiting until after graduation. While residency is a busy time given the demands of clinical duties and call, it is also a time when residents are sheltered from the demands of administrative and billing work. Starting a project early in residency affords the opportunity to develop a more balanced experience and learn how to integrate research time with clinical work. Research exposure may also influence residents’ long-term professional choices. 1. Challenges and obstacles Despite the field’s need for more clinicians with research experience, there are many obstacles that psychiatry residents may face as they seek to engage in research (Abrams, 2003). One barrier may simply be an intimidation factor. While the word ‘research’ often conjures up images of wet labs and pipettes, the range of both research topics and modalities in psychiatry is enormous, encompassing everything from the basic biology of synapses to psychotherapy outcomes or public policy. Residents new to the field may feel that they do not know enough to contribute, but their unbiased perspective is actually a tremendous advantage enabling them to re-examine longstanding questions in a new light. From healthcare delivery Fried et al., 2014 research, studies of novel technology (Hilty et al., 2014), to the study of
* Corresponding author at: Harvard Longwood Psychiatry Residency Training Program, 330 Brookline Ave., Boston, MA 02215, United States. Tel.: +1 617 667 4630; fax: +1 617 667 5575. E-mail address: [email protected] (J. Torous). http://dx.doi.org/10.1016/j.ajp.2014.12.001 1876-2018/ß 2014 Elsevier B.V. All rights reserved.
genetic polymorphisms, residents have the opportunity to contribute to the future of psychiatry at the largest and smallest levels. But even for those residents who are aware of the broad opportunities, navigating the logistical hurdles of research is still a barrier. One barrier that cannot be overlooked are the clinical demands of residency training (Mulderig et al., 1992). Research and writing necessitate uninterrupted spans of time for concentrated work, which tends to be scarce during clinical training. Relatively few psychiatry programs appear to offer protected research time, although the balance is gradually changing. While many internal medicine and neurology programs provide dedicated ‘elective’ rotations without clinical duties, the longitudinal nature of outpatient training in the second half of psychiatry residency may make it difficult to schedule blocks of purely non-clinical elective time. A recent survey indicated that both residents and faculty consider research training important, but only 32% felt such should actually be required according to one study (Fitz-Gerald et al., 2001). With the promulgation of the Accreditation Council for Graduate Medical Education milestone evaluation criteria for psychiatry residency programs (Thomas and Keepers, 2014), there is the possibility that more programs may offer research time and opportunities in order to fulfill the Practice-Based Learning and Improvement competency criteria. Choosing a mentor is likely the most important factor for fruitful resident research but is also one of the most difficult decisions (Mulderig et al., 1992). There are several approaches to take when choosing a mentor. One is to first select a topic or disease of interest to the resident, then look into investigators researching that subject. Another approach is to somewhat deprioritize interest in a select topic and instead focus on the
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J. Torous, J. Padmanabhan / Asian Journal of Psychiatry 13 (2015) 81–82
investigator, choosing one who has an established reputation, access to data, or a track record of excellence in mentoring. Early career investigators may have smaller labs and potentially more time for one-on-one guidance, while later career investigators may have stores of data that could be mined, but may have less time for individual instruction. However, in the latter cases, there are often research assistants or junior faculty who can serve that role and assist with technical issues. Additionally, program directors and senior residents can often provide the new resident with a vetted list of mentors that may save the new resident from a long search or a potentially unproductive research experience. Senior residents can also serve as valuable peer mentors, demonstrating to new residents how to integrate research with clinical demands. Choice of project is another fundamental decision (Keshavan, 2012) that residents face. Selecting projects founded on translational research often allows for better success, as these projects are often more related to clinical care and results are often more tangible. Of course, many residents also do well with more abstract or theoretical psychiatry research as well. Given residents time constraints and the administrative hurdles involved in data collection, it often makes sense to pursue a project analyzing data that has already been collected. Residents may also have success with projects involving computerized surveys of clinicians or patients. Chart reviews may also offer faster access to data, although psychiatric records typically contain fewer quantifiable data points. Good mentorship is often crucial in helping residents narrow their area of interest into a practical, answerable research question. Finally, some projects may require additional resources or funding. Many residents may become discouraged at the prospect of finding funds and not realize that they are actually able to draw from many different resources. If residents first check at the departmental, then university, and finally national level, they will often discover that there are special funds set aside for resident research. As an example, Harvard University in Boston sponsors the Harvard Catalyst program, which provides a broad array of support for resident researchers. Keeping an open mind and exploring all potential sources of funding will often provide the additional resources necessary for a resident research project. 2. Benefits and rewards Despite the numerous obstacles, research during residency offers many rewards, many of which may not be evident until the resident is well into their project. Research allows the resident to develop indepth knowledge on an aspect of psychiatry, whether it is a specific disorder, a neurobiological process, or a treatment modality. Participation in research may yield behind-the-scenes insight into the limitations of the current state of knowledge and may offer a broader perspective on the challenges in advancing the field. The process of research requires developing analytic reasoning skills and often requires specific technical skills as well, such as statistics. Although skill development is an obstacle, it can often be
an intrinsically satisfying process in itself, and skills can sometimes be carried over to other settings. Residents frequently report enjoying the opportunity to ‘exercise’ a part of their brain that is not normally used during their other work. Analytical skills are only part of the personal growth that can happen through participation in research. The process of completing a project can be emotionally as well as intellectually challenging, requiring patience, steadfastness, and tolerance of uncertainty. While the clinical world tends to be governed by hierarchy and routine, research involves self-reliance, independent thinking, and initiative, given the lack of established ‘rules’ about how things should be done. For example, it is usually necessary in the course of a project to choose between different methods or analytic approaches, and there will likely be no hard and fast guidelines about how to do so. For residents acculturated to the clinical setting, participation in research may help develop a more entrepreneurial attitude, in which the status quo must be challenged. A number of other intangible benefits await residents involved in research. The opportunity to present work at scholarly meetings allows residents to see the value of their own efforts while simultaneously forming useful professional connections. Sharing one’s original work with an interested audience offers a unique intellectual thrill. Involvement in research also provides the chance to form friendships and connections with others with similar interests. Last, but not least, even small successes in research may generate satisfaction at having contributed to the advancement of the field. While it impossible to predict how psychiatry will evolve in the near future, it is likely that residents who engage in research will have a role in shaping that future. Despite the barriers to research during residency, involvement in research offers numerous rewards that can propel residents toward their professional and personal goals.
References Abrams, MT, Patchan, K, Boat, TF (Eds.), 2003. Institute of Medicine (US) Committee on Incorporating Research into Psychiatry Residency Training. Research Training in Psychiatry Residency: Strategies for Reform. National Academies Press (US), Washington, DC. Available from: http://www.ncbi.nlm.nih.gov/books/ NBK222021/ Fitz-Gerald, M.J., Kablinger, A., Manno, B., Carter, O.S., Caldito, G., Smith, S., 2001. Psychiatry residents’ participation in research. Acad. Psychiatry 25 (1) 42–47. Fried, J.L., Arbuckle, M.R., Weinberg, M., Carino, A., McQuistion, H.L., Shoyinka, S.O., Skiandos, A., Stern, D.A., Ranz, J.M., 2014. Psychiatry residents’ experiences with systems-based practice: a qualitative survey. Acad. Psychiatry 38 (4) 414–419. Hilty, D.M., Belitsky, R., Cohen, M.B., Cabaniss, D.L., Dickstein, L.J., Bernstein, C.A., Kaplan, A.S., Scheiber, S.C., Crisp-Han, H.D., Wrzosek, M.I., Silberman, E.K., 2014. Impact of the information age on residency training: communication access to public information, and clinical care. Acad. Psychiatry. Keshavan, Matcheri S., 2012. How to come up with a research idea. Asian J. Psychiatry 5 (1) 108–110. Mulderig, J., Sansone, R.A., Fine, M.A., 1992. Psychiatry residents’ attitudes toward personal involvement in research. Acad. Psychiatry 16 (2) 96–102. Thomas, C.R., Keepers, G., 2014. The milestones for general psychiatry residency training. Acad. Psychiatry 38 (3) 255–260.
Contents lists available at ScienceDirect
Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Research by residents: Obstacles and opportunities John Torous a,b,*, Jaya Padmanabhan b,c a
Harvard Longwood Psychiatry Residency Training Program, Boston, MA, United States Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States c McLean Hospital, Boston, MA, United States b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 24 October 2014 Accepted 3 December 2014
As the psychiatric field continues to evolve in a world with nascent mobile technology (Hilty et al., 2014), novel neuroscience and genetic research, and new payment and care models (Fried et al., 2014) it is likely that the psychiatry residents learn today will not match what they will be practicing tomorrow. Residents have the opportunity to help shape that future through conducting research today. While the prospect of research can initially seem daunting to the busy resident, here we examine, from psychiatry residents’ perspective, the common pitfalls and rewards of research during residency. ß 2014 Elsevier B.V. All rights reserved.
Keywords: Residency Education Research
It is important for residents to become involved in research efforts early in their training rather than waiting until after graduation. While residency is a busy time given the demands of clinical duties and call, it is also a time when residents are sheltered from the demands of administrative and billing work. Starting a project early in residency affords the opportunity to develop a more balanced experience and learn how to integrate research time with clinical work. Research exposure may also influence residents’ long-term professional choices. 1. Challenges and obstacles Despite the field’s need for more clinicians with research experience, there are many obstacles that psychiatry residents may face as they seek to engage in research (Abrams, 2003). One barrier may simply be an intimidation factor. While the word ‘research’ often conjures up images of wet labs and pipettes, the range of both research topics and modalities in psychiatry is enormous, encompassing everything from the basic biology of synapses to psychotherapy outcomes or public policy. Residents new to the field may feel that they do not know enough to contribute, but their unbiased perspective is actually a tremendous advantage enabling them to re-examine longstanding questions in a new light. From healthcare delivery Fried et al., 2014 research, studies of novel technology (Hilty et al., 2014), to the study of
* Corresponding author at: Harvard Longwood Psychiatry Residency Training Program, 330 Brookline Ave., Boston, MA 02215, United States. Tel.: +1 617 667 4630; fax: +1 617 667 5575. E-mail address: [email protected] (J. Torous). http://dx.doi.org/10.1016/j.ajp.2014.12.001 1876-2018/ß 2014 Elsevier B.V. All rights reserved.
genetic polymorphisms, residents have the opportunity to contribute to the future of psychiatry at the largest and smallest levels. But even for those residents who are aware of the broad opportunities, navigating the logistical hurdles of research is still a barrier. One barrier that cannot be overlooked are the clinical demands of residency training (Mulderig et al., 1992). Research and writing necessitate uninterrupted spans of time for concentrated work, which tends to be scarce during clinical training. Relatively few psychiatry programs appear to offer protected research time, although the balance is gradually changing. While many internal medicine and neurology programs provide dedicated ‘elective’ rotations without clinical duties, the longitudinal nature of outpatient training in the second half of psychiatry residency may make it difficult to schedule blocks of purely non-clinical elective time. A recent survey indicated that both residents and faculty consider research training important, but only 32% felt such should actually be required according to one study (Fitz-Gerald et al., 2001). With the promulgation of the Accreditation Council for Graduate Medical Education milestone evaluation criteria for psychiatry residency programs (Thomas and Keepers, 2014), there is the possibility that more programs may offer research time and opportunities in order to fulfill the Practice-Based Learning and Improvement competency criteria. Choosing a mentor is likely the most important factor for fruitful resident research but is also one of the most difficult decisions (Mulderig et al., 1992). There are several approaches to take when choosing a mentor. One is to first select a topic or disease of interest to the resident, then look into investigators researching that subject. Another approach is to somewhat deprioritize interest in a select topic and instead focus on the
82
J. Torous, J. Padmanabhan / Asian Journal of Psychiatry 13 (2015) 81–82
investigator, choosing one who has an established reputation, access to data, or a track record of excellence in mentoring. Early career investigators may have smaller labs and potentially more time for one-on-one guidance, while later career investigators may have stores of data that could be mined, but may have less time for individual instruction. However, in the latter cases, there are often research assistants or junior faculty who can serve that role and assist with technical issues. Additionally, program directors and senior residents can often provide the new resident with a vetted list of mentors that may save the new resident from a long search or a potentially unproductive research experience. Senior residents can also serve as valuable peer mentors, demonstrating to new residents how to integrate research with clinical demands. Choice of project is another fundamental decision (Keshavan, 2012) that residents face. Selecting projects founded on translational research often allows for better success, as these projects are often more related to clinical care and results are often more tangible. Of course, many residents also do well with more abstract or theoretical psychiatry research as well. Given residents time constraints and the administrative hurdles involved in data collection, it often makes sense to pursue a project analyzing data that has already been collected. Residents may also have success with projects involving computerized surveys of clinicians or patients. Chart reviews may also offer faster access to data, although psychiatric records typically contain fewer quantifiable data points. Good mentorship is often crucial in helping residents narrow their area of interest into a practical, answerable research question. Finally, some projects may require additional resources or funding. Many residents may become discouraged at the prospect of finding funds and not realize that they are actually able to draw from many different resources. If residents first check at the departmental, then university, and finally national level, they will often discover that there are special funds set aside for resident research. As an example, Harvard University in Boston sponsors the Harvard Catalyst program, which provides a broad array of support for resident researchers. Keeping an open mind and exploring all potential sources of funding will often provide the additional resources necessary for a resident research project. 2. Benefits and rewards Despite the numerous obstacles, research during residency offers many rewards, many of which may not be evident until the resident is well into their project. Research allows the resident to develop indepth knowledge on an aspect of psychiatry, whether it is a specific disorder, a neurobiological process, or a treatment modality. Participation in research may yield behind-the-scenes insight into the limitations of the current state of knowledge and may offer a broader perspective on the challenges in advancing the field. The process of research requires developing analytic reasoning skills and often requires specific technical skills as well, such as statistics. Although skill development is an obstacle, it can often be
an intrinsically satisfying process in itself, and skills can sometimes be carried over to other settings. Residents frequently report enjoying the opportunity to ‘exercise’ a part of their brain that is not normally used during their other work. Analytical skills are only part of the personal growth that can happen through participation in research. The process of completing a project can be emotionally as well as intellectually challenging, requiring patience, steadfastness, and tolerance of uncertainty. While the clinical world tends to be governed by hierarchy and routine, research involves self-reliance, independent thinking, and initiative, given the lack of established ‘rules’ about how things should be done. For example, it is usually necessary in the course of a project to choose between different methods or analytic approaches, and there will likely be no hard and fast guidelines about how to do so. For residents acculturated to the clinical setting, participation in research may help develop a more entrepreneurial attitude, in which the status quo must be challenged. A number of other intangible benefits await residents involved in research. The opportunity to present work at scholarly meetings allows residents to see the value of their own efforts while simultaneously forming useful professional connections. Sharing one’s original work with an interested audience offers a unique intellectual thrill. Involvement in research also provides the chance to form friendships and connections with others with similar interests. Last, but not least, even small successes in research may generate satisfaction at having contributed to the advancement of the field. While it impossible to predict how psychiatry will evolve in the near future, it is likely that residents who engage in research will have a role in shaping that future. Despite the barriers to research during residency, involvement in research offers numerous rewards that can propel residents toward their professional and personal goals.
References Abrams, MT, Patchan, K, Boat, TF (Eds.), 2003. Institute of Medicine (US) Committee on Incorporating Research into Psychiatry Residency Training. Research Training in Psychiatry Residency: Strategies for Reform. National Academies Press (US), Washington, DC. Available from: http://www.ncbi.nlm.nih.gov/books/ NBK222021/ Fitz-Gerald, M.J., Kablinger, A., Manno, B., Carter, O.S., Caldito, G., Smith, S., 2001. Psychiatry residents’ participation in research. Acad. Psychiatry 25 (1) 42–47. Fried, J.L., Arbuckle, M.R., Weinberg, M., Carino, A., McQuistion, H.L., Shoyinka, S.O., Skiandos, A., Stern, D.A., Ranz, J.M., 2014. Psychiatry residents’ experiences with systems-based practice: a qualitative survey. Acad. Psychiatry 38 (4) 414–419. Hilty, D.M., Belitsky, R., Cohen, M.B., Cabaniss, D.L., Dickstein, L.J., Bernstein, C.A., Kaplan, A.S., Scheiber, S.C., Crisp-Han, H.D., Wrzosek, M.I., Silberman, E.K., 2014. Impact of the information age on residency training: communication access to public information, and clinical care. Acad. Psychiatry. Keshavan, Matcheri S., 2012. How to come up with a research idea. Asian J. Psychiatry 5 (1) 108–110. Mulderig, J., Sansone, R.A., Fine, M.A., 1992. Psychiatry residents’ attitudes toward personal involvement in research. Acad. Psychiatry 16 (2) 96–102. Thomas, C.R., Keepers, G., 2014. The milestones for general psychiatry residency training. Acad. Psychiatry 38 (3) 255–260.
