‘Good clinical care leads inevitably to good clinical questions for which we need evidence’
From ACLP president Maryland Pao, MD, FACLP
A Psychiatry resident recently asked me how I got into research. I was not one of those people who knew they wanted to be a researcher, or to administer research for a living—who even knew the latter was a job?
When I was in medical training, the consummate academic or ‘compleat’ physician we were striving to be was an astute clinician who provided excellent clinical care, was an engaged educator, and ‘did research’—the so-called ‘triple threat’, a three-legged stool. Advocacy was added as the fourth leg along the way.
This tradition was borne out of an environment where clinical research was initially largely conducted at the bedside, before educators, researchers, and clinicians were separated into different tracks for promotion in the 1990s.
I learned early that I was a good listener and liked being with patients, hearing their stories, helping them see how their behaviors and thoughts might be linked. I intentionally chose my residency training program with a focus on being a strong clinician first and foremost.
I grew into research organically, but a few key seeds were present in the soil. You have to be curious and open to new experiences to broaden your understanding of the world around you and ‘discover’ guiding principles. It helps if you love to read and like to write. Being able to tolerate rejection and delayed gratification without mortal wounding helps.
I also like to look for emerging trends. Every learning environment I found myself in pushed me out of my comfort zone of an obedient, rule-following Asian child. “How does it work?” or “Can you test a hypothesis?” my professors demanded. My parents were both psychiatrists. My father was a prominent psychoanalyst, but psychoanalysis alone did not offer me refutable hypotheses. However, C-L Psychiatry gave me a brain-based and mind dualism that satisfied my appreciation of the whole person in complicated contexts. My pediatric chair’s mantra was: “Question authority.” This was particularly hard for me, but I learned.
After about five years of running my second pediatric C-L service, I began to recognize clinical patterns that I was encouraged to share through publication. I began to have more questions I couldn’t answer and for which there was NO evidence. I had mentors who showed me how to collect and write-up evidence, skills that can be taught. Every few years I would challenge myself on my current clinical practice: “How do I know what I know? Do I really know what are the best antidepressants to use in medically ill children? What is the evidence?”
Along the way I learned how research is conducted and evaluated, about human subjects protections, about institutional regulatory requirements; in other words, I learned new skills outside of being a C-L psychiatrist. Working on research teams has similar qualities to leading a C-L Psychiatry team. Though it took me several years to produce my first research paper (longer than it takes to gestate a baby!), I learned that research papers can have a larger impact on overall patient care in hospitals than working with a single patient. I was hooked.
Concurrently, using my C-L skills, I realized I am capable of working with complex hospital systems, people management, and liaising with other administrators to get things done. At the NIMH [National Institute of Mental Health], I learned I had a knack for research administration—and I enjoy it! I collaborated with other, better researchers to learn about quality improvement methodology, partnered with statisticians, and learned about mixed methods, clinical trials, and basic neuroscience.
My journey into research has been long, circuitous, interesting, and impactful. I believe good clinical care leads inevitably to good clinical questions for which we need evidence. Clinicians and basic scientists can learn from one another to ask even better translational questions that hopefully lead to creative interventions and treatments. ‘Doing clinical research’ takes time and patience, both to acquire a variety of skills and to work with humans in their infinite variability and need.
At this year’s half-day preconference research colloquium at CLP 2023, I hope clinicians and researchers will gather to learn more about the resources of the NIMH, what it is funding these days, and to give feedback on what it should be funding. Then participants will be able to break out into small groups to meet at whatever level of discovery science they are embarking upon.
Whether you want to learn to ‘do’ research with a small ‘r’, or you want to conduct Research with a big R, and go for the R01, come to Austin and let’s acquire skills together on our career journey, and learn how to move the field of C-L Psychiatry forward for our patients.