BUMC-MGH Global Psychiatry Clinical Research Training Program
Psychiatric and neurological disorders are dominant contributors to the global burden of disability and mortality, linked to substantial social and economic costs, and associated with worse general health and chronic disease outcomes. The current dearth of mental health research in low to middle-income countries, and the limited human capacity to conduct rigorous, culturally-appropriate, clinically relevant studies in these areas with the highest needs, hinders the development of evidence-based policy and practice, and stunts the advancement of effective service delivery.
As communicable diseases are supplanted by non-communicable, chronic, and neurological and psychiatric diseases, the academic medicine workforce must be realigned with the emerging health priorities of the new century. The Global Psychiatry Clinical Research Training Program at Boston University Medical Campus (BUMC) and Massachusetts General Hospital (MGH) will prepare a cadre of researchers committed to working collaboratively across disciplines and cultures to address priority global mental health challenges through a well-defined clinical career path, rigorous training in clinical research methods, cross-cultural and public mental health competencies, and significant global mental health research experience in resource-constrained areas, conflict-affected settings and countries ravaged by poverty.
- David C. Henderson, MD – Professor and Chair, Department of Psychiatry and Assistant Dean, Diversity and Multicultural Affairs, Boston University Chobanian & Avedisian School of Medicine; Psychiatrist-in-Chief, Division of Psychiatry, Boston Medical Center. firstname.lastname@example.org
- Gregory L. Fricchione, MD – Director, Chester M. Pierce, MD Division of Global Psychiatry and Director Emeritus, Division of Psychiatry and Medicine, Massachusetts General Hospital; Director, Benson-Henry Institute for Mind Body Medicine. email@example.com
- Select candidates from a wide applicant pool, including outstanding psychiatrists, clinical psychologists, and PhD candidates from an accredited School of Public Health, targeting candidates’ motivation and potential for an independent research career in academic medicine.
- Provide fellows with financial support, scientific mentorship, didactic training, supportive institutional environment (domestic and abroad), and challenging research questions to assist productive independent research careers in global mental health.
- Create a cadre of health professionals who are committed to long-term global mental health in resource-limited areas, and who are able to work collaboratively across disciplines and borders.
- Harness the growing interest in issues in global health to attract high-quality trainees to the field of mental health and position graduates to become the mentors and educators of the future.
- Address the national shortage of globally oriented researchers in clinical psychiatry and psychology who can meet the mental health needs in resource limited and post-conflict areas.
- Boston University Medical Campus (Boston, MA)
- Massachusetts General Hospital (Boston, MA)
- Addis Ababa University (Addis Ababa, Ethiopia)
- Barbados Nutrition Study Research Centre (St. Michael, Barbados)
- Universidad Peruana Cayetano Heredia (Lima, Peru)
- University of Cape Town (Cape Town, South Africa)
- University of KwaZulu-Natal (Durban, South Africa)
- Stellenbosch University (Stellenbosch, South Africa)
- Mbarara University of Science and Technology (Mbarara, Uganda)
- National University of Kyiv-Mohyla Academy (Kyiv, Ukraine)
The core curriculum, which includes didactical instruction, coursework at the Boston University School of Public Health (BUSPH) or Harvard T.H. Chan School of Public Health (HSPH), and mentored research projects, will position graduates to become productive leaders in the field of global mental health and create an established collaborative research base to conduct further studies. It will provide a rich environment for fellows as they refine their research questions and career paths. Global mental health is a broad, interdisciplinary field that requires: diversified methodological training in quantitative and qualitative methods; an understanding of the impact of culture on the expression of and treatment strategies for mental illness; an appreciation of the nature and impact of psychosocial and other environmental factors on individual, community and society well-being; and general knowledge of the clinical phenomenology of mental disorders in cross-cultural populations.
The program will provide fellows with a basic knowledge in conducting psychiatric-related studies in international settings, field methods including measurement approaches and application in both clinical and community settings, and analytic methods for investigating prevention, intervention, and health promotion strategies in a global, public health, resource-limited context.
The program will include study in seven thematic cores in which fellows may focus their research training: addictions, mood disorders, psychotic disorders, PTSD/trauma/complex emergency, HIV mental health, women’s mental health, and childhood mental disorders. The program also offers a research methods core including clinical trials, qualitative/quantitative research, and translational/ implementation science. These thematic cores leverage the strengths of the faculty, the breadth of the National Institute of Mental Health (NIMH), the interest of potential trainees, the available research and training opportunities at the international sites, the needs of the populations in the training environments, and the general demands of the field.
Through a learn-by-doing approach, fellows will learn how to create a project of realistic scope, map a timeline for conducting an international study, select appropriate research methodologies, and understand the country and population. Upon completion of the fellowship, graduates will be able to:
- Conceptualize and evaluate mental health systems, policies and plans, and develop research questions that are clinically and culturally relevant to the identified community and public health needs.
- Build productive international collaborations with governments, NGOs and academics abroad.
- Develop and manage an international research team.
- Create and manage an international project of realistic scope, including mapping a timeline for conducting an international stud and selecting appropriate methodologies.
Based on the potential applicant pool, the strengths of the faculty, and the research needs of the field, we have structured the program to include psychiatrists, clinical psychologists, or PhD candidates from an accredited school of public health, depending on the quality of applicants. Key components of the proposed program include:
- Fellows will identify a primary mentor and a broad area of focus prior to starting the program. Once they are in the program, each fellow will be mentored by an identified international mentor, and will have access to ongoing faculty research in the U.S. and at the international sites.
- The fellowship will be structured around the following thematic cores, in addition to a research methods core: addictions, mood disorders, psychotic disorders, PTSD/trauma/complex emergency, HIV mental health, women’s mental health, and childhood mental disorders.
- Clinicians without PhD-level research training will be required to complete the Program in Clinical Effectiveness (PCE) at HSPH or equivalent courses at BUSPH in year 1 of the fellowship. They may also take supplemental courses at BUSPH under faculty mentor advisement.
- Fellows will be encouraged to attend the HPRT Trauma and Recovery course in Italy in November. While fellows may not focus directly on trauma, the curriculum provides valuable training in managing the challenges of conducting research in resource-limited environments.
- Fellows will conduct an international research project at one of the training sites where they will generate a proposal, obtain IRB approval, and collect data. Fellows will also generate a research proposal with their mentors within the first 18 months of starting their fellowship.
- Through the assistance of site-specific faculty mentors, fellows will identify existing datasets from the international sites that align with their research interests. They will work on secondary data analysis projects both to develop analytical and research skills and to meet authorship goals of the program.
- Fellows will participate in a monthly Research-in-Progress seminar with mentoring faculty. They will be expected to provide periodic, in-depth updates on the status of their research projects and to provide critical feedback to their peers during regularly-scheduled working meetings.
- Fellows will attend the BUMC/MGH Global Psychiatry Series, a weekly 90-minute interactive seminar led by former T32 fellows, program faculty and leaders in the field of global psychiatry.
- Fellows will participate in the monthly BUMC/MGH Global Mental Health Dinner Series. Fellows will meet with the presenting faculty/researcher for half an hour prior to the seminar.
- Fellows will benefit from a core global curriculum spanning the duration of the program (via weekly seminars with videoconferencing when traveling).
- Fellows will submit a NIH or equivalent K award application by the end of year 3 or earlier in the program when they have obtained adequate data and publications to be competitive for submission. While a successful grant award is not required during the fellowship, fellows will be well positioned to submit or resubmit their application during or shortly after the training program.
- Fellows may spend up to a half-day per week in clinical rotations to continue seeing patients, focusing on their area of interest when possible, at the BMC or MGH sites, both of which serve immigrant communities.
- An annual conference will be held at the international sites on a rotational basis, coinciding with the advisory committee evaluation meeting (funding permitted). This will expose new fellows to faculty and prior trainee research, develop a training community environment amongst the sites, help identify areas of common interest, and foster cross-country, collaborative research opportunities amongst BUMC, MGH, HSPH, and international groups.
- Fellows will be strongly encouraged to present their completed work at appropriate national meetings (e.g., American Society of Clinical Psychopharmacology (ASCP), World Psychiatric Association (WPA), World Federation of Mental Health (WFMH)) to encounter true extramural peer review.
Mentored Research Experience
To gain the skill sets and confidence to perform independent research, fellows will conduct an independent, mentored research project tailored to their unique career goals at one of the sites. They will also work on secondary data analysis projects using existing datasets from the international sites and identified by faculty mentors to develop analytical and research skills, and to meet authorship goals of the program. Each international site possesses a strong research portfolio, which aligns with the thematic areas of the training program and compliments the expertise of the domestic faculty at BUMC and MGH/HSPH. Each site also has an established research infrastructure for protocol development, IRB approval and data collection, and a proven track record for participant recruitment and study completion. Fellows will have access to patients, clinical samples, relevant patient databases and laboratory/equipment to support their projects. The international sites, supported by the primary training site, will provide a rich research-training environment for fellows. In addition to the history of scientific and training collaborations amongst the departments and the available resources of the institutions, the research activities of the participating faculty will enable trainees to rapidly immerse themselves in projects locally and globally at the interface of the thematic cores and methodological areas.
Representative research areas and program faculty available to fellows include:
- Addictions (Drs. Devine, Greenfield, Kagee, Kaplan, Magidson, Renner, M Stein, Teferra): substance use disorders, alcohol and stimulant dependence and trauma
- Mood Disorders (Drs. Barlow, Chang, Cohen, Fava, Fekadu, Galea, Jack, Nierenberg, D Stein, Trinh, Yeung): population-based epidemiological studies of depression, its antecedents, characteristics, consequences, and morbidity; biological and behavioral treatment strategies for mood disorders in resource-limited and cross-cultural settings; indigenous characterizations of mood disorders, etc.
- Psychotic Disorders (Drs. Asmal, Borba, Chiliza, Fekadu, Fricchione, Henderson, Holt, Kaplan, McGurk, Mueser,
Roffman, Teferra): origins and outcomes of schizophrenia in resource-limited areas; treatment use and effectiveness for schizophrenia in African populations; gender differences in presentation and treatment of schizophrenia; neurological impairments, brain structure and function; genetic studies and phenotype characterization; effectiveness of medication; social impact of schizophrenia on household functioning and economics, etc.
- PTSD/Trauma/Complex Emergency (Drs. Belfer, Bolton, Bogdanov, Galea, Galovski, Gradus, Henderson, Iverson, Kagee, Keane, Koenen, Park, Piwowarczyk, Rasmusson, Raviola, Seedat, Valentine, Vasterling): interactions of social environmental factors on the development and course of PTSD; resilience in war-affected youth; indigenous characterizations of trauma and PTSD; impact of trauma on family and community, etc.
- HIV Mental Health (Drs. Gouse, Joska, Kagee, Magidson, Maling, Mashaphu, Messersmith, O’Cleirigh, Rukundo, Seedat, M Stein, Tsai, Valentine): social determinants of ART adherence; impact of HIV on social network and economics; comorbidities with psychiatric disorders; interventions for high risk behaviors in adolescents and adults, etc.
- Women’s Mental Health (Drs. Boehmer, Cohen, Galler, Gelaye, Hibberd, Messersmith, Rondón, Williams): maternal & child health; genetic and environmental causes of adverse pregnancy outcomes and non-communicable disorders along the life course.
- Childhood Mental Disorders (Drs. Becker, Belfer, Bryce, Durham, Galler, Paruk; Raviola): childhood malnutrition and mental health outcomes; cognitive function outcomes in HIV/AIDS infected youth; depression treatment and impact on functioning and school/learning; childhood risk factors for psychiatric disorders; interventions to reduce substance abuse and early sex, etc.
- Research Methods (Drs. Asmal, Bolton, Bogdanov, Borba, Bryce, Cabral, Chiliza, Cohen, Drainoni, Fava, Fekadu, Gelaye, Gouse, Henderson, Jack, Kagee, Magidson, Messersmith, Nierenberg, Paasche-Orlow, Park, Rondón, Rukundo, Teferra, Valentine): clinical trials; qualitative/quantitative research; and translational/implementation science.