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Perceptions and barriers towards research among medical students: A mixed-method study
Correspondence to AMULYA NINGAIAH; amulya.ningaiah@gmail.com
[To cite: Ningaiah A, Ramaiah R. Perceptions and barriers towards research among medical students: A mixed-method study. Natl Med J India 2025;38:207-11. DOI: 10.25259/NMJI_139_2022]
Abstract
Background
Research is important for medical education and evidence-based patient care. Efforts should be made to enhance student engagement in research. Students should be able to appraise the literature to identify credible and high-quality research critically. Hence, it is necessary to understand the reasons that deter students from getting involved in research, which will help institutions and universities initiate effective measures. We identified factors associated with research attitudes among medical students and assessed barriers to research practice among them.
Methods
A mixed-method study was done at a rural medical college in southern Karnataka from October to December 2021. A quantitative method was used to assess perceptions and practices towards research through a cross-sectional survey. The questionnaire consisted of separate sections to gather information regarding the sociodemographic characteristics of the participants and their perceptions and practices regarding research among medical students. Focus group discussions (FGDs) were conducted to identify barriers to conducting research from the students' perspective.
Results
Of 575 participants, 40.9% of students had good knowledge, 50.8% had a favourable attitude, and 11.1% had satisfactory research practice. The MBBS phase of study and peer involvement in research were independent factors associated with students' research attitudes (p=0.04 and p=0.002, respectively). FGDs revealed that the lack of awareness and interest (24, 40%), lack of guidance (18, 30%), feasibility issues (12, 20%), and a rigid curriculum (6, 10%) were the barriers to research from the students' perspective.
Conclusion
Knowledge about research is not translated into practice due to certain barriers. Hence, students need to be equipped with skills to conduct and complete research projects independently. Institutions need to develop and implement effective strategies to promote research among undergraduates.
INTRODUCTION
Research is a systematic and creative activity that expands human knowledge, culture, and society, utilizing acquired knowledge to formulate new applications.1 It paves the way for improved medical care and education. Research aptitude also broadens future career prospects by improving the curriculum vitae for medical graduates.2,3 Knowledge about research enables students to critically appraise literature, which helps them in decisionmaking about patient care, and updates them on current trends in management.4 Involvement in research activities or projects trains students in the necessary skills of literature search, scientific writing, data collection and analysis. This also makes them better equipped for a postgraduate course and clinical practice.5
Developed countries provide considerable importance to research in undergraduate courses.6 However, the traditional MBBS curriculum in developing countries does not dedicate ample time and importance to research.7 Academics and examinations are the primary focus, and there is no scope for training students in research methodology. Even if students get involved in research, completing and publishing it is an uphill task, as academics often take priority.6 However, the newly implemented competency-based medical education (CBME) curriculum is learner-centred, focused on acquiring skills and has provided flexibility in terms of choosing elective postings wherein interested students can take up research projects in clinicals, basic sciences or in the community.8 However, the impact that this revised curriculum will have on students’ involvement in research will require a few more years to assess.
Undergraduate students are conditioned to prioritise and focus on examinations, neglecting research. There is a lack of awareness about research methodology, existing opportunities, and quality guidance, which deters students from pursuing research. The short-term studentship programme, funded by the Indian Council of Medical Research, provides an opportunity to conduct independent research, in which very few students are involved.9
Hence, there is a need to assess students’ perceptions regarding research. Furthermore, if effective measures are to be implemented, the factors responsible for poor involvement in research need to be assessed. A mixed-methods approach is suited to identifying barriers and understanding students’ insights and perceptions, which may help institutions promote a research- conducive environment. We did this study to identify factors associated with research attitude among medical students and to assess barriers to research practice among undergraduate medical students.
METHODS
The study was done in a rural medical college in southern Karnataka from October to December 2021. Medical students of all phases were included in the study. A mixed-method approach was used. A quantitative method was used to assess knowledge, attitude, and practices towards research through a cross-sectional survey. A qualitative component was conducted to identify barriers to conducting research from the students’ perspective. There are 2 medical colleges in the Mandya district, Karnataka. Among them, one medical college was selected using the convenience sampling method, and a complete enumeration of the students at that college was done.
Data collection for quantitative component
A questionnaire was prepared following a thorough literature review, and a pilot study was done to test its validity. After minor modifications, it was incorporated into the main study. Ethical clearance was obtained from the institutional ethics committee. Informed consent was obtained from the study participants, and the purpose of the study was explained to them before administration of the questionnaire. Anonymity and confidentiality were ensured. Data were collected using a predesigned, pretested, structured questionnaire. The questionnaire consisted of separate sections to gather information regarding the socio-demographic characteristics of the participants and their perceptions and practices regarding research among medical students.
Knowledge was assessed using 10 questions; a correct response was scored as 1 and an incorrect response as 0. A knowledge score was considered good if it was above or equal to the median. Attitude was assessed using a 5-point Likert’s scale response to 7 statements. (Strongly disagree, Disagree, Neutral, Agree, Strongly agree) and scoring was 1-5 in the same order. The attitude score was considered favourable if it was above or equal to the median score. Research practice was considered satisfactory if students had presented at any conference and/or published research articles in scientific journals.
Data collection for qualitative component
Focus group discussions (FGD) were conducted. Groups consisted of 7-10 students, which included those who had been involved in research projects or activities and those without any research experience. An FGD guide was prepared to understand students’ opinions and perceptions about research involvement by asking them to provide reasons for either participating in or refraining from research projects. Students’ perspectives regarding measures that institutions and universities need to take to promote undergraduate research were also inquired. One investigator moderated the discussion, and the other recorded the transcript of the conversations. FGDs were concluded by the fifth session, as there was a repetition of major and minor themes, and the responses were compiled.
Data analysis
Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 18.0. Quantitative variables, such as knowledge and attitude scores, were summarized as median and interquartile range. Qualitative data, such as research practices and socio-demographic variables, were summarized as percentages. The Kruskal-Wallis test was used to assess the difference in median knowledge and attitude scores. Binary logistic regression was used to identify independent predictors of attitude towards research among medical students, and factors were considered significant if p<0.05.
Content analysis was done for data collected from FGDs. Responses were coded, with phrases from the conversation used to determine the coding. Similar responses were condensed into suitable categories, and themes were generated.10
RESULTS
Of the 600 medical students in the college, 575 participated in our study; 24 (4%) students mostly from Phase I MBBS did not respond. The mean (SD) age of the participants was 21.02 (1.73) years. Table 1 presents the socio-demographic characteristics of the study participants. The median (interquartile range [IQR]) knowledge score of students was 6 (2), and 40.9% of the students had a good knowledge score. Binary logistic regression showed that higher phases of MBBS and peer involvement in research were independent predictors of research attitude with P=1.62 (1.09-2.02) and P=1.56 (1.38-1.88), respectively (Table 2). There was a statistically significant difference in the knowledge score of students based on the phase of MBBS.
| Characteristic | n (%) | |
|---|---|---|
| Gender | Male | 216 (37.6) |
| Female | 359 (62.4) | |
| Phase of MBBS | I | 128 (22.3) |
| II | 148 (25.7) | |
| III | 157 (27.3) | |
| IV | 142 (24.7) | |
| Mother’s education | Illiterate | 22 (3.8) |
| Primary | 10 (1.7) | |
| SSLC | 87 (15.1) | |
| College | 97 (16.9) | |
| Graduate | 256 (44.5) | |
| Post graduate | 103 (17.9) | |
| Father’s education | Illiterate | 13 (2.3) |
| Primary | 8 (1.4) | |
| SSLC | 46 (8.0) | |
| College | 86 (15.0) | |
| Graduate | 270 (47.0) | |
| Post graduate | 152 (26.4) | |
| Mother’s occupation | Homemaker | 397 (69.0) |
| Unskilled | 8 (1.4) | |
| Skilled/Business | 22 (3.8) | |
| Govt/private employee | 103 (17.9) | |
| Doctors | 23 (4.0) | |
| Other Professional | 22 (3.8) | |
| Father’s occupation | Unskilled | 84 (14.6) |
| Skilled/Business | 160 (27.8) | |
| Govt/private employee | 126 (21.9) | |
| Doctors | 70 (12.2) | |
| Other Professional | 135 (23.5) | |
| Board of passing PUC | State | 450 (78.3) |
| CBSE | 109 (19.0) | |
| ISC | 16 (2.8) |
SSLC Secondary School Leaving Certificate PUC Pre-University Course CBSE Central Board of Secondary Education ISC Indian School Certificate
| Variable | Attitude score | P value | ||
|---|---|---|---|---|
| Regression co-efficient (ß) | 95% CI | |||
| Phase of MBBS | Phase III/IV | 1.62 | (1.09-2.02) | 0.04 |
| Phase I/II | Ref | |||
| Gender | Male | 1.27 | (0.89-1.0) | 0.18 |
| Female | Ref | |||
| Parents’ occupation | Doctors | 0.66 | (0.27-1.61) | 0.36 |
| Non-Doctors | Ref | |||
| Parents’ education | Postgraduation | 1.31 | (0.83-2.07) | 0.23 |
| graduation and | Ref | |||
| less | ||||
| Parents/siblings | Yes | 0.56 | (0.26-1.19) | 0.13 |
| involvement in | No | Ref | ||
| research | ||||
| Peers’ involvement | Yes | 1.56 | (1.38-1.88) | 0.002 |
| in research | No | Ref | ||
| Board of passing | ISC/CBSE | 0.79 | (0.79-1.82) | 0.28 |
| PUC | State | Ref | ||
Binary logistic regression SSLC Secondary School Leaving Certificate PUC Pre-University Course CBSE Central Board of Secondary Education ISC Indian School Certificate
Post hoc tests revealed a significant difference between phase 1 and 3 (p=0.01; Table 3).
| Phase of MBBS | Knowledge score (median, IQR) | p value* |
|---|---|---|
| Phase I («=128) | 6 (2) | 0.02 |
| Phase II («=148) | 6 (2) | |
| Phase III («=157) | 6 (3) | |
| Phase IV («=142) | 6(2) |
The overall median (IQR) attitude score was 26 (5). The maximum score was 31, with six questions having Likert scale responses and one question with a dichotomous response. Table 4 presents the phase-wise attitude scores of students, and the difference in scores was not statistically significant; 50.8% of students had a favourable attitude towards research (Table 5).
| Phase of MBBS | Attitude score (median, IQR) | p value* | |
|---|---|---|---|
| Phase I («=128) | 26 (5) | 0.07 | |
| Phase II («=148) | 26 (5) | ||
| Phase III («=157) | 25 (5) | ||
| Phase IV («=142) | 26 (3.25) | ||
| Questions assessing attitude | 1 n(%) | 2 n(%) | 3 n(%) | 4 n(%) | 5 n(%) |
|---|---|---|---|---|---|
| Research is important in medical education | 8 (1.4) | 10 (1.7) | 41 (7.1) | 205 (35.7) | 311 (54.1) |
| Every medical student has to be well trained in research methodology | 5 (0.9) | 17 (3.0) | 98 (17) | 311 (54.1) | 144 (25) |
| Research methodology should be made a part of MBBS curriculum | 13 (2.3) | 25 (4.3) | 127 (22.1) | 258 (44.9) | 152 (26.4) |
| Research improves prospects for future career | 3 (0.5) | 8 (1.4) | 78 (13.6) | 254 (44.2) | 232 (40.3) |
| Medical research has a positive influence on academics and clinical practice | 2 (0.3) | 10 (1.7) | 74 (12.9) | 290 (50.4) | 199 (34.6) |
| Research enhances knowledge and critical thinking | 2 (0.3) | 9 (1.6) | 44 (7.7) | 288 (50.1) | 232 (40.3) |
Scoring: Strongly disagree=1, Disagree=2, Neutral=3, Agree=4, Strongly agree=5
Research practice was found to be satisfactory among 64 (11.1%) of the students, with 41 (7.1%) having either published or presented, and 23 (4%) of the students having done both.
The main motivators for pursuing research were to gain better opportunities in future careers, to achieve United States Medical Licensing Examination (USMLE) aspirations, to experience the research process, to learn methodology, and to be involved with peers (Fig. 1). The barriers to conducting research among students (Fig. 2) were summarized from the FGDs conducted. Of the 60 responses from students, the themes that emerged were lack of awareness/interest (24 [40%]), lack of guidance (18 [30%]), feasibility issues (12 [20%], and rigid curriculum (6 [10%]). Verbatim examples in each of the themes were:
- Future career planned by students
- Perceived barriers for involvement in research among medical students
Lack of awareness/interest: ‘I don’t think research is very important to me at this stage’ (1st year student).
Lack of guidance: ‘There is no research-oriented teaching. Teachers do not give information about areas of research while taking a class on a particular topic (final-year student).
Rigid curriculum: ‘Doing good research takes time. But we are already burdened with classes, internals, and examinations. There is not enough time’ (3rd year student).
Feasibility issues: ‘I have seen my batchmates struggle to get permissions to conduct tests in the laboratory or access medical records, and are not able to complete data collection. Seeing them, I have realised doing research is difficult’ (Final year student).
Measures that institutions and universities need to take from a student’s perspective for promoting research are presented in Fig. 3.
- Measures to be taken by institutions and universities to promote research
DISCUSSION
We did this study with the aim of assessing attitudes and perceived barriers towards research among medical students, with the hope of improving the research aptitude of students and promoting a research environment in institutions. Catching them early and broadening their horizons towards research at the undergraduate level is necessary.
In our study, of the 575 participants, 40.9% of students had good knowledge, 50.8% had a favourable attitude, and 11.1% had satisfactory research practice. Knowledge and attitude towards research are not reflected in practice due to numerous barriers. Very few students completed a project and had their work published. Alsayegh et al. had similar findings, where students’ knowledge, attitude, and actual participation in research work were 57.2%, 76%, and 31.5%, respectively.11
In our study, the MBBS phase of study and peer involvement in research were independent factors associated with students’ research attitudes (p=0.04 and p=0.002, respectively). Datta et al. showed that 3rd and 4th-year students were more likely to be involved in research activities compared to 2nd-year students (Odds ratio: 0.60, 95% confidence interval 0.33-1.09).9 Chatterjee et al. also had similar results—students in the senior years spent more time on research than those in the junior years (2nd: 66.7% and 4th: 77.8%; difference across semesters p=0.03).12
Parents’ occupation did not show a statistically significant association with the research attitude of students (p=0.36). A similar finding was observed by Moraes et al., where the presence of physicians in the family did not have a statistically significant association with the research interests of students.13 However, Chatterjee et al. in Kolkata observed that students whose parents were doctors had a better research perception score.12
In our study, the board of passing pre-university college did not show a significant association with the research attitude of students in medical college (p=0.28). Similar findings were seen in previous studies where students from different high school backgrounds showed no significant difference in their attitude towards research.14,15
FGDs from our study identified the following barriers to research: lack of awareness/interest, 24 (40%); lack of guidance, 18 (30%); feasibility issues, 12 (20%); and a rigid curriculum, 6 (10%). Datta et al. conducted FGDs to identify barriers to research, which included a lack of recognition (50.2%), lack of institutional support (43%), less monetary benefit (28.1%), and wastage of time.9 In a quantitative study conducted by Pallamparthy et al., the barriers to research were a lack of awareness (53%), interest (54%), funds (62%), time (59%), and difficulty in following up patients (67%).16
Previous studies addressing this problem are mainly quantitative, but we used a mixed-methods approach to gather a comprehensive understanding of the current problem. A pilot study was done, which helped to structure and refine the questionnaire. Simultaneous explanation of questions while administering the questionnaire helped participants better understand the information and reduced information bias.
The limitation of the study is its generalizability, as the medical college was selected using convenience sampling.
Recommendations
Modifications are needed to accommodate research into the curriculum. A phase-wise inclusion of research methodology would be ideal, from basic concepts to application. The timetable needs to be planned ahead to include these topics (e.g. the Community Medicine subject is taught for the first three years of MBBS). In Phase I, ‘Demography and vital statistics’ is one of the topics that must be taught according to the Rajiv Gandhi University of Health Sciences curriculum.17 During this course, sources of data, types of data and summarising descriptive statistics can be taught. In Phase II, epidemiological study designs can be discussed during lecture hours and in block postings. A diet survey can be conducted as a research activity, where students will collect and summarize data themselves and present their findings in a report. In Phase III, Part 1, the field application of various study designs, epidemiological methods, and inferential statistics can be introduced through field postings, small group teaching, or by conducting a research methodology workshop, where students receive hands-on training. Elective postings in the new CBME curriculum by the National Medical Commission (NMC) recommend that block 1 (4 weeks) of the postings can be used to promote research uptake among students under the guidance of a preceptor.18
Furthermore, when discussing any topic in class, research areas and ideas relevant to the topic can be highlighted to arouse students’ interest in research. The Basic Course in Biomedical Research certification, mandated by the NMC for all teaching faculty of medical colleges, is a welcome step towards improving research quality and faculty exposure.
Another set of measures to motivate students to do research is to conduct workshops and guest lectures, equipping them with adequate skills and knowledge to do research confidently. Colleges can also devise a credit point system to award certificates or provide monetary incentives to students who complete research projects, avail themselves of funding, or publish an article in a journal.
Allotting mentors to individual students helps to motivate, guide, and facilitate them in research activities. Based on their own and their peers’ experiences, students expressed concern about the tedious process of obtaining permissions for data collection and laboratory tests. Colleges must take measures to facilitate the research process and increase the probability of project completion by students. Establishing a dedicated department for research and patents at each college will encourage innovation and research, generating credible publications by students and improving the overall research performance of institutions.
Conclusion
Understanding students’ perceptions towards research is a step that needs to be taken to improve research output of undergraduates. Providing adequate knowledge and equipping them with skills will motivate them to pursue research. Even with adequate knowledge, research practice is lacking, and perceived barriers need to be addressed. Institutional and organizational barriers should be addressed, which will make the research process easier for students and create a research-conducive environment in medical colleges.
Conflicts of interest.
None declared
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