The Legacy Impact of the CATIE Study on Healthcare Policy and Psychiatric Resident Education: A Cross-Sectional Mixed-methods Survey of U.S. Psychiatry Residency and State Medical Directors

Objective: The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study has had a lasting impact on the treatment of schizophrenia, yet its current role in psychiatric education and treatment policy remains unclear. This study aimed to assess how the CATIE trial is taught in U.S. psychiatry residency programs and whether its findings influence state-level treatment protocols. Methods: A cross-sectional mixed-methods survey was distributed to U.S. psychiatry residency program directors and members of the National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. The survey included closed-ended and open-ended questions assessing the educational and policy relevance of the CATIE study. Quantitative data were summarized descriptively, and qualitative responses were analyzed thematically and categorized by sentiment. Participation was voluntary and anonymous, and institutional review board exemption was obtained. Results: A total of 75 responses were analyzed, including 60 psychiatry residency program directors and 15 NASMHPD medical directors. Among residency directors, 57% reported teaching the CATIE study for its clinical significance, 32% for its historical relevance, and 12% did not routinely include it in training. In contrast, 80% of state medical directors reported that CATIE findings no longer inform treatment protocols or formulary decisions. Qualitative responses highlighted CATIE’s continued educational value for teaching study design, clinical decision-making, and the evolution of antipsychotic therapy, while also noting concerns regarding generalizability. These findings underscore a widening gap between academic instruction and policy application of psychiatric evidence. Conclusions: The CATIE study continues to serve as a valuable educational tool in psychiatric training, yet its influence on state-level clinical policy appears limited. These findings highlight a divergence between academic and institutional priorities and suggest a need for updated research that reflects contemporary clinical realities and pharmacologic advancements.