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Attitude of undergraduate medical students towards medical research: A cross-sectional study
[To cite: Patil AB. Attitude of undergraduate medical students towards medical research: A cross sectional study. Natl Med J India 2025;38:156–62. DOI: 10.25259/NMJI_987_2021]
Abstract
Background
Medical research is the backbone of advances in medical technology. To decrease the deficit in the physician– scientist ratio in developing countries, initiatives are being taken to inspire medical students to pursue research careers. Hence, it is necessary to understand the attitudes of undergraduate (UG) medical students towards medical research.
Methods
This cross-sectional survey included 241 UG medical students of the 2016–17 academic year from the 1st, 2nd and 3rd years of a teaching institute and a tertiary care hospital. A pretested, structured questionnaire containing 25 items was used to capture the various dimensions of attitudes towards medical research, such as the importance of research, the scientific rigour of medical research, perceived personal benefits and difficulties, and motivators for pursuing research as a medical student.
Results
Of the 241 students, 20 (8.3%) had undertaken research during medical school, and 144 (60%) had a positive attitude with strong agreement on the statement ‘Research discovery is essential for clinical care’. In exploratory factor analysis, 5 attitudes towards research were obtained: (i) Instrumental motivated attitude, (ii) externally motivated or forced attitude, (iii) positive attitude, (iv) negative attitude and (v) seriousness towards research.
Conclusion
UG medical students had a positive attitude towards the idea that ‘research is essential for clinical care’ and showed interest in attending training in research methodology.
INTRODUCTION
Medical research is the cornerstone of medical technology, improving healthcare services.1 Globally, there is a declining number of physician–scientists in medical practice.2 From 1992 to 2001, South Asian health researchers contributed only 1.2% of the published research output in the Institute for Scientific Information database.3 Hence, developing countries should provide training in medical research at the graduate level. This might allow capacity building to study the growing burden of diseases effectively.3
Research in the health sector has remained a low priority in developing countries. Training provided to medical students early in their careers can help improve their ability to address complex issues in health research.3 Studies have suggested a link between mandatory research participation at the undergraduate (UG) and postgraduate (PG) levels.4,5 In addition, a study has suggested informing UG medical students of medical research training programmes.1 The importance of the involvement of medical students in medical research at the UG level is linked to future research activities.6 Exposure to skills such as critical thinking, independent learning and writing research papers may help UG students to identify future careers, key contacts and better residency places. With these advantages, 97% of students reported a desire to participate in research, viewed as a viable alternative to electives.3
At Tehran University of Medical Sciences, a Rapid Research Education (RRE)2 programme has been designed to train UG medical students, involve them in research projects and improve the quality of research in the health sciences.7
In India, the Indian Council of Medical Research (ICMR) has been conducting the Short-Term Studentship (STS) programme for UG students to promote an interest in research.8 However, training in research methodology is not yet part of the UG curriculum.
Most medical education centres lack training in research methods, and only a small percentage of UG medical students are interested in research. Professor M.G. Deo suggested ‘a short-duration’, ‘in-study’, economic module of ‘mobile’ workshops in clinical and laboratory medicine research methods that could be conducted in medical colleges with even a modest research infrastructure’. Cost-effective training programmes in research methodology would be an asset for UG students.9,10
Most medical graduates learn about research methods for the 1st time when they pursue their PG. The perceived barriers to PG students conducting research include a lack of time due to the extensive curriculum, low motivation, inadequate support and facilities, personal obligations, and others. 11 Efforts are being made to motivate medical students to pursue research careers to overcome the deficit of physician–scientists in developing countries. Therefore, it would be useful to understand the attitude of medical students towards medical research and the factors influencing them.1,4
METHODS
In this cross-sectional study, all (n=276) UG medical students in the first 3 years at a teaching institute and tertiary care hospital in southern India during 2016–17 were invited to participate.
Sample size calculation
Assuming a 50% proportion (p) of favourable attitude towards medical research amongst medical students with an absolute precision of 6% and a 95% confidence level, the required sample size was 267. Of the 276 students, 241 provided consent and completed the survey. The census method was used to recruit the participants.
All students who were willing to participate were required to sign a written informed consent form before completing the questionnaire. Absent students were excluded from the study. The institutional ethics committee approved the study (No.15 - July 2016).
Data collection
The self-administered questionnaire was distributed to the students between two class lectures. To ensure proper data collection, students were informed about the purpose of the survey and assured that their participation was voluntary. They were informed that their answers would be kept confidential and used exclusively for research purposes.
The questionnaire consisted of 25 items, each on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree), and captured the various dimensions of attitude towards medical research among medical students, as well as their demographic details. The domains, including the importance of research in clinical practice, the scientific rigour of medical research, perceived personal benefits and obstacles in pursuing medical research, and motivators for pursuing research as medical students, were used to assess the students’ attitudes. While assessing the responses, specific attention was paid to negative questions. Both positive and negative questions were subjected to the reliability test.
The Kaiser–Meyer–Olkin (KMO) test measured the sampling adequacy, checking the case-to-variable ratio for the analysis, which was 0.663 (above the accepted value of over 0.6). Bartlett’s test of sphericity yielded a p value of 0.0001, suggesting suitability of the data for exploratory factor analysis (EFA). Twenty-five items were factored using principal component analysis (PCA), Varimax (orthogonal) rotation technique and Kaiser normalization to reflect students’ attitudes about medical research (Rotation converged in 12 iterations). EFA yielded 8 components, explaining 55.7% of the cumulative variance in rotation sum of square loadings with more than one eigenvalue. The selection of 5 components was considered, based on the percentage of variance ≥6 that explained the students’ attitude. These 5 components used 21 questions (variables) of 25, capturing the 5 types of attitudes. Each item’s factor loadings were in proportion to the various factors. Factor loadings were selected ≥0.3 in each component since they showed an insignificant relation between an item and a component for <0.3.
Statistical analysis
The participants’ responses were entered into a Microsoft Excel Spreadsheet. The Statistical Package for the Social Sciences (SPSS; Trial Version 21.0, IBM SPSS, Armonk, NY, IBM group) was used to analyze the data. p<0.05 was considered statistically significant. Categorical data were presented as frequencies and percentages. Stacked bar diagrams were used to represent the Likert scale analysis. A non-parametric, Chi-square test was used to test the significance of the responses to each question, assuming that all categories (5-point Likert responses) were equal.
EFA was done to understand meaningful attitudes using the PCA extraction method. Missing responses on the Likert scale were replaced with the mean for EFA. Missing values, reliability analysis, detailed EFA and other analyses are available at www.nmji.in (Supplementary Files).
RESULTS
The results are provided in two parts: (i) the students’ attitudes in 5 domains; and (ii) the EFA.
Of the 276 students enrolled in three batches, 241 responded (response rate 87%). The mean (SD) age of the participants was 19.4 (1.3) years, 101 (42%) were men and 216 (90%) came from a nuclear family. Thirty-six (15%) students came from families of doctors, while 6% (14) had researchers in their family. Twenty (8.3%) students were involved in research activities, and 14 (70%) of these 20 did not come from a family of doctors or researchers (Fig 1).
- Socio-demographic characteristics of the participants (n=241)
Findings of the survey
Of the 241 students, 144 (60%) agreed that research is essential for clinical care, indicating a positive attitude towards research, and 134 (56%) agreed on the importance of medical research and that paying attention to minor details is critical in scientific research. A nearly equal number (140 [58%]) of students expressed willingness to do a good course on research methodology, and 130 (54%) agreed to research if they received assistance from a good guide.
It is important to note that 125 (52%) students believed that conducting a meaningful research study is difficult, indicating the depth of thought among the students (Table 1). Therefore, it is necessary to establish whether this difficulty level is due to any barriers or an inability to conduct research.
| Attitude | Statistics (n=241) |
|---|---|
| Research discovery is essential for clinical care. | 144 (60%) students strongly agreed |
| It is important to pay attention to even small details in medical research | 135 (56%) students agreed |
| If they get a good course on research methodology, they will conduct research. | 139 (58%) students agreed |
| If they have a good guide to help them out with research, they will conduct it. | 129 (54%) students strongly agreed |
| It is difficult to conduct a good medical research study. | 125 (52%) students agreed |
The variation in the proportion of responses to each question was found to be statistically significant. The EFA identified five different types of attitudes: instrumentally motivated, externally motivated, negative, positive, and serious (explained in the discussion).
Importance of research in clinical practice
The number of students agreeing with the importance of medical research, clinical practice, and research discovery for clinical care was 81%–94% (including those who agreed and strongly agreed on the Likert scale). Fifty per cent of students agreed that clinicians should be involved in research, and 19% disagreed. However, 31% of students were neutral and 60% of students disagreed with the statement ‘doctors are trained to treat and cure patients and not to conduct research’ (Fig 2).
- The stacked bar diagram explains participants’ agreement (%) with components (questions) in the domain of importance of research in clinical practice
Scientific rigour of medical research
A total of 45% of students agreed with the statement that medical research is very rigorous, but 30% of students had a neutral stand on this statement––89% of students were aware of the importance of small details in medical research, while 65% of students believed that conducting good research is challenging. Furthermore, 70% of students agreed that being a successful researcher necessitates specialised training. This suggests that a research training programme started at the graduate level may be beneficial (Fig 3).
- The stacked bar diagram explains participants’ agreement (%) with components (questions) in the domain of scientific rigor of medical science.
Perceived personal benefits of pursuing medical research
Interestingly, 56% of students agreed that if they were externally motivated, they would pursue research activities, while 29% disagreed––still an indicator of their positive attitude towards research. However, 15% of students were unable to take a stand on this statement (Fig 4).
- The stacked bar diagram explains participants’ agreement (%) with components (questions) in the domain of perceived personal benefits of pursuing medical research.
Perceived personal difficulties in pursuing medical research
While half of the students were aware of their personal difficulties in conducting research, 25% of the students were neutral. Nonetheless, 79% of students felt that undertaking research is not a waste of time. This suggests that they may not be averse to undertaking a research training programme at the graduate level (Fig 5).
- The stacked bar diagram explains participants’ agreement (%) with components (questions) in the domain of perceived personal difficulties of pursuing medical research.
Motivators for pursuing research as medical students
Over four-fifths (85%) of students were motivated to do medical research after receiving assistance from a competent mentor and a quality course on research methods. This number again suggests that UG students are interested in research, and 74% of students expressed an interest in research if it is required for their PG admission. Furthermore, 50% expressed the same if it was required for their promotion. The students were not interested in winning a prize or award for their best project (48% disagreed; Fig 6).
- The stacked bar diagram explains participants’ agreement (%) with components (questions) in the domain of motivators for pursuing research as medical students.
Average responses on Likert scale
The average score on the Likert scale for students’ opinions indicated total agreement in 57.3%, suggesting a desire for good research knowledge, whereas total disagreement was indicated in 20.5%, suggesting a lack of research interest. ‘Neither’ contributed 21%, indicating a lack of awareness of research knowledge amongst students who participated (Fig 7).
- The average agreement scale measured for 25 questions asked to participants in the study.
EFA
The EFA identified five types of attitudes towards research: instrumentally motivated attitudes, externally motivated attitudes, negative attitudes, positive attitudes, and serious attitudes (Table 2).
| Rotated component matrix* The five factors† using the principal component analysis extraction method |
Factor loadings‡ |
|---|---|
| 1. Instrumentally motivated attitude towards research | |
| If I do good quality research, I will become famous | 0.65 |
| To contribute meaningfully to the field of medicine, I must conduct good-quality research | 0.35 |
| If I do good quality research, I can earn substantial money and settle down in life | 0.76 |
| Seeing my name as an author in a research publication will give me immense pleasure | 0.53 |
| If I am actively involved in research, I will be able to influence policy and practices | 0.44 |
| If I am actively involved in research, I will be respected by all | 0.59 |
| 2. Externally motivated attitude towards research | |
| I will do a research project if there is a prize or award for the best project | 0.61 |
| If research is made mandatory for promotion, then I will do research | 0.80 |
| If I have a good course on research methodology, I will conduct research | 0.42 |
| If research is made mandatory for postgraduate admission, I will do research | 0.76 |
| 3. Negative attitude towards research | |
| Doctors are trained to treat and cure patients and not to do research | 0.69 |
| I would rather call myself a clinician than a researcher | 0.47 |
| Doing research is a waste of time | 0.57 |
| If I have a good guide to help me with research, I will do research | −0.64 |
| 4. Positive attitude towards research | |
| Medical research and medical practice go hand in hand | 0.65 |
| Research discovery is essential for clinical care | 0.68 |
| All clinicians should participate in research | 0.52 |
| All clinicians can do good research | 0.41 |
| 5. Seriousness towards research | |
| Medical research is very rigorous | 0.68 |
| It is important to pay attention to even small details in medical research | 0.65 |
Extraction method: Principal component analysis Rotation method: Varimax with Kaiser normalization*rotation converged in 12 iterations †The number of factors was selected based on consideration of the total variance explained >6% by a component ‡factor loadings were considered >0.3. Measure of sampling adequacy–KMO value=0.66 (accepted index over 0.6). Bartlett’s test of sphericity p=0.0001
Respect, fame, prestige, and policy influence were instrumental motivators for becoming a researcher, resulting in factor 1. To carry out research, factor 2 derived the following external motivators: a prize or award, promotion, PG admission and research training. In factor 3, the items demonstrated a negative attitude, such as the view that conducting research is a waste of time and that doctors are trained to treat patients rather than conduct research. They prefer to be clinicians rather than researchers, and they will conduct research with the guidance of a skilled mentor. Factor 4 indicates that medical students have a positive attitude towards research, such as clinicians can conduct good research and should participate in research activities. Medical practice and research discovery are inextricably linked. Factor 5 suggests that medical students are seriously considering research because they recognize that doing research requires thoroughness and diligence.
DISCUSSION
This study provided two findings. The students’ attitudes were first described and quantified in 5 dimensions using stacked bar diagrams. Second, the EFA yielded 5 components that explained the various attitudes of UG students that influence their willingness to participate in research. While understanding the scientific rigour of medical research, 30% students responded neither agree nor disagree. Can we therefore conclude that they may not be sufficiently aware of the field of medical research, as nearly the same proportion of students had a neutral response on a clinician’s ability to conduct good research.
The high level of disagreement (79%) with the statement ‘conducting research is a waste of time’ suggests that students were aware of the importance of research. Hence, starting research training at the graduate level will be useful in clarifying their attitudes and understanding of ambiguities about medical research.
While studying motivation factors, 48% of students showed disinterest in winning a prize or award for their research project. Hence, the author believes that this is the ideal time to encourage UG students to do research, thereby developing into competent medical researchers, a critical need in healthcare. Furthermore, 28% of students took a neutral stance, suggesting a lack of knowledge about research.
It was encouraging that 60% of students disagreed with the statement ‘doctors are to treat and cure patients, not to conduct research’. Furthermore, 70% of students agreed that training is required to be a successful researcher. These numbers suggest the need for providing good research training to them.
In addition, the average response of ‘neither’ from 21% of the students should be taken into consideration because it also reveals a lack of research knowledge among those who participated in the study.
Overall, there is a need to initiate a research training programme at the graduation level, which would be better integrated into their MBBS curriculum. The factor loadings in the EFA analysis (Table 2) also align with the absolute responses from the study participants, underscoring the importance of research training for MBBS students.
Comparison with other studies
In this survey of UG students, 8.3% (20 of 241) participated in ICMR-funded research projects. In a study from southern India, nearly the same number of students (9.3% of 308) participated in ICMR research programmes.12 Almost 60% of students in this study had a positive attitude towards medical research. Although a small number of students were involved in research, medical students agreed that research is essential for clinical care and expressed an interest in research.
Alghamdi et al. found that 97% of 172 students agreed with the importance of empirical evidence in the medical field. In addition, 67.4% stated that conducting research should be mandatory for all medical students.13 In a study from Africa (2013), 61% of students had a positive attitude towards research, and 74% understood the importance of participating in research.14 While a study in Iran reported that UG students had a more positive attitude towards medical research than PG students.15
In a Canadian study, 87% of students were involved in research activities before entering medical school. However, during their medical school, 43% reported no significant involvement in research and 24% had shown no interest in research.4 Overall, the literature suggests the need for effective research training for UG students.
Barriers
In this study, approximately 50% of participants reported facing personal challenges when conducting medical research (Fig 5). In a study done in Auckland, New Zealand, financial and social factors deterred medical students from pursuing research jobs.16 As per a Canadian study, time is one of the most important impediments to conducting research, followed by a lack of awareness of research methodology and mentors/guides.4 Many other studies have reported similar findings and barriers.13,15–19
A study done in Maharashtra, India, reported that PG students had a poor understanding of medical research. However, they also had a favourable view of research and its relevance in improving medical outcomes.11 A study of senior medical students’ attitudes towards research in Saudi Arabia found that most students had a positive attitude towards medical research, with 55% participation in some form of research.13 These findings suggest that instructions in research methods should begin early in medical school.
Efforts by different countries to incorporate research training early in the medical curriculum
To overcome the important challenges, such as inadequate training in critical evaluation, research methodology, and data analysis,19,20 Marušić et al. conducted an integrated course within the UG syllabus and emphasized the step-by-step teaching of research methodology in detail, which proved to be rewarding.21
A RRE programme in Iran connects with students interested in research and separates them into groups based on their favourite subjects. These students receive training by organizing a research methodology workshop with subject-matter experts from the faculty. This RRE programme appears to be effective in achieving the desired results.7
In India, the Medical Council of India launched the ‘Vision 2015’ initiative, which included remarkable recommendations for improving the current system and ensuring high-quality research. Recently, the research methods training programme has also been incorporated, but only as an elective. It should be made mandatory to maximise the impact of high-quality research.12,22
The STS8 was established by the ICMR23 in 1979 to encourage UG students to pursue their interest in medical research. Thousands of students have shown an interest in this STS programme every year for the past 42 years. The success of this move indicates that UG students are interested in research. A study from southern India showed that 80.4% of 308 medical UG students required direction and guidance to complete their research projects,12 a similar number (85%) was obtained in this study. According to the same study,12 25.4% of students were aware of the ICMRSTS programme, while 68.4% of students expressed interest in participating in research initiatives.
Many knowledge, attitude, practice studies on ‘medical research’ amongst medical students report knowledge scores of 69%–81.7%, attitude scores of 60%–75.7%, with varying sample sizes (114–3458).24–26 Therefore, it would be beneficial for students to receive timely training in research methods, enabling them to produce high-quality research.
Limitations
The structured questionnaire survey had subjective responses. The current survey drew almost all UG medical students; however, a larger sample size would have provided a more accurate representation. In addition, students’ responses might have been influenced by social media findings, general conversations with peers and seniors, and other factors. As a result, these apparent constraints might have affected the generalizability of this cross-sectional study.
Implications
This study provides insight into a positive attitude towards medical research, supported by published literature. As a result, to increase interest in research and its quality, concerted efforts should be made to incorporate a comprehensive research methodology programme into the UG curriculum.
Future scope
Research is necessary for evidence-based healthcare practice. The medical field is constantly advancing due to the rapid advancement of technology. To compete in the research area, introducing research training in the early stages of healthcare education is necessary. Hence, periodic research studies should be done to assess UG students’ attitudes towards research in India.
Conclusion
UG medical students agreed that research is critical for clinical care and expressed a desire to participate in a research methodology training workshop to equip them better to conduct research. The attitudes of medical students revealed that many aspired to be actively involved in research throughout their medical studies.
ACKNOWLEDGEMENTS
I would like to thank Dr Kuberan D. (Professor and Head, Department of Community Medicine) for his review and comments, and Assistant Professor Dr Vijayaprasad G. (Department of Community Medicine) for providing the data collection tool.
Conflicts of interest
None declared
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