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Developing Mental Health Researchers by Training Undergraduates: A Report of the Pittsburgh Experience, 1994-2008 By Gretchen L. Haas, PhD1; Jason Rosenstock, MD1; Edward M. Stricker, PhD2; A. Hussain Tuma, PhD1 1-Department of Psychiatry/University of Pittsburgh School of Medicine/ Western Psychiatric Institute and Clinic 2-Department of Neuroscience/University of Pittsburgh 1 Background Researc h Mentor Psychiatry has struggled with a serious ongoing shortage of academic scientists, hampering advancement of the field.1 Prior efforts to address this challenge have targeted early career physicians/investigators or even medical/graduate students with less than satisfactory success.2 Relatively little3 has been done to recruit students earlier in the course of their education—as during the undergraduate years--when critical career decisions are often made. This is despite the fact that a history of early research exposure and strong faculty mentorship is characteristic of many of those who choose to pursue careers in science or academic medicine.4 We sought to develop a model program that would provide early intensive exposure to neuroscience research and related clinical experiences to talented undergraduates, and to then follow career outcomes over a long period of time to better assess effectiveness. 2 At the three-year follow-up, we have data on 97 fellows (a 94% response rate). Over 85% of those trainees have chosen to pursue graduate education in health sciences (similar proportions to their initial plans with respect to graduate vs. medical school). Two-thirds have published research in peer-reviewed journals and/or presented their work in front of academic audiences; although over half of our students were female, male trainees were more than twice as likely to have published. Research Project: 20hpw x9mo, then 40hpw in lab/clinic Over 50 faculty provided multidisciplinary and collaborative research mentoring, education in research methods and mental health, and active experiences in clinical and basic science laboratories over a twelve-month period for about 10 scholars annually. Unlike the typically brief undergraduate research experience (two months in the summer and a few hours per week during the academic year), NIMH fellows worked a minimum of 20 hours per week during the academic year and more than 40 hours per week during the summer for at least a year. Fellows also worked on and took “ownership” of particular projects, rather than simply doing assigned tasks and chores based on the needs of the laboratory or clinic. This responsibility for project development and completion helped fellows better identify with the role of an investigator, much more so than in typical student research settings. Student Career Goals: Initial Plans vs. 3-Year Follow-up Clinical Rounds: 10hpw x1mo+ of inpatient exposure 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Student Formal Curriculum: Mental health course (patient interviews with experts), plus weekly seminars Peer Support 3 Guidance/Advising: Meetings, support, mentorship Other Students Speakers & Instructors Methods Through an NIMH R25 mental health education grant beginning in 1993-4, Pittsburgh’s Undergraduate Fellowship in Mental Health Research began providing direct research exposure to undergraduates from the local universities. We selected undergraduates who possessed high academic credentials and strong interest in research, many of whom were encouraged by existing faculty mentors. Clinical Precepto r Over 15 years, 149 students (55% female, 18% minorities, 30% rural) participated in the Fellowship. Our admission rate was about 55%, decreasing over the years as the program became more competitive. Student GPA at entry averaged 3.7 with no significant change over the course of the program. Most students were majoring in neuroscience or psychology and were planning careers in graduate or medical school. About half pursued clinical research in some area of psychiatry—schizophrenia, affective disorders, child psychiatry, etc. Others chose cognitive, developmental, health or other area of psychology, while almost 20% focused on more basic neuroscience, genetics, or biochemistry. Focus of Student Research 7% Neuroscience 19% Clinical Psychiatry Clinical Psychology Psychology/Cognitive Science Biology/Bioengineering Fellows also took part in monthly seminars, advanced neuroscience and clinical psychiatry coursework, and clinical rounds. They received special mentoring, weekly participation in a structured and supportive environment of students with similar interests, and exposure to psychiatric patients and academic psychiatrists (both clinician-educators and investigators). These experiences exposed students not only to psychiatry and mental health, but also to other areas of health and human development that fostered a broad view of the relationships between mind, brain and behavior. 64% Other None 45% Initial Plans Other 16% Biology 18% Other PhD Neuroscience Psychology 3Yr F-U 4 5% 1% 4% Neurobiology MD By the five-year follow-up, our response rate dropped to 87%, giving us data on 72 graduates. The proportion no longer working in science had risen to 40%, but about a third were pursuing or had completed medical school while one in five continued in graduate work. Over half were doing some research, and three out of four of those graduates had kept their research focus on brain and behavior. Results 30% 7% 10% MD/PhD Program Leadershi p Student Major at Entry (N=149) Five-Year Follow-Up: Research Focus 51% Basic Science Other Discussion/Conclusion The initial goal of the Pittsburgh Undergraduate Fellowship in Mental Health Research was to address the severe and still ongoing shortage of new trainees entering the field of academic psychiatry and related disciplines. However, assessing the success of this endeavor may be extremely challenging, for two reasons: 1) program graduates are still in training and their career goals have not yet been settled, and 2) lacking a control group, we may never know whether their experience in the program helped shape their career path, or if they would have found their way even without participating in the Fellowship. On the other hand, we can say that the Fellowship provided an outstanding educational experience for undergraduate students, an experience which is very unusual if not absolutely unique (particularly the systematic early exposure to psychiatric patients and academic psychiatrists). Furthermore, findings from this project do, at least, demonstrate the feasibility of training undergraduates in mental health research. While not every fellow pursued mental health careers, almost all have gone on to advanced training and most have produced scholarly output. These outcomes far exceed what are typical for pre-medical education programs, and the rates of recruitment found for training programs that engage students at the medical student or graduate student level of training. This Fellowship has worked largely because of the local juxtaposition of collaborative basic and clinical science departments, with a critical mass of research faculty willing and able to serve as mentors; this situation exists at other institutions, and we believe this model is a useful approach for other programs to consider. 23% References: In-program satisfaction measures demonstrated high collective satisfaction with their experiences. Students most highly valued their mentorship relationships, but also cited formal coursework, the seminar series, and the summer clinical rounds as powerful and important for their training. Response Rates to Follow-Up Surveys We contacted graduates at regular intervals to assess their work, education, and scientific accomplishments. Follow-up rates were quite high; even at 10 years, we obtained data on 44% of graduates. 1. Kupfer DJ, Hyman S, et al. Recruiting and retaining future generations of physician scientists in mental health. Arch Gen Psychiatry 2002; 59:657–660. 2. Yager J, Greden J, et al. The Institute of Medicine’s report on research training in psychiatric residencies: strategies for reform—background, results, and follow up. Acad Psychiatry 2004; 28:267–274. 3. Jeste DV, Halpain MC, et al. UCSD’s short-term research training programs for trainees at different levels of career development. Acad Psychiatry 2007; 31:160-167. 4. O’Sullivan PS, Neihaus B, et al. Becoming an academic doctor: perceptions of scholarly careers. Med Educ 2009; 43:335-341. 140 120 100 80 60 No data 40 Completed 20 0 1yr 3yr 5yr Years after graduation 10yr Special thanks to: David J. Kupfer, MD; Aaron Jacoby, PhD; Julianne Faria, MA and all of the student and faculty participants in the program.