Abstract
Background
Research experiences early in the medical student’s education are an important factor for attracting a greater number of doctors to careers with a research component.
Objective
To determine the factors contributing to a lack of enthusiasm about research activities among medical students, and to suggest ways to help students develop an interest in research.
Design
A medical institution-based, case-control study was conducted. A case was defined as any fourth year medical student who believed that undertaking research was not interesting; controls were matched for age and sex. A pretested, structured, and self-administered questionnaire was used; the data were analyzed using statistical methods.
Results
In all, 122 students (54% male, 46% female) were recruited to the study. Factors found to be significant were lack of Internet facilities (odds ratio 0.218) and considering research useless (odds ratio 4.570).
Conclusion
Measures should be taken at undergraduate level to involve students in research activities. Ensuring easy access to Internet facilities could be one positive step. Further research should be done to explore the reasons why some medical students consider research useless.
Introduction
Research is a human activity based on the use of intellect to investigate, interpret, and revise human knowledge about different aspects of the world. Research updates medical students on the latest advances in medicine and science and provides new interpretations of existing facts. However, a trend away from research activities has been seen, particularly in developing countries.Citation1–Citation10 In Pakistan, a decreased level of interest in research is seen in some medical students,Citation7 resulting from a variety of factors needing to be identified and approached.Citation11
In research conducted at Aga Khan University (Karachi, Pakistan), it was found that knowledge of research is lower, and attitudes more indifferent, during the initial years of medical school.Citation7 Another study showed that students face a number of problems in conducting research: curriculum overload, time limitation, lack of proper training, uncooperative staff, and lack of motivation and incentives.Citation8 Another study at the same university established that students undergoing lecture-based learning showed less interest in health research than those undergoing problem-based learning.Citation12 It has been found that lack of interest in research among medical students results from insufficient attention given by the faculty and administration to medical students, which can be improved by a well-considered approach.Citation13 Another study showed that lack of interest in research is more prevalent among medical students studying in public medical schools than among those in private medical schools.Citation14
Physician-scientists are key players in the research community. They can treat patients in amazingly effective ways.Citation9,Citation10,Citation13 Increasingly, medical research has emphasized the need for recruiting more and more physicians to research careers. Increasing physician contributions leads to an increase in the number of studies, an increase in public education, and an increase in subject recruitments for various trials.Citation15 A decreasing trend in the number of doctors pursuing a research career has been seen in the United States. To counterbalance this situation, a number of solutions have been put into effect. However, most of these focus on postdoctoral fellowships and other higher-level programs, with almost no attention paid to the medical student’s early research opportunities.Citation16,Citation17 Increased participation of medical students in research activities could have a positive influence on their career choice.Citation9,Citation18–Citation24 For instance, medical students with good research skills could have increased employment options in their future career.Citation25–Citation28 Between 1987 and 1997, there was a significant decrease in graduation numbers of premedical and medical students who had a strong research interest. These students included both sexes; men showed a greater desire for research careers, but did not achieve graduation rates as frequently as women. Furthermore, women who had strong research interests after matriculation had a decreased interest during medical school.Citation29
Lack of interest in research activities, by depriving medical students of the understanding and utilization of latest medical advances, has led to deterioration in the health care system.Citation30 As very few studies have been conducted on the lack of interest in research activities, including in Lahore, Pakistan, we structured our study to explore the extent and distribution of the problem in different socio-economic groups. We investigated the various social factors responsible for the problem of decreased interest in research and suggested means to solve it, so that the authorities concerned might be able to redesign policies for the benefit of communities.
Methods
Study design
The study was performed from July 2007 to December 2007. Approval was received from the ethics committee of King Edward Medical University, Pakistan. It was an institution-based case-control study with subjects matched for age and sex, to investigate the factors contributing to the lack of interest in research among medical students during the fourth year of a Bachelor of Medicine (MB) or Bachelor of Surgery (BS) at King Edward Medical University, Pakistan.
King Edward University is a public medical institution located near Nila Gumbad in Lahore; its style of teaching is primarily lecture-based. According to 2013 statistics, it is ranked by the higher education commission among the best medical universities in Pakistan.Citation31,Citation32 The initial two years of medical school focus on basic science, whereas the later years involve greater exposure to clinical departments and research options.
Research activity is a mandatory component of the fourth year class; at the time of this study, 175 students were enrolled in the class and were included in our study population. A sample size of 122 students met the objectives of this study at 95% confidence interval (CI). The sample size was calculated using Raosoft (available online from www.raosoft.com), assuming a 50% response distribution and a 5% margin of error. The students were randomly chosen to participate in the study’s simple random sampling.
Case-control definitions
A case was defined as any fourth year medical student younger than 30 years of age who believed that undertaking research is not interesting. A control was defined as any fourth year medical student younger than 30 years of age who believed that undertaking research is interesting; each control was matched to a case for sex and age in years. All other students of the University, teaching staff, and official staff were excluded from the study.
Data collection and analysis
An interview schedule was designed to collect information using a pretested, structured, and self-administered questionnaire to gather data. Extensive discussions with the faculty of the Community Medicine department were undertaken before approving the questionnaire for use. The questionnaire was then tested on a small group of students from the same class to identify the factors most relevant to the topic of lack of interest in research among medical students. Further discussions with faculty members helped us formulate the final questionnaire.
Written informed consent was provided by all participants. Demographic details collected from the participants included age, sex, and hometown. Factors considered relevant according to the questionnaire design were presented in a yes/no format to participants. The responses are shown in .
The data collection process was closely supervised by the staff of the Community Medicine department, who reviewed the completed data collection questionnaires. Data were analyzed using Statistical Package for Social Sciences (SPSS, version 16.0.2; IBM Corporation, Armonk, NY, USA) software. Regression analysis was used to assess the relationship between different exposure, confounding, and outcome variables. In analyzing the results, a P-value of <0.05 was considered significant. Odds ratios (ORs) with a 95% confidence interval (CI) were calculated after applying bivariate analysis (crude OR) and multinomial logistic regression.
Results
In all, 122 students (61 cases, 61 matched-controls), all under 30 years of age, were recruited into the study; 54% were male and 46% were female.
Fewer of the cases than controls believed that curriculum overload, Internet inexperience, an uncooperative community, difficulty in finding a mentor, difficulty in selecting a topic, lack of previous exposure, and lack of Internet facilities lead to a lack of interest in research. There was no significant association between curriculum overload, Internet inexperience, an uncooperative community, difficulty in finding a mentor, difficulty in selecting a topic, lack of previous exposure, and lack of interest. After applying multinomial logistic regression, a lack of Internet facilities was found to be significantly associated with the lack of interest of medical students in research activities.
More cases than the controls believed that sleep loss, extracurricular activities, uncooperative colleagues, inclement weather (hot and humid), lack of knowledge, bad past experiences, social commitments, drugs/addictions, laziness, uncooperative faculty, transportation problems, lack of motives and incentives, faculty-forced research, fatigue, and an attitude that considered research useless led to a lack of interest in research. However, there was no significant association between sleep loss, extracurricular activities, uncooperative colleagues, improper weather, lack of knowledge, bad past experiences, social commitments, drugs/addictions, laziness, uncooperative faculty, transportation problems, lack of motives and incentives, faculty-forced research, fatigue, and lack of interest. Finding research useless was a significant factor associated with lack of interest of students in research activities. Students who consider research useless are 4.970 times more likely to be uninterested in research.
Discussion
After multinomial logistic regression, considering research useless and lack of Internet facilities emerged as the only significant factors in our study.
The Internet is a very important resource, and much past research would not have been as fruitful without it. Today the digital world embraces libraries that once used to be difficult to access across long distances. Medical databases such as PubMed, eMedicine, MEDLINE, and several others are particularly useful for finding research articles. These resources are important to research because they make recent information available; the Internet is very useful for other reasons as well. For example, Google, being a general search engine, has a large number of medical articles. Doctors have used these searches to diagnose many challenging cases. A Google or Google Scholar search is quite effective in helping doctors make a diagnosis.Citation33–Citation35 We strongly believe that much research is not feasible without access to the Internet. Better funding for research projects can have a significant impact on this. For example, provision of electronic media and Internet to students where these facilities are not available can counter this factor, as depicted by our research.
Burgoyne et alCitation24 in their 2010 article supported our finding that students with no interest in research believe it to be useless; in this study, the students stated that researchers are cut off from clinical practice. This notion shows that students have a poor understanding of research and its vastness. Further research is needed in Pakistan to uncover any other reasons that might be responsible for this perception. The concept of translational research should be promoted among medical students.
Previous studies have shown an association between nonparticipation in research and an uncooperative faculty, a lack of motivation and incentives,Citation8–Citation10 curriculum overload,Citation8,Citation9 and lack of knowledge.Citation9 We came to different conclusions through our research; however, these discrepancies are not truly contradictory. For example, Mokry and MokraCitation9 in a 2007 study found a relationship between students’ participation in research and financial incentives. On the other hand, we did not define any particular benefits, such as finances. Furthermore, these studies count the above-mentioned factors as causing hindrance to student involvement, but most of the study subjects were interested in research activities, and the authors did not hold these factors responsible for causing a lack of interest.Citation8–Citation10 Hence, although these factors might be responsible for nonparticipation in research, we conclude that they are not responsible for causing a lack of interest. However, these factors cannot be ignored; improving these aspects of medical education can promote research activities. For example, the students’ curriculum workload can cause time constraints, so small working groups can be formed to make the study process better. In addition, students can be encouraged to take part in stimulating activities like games or puzzles.
Medical student research programs have the proven benefit of increasing the number of research-oriented physicians.Citation16,Citation37,Citation38 Their use is strongly recommended whenever feasible.Citation16,Citation36–Citation38 Examples of these programs include the medical student research fellowship program (MSRF),Citation16 the Doris Duke clinical research fellowship (CRF) program,Citation39 the Norwegian medical student research program,Citation38 the Baylor College of Medicine and Cleveland Clinic Learner COM,Citation40 the student selected components (SSC) program in the UK,Citation41 scholarly concentration (SC) programs at the Alpert medical school of Brown University,Citation40 and mandatory medical students’ research projects in the Netherlands.Citation42 The Howard Hughes medical institute (HHMI) conducted two 1-year research training programs for concentrating on the awardees’ research careers. A study conducted to evaluate the effect of those programs on medical students’ decisions to take up a research career showed that these training programs had a lasting imprint on health professionals’ careers.Citation43 Undergraduate research electives can also help. A mandatory research elective during medical school makes a difference. A survey was conducted at the Queen’s University (Kingston, ON, Canada) to determine students’ views about such electives. It was unanimously agreed upon that a mandatory rotation has a positive impact, even if a research career is not eventually opted for.Citation44
Seminars, symposiums and courses should be more frequently conducted to attract more students toward research activities. Such seminars may be focused on eliciting the importance of research, explaining different methods of research, and above all, showing the newer students the research work of experienced professionals. This can inspire medical students to do research, strengthen their careers, and be better doctors in the long run. In short, such activities have a positive impact on students.Citation45,Citation46
A review of the literature suggests a marked geographical variation in the level of participation by medical students in research projects.Citation7,Citation9,Citation10,Citation24,Citation28,Citation47,Citation48 This variation is also prominent within a country and relies on factors such as the curriculum design and opportunities provided to potential researchers.Citation10 Our findings are noteworthy in comparison to the existing literature. However, policymakers should use local data whenever possible for formulating policies favoring research among medical students.
To our knowledge, this study is the first to report most of the factor associations to interest in research. Although the progress in research and research-oriented careers could be hindered by Internet and computer inexperience,Citation28 or the nonavailability of a mentor,Citation47 they do not necessarily affect the level of interest of students in research activities.
Conclusion
Measures should be taken at undergraduate level to involve students in research activities. Ensuring easy access to Internet facilities is essential. Further studies should be conducted to find out the reasons why some medical students consider research useless, and steps should be taken to change these attitudes. Factors associated with decreased participation in research by those students who demonstrate a positive level of interest should also be explored.
There are a number of limitations to this study. First, it has been undertaken only in one university, in one class, and using a cross-sectional methodology. It is difficult to make generalized conclusions and causal relation-based recommendations. Second, this study has only collected binary answers. To analyze the complexity of social and academic issues that might influence the level of interest in research medicine, a stronger, more detailed study design would be valuable. Finally, the study was conducted on a senior class. The picture might be entirely different in junior classes as different levels of education are likely to motivate students in different ways.
Acknowledgments
The authors thank Professor Dr Maaz Ahmad and other members of the teaching staff of the Community Medicine department, King Edward Medical University, for their support, guidance, and supervision during the research process.
Disclosure
The authors report no conflicts of interest in this study.
References
- WyngaardenJBThe clinical investigator as an endangered speciesN Engl J Med19793012312541259503128
- GoldsteinJLBrownMSThe clinical investigator: bewitched, bothered, and bewildered – but still belovedJ Clin Invest19979912280328129185499
- RosenbergLEThe physician-scientist: an essential – and fragile – link in the medical research chainJ Clin Invest1999103121621162610377167
- CampbellEGWeissmanJSMoyEBlumenthalDStatus of clinical research in academic health centers: views from the research leadershipJAMA2001286780080611497533
- MokryJSevecovaDSulajMStudent scientific activities at Jessenius Faculty of Medicine, Comenius University in Martin – current state and its futureBratisl Lek Listy20041051252915141813
- LeyTJRosenbergLEThe physician-scientist career pipeline in 2005: build it, and they will comeJAMA2005294111343135116174692
- KhanHKhawajaMRWaheedARaufMAFatmiZKnowledge and attitudes about health research amongst a group of Pakistani medical studentsBMC Med Educ200665417081286
- MostafaSRKhashabSKFouaadASAbdel BakyMAWalyAMEngaging undergraduate medical students in health research: students’ perceptions and attitudes, and evaluation of a training workshop on research methodologyJ Egypt Public Health Assoc2006811–29911817382086
- MokryJMokraDOpinions of medical students on the pre-graduate scientific activities – how to improve the situation?Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub2007151114714917690760
- de OliveiraNALuzMRSaraivaRMAlvesLAStudent views of research training programmes in medical schoolsMed Educ201145774875521649708
- SalgueiraACostaPGonçalvesMIndividual characteristics and student’s engagement in scientific research: a cross-sectional studyBMC Med Educ2012129523066758
- KhanHTaquiAMKhawajaMRFatmiZProblem-based versus conventional curricula: influence on knowledge and attitudes of medical students towards health researchPLoS One200727e63217637847
- ZierKStagnaro-GreenAA multifaceted program to encourage medical students’ researchAcad Med200176774374711448834
- KassebaumDGSzenasPLRuffinALMastersDRThe research career interests of graduating medical studentsAcad Med19957098488527669166
- ZierKFriedmanESmithLSupportive programs increase medical students’ research interest and productivityJ Investig Med2006544201207
- SolomonSSTomSCPichertJWassermanDPowersACImpact of medical student research in the development of physician-scientistsJ Investig Med2003513149156
- VujaklijaAHrenDSambunjakDCan teaching research methodology influence students’ attitude toward science? Cohort study and nonrandomized trial in a single medical schoolJ Investig Med2010582282286
- FisherWRMedical student research: a program of self-educationJ Med Educ198156119049087299797
- Campos-OutcaltDSenfJWatkinsAJBastackySThe effects of medical school curricula, faculty role models, and biomedical research support on choice of generalist physician careers: a review and quality assessment of the literatureAcad Med19957076116197612127
- AltunbasACursiefenCResearch activities of medical students in Germany using as an example the Würzburg University ClinicDtsch Med Wochenschr199812320617620 German [with English abstract]9627569
- RemesVHeleniusISinisaariIResearch and medical studentsMed Teach200022164167
- LloydTPhillipsBRAberRCFactors that influence doctors’ participation in clinical researchMed Educ200438884885115271045
- BiererSBChenHCHow to measure success: the impact of scholarly concentrations on students – a literature reviewAcad Med201085343845220182116
- BurgoyneLNO’FlynnSBoylanGBUndergraduate medical research: the student perspectiveMed Educ Online201015
- LeonardJCEllsburyKEGender and interest in academic careers among first- and third-year residentsAcad Med19967155025049114871
- JesteDVHalpainMCTrinidadGIReichstadtJLLebowitzBDUCSD’s short-term research training programs for trainees at different levels of career developmentAcad Psychiatry200731216016717344459
- LopattoDUndergraduate research experiences support science career decisions and active learningCBE Life Sci Educ20076429730618056301
- SheLWuBXuLWuJZhangPLiEDeterminants of career aspirations of medical students in southern ChinaBMC Med Educ200885919077214
- GuelichJMSingerBHCastroMCRosenbergLEA gender gap in the next generation of physician-scientists: medical student interest and participation in researchJ Investig Med2002506412418
- DeressaWAzazhAAttitudes of undergraduate medical students of Addis Ababa University towards medical practice and migration, EthiopiaBMC Med Educ2012126822867022
- HEC announced ranking of Pakistani universities 2013The News InternationalJuly052013Web Edition Available from: http://www.thenews.com.pk/article-108140-HEC-announced-ranking-of-Pakistani-universities-2013Accessed September 17, 2013
- Quality and research based ranking of Pakistani HEIsRanking, methodology, criteria and weights Available from: http://www.hec.gov.pk/InsideHEC/Divisions/QALI/Others/RankingofUniversities/Documents/Quality%20and%20Research%20Based%20Ranking%20of%-20Pakistan%20HEIs_Updated.pdfAccessed September 17, 2013
- GiustiniDHow Google is changing medicineBMJ200533175311487148816373722
- HendersonJGoogle Scholar: A source for clinicians?CMAJ2005172121549155015939908
- TangHNgJHGoogling for a diagnosis – use of Google as a diagnostic aid: internet based studyBMJ200633375791143114517098763
- JacobsCDCrossPCThe value of medical student research: the experience at Stanford University School of MedicineMed Educ19952953423468699971
- FrishmanWHStudent research projects and theses: should they be a requirement for medical school graduation?Heart Dis20013314014411975783
- HunskaarSBreivikJSiebkeMTømmeråsKFigenschauKHansenJBEvaluation of the medical student research programme in Norwegian medical schools. A survey of students and supervisorsBMC Med Educ200994319602226
- GallinEKLeBlancq SMClinical Research Fellowship Program LeadersLaunching a new fellowship for medical students: the first years of the Doris Duke Clinical Research Fellowship ProgramJ Investig Med20055327381
- GreenEPBorkanJMProssSHEncouraging scholarship: medical school programs to promote student inquiry beyond the traditional medical curriculumAcad Med201085340941820182113
- RobinsonLDrewerySEllershawJSmithJWhittleSMurdoch-EatonDResearch governance: impeding both research and teaching? A survey of impact on undergraduate research opportunitiesMed Educ200741872973617661880
- van EykHJHooiveldMHVan LeeuwenTNVan der WurffBLDe CraenAJDekkerFWNVMO-special Interest Group on Scientific EducationScientific output of Dutch medical studentsMed Teach201032323123520218838
- FangDMeyerREEffect of two Howard Hughes Medical Institute research training programs for medical students on the likelihood of pursuing research careersAcad Med200378121271128014660432
- HouldenRLRajaJBCollierCPClarkAFWaughJMMedical students’ perceptions of an undergraduate research electiveMed Teach200426765966115763861
- MarusićAMarusićMTeaching students how to read and write science: a mandatory course on scientific research and communication in medicineAcad Med200378121235123914660423
- HrenDLukićIKMarusićATeaching research methodology in medical schools: students’ attitudes towards and knowledge about scienceMed Educ2004381818614962029
- SiemensDRPunnenSWongJKanjiNA survey on the attitudes towards research in medical schoolBMC Med Educ201010420096112
- VodopivecIVujaklijaAHrabakMKnowledge about and attitudes towards science of first year medical studentsCroat Med J200243586211828562