Assessment of perceptions, barriers and enablers towards uptake of research activities among undergraduate medical students: A mixed methods study

INTRODUCTION

The goals prescribed for an Indian medical graduate (IMG) are that of a clinician, leader, communicator, lifelong learner, and professional by the Medical Council of India (MCI). In order to fulfil these goals, medical students have to be competent enough not only with regards to medical knowledge but also various procedural skills during the MBBS course. The medical graduates are expected to practice evidence-based medicine (EBM) which requires command over higher cognitive skills of assimilation and critical reasoning. Although, research is not one of the primary goals of an IMG, conduct of research activities is essential to inculcate higher cognitive skills of critical thinking, reasoning, analysis, evaluation and creation. EBM is a synthesis of evidence from the literature, clinical acumen of the physician and the patients’ perspective.¹ In order to collate the evidence from scientific publications, the clinician has to have critical thinking and clinical reasoning skills which can be developed by active participation in doing research.

Medical students need to be sensitized about medical research in order to develop interest among them about research and its application in medical science. The students must understand the need of medical research and its utility in improving the quality of day-to-day clinical practice and how medical research is useful for the healthcare needs of the people. As students are naïve, they need training in basics of research and research methodology.²

Clinicians who are involved in clinical research as a part of their career are physician–scientists. It has been reported that there has been a steady decline in the number of physician scientists throughout the world over the decades; down from around 5% in the 1980s to less than 1.5% in 2011.^3,4 These physician–scientists are the need of the hour for innovation and advancing of medical science with translational research from bench to bedside especially with many emerging and re-emerging diseases cropping up across the globe. In order to develop research aptitude from a young age, it is necessary to integrate the research component in the undergraduate medical curriculum from the first year. We assessed medical undergraduates’ perspectives and explored various barriers and enablers towards the uptake of research activities by them.

METHODS

The study was a mixed methods study conducted over a period of 8 months from January to August 2021. The study population comprised of undergraduate medical students in the second year, final year Parts I and II, and Interns. In the first 3 months data collection was done using Google form (Quantitative phase). A pre-tested and validated semi-structured questionnaire was circulated to all the study participants to assess students’ perception, attitude and practice about research activities. The initial part of the Google form was designed as informed consent explaining the study scope. The responses received within the timeframe of the quantitative phase were analysed.

In the next 5 months, two focused group discussions (FGDs) were conducted to explore the barriers and enablers towards research uptake among the students. We excluded first year students and those who did not give consent to participate in the study. The FGDs were done using a FGD guide with a group of 10 students each to explore the barriers and enablers for uptake of research activities. The first FGD included final year students and interns while the second FGD included second year students.

RESULTS

DISCUSSION

Our study included 386 students for the quantitative phase. The profile of our participants were similar to those in studies done in Puducherry, Karnataka, etc.^6,7 On the contrary, studies conducted in Pakistan and Saudi Arabia had more male as compared to female students.^8,9 These variations may be due to socio-cultural differences across various countries.

We observed that more than half the participants were aware about research methodology. A study done in Chennai, reported that less than half the students had proper knowledge about sampling methods, ethical issues, research protocol, and statistical analysis. Only about 20% knew about PubMed.¹⁰ Another study from India, reported better overall knowledge about research among almost 60% participants.¹¹ In a study from southern India, almost 80% of final year students had knowledge about research methodology.¹² In contrast, we observed that among final year students only 48.4% and 39.8% had knowledge about research methodology and statistical analysis. This may be because of the shift from conventional teaching–learning to online teaching–learning platform due to the Covid-19 pandemic during the study period and the main focus being on academic aspects as opposed to research.

We found that interns and final year part II students had better knowledge about various aspects of research as compared to second year and final year part I students. Similar results were obtained in studies done in America and Saudi Arabia.^13,14 This may be due to the fact that research workshops for MBBS students are conducted mainly after the first year and the students tend to be involved in carrying out research projects in the second and final years. There was also a study which showed decreasing knowledge levels with enhancing academic year.¹¹ This may be because an increasing load of course material in the latter part of the course.

We also found that 161 (41.7%) participants were willing and interested in attending research methodology workshops. A study among Egyptian medical students also reported a positive attitude towards research.¹⁵ Another study reported an increase in the attitude score of the students with advancing academic years.¹¹ The reason for this could be better rapport with faculty in the later academic years than in the initial years and thus more encouragement and motivation for the students. A study from Pakistan found that almost one-third of their students believed that research was a good career option for them.⁸ Similar findings have also been documented by other studies as well.^16,17

Only 96 (24.9%) of our respondents had ever done a research project and only 20 of them (20.8%) had published the research. In a study done in Chennai, almost similar results were obtained with about 35% participants who had done a research project and less than a quarter had published an article, and only 28% had presented a paper. However, majority of the participants had attended research methodology workshops.¹⁰ This shows that even though students have a positive attitude towards research, there is a gap between doing research and presenting or publishing it. There is a need to hand hold student researchers through the various stages of conducting research till its publication in a peer reviewed journal. Another study from Syria found that most students wrote case reports.⁵ This practice may be due to lack of guidance on writing a research paper or a possible publication bias for authors from less renowned institutions.¹⁸

We identified various barriers to uptake of research activities through FGDs. The major barriers identified were lack of awareness, lack of time, lack of workshops and conferences related to student research and logistic issues. Similar responses have been documented in other quantitative surveys.^19–21 Few studies have reported the lack of research curriculum and lack of mentorship as other important barriers.^{16,20,22–26}

Other studies have reported financial constraints and lack of incentives as major barriers for students to do research.^{22,23,27–30} Many students have also highlighted lack of funding for their research by their own institutes as a barrier.^29–33

We also explored enablers for the uptake of research. These included the conduct of regular workshops on research methodology, funding for student research projects with special emphasis on projects rejected by ICMR, exclusive time for research work, etc. There are few studies which have explored the enabling factors with regards to uptake of research activities by undergraduate students. An editorial highlighted many areas including funding for student research projects, student mentorship, recognition of student researchers, research methodology workshops for students as well as mentors, provision of mandatory research project for each MBBS student, etc. Another article emphasized the need to integrate training in formal research into the medical curriculum to provide diverse research opportunities of a high quality.^34,35