Training the Next Generation Of Patient-Oriented Investigators

Psychiatry is not exempt from concerns common to other areas of medical research regarding the“ endangered” status of the patient-oriented physician scientist. Nonetheless, promising developments—and more important, an invigorating spirit of cooperation among disparate entities within our field—provide grounds for optimism that we can and will reverse recent worrisome trends. APA is playing a key role in the turnaround, and I want to be sure that you all know of our contributions to a truly transformational process.

Problem Recognized and Addressed

Accelerating progress in neuroscience and behavioral science mirrored by burgeoning efforts in clinical and translational research has revealed a stark imbalance between the need for and the availability of psychiatrist investigators. These problems are particularly acute in child and adolescent psychiatry, but they also are critical factors in holding back the advancement of quality care across all clinical psychiatry. Fortunately—and thanks in large part to the proactive posture of the APA leadership— the National Institute of Mental Health (NIMH) has been aware of an impending but avertable crisis in clinical research for some time. In November 2001, during the tenure of NIMH director Steven Hyman, M.D., NIMH convened national leaders to begin formulating strategies to stimulate the training of patient-oriented investigators. As a participant in that meeting, APA helped frame a process for change.

An immediate outcome of the 2001 summit was NIMH's commissioning the Institute of Medicine (IOM) to conduct a study assessing obstacles to psychiatric research training and to propose solutions. Chair Thomas F. Boat, M.D., and committee members quickly realized that not only were the data quite limited, but also that several confounding factors had to be considered. Among them: the extent of psychiatric clinical research that is carried out by Ph.D. researchers as well as by psychiatrists, the smaller number of standard treatment approaches in psychiatry as compared with other specialties, and the traditional focus of psychiatry residency training on clinical competence rather than research competence or literacy. APA members interacted extensively with the IOM committee, and, indeed, APA was well represented on the committee.

The IOM's report, “Research Training in Psychiatry Residency: Strategies for Reform,” was published late last year (Psychiatric News, December 5, 2003). Its overarching recommendation called for the creation of a federation comprising all of the key organizations and authorities involved in psychiatric research training to obtain vital monitoring data; to promote coordination among the diverse and largely autonomous entities that have a role in planning, overseeing, and conducting psychiatry residency programs; and—a seemingly immense challenge—to devise a centralized plan for redressing problems.

What Has Evolved

Acknowledging the importance and urgency of the IOM recommendations, NIMH again stepped up to the plate and again called on APA to contribute both vision and muscle to the task of responding to the IOM. Last month NIMH Director Thomas R. Insel, M.D., convened the new National Psychiatry Training Council (NPTC). It is headed by John Greden, M.D., chair of the APA Council on Research and the department of psychiatry at the University of Michigan, and James Leckman, M.D., director of research at the Yale Child Study Center. The NPTC debut was historic in that—for the first time in the collective memory of participants—it successfully pulled together every organization that has a stake and a voice in psychiatry residency research training. NIMH has charged the NPTC to do the following:

I want to list for the record of this historic occasion the organizations that participated:

In addition to NIMH and APA (represented by the medical director, American Psychiatric Institute for Research and Education, Council on Research, and Corresponding Committee on Research Training), they included the Residency Review Committee for Psychiatry, which is a component of the Accreditation Council for Graduate Medical Education; American Association of Chairs of Departments of Psychiatry; American Association of Directors of Psychiatric Residency Training; American Academy of Child and Adolescent Psychiatry; Association for Academic Psychiatry; American Board of Psychiatry and Neurology; American College of Neuropsychopharmacology; and Council of Deans. Also present were representatives from academic institutions that have been national leaders in training and developing students and residents for careers as adult and child and adolescent psychiatrist investigators. Additionally, advocacy groups and other allied organizations will be invited to join as members of task forces, consultants, advisors, and so on.

NIMH is requesting the field of psychiatry to work together to provide“ deliverables” that will ensure the next generation of psychiatrist investigators. Toward this end, proposals now on the table include changing residency training, offering flexible options for residents who want to strive for research careers, and making all psychiatry residents, regardless of career plans, “research literate.” It is also proposed that the NPTC work with and for training directors and programs to implement model strategies.

The tasks that lie ahead are formidable, and the route is strewn with potholes. How can we ensure flexibility in residency training without negatively impacting the emerging demands for assessing clinical competence or ABPN eligibility? How can we allow some residents to have more time for research without pressuring other residents or already overstretched hospital systems to have to provide more of the clinical care? How can we realize and assess research literacy for residents in systems that may not have adequate scientific programs or resources? How can we harness new technologies to achieve our vision and goals? How can we find and maintain stable funding for a long-term research agenda and training mission?

APA and your leaders are committed to helping the NIMH and the NPTC succeed. We will embrace the challenges with enthusiasm, and I pledge to keep you informed about our progress. ▪