MIRECC Psychiatry Fellowship - MEDVAMC
Special Fellowship in Advanced Psychiatry
South Central Mental Illness Research, Education, & Clinical Center (MIRECC)
Direction and framework of the fellowship program
The overarching goal of this two-year fellowship program is to train future veteran affairs leaders for research careers in a rapidly evolving health care arena by providing a firm foundation in mental health research, education, and clinical care. Within this overall context, the fellowship will offer four specialty tracks:
- Health Services Research track trains researchers who are well-versed in the issues of access, utilization, outcomes, and effectiveness of geriatric mental health disorders. The specific educational activities will serve to enhance knowledge of the clinical issues underlying the health services issues.
- Clinical Psychopharmacology track helps investigators to translate discoveries in brain science into clinically effective treatments for the brain-based illnesses like depression and bipolar disorder.
- Substance Addictions track develops investigator and clinical careers in treatment for substance use disorders including opioid, stimulant, nicotine, and alcohol dependence. Our clinical trials combine medications with various behavioral therapies such as contingency management for drug dependence. We also examine the pathophysiology of addictions using genetics, neuroimaging, and acute drug administration studies in humans. The neuroimaging research includes both SPECT and functional MRI (fMRI) to detect and treat cocaine-induced cerebral perfusion defects and to predict pharmacotherapy outcome. These clinical studies are complemented by pre-clinical laboratories in behavioral pharmacology, immunology, and molecular genetics.
- Neuropsychiatry track explores brain and behavior relationships in mental illness that influence their cause and treatment. Conditions such as anxiety disorders and complications of impulsivity, aggression, language, and mood disturbances are presently under study, but in principle this approach is applicable to a wide range of conditions. The trainee will be exposed to a variety of disciplines, techniques, and approaches, and will have the opportunity to develop their own focus based on their interest and training. The applicant will be guided toward generation of hypothesis-driven research that leads to measurement (e.g., brain structure or function, neuropsychological performance) and the testing of a therapeutic intervention.
The fellowship training program is designed to create an environment that fosters professional growth and development in young investigators, allowing them to mature into independent researchers capable of and interested in pursuing independent research that contributes to the overall VA mission of health care. Each fellow will have a committee of mentors, consisting of two investigators and a clinical supervisor. Consultants from off-site faculty may be included. Dr. Kunik will be on each fellow's committee to provide administrative oversight and to monitor the fellow's progress toward completing each specific task required by the fellowship.
The second committee member will be the primary mentor, who will have experience conducting research in the topic areas that the fellow chooses to pursue. This mentor will have primary responsibility for guiding the fellow to meet the research and education goals.
The third committee member will be a clinician who supervises the fellow in clinical activities in one of the major mental health clinics at Michael E. DeBakey Veterans Affairs Medical Center. The clinical mentor will provide clinical experiences and feedback regarding the fellow's development in assessment and treatment of specific mental disorders. Fellows will meet with their primary mentor on a biweekly basis and with their mentoring committee quarterly. The program director will meet with the fellow semiannually to review the fellow's progress.
At the beginning of the fellowship year, the mentoring committee will meet with each fellow to individualize the training experience, with the goal of compensating for any academic or clinical deficits, and to enhance the fellow's existing expertise, academic preparation, and research interests. All fellows are expected to:
- Complete course work specific to their specialty track
- Participate in ongoing research projects and grant writing in their area of interest
- Participate in one of the MIRECC groups (Access, Returning Combat Veterans, Geropsychiatry)
- Develop a research project in their area of interest that should result in a publication in a peer-reviewed journal and/or grant application
- Make a presentation at a national meeting
- Participate in clinical activities as assigned
- Attend the annual MIRECC retreat
- Attend the annual fellowship national meeting
- Participate in teaching opportunities (e.g., Faculty Education Initiatives Skill Building Program; Psychiatry Journal Clubs)
- Attend biweekly MIRECC Fellowship video teleconferences.
Acquisition of knowledge
The fellowship education program will have several components:
- Optional 4-week (32-hour) course on the Fundamentals of Clinical Investigation
- Optional 28-week (48-hour) course, Clinical Investigation for the Career Scientist
- Required 6-hour Ethics in Research seminar
- Recommended additional coursework to meet individual needs of trainees
- Fellows will also have the opportunity to attend the monthly MEDVAMC Mental Health Conference and the weekly BCM Psychiatry Grand Rounds.
The Fundamentals of Clinical Investigation and the Clinical Investigation for the Career Scientist courses will be taught at Baylor College of Medicine through the Clinical Scientist Training Program, a multidisciplinary didactic training program for researchers. The Fundamentals of Clinical Investigation is a 32-hour course that offers the essentials of research design, statistics, and ethical issues. The Clinical Investigation for the Career Scientist course is comprised of three components: a 24-hour Scientific Writing module, a 12-hour Clinical Decision Analysis module, and a 12-hour Health Service Research module.
The biweekly Mental Health Research course will supplement the course from the Clinical Scientist Training Program and will be more specific to research issues in mental health research and career development. The seminar will address mental health topics such as sampling, measurement, analytic strategies, legal and ethical concerns, and policy issues. These will be addressed through directed readings, faculty and student presentations of current literature, and presentations of current or potential research projects. The seminar will include representatives from mental health agencies and consumer groups. The content of these biweekly seminars will also be guided by the curriculum established by the hub site.
The Ethics in Research seminar is required of all BCM scientists. This 6-hour seminar covers topics such as data ownership and management, authorship, plagiarism and peer review, scientific misconduct with specific reference to conflicts of interest and policies, and ethical considerations in animal and human subjects research.
Finally, coursework will be recommended based on prior education, clinical experience, and areas of competency which trainees bring to the program as outlined in the Customized learning section. Faculty will individualize the academic and research programs for postdoctoral trainees with the goal of compensating for any academic or clinical deficits and enhancing trainees’ existing expertise, academic preparation, and research interests. In particular, mental health services fellows need to have an understanding of basic concepts in epidemiology, and all fellows need competence in statistics before fellowship completion.
There is a rich selection of relevant coursework available to trainees from the University of Texas School of Public Health, University of Houston, and Rice University. All applicants will be able to complete an MPH through the University of Texas School of Public Health or a Masters in Clinical Investigation through the Graduate School of Baylor College of Medicine, if so desired. Fellows may also attend content-specific courses in Health Services Research or Psychopharmacology.
Fellows will participate in the Faculty Education Initiatives Skill Building Program at Baylor College of Medicine. This program includes a two-hour orientation lecture, a bimonthly Medical Education Seminar Series, and a two-hour interactive Teaching Skills Workshop. Fellows will also have the opportunity to co-lead and participate in the bimonthly Psychiatry Journal Clubs. Finally, fellows will be given teaching responsibilities by their clinical mentors and will receive feedback on their teaching.
To customize each fellow’s learning experience, a rich selection of relevant coursework is available from the University of Texas School of Public Health, University of Houston, and Rice University. All fellows will be able to complete an MPH through the University of Texas School of Public Health, if so desired. Fellows may also attend content-specific course in Health Services Research or Psychopharmacology, as outlined below in the Health Services and Psychopharmacology emphasis sections.
Clinical activities: All fellows will spend 25 percent of their time in clinical activities within one of several mental health clinics at MEDVAMC. Their assignment will be determined by the fellow’s interest and with the input of the Internal Review Committee and the fellow’s mentors. Regardless of discipline, fellows will be assured of discipline-specific supervision. In addition, fellows will be given an opportunity to participate in the clinical teaching of other trainees. The clinics include the Comprehensive Mental Health Program, Trauma Recovery Program, Substance Dependence Treatment Program, In-Patient, Health Care for Homeless Veterans, Consultation & Special Evaluation, and Community Re-Integration. Directors of these programs have indicated enthusiastic support for participation in the fellowship program.
A brief description of each of the programs follows:
Comprehensive Mental Health Program
Director: Sanjay Mathew, M.D.
This program provides ongoing care in both inpatient and outpatient settings to veterans who have severe and persistent mental illness, including schizophrenia, bipolar disorder, and other related disorders. The program’s Psychiatric Evaluation and Admission Clinic offers inpatient and outpatient evaluation and crisis services 24 hours a day, 365 days a year
CMHP offers a wide array of services: acute inpatient care; outpatient medication management and supportive therapy; specialized group therapy for veterans with mood disorders, psychotic disorders, traumatic brain injury; social services; geriatric psychiatry; family treatment for all veterans enrolled in the program; and intensive case management for the most seriously mentally ill.
Trauma Recovery Program
Director: Janine Shaw, Ph.D.
Recognizing the special risk of posttraumatic stress disorder and related illnesses in the veteran population, this program has a broad range of outpatient, day hospital, and acute inpatient services available for veterans suffering from PTSD and other anxiety disorders. Program staff members work closely with the two Veterans Outreach Centers in Houston.
Substance Dependence Treatment Program
- Director: Jill McGavin, Ph.D.
- Research Director: Thomas Kosten, M.D.
This program offers three levels of care for drug and alcohol use disorders, inpatient and outpatient detoxification, and opiate replacement treatment. The clinic is open 6 a.m. to 8 p.m., and patients are enrolled immediately upon application. Staff work as a team to provide individualized treatment to the recovering veteran.
- In-Patient (Director: Ismael Carlo, M.D.)
- Health Care for Homeless Veterans (HCHV) (Director: Luis Paulino)
- Consultation & Special Evaluation (CASE) (Director: Aruna Gottumukkala, M.D.)
- Community Re-Integration (Director: Su Bailey, Ph.D.)
All of these clinics function through an interdisciplinary team approach. MEDVAMC is a major training site for BCM residents, medical students, and physician assistant students, as well as psychology interns, psychology practicum students, social work students, and nursing students. Involvement of trainees in the therapeutic activities of the clinics is a highly valued activity by staff members. Trainees will have a multitude of training activities available to them, depending on their interest and training needs. Fellows can function within interdisciplinary teams, gain experience in clinical settings with varying levels of treatment intensity, provide individual and group therapies, learn specialized assessment techniques, and provide medication management. Fellows will also have the opportunity to be involved in the myriad of clinical educational programs available in the Texas Medical Center (e.g., BCM Psychiatry Grand Rounds, continuing education conferences, monthly MEDVAMC Mental Health Conference, brain dissection rounds, and psychology assessment and therapy seminars)
Stipend and Benefits
- Full-time salary (approximately $51,000 for PGY-5 level)
- Vacation (13 days per annum); Sick Leave (13 days per annum)
- Benefits as applicable including eligibility for health insurance and retirement
- Authorized leave for professional conferences (travel funds usually available)
- Funding for attendance at the annual MIRECC and VA Mental Health conferences
- $5,000 in research start-up funds
- $1,000 for tuition and book costs per year
Please submit the following application materials:
- Cover Letter
- Curriculum Vitae
- Three Letters of Recommendation
- Official graduate school transcripts (sent directly by your university)
Administrative Contact / Submission of Materials
Ms. Brenda Schubert
VA Special Fellowship Program in Advanced Psychiatry
2450 Holcombe Blvd. Suite 01Y
Houston, TX 77021
Mark E. Kunik, MD, MPH
Director, SC MIRECC Psychiatry Fellowship Program