What Studies Do We All Need to Know?

As a junior psychiatry resident at Yale, I sometimes feel overwhelmed by the abundance of journal articles and papers at our disposal. I often hear more senior residents and attendings cite various landmark studies that guide our current standards of care. It is daunting for me to wade through the academic literature to find these famous papers while also keeping up with new evidence.

I eventually saw the need for a centralized publication that provides a basic evidence-based foundation for residents and early career psychiatrists. To tackle this issue, I decided to write a proposal for a book called 50 Studies Every Psychiatrist Should Know. The book would provide value in two ways: selecting 50 of the most important studies and critically evaluating each using a defined approach.

My first step was to find a mentor. I approached my associate program director, Dr. Vinod Srihari, who has a special interest in the dissemination of evidence-based practice to trainees. After I explained my idea, he agreed to join the project.

In our first meetings, we decided how to segment the book and formed a plan to enlist the help of our department’s expert clinical and research faculty whose career interests aligned with each of the subsections. These educators would help choose the studies and eventually coauthor chapters. I was interested to observe Dr. Srihari’s thought process for recommending faculty to fill this role. He carefully considered broad issues such as the political impact of his selection and seniority in the department as well as practical issues such as willingness to work with residents and ability to respond quickly to emails. This process involved querying department leadership for nominations for potential candidates.

I was admittedly intimidated to electronically approach these senior faculty members as a second-year resident, especially when asking them for so much of their time. I was pleasantly surprised at the reception of my initial contact email. As expected, a few of these individuals were slow to respond. It felt awkward to electronically nudge them every now and then. Dr. Srihari encouraged me to actually wait outside the office of one senior professor with the inkling that he might be missing my emails. He joked that it is harder to turn down a physical being than to passively reject participation by not responding to a message. I still remember running into this professor in the hallway and pitching him the idea on the short walk to his office. We ended up having a rich conversation on the topic, and soon thereafter he sent me several studies to consider.

Also interesting was the different way in which each adviser chose to craft his or her list of studies even though I sent every nominee the same prompt.

One of our advisers who is an associate fellowship director asked herself what she would like all entering fellows to have read by their first day in the program: “If you know nothing else, know this.” A vigilant faculty expert suggested including a study that cautions psychiatrists about big pharmaceutical companies’ influence on clinical practice.

More research-oriented physician-scientists selected studies that have promise for future investigation or those with less clinical applicability that have not yet been translated to a human population.

Of course, some of this heterogeneity comes from the nature of the particular topic, but my sense is that the bulk can be attributed to varying opinions of competent experts regarding what every psychiatrist should know. I negotiated with the authors to include only studies that affect providers’ impressions and decisions at the bedside. We wanted to be conservative and assemble a list based not only on the most novel and innovative ideas of today but one that would stand the test of time.

Assembling this list of studies as a resident was both challenging and rewarding. Finding a strong, respected mentor-advocate was instrumental in negotiating the politics of a large academic department. It was quite satisfying to balance the years of specialized expertise of senior faculty with the basic question we have as junior trainees: What studies do I need to know? ■