Original Article

Growing Our Own: A Regional Approach to Encourage Psychiatric Residents to Enter Research
Mark E. Kunik, M.D., M.P.H., Sonora Hudson, M.A., Brenda Schubert Henry Nasrallah, M.D., JoAnn E. Kirchner, M.D. Greer Sullivan, M.D., M.S.P.H.
Objective: This article describes a regional program developed by the Department of Veterans Affairs South Central Mental Illness Research, Education and Clinical Center for training psychiatry residents in research and attracting them to academic careers. Methods: The authors describe a low-cost, innovative program developed to increase the number of psychiatry residents entering postresidency research training fellowships by providing them with mentorship and exposure to seasoned researchers, didactic coursework, and a stipend to cover academic expenses. Results: Over the rst 4 years, the program has generated enthusiastic participation among postgraduate year 3 (PGY-3) residents, with a high percentage of underrepresented ethnic minorities and women. Products include publication of four rst-authored and two coauthored manuscripts, one rstauthored abstract, submission of six additional papers, 28 academic presentations and development of research projects. Half of graduating awardees have gone on to pursue research careers. Conclusion: Our regional approach provides sufcient academic expertise to make residency training feasible in a costeffective manner.
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Received February 26, 2007; revised May 31 and July 18, 2007; accepted July 25, 2007. Dr. Kunik is afliated with the Menninger Department of Psychiatry and Behavioral Sciences, and Department of Medicine, at Baylor College of Medicine in Houston, Tex.; Dr. Kunik and Ms. Hudson are afliated with the Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, in Houston; Drs. Kunik, Kirchner, Sullivan and Ms. Schubert are afliated with the VA South Central Mental Illness Research, Education, and Clinical Center; Dr. Nasrallah is afliated with the Department of Psychiatry and the Neuroscience Program at the University of Cincinnati College of Medicine in Cincinnati, Ohio; Drs. Kirchner and Sullivan are afliated with the Department of Psychiatry at the University of Arkansas for Medical Sciences in Little Rock, Ark., and Dr. Sullivan is afliated with the RAND Gulf States Policy Institute. Address correspondence to Mark E. Kunik , M.D., M.P.H., Department of Psychiatry and Behavioral Science, Baylor College of Medicine, MEDVAMC, 2002 Holcombe (152), Houston, TX 77030; mkunik@bcm.tmc.edu (e-mail). Copyright 2008 Academic Psychiatry

cademic centers that produce the greatest volume of research and researchers tend to be at large academic institutions with long-standing research programs (1). Since key skills (writing effective research proposals, becoming procient in research design methods and statistics, conducting research, and disseminating research ndings) required for a successful clinician researcher are most often learned through apprenticeship, building research programs in geographic areas without a substantial research base and with a limited pool of senior mentors is a challenge. This challenge is particularly intense in specialties already experiencing uctuations in recruitment, such as psychiatry. Trends in the 90s showed declining numbers of U.S. psychiatric residents and downsizing of training programs (2), in addition to negative attitudes of new medical students toward psychiatry (3). Recent gures show approximately a 4% interest level in U.S. senior medical school students in entering general psychiatry residency programs (4). The insufcient numbers of residents entering the research training path (5) and the small percentage of psychiatrists who consider research their dominant activity (estimated from surveys in 1999 and 2000 to be fewer than 2% of all U.S. psychiatrists) (6) are cause for concern for the future growth of academic psychiatry. Reports from psychiatry (7) and other specialties (810) have linked intensive research experience during residency
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with future research activity, and a program that mentors medical students and psychiatric residents has been successful in resulting in rst publications for participants (11). As evidenced by the numerous residency research training efforts now underway nationally (12), the general consensus is that exposure to research theory and practice during residency will encourage more psychiatrists to pursue a research career. The Training Residents in Psychiatry Scholarship (TRIPS) Program (for description, see section Components of the Program) was established by the U.S. Department of Veterans Affairs (VA) South Central Mental Illness Research Education and Clinical Center (MIRECC) in 2003 in response to an Institute of Medicine Report (13), with the aim of increasing the number of psychiatry residents entering postresidency research training fellowships in the South Central VA network. Intended to expose residents in psychiatry to research and academic careers, it represents a regional effort and collaboration between 10 VA medical centers and six schools of medicine.

3 year, which allows time to learn about a research career and consider a postresidency research fellowship. Selected residents send the research training director a letter of acceptance that includes information about their research interests. The MIRECC administrative assistant and research training director then schedule a conference call with all awardees for an initial discussion of the program.

Regional Elements of the Program The South Central MIRECC is based in Veterans Integrated Service Network 16, which includes most of Arkansas, Louisiana, Mississippi, Oklahoma, adjacent areas of eastern Texas, and parts of Florida, Alabama, and Missouri. In this very large region, six of 10 VA Medical Centers have academic afliations with medical schools. The South Central MIRECC has established very strong collaborative relationships with the Departments of Psychiatry at Baylor College of Medicine in Houston, Tex., the University of Mississippi in Jackson, Tulane School of Medicine in New Orleans, La., and the University of Arkansas for Medical Sciences in Little Rock, the locations where it has its key research and administrative anchor sites. Afliations also exist with the University of Oklahoma and Louisiana State University-Shreveport. MIRECCs have research, education, and clinical missions; within this context, research may have a basic science, clinical, or services research orientation. Annually, the residency training directors of the six medical schools are each asked to name one TRIPS awardee from their postgraduate year 2 (PGY-2) class. Applicants are selected on the basis of demonstrated interest in a career as a clinical scientist and/or a career in mental health research, academic medicine, and the VA, in addition to good academic standing and leadership potential. Residents are chosen at the PGY-2 year to provide them with the TRIPS experience through the entire PGYAcademic Psychiatry, 32:3, May-June 2008

Components of the Program Benets of the TRIPS program include travel to a South Central MIRECC regional meeting, a 3-day conference that rotates between Houston, Tex., Little Rock and Jackson, Miss.; the opportunity to attend didactic sessions; assignment of a research career mentor; and a stipend. Attendance at the South Central MIRECC annual meeting occurs at the end of the PGY-2 year, shortly after selection, and is the participants rst formal introduction to TRIPS. The meeting provides the awardee the opportunity to learn about new scientic developments and make formal oral presentations and/or posters; but, more importantly, it provides and facilitates informal interactions with mental health fellows and researchers. A 4-hour didactic workshop especially for the awardees, led by two MIRECC investigators, both research psychiatrists, is held during the annual meeting. Lectures cover a variety of topics, including an overview of MIRECC and its academic mission, as well as an overview of the TRIPS program and mental health research priorities, and describe the attraction of a career in research and successful pathways to a research/ academic career. TRIPS awardees are assigned a research career mentor throughout their PGY-III year. The primary role of the mentor is to provide one-on-one guidance, coaching, information, personal encouragement, and career counseling on research careers in psychiatry. Mentors are primarily psychiatrists who spend a substantial portion of their time in research pursuits. They are chosen based on geographic proximity and shared interests with the awardee; however, about half the time, a local mentor is not available, so a remote mentor at another institution may be assigned. Mentors are compensated $500 for the year and are expected to have regular (at least quarterly) telephone or in-person meetings with the TRIPS awardee. Mentors and awardees are encouraged to develop projects together, but the minimal expectation is the four meetings focused on career development. Mentors and awardees are provided with a mentee-needs assessment, a tool to help initiate focused discussion, before the rst call (Table 1).
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They are contacted by the program administrator on a quarterly basis to ensure that calls are occurring. The $1,000 academic allowance awarded to participants is intended to be used for books, journals, and travel to scientic conferences. It is paid in installments, with $250 paid at the start of the year and the nal payment at the end of the year upon successful completion of the TRIPS experience, which includes attending the MIRECC meeting and having at least four conference calls with the mentor.

coordinates the program. The total annual cost of the program has been approximately $15,000 for an average of six awardees.

Results
The program has been successful, with two schools requesting that they be allowed to select additional awardees. From 2003 through 2006, 26 residents were selected to participate in the program (University of Mississippi, six; University of Arkansas for Medical Sciences, ve; University of Oklahoma Health Science Center, two; Tulane School of Medicine, ve; Baylor College of Medicine, four; and Louisiana State University-Shreveport, four). Of the 26 awardees selected, 13 (50%) have belonged to an underrepresented ethnic minority; and 7 (26.5%) have been women. All but one of the awardees have successfully completed the program (this individual was prevented from continuing by the disruption caused by Hurricane Katrina in 2005). Resulting publications (during their residencies) have included four rst-authored and two coauthored manuscripts, and one rst-authored abstract; six additional papers have been submitted, 28 academic presentations have been presented, and a number of projects have been developed under the guidance of research mentors. Of the rst two groups of graduating TRIPS awardees, six (50%) have accepted a fellowship or academic position. According to feedback from awardees, the most valuable aspects of the program are the opportunity to learn about the MIRECC as a network-wide research center and identify strategies for developing career and research interests, the opportunity to learn about research and think in terms of translation, and interactions with MIRECC leaders and mentors. The most frequent suggestion for improving the program has been to extend it beyond 1 year and to continue mentoring for a minimum of 2 years. The achievements of one 2006 TRIPS participant highlight how the program can benet residents. Although this may not be a typical outcome, it illustrates what can be achieved with a talented, motivated trainee, committed mentors and a supportive environment. As a TRIPS participant, this resident (also a PhD candidate in neuroscience) was able to devote 25% of his time to research, which provided time for him to work with a project already underway at the Michael E. DeBakey VA Medical Center (MEDVAMC), using magnetoencephalography to look at plasticity in patients with stroke. During his TRIPS year, he wrote a manuscript that won the Resident Paper Award for 20052006 from the Journal of PsyAcademic Psychiatry, 32:3, May-June 2008

Costs of the Program The costs of the TRIPS program, funded by the South Central MIRECC, include the honorariums to mentors and stipends to awardees, travel to the annual meeting, and 10% of the costs of an administrative assistant who
TABLE 1. TRIPS Awardee Needs Assessment Form
Needs Assessment Directions: This form should be used to facilitate a discussion between mentor and mentee regarding the mentees training needs and interests. The mentee should email the completed form to his/her mentor before the rst contact. Rate each area on a scale of 15 (1no knowledge/skills, 5 very knowledgeable/skilled), and note specic areas of need/interest. Professional/Career Development Preparation for an academic career during residency Finding the right fellowship program Fellowship opportunities in the South Central United States Role of MIRECC in training and career development Choosing between a junior faculty position or fellowship Options for academic careers (e.g., clinician-educator, research-scientist) Career award grants Publications/Presentations Finding research projects during residency that may result in publications or presentations Authorship guidelines Writing skills Manuscript development skills (writing the sections of the manuscript, choosing a journal, communicating appropriately with editors, submitting a manuscript) Oral presentation skills Presentation experience (applying for a conference presentation, preparing a poster, preparing a paper presentation) Administration/Other Time management Time for writing Leadership experiences (local, regional, and national levels) Negotiating skills Knowledge about the MIRECC Knowledge about careers and research opportunities at the VA

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chiatric Practice (14) and rewrote part of his doctoral dissertation, developing an article that was published in the Journal of Pineal Research (15). In addition, he rewrote an earlier award-winning paper using a new perspective, which is now in revision and close to publication, presented a paper at the Southern Medical Association Annual Conference in October 2006 and presented at Grand Rounds for the Baylor College of Medicine Department of Psychiatry in early 2007. According to this individual, he has beneted greatly from the networking opportunities afforded by his TRIPS experience and from quality mentoring in terms of his research and writing efforts. He used part of his TRIPS funding to take two courses at Rice University to improve his writing skills.

Discussion
The TRIPS program has been successful in sparking interest in research on the part of residents and has been a low-cost initiative that has successfully recruited a high percentage of individuals from underrepresented minorities and women. Since its inception in 2003 through 2006, it has provided 26 residents with an opportunity to work with a mentor to conduct research and draft a manuscript for possible publication and has generated greater interest in the networks postresidency fellowship program. The TRIPS program was initiated as the rst entry port of the research pipeline continuum of the South Central MIRECC, which regards itself as an incubator for young investigators. Other components include a fellowship program in psychiatry and psychology, a grant writing scholars program to train junior investigators to write successful grant applications, and pilot/bridging funding to help new investigators move forward until they receive external funding. Early on, leaders in the MIRECC recognized that having a successful research program would require both attracting more senior researchers to the region and to the MIRECC, and developing local training programs to promote research and grow our own investigators. The programs were designed on the basis of generally accepted recommendations for mental health research training (13). In particular, they provide trainees with a vehicle allowing them to move through the stages of training without interruption; support the participation of trainees in interest groups and exible research opportunities; provide nancial incentives beyond the core clinical training programs for residents; and successfully recruit women, minority researchers, and international medical
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graduates. They are also in line with recommendations suggested by proponents of some of the current leading models of research training in psychiatry (12) in that they are established on a regional basis, encourage students to attend national meetings in psychology/psychiatry and aggressively recruit women. The program has some limitations. At present it is limited to the VA system, specically, the South Central MIRECC; however, it should be easily exportable to other MIRECCS and other systems with components in different geographical settings. It is currently restricted to the PGY-3 year but would undoubtedly be more effective if it could be extended to a 2-year experience. Other strategies, such as incorporating a research track within the curriculum or providing intensive summer experiences, would also strengthen the program; however, both would entail considerable additional expense. One area that needs to be strengthened is our follow-up of participants after they complete their residencies; we need to carefully track them after they complete the program to determine whether they are continuing to pursue research interests to determine the success of our efforts. So far our data are primarily anecdotal in nature. One challenge for the TRIPS program is presented by the limited pool of psychiatrist research mentors in our region. When the South Central MIRECC was founded and competitively funded in 1998, it boasted only one researcher at the full professor level. Most individuals doing research, or interested in doing research, in mental health were assistant or associate professors; and many of the afliated medical schools in this region did not have strong track records in research within their departments of psychiatry. In the future, we may include mentors from outside our region. We have developed a telementoring program to facilitate mentoring when optimal matching involves collaboration outside the immediate research environment. In conclusion, the TRIPS program is one approach designed to expose psychiatric residents to research and researchers. It is innovative in that it represents a collaboration between six departments of psychiatry and the VA South Central MIRECC. This collective effort provides a critical mass of academic expertise to make it a feasible program. Conducted at modest cost, over the past 4 years it has encouraged academic pursuits in 26 residents, many of whom would not have had such an experience otherwise. Building psychiatric research capacity in this region is a long-term goal, and we cannot know at this time how successful our efforts have been. But the TRIPS program
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mental model for enhancing research training during psychiatry residency. Acad Psychiatry 2006; 30:5562 8. Bernstein J, Ahn J, Ianotti JP, et al. The required research rotation in residency: the University of Pennsylvania experience, 19781993. Clin Orthop Relat Res 2006; 449:9599 9. Dunn JC, Lai EC, Brooks CM, et al: The outcome of research training during surgical residency. Pediatr Surg 1998; 33:362 364 10. DeHaven MJ, Wilson GR, OConnor-Kettlestrings P: Creating a research culture: what we can learn from residencies that are successful in research. Fam Med 1998; 30:501507 11. Lambert MT, Garver DL: Mentoring psychiatric trainees rst paper for publication. Acad Psychiatry 1998; 22:4755 12. Balon R, Heninger G, Belitsky R: Medical school research pipeline: medical student research experience in psychiatry. Acad Psychiatry 2006; 30:1622 13. Committee on Incorporating Research into Psychiatry Residency Training, Board on Neuroscience and Behavioral Health: Research Training in Psychiatry Residency: Strategies for Reform. Washington, D.C., The National Academies Press, 2003 14. Bellon A: Searching for new options for treating insomnia: are melatonin and remelteon benecial? J Psychiatr Pract 2006; 12:229246 15. Bellon A. Melatonin induces neuritogenesis at early stages in N1E-115 cells through actin rearrangements via activation of protein kinase C and rho-associated kinase. J Pineal Res 2007; 42:214-221

has so far exceeded our expectations in creating enthusiasm for research among the next generation of psychiatry residents.
The authors would like to thank Patricia Dubbert, Ph.D., Michael Kauth, Ph.D., and Jennifer Vasterling, Ph.D., for their assistance in the preparation of this manuscript.

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