Contemporary global perspectives of medical students on research during undergraduate medical education: a systematic literature review

Figures & data

Figure 1. Schematic PRISMA diagram showing the literature selection process.

Table 1. Number of studies included by country/region of origin.

Country	Region	Number of Articles
Australia	Asia	1
Brazil	South America	3
Canada	North America	1
India	Asia	2
Iran	Middle East	1
Kuwait	Middle East	1
New Zealand	Asia	2
Pakistan	Asia	5
Saudi Arabia	Middle East	4
South Africa	Africa	1
Sweden	Europe	1
United States (U.S.)	North America	3
United Kingdom (U.K.)	Europe	1
TOTAL		26

Table 2. Characteristics of each article included in the study.

*Source	Country Source	Sampled Population with N	Perspective Studied	Methods	Outcomes
Abu-Zaid et al. 2014 [54]	Saudi- Arabia	116/171 female medical students	Perceived barriers	-Online, self-rating survey, using Likert scale	-Top three barriers identified: Greater preference for patient care than research (75.0%); Work/life balance (52.6%); and lack of female role models (48.3%).
Abu-Zaid, 2014 [14]	Saudi-Arabia	61 female second year undergraduate medical students	Perceived attitudes	-Cross-sectional, self-rating survey	−31.1% had previous summer research experiences (68.0% local and 33.0% international programs). -All showed positive attitudes towards undergraduate research. - 72.0% endorsed the importance and 44.0% the compulsoriness of integrating scientific research into undergraduate medical education curricula.
Al-Halabi, 2014 [15]	Kuwait	150 sixth and seventh year medical students	Experiences, attitudes, and barriers	-Questionnaire	−66.0% of the students had participated in research. -54.0% students read medical journals regularly. -Barriers included: Lack of time due to other commitments or studies (33.9%), lack of interest either by the participant or other members of his/her project group (27.4%), lack of guidance and supervision (16.1%), lack of encouragement from the project’s mentor (12.1%), and lack of knowledge on how to write a scientific article for publication (10.5%). -42.0% of the students believed that research is important during undergraduate education, while 77.3% believed that it will become important during their future career.
Anbari et al. 2015 [58]	Iran	627 students in six schools of medical sciences	Barriers and infrastructure	-Quantitative and qualitative analytical approaches. - Research vs non-research groups -Barriers were validated using the Delphi technique on 36 students.	- Research students reported institutional barriers such as time, lack of access to electronic resources and prolongation of the process of buying equipment. -Non-research students reported individual barriers including lack of time, scientific writing skills, and access to trained assistants.
Baig, 2013 [33]	Pakistan	398 medical students at four medical universities	Perceptions, Prior experience and future research intent	-Data collection tool using a questionnaire and open-ended questions.	−88% intended to do research prior to medical school but only 51% reported they had previous research experience. -Reasons for engaging in research were to improve curriculum vitae (75%) and increase competitiveness for residency in the USA (43%).
Burgoyne, 2010 [16]	United Kingdom	317 undergraduate medical students	Transferable and research skills, prior research experience, attitude and motivation	-Questionnaire	−81% reported unawareness of opportunities. -51% expressed interest in research career. -56.5% reported moderate motivation, 35.8% high motivation, and 7.7% low motivation. -Barriers included: Isolation from friends (9%), felt like it was overly challenging or uninteresting (13%), undecided (11%).
Carter, 2016 [20]	United States (U.S)	266/346 osteopathic medical students	Research experience, interest during medical school	-Questionnaire	−81% had prior research experience. -75% had interest during medical school. -82% favored clinical research.
de Oliveira et al. 2011 [17]	Brazil	1004 medical students from 13 medical programs	-Availability and degree of involvement -Barriers	-Questionnaire	−7% had no interest in research. - 60% of them were involved in research training. -Barriers: Lack of institutional incentive, defective infrastructure, insufficient time available for professors to mentor undergraduate students.
Ejaz, 2011 [47]	Pakistan	387 final year medical students and fresh graduates	Research involvement, interest and barriers	-Cross-sectional questionnaire	-Medical students results only: 49% conducted literature search, 65% had journal reading experience due to the requirement of their institution. 41% undergraduates had already participated in a research project, however, mostly in the field as data collectors or computer assistants. -Barriers included: Current research status and teachings of Pakistan to be inadequate.
Funston et al. 2016 [48]	United Kingdom (UK)	1625 responses from 38 countries (excluding US); analysis restricted to countries with > 100 responses (n  =  890)	Perceptions	-Online questionnaire	-Less than 50% thought their institution provided adequate research training. -Key barriers were lack of time and mentors. -Females were less interested. -The barriers and satisfaction with research training differed significantly among countries.
Jimmy, 2013 [29]	India	114 medical students	Perception and benefits	-Cross sectional study: Questionnaires	−20.9% had publications. -81.7% saw research being essential to understanding. -38.3% thought it cumbersome. -24.3% of the students were involved in research purely for acquiring knowledge. -18.3% were pursuing interest in research, while 1.7% were doing research to improve their curriculum vitae. -73.9% found it essential for all students to do research. -Barriers found: Lack of time, lack of incentives in the form of scholarships, and post-graduate specialty selection.
Kharraz et al. 2016 [55]	Saudi Arabia	221/350 medical students.	Perceived barriers	-Online, cross-sectional, self-rating survey	-Participation significantly differed by gender (males vs. females): 68.6% vs. 45.4%. -Top three barriers: Lack of time (77.4%), lack of formal courses in curriculum (76%), and lack of UR mentors (70.1%). Others were lack of mentors, lack of interest in research, lack of finding same-gender research mentor, and lack of opportunities.
Kumar, 2009 [40]	India	471 medical students	Awareness, perceptions and practices	-Questionnaire-based qualitative study	−70% were aware about research although the level of awareness varied. -Various skills of conducting research were known to 47% of the students. -76% were part of a research team mainly as a part of the medical curriculum. -8.3% were confident of research as a career option.
Mahmood, 2017 [4]	Pakistan	294 medical students	-Current research practices. -Future intentions. -Related motivations, barriers, and sought-after interventions	-Self-administered questionnaire	-Intentions to pursue research at a professional level remained low (19.7%). -Intentions decreased each passing year of study. -Most commonly expressed motivation for pursuing research was “admission into a residency program” (71.8%). -Such intention was associated with a decreased likelihood of pursing research professionally. -Barriers: Lack of time (72.4%), lack of supervisors (50.3%), lack of opportunity (48.3%).
Meraj, 2016 [34]	Pakistan	172 medical students	Perceptions and attitudes	-Cross-sectional questionnaire	−45.3% were aware of research opportunities. -65.7% thought research was important to future career and relevant to their lives -41.9% not interested in research as a career. -41.3% students enjoyed research -70% perceived research as stressful and 62.2% complex
Mina et al., 2016 [32]	Saudi Arabia	218/350 medical students	Perception and participation	-Online survey	-Top three influential factors: Facilitate entry into competitive residency programs (88.1%), improve curriculum vitae (81.2%), and publish in peer-reviewed journals (79.8%). -Participation in research significantly differed by gender, academic year, and GPA.
Moraes, 2016 [27]	Brazil	278 medical students from first to sixth year.	Interest in research	-Cross-sectional, self-administered questionnaire	−81.7% were interested in research. -Only 4.7% of the students thought research is important. -No statistically significant association with age, gender, number of physicians in their family, prior college courses were found.
Nel et al., 2013 [30]	South Africa	733 medical students	Attitudes	-Cross-sectional survey	−61% had positive attitudes toward research. -74% thought involvement is important -22% voluntarily engaged in research -4% presented at a meeting and 3% had published Perceived barriers: Lack of adequate training, time, and research opportunities.
Oliveira, 2014 [49]	Brazil	415 first through sixth year medical students	Understanding, advantages, difficulties and motivations	-Questionnaire	−47.2% were involved in research. -Main barrier reported was time constraint. -Among students not involved in research, 91.1% reported, however, that they favored its inclusion in the curriculum.
O’ Sullivan, 2009 [50]	United States (U.S)	40 medical students	Attitudes	-Qualitative based on interviews conducted in person at locations chosen by participant.	- Five (5) themes were reported: Early exposure to research, role models and mentoring, career pathways, interplay of personal and social factors, and career support for junior faculty members.
Park et al., 2010 [35]	New Zealand	558 medical students	Attitudes	-Questionnaire	−25% participated in some form of research activity, mostly in the summer, during medical school. -70% expressed interest in participating in research during medical school. -68% of respondents were aware of the intercalated research degree option but only 8.6% were interested. -35% of respondents planned to be involved in research throughout their medical career. -More students rated lifestyle (84% affirmative) and earning potential (43% affirmative) as more important factors than opportunity for research (23% affirmative) when choosing a career specialty.
Pathipati, 2016 [31]	United States (U.S)	328 medical students	Perception of research year	-Online survey at 5 medical schools with highly regarded research programs	-Reasons for research years off: Increase competitiveness for residency application (32%), time to pursue other opportunities (24%), and academic interest (23%). -Students who would still take a research year even if they were already assured a position in a residency program of their choice were at 65%, while 35% would not take a research year.
Rosenkranz, 2015 [18]	Australia	579/806 medical students from first year through fifth year	Attitudes, motivations, and barriers	-Convergent parallel mixed methods study using cross-sectional quantitative survey data and qualitative semi-structured interview findings	−7.5 % of students had prior research experience. -42% indicated interest beyond medical school. -89.1% of students believe conducting research is advantageous for medical career. -44.2% believe bureaucracy surrounding research is a significant deterrent. -49.8% of students were neutral to research and lower salary.
Sheikh, 2013 [59]	Pakistan	122 students	Interest and enthusiasm	-Case (not interested in research)-control (those interested) study	-Barriers identified by interested students: Curriculum overload, internet inexperience, an uncooperative community, difficulty in finding a mentor and selecting a topic, lack of previous exposure, and lack of internet facilities. -Barriers identified by non-interested students: 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.
Siemens, 2010 [51]	Canada	327 second and fourth year medical students at three medical schools.	Attitudes and experience	-Questionnaire	-Involved in research prior to medical school (87%). -43% were not significantly involved in research during medical school. -24% were not interested. -44% believed research is important in future career. -Barriers included: Time, availability of research mentors, lack of formal teaching of research methodology, and lack of appropriate acknowledgement.
Stockfelt, 2016 [19]	Sweden	471 medical students	Research interest and activity	-Questionnaire administered as a follow up to a 2006 survey	−16% were actively involved in research. -36% were interested. -Barriers to research included: Lack of time (23%), excessive workload (22%), and not enough time to study (16%). -Financial compensation, expansion of research opportunities, and career planning would aid in research interest.

*Brackets denotes the number in the reference list.

Table 3. Common themes from global perspectives on research during medical education derived from content analysis of the abstracts/full-text articles.

Theme	Perspectives
Research interest	-Medical students express very high interest in research while in training. -Majority have positive attitude toward research.
Physician-scientist career (decline and shortage)	-Universal consensus on the reality of a decreasing numbers of physician-scientists that should not be ignored.
Response to physician-scientist shortage – MD/PhD and other combined programs, Specialized programs, NGOs, Curriculum	-Dual degrees MD/DO/PhD. -Curriculum changes reflecting research and academic medicine tracks. -Intercalated programs (Equivalence of dual degrees). -Research courses or fairs featuring keynote speakers, presentations, etc. (Germany). -Development of national research programs (Norway). -Voluntary immersion at individual institutions (Lebanon). -Workshops (Saudi Arabia).
Curriculum	-Curriculum often did not incorporate research across the board. -Curriculum not adequate in focusing on research in medical education. -No curriculum at all in some other situations. -Research was buried in the curriculum and not obvious. -Curriculum efforts varied greatly across institutions.
Skills – Motivation, Self-efficacy	-Willing to do research but lack the necessary skills and self-efficacy. -Well motivated but constrained by barriers. -Lack the necessary skills by little exposure to research earlier. -Highly motivated but not self-efficacious.
Needs – Training, Curriculum, Infrastructure, Competitiveness for residency/fellowships for residents	-Curriculum-based training in research necessary to provide the basic skills in research. -Training in clinical research. -Availability of research infrastructure. -Research itself needed for competitiveness for fellowships and residencies for students. -Needs research to improve CV. -For getting into academic medicine or becoming a physician-scientist.
Socio-Economic and Cultural – Organization, Gender	-Males rather than females would want to go into academic medicine or physician-scientists than females. -Cultural issues in some countries where the two genders do not mix. -Males more likely to engage in research than females.
Barriers – Institutional, Non-institutional	-Institutional barriers such as time unavailability, lack of mentors, inadequate support for research, lack of access to electronic resources, lack of mentors, and prolongation of the process of buying equipment, and lack of infrastructure. -Non-institutional: Lack of time, inadequate scientific writing skills, lack of early exposure to research and lack of access to assistance.

Table

Database		Strategy/Limits
PubMed	1	Medical student* OR students, medical [MeSH] OR osteopathic medical student* OR osteopathic medicine[MeSH]
	2	Research OR research[MeSH] OR career choice* OR career choice[MeSH] OR physician scientist*
	3	1 AND 2
	4	Motivation* OR motivation[MeSH] OR attitude* OR attitude[MeSH] OR perception* OR perception[MeSH] OR interest
	5	3 AND 4 (Limited to 9/29/2007–9/29/2017
Database		Strategy/Limits
Scopus	1	[TITLE-ABS-KEY] ‘medical student’ OR ‘medical students’ OR ‘osteopathic medical student’ OR ‘osteopathic medical students’ OR ‘osteopathic medicine’
	2	[TITLE-ABS-KEY] ‘career choice’ OR ‘career choices’ OR career OR careers
	3	[TITLE-ABS-KEY] research
	4	[TITLE-ABS-KEY] ‘physician scientist’ OR ‘physician scientists’
	5	[TITLE-ABS-KEY] motivation OR motivations OR attitude OR attitudes OR perceptions OR perception OR interest OR interests
	6	1 AND 2 AND 3 AND 4 AND 5
	7	PUBYEAR limited to 2007–2017, LANG English
Database		Strategy/Limits
Cochrane	#1	medical students
	#2	MeSH descriptor: [Students, Medical] explode all trees
	#3	#1 or #2
	#4	osteopathic medical students
	#5	osteopathic medicine
	#6	MeSH descriptor: [Osteopathic Medicine] explode all trees
	#7	#4 or #5 or #6
	#8	#7 or #3
	#9	perceptions
	#10	motivations
	#11	attitudes
	#12	interests
	#13	MeSH descriptor: [Motivation] explode all trees
	#14	MeSH descriptor: [Perception] explode all trees
	#15	MeSH descriptor: [Attitude] explode all trees
	#16	#9 or #10 or #11 or #12 or #13 or #14 or #15
	#17	career
	#18	career choice
	#19	MeSH descriptor: [Career Choice] explode all trees
	#20	#17 or #18 or #19
	#21	physician scientist
	#22	physician researcher
	#23	#21 or #22
	#24	#3 or #7
	#25	#24 and #16
	#26	#20 and #25
	#27	#23 and #26
	#28	#8 and #16
	#29	#20 and #28
	#30	#29 and #23
	#31	research
	#32	MeSH descriptor: [Research] explode all trees
	#33	#31 or #32
	#34	#30 and #33 Publication Year from 2007 to 2017

Abu-Zaid A, Altinawi B. Perceived barriers to physician-scientist careers among female undergraduate medical students at the College of Medicine - Alfaisal University: a Saudi Arabian perspective. Med Teach. 2014;36(Suppl 1):S3–7.

 PubMed Web of Science ®Google Scholar

Abu-Zaid A, Alnajjar A. Female second-year undergraduate medical students’ attitudes towards research at the College of Medicine, Alfaisal University: a Saudi Arabian perspective. Perspect Med Educ. 2014;3(1):50–55.

 PubMedGoogle Scholar

Al-Halabi B, Marwan Y, Hasan M, et al. Extracurricular research activities among senior medical students in Kuwait: experiences, attitudes, and barriers. Adv Med Educ Pract. 2014;5:95–101.

 PubMedGoogle Scholar

Anbari Z, Mohammadbeigi A, Jadidi R. Barriers and challenges in researches by Iranian students of medical universities. Perspect Clin Res. 2015;6(2):98–103.

 Google Scholar

Baig SA, Hasan SA, Ahmed SM, et al. Reasons behind the increase in research activities among medical students of Karachi, Pakistan, a low-income country. Educ Health (Abingdon). 2013;26(2):117–121.

 PubMedGoogle Scholar

Burgoyne LN, O’Flynn S, Boylan GB. Undergraduate medical research: the student perspective. Med Educ Online. 2010;15:5212.

 Web of Science ®Google Scholar

Carter J, McClellan N, McFaul D, et al. Assessment of research interests of first-year osteopathic medical students. J Am Osteopath Assoc. 2016;116(7):472–478.

 Web of Science ®Google Scholar

de Oliveira NA, Luz MR, Saraiva RM, et al. Student views of research training programmes in medical schools. Med Educ. 2011;45(7):748–755.

 PubMed Web of Science ®Google Scholar

Ejaz K, Shamim MS, Shamim MS, et al. Involvement of medical students and fresh medical graduates of Karachi, Pakistan in research. J Pak Med Assoc. 2011;61(2):115–120.

 Web of Science ®Google Scholar

Funston G, Piper RJ, Connell C, et al. Medical student perceptions of research and research-orientated careers: an international questionnaire study. Med Teach. 2016;38(10):1041–1048.

 PubMed Web of Science ®Google Scholar

Jimmy R, Palatty PL, D’Silva P, et al. Are medical students inclined to do research? J Clin Diagn Res. 2013;7(12):2892–2895.

 PubMedGoogle Scholar

Kharraz R, Hamadah R, AlFawaz D, et al. Perceived barriers towards participation in undergraduate research activities among medical students at Alfaisal University-College of Medicine: a Saudi Arabian perspective. Med Teach. 2016;38(Suppl 1):S12–18.

 Google Scholar

Kumar HNH, Jayaram S, Kumar GS, et al. Perception, practices towards research and predictors of research career among UG medical students from coastal south India: a cross-sectional study. Indian J Community Med. 2009;34(4):306–309.

 Google Scholar

Mahmood Shah SM, Sohail M, Ahmad KM, et al. Grooming future physician-scientists: evaluating the impact of research motivations, practices, and perceived barriers towards the uptake of an academic career among medical students. Cureus. 2017;9(12):e1991.

 Web of Science ®Google Scholar

Meraj L, Gul N, Zubaidazain, et al. Perceptions and attitudes towards research amongst medical students at Shifa College of Medicine. J Pak Med Assoc. 2016;66(2):165–189.

 Web of Science ®Google Scholar

Mina S, Mostafa S, Albarqawi HT, et al. Perceived influential factors toward participation in undergraduate research activities among medical students at Alfaisal University-College of Medicine: a Saudi Arabian perspective. Med Teach. 2016;38(Suppl 1):S31–36.

 Google Scholar

Moraes DW, Jotz M, Menegazzo WR, et al. Interest in research among medical students: challenges for the undergraduate education. Rev Assoc Med Bras (1992). 2016;62(7):652–658.

 PubMed Web of Science ®Google Scholar

Nel D, Burman RJ, Hoffman R, et al. The attitudes of medical students to research. S Afr Med J. 2013;104(1):33–36.

 Web of Science ®Google Scholar

Oliveira CC, de Souza RC, Abe EHS, et al. Undergraduate research in medical education: a descriptive study of students’ views. BMC Med Educ. 2014;14:51.

 PubMed Web of Science ®Google Scholar

O’Sullivan PS, Niehaus B, Lockspeiser TM, et al. Becoming an academic doctor: perceptions of scholarly careers. Med Educ. 2009;43(4):335–341.

 PubMed Web of Science ®Google Scholar

Park SJ, Liang MM, Sherwin TT, et al. Completing an intercalated research degree during medical undergraduate training: barriers, benefits and postgraduate career profiles. N Z Med J. 2010;123(1323):24–33.

 PubMedGoogle Scholar

Pathipati AS, Taleghani N. Research in medical school: a survey evaluating why medical students take research years. Cureus. 2016;8(8):e741.

 Web of Science ®Google Scholar

Rosenkranz SK, Wang S, Hu W. Motivating medical students to do research: a mixed methods study using self-determination theory. BMC Med Educ. 2015;15:95.

 PubMed Web of Science ®Google Scholar

Sheikh AS, Sheikh SA, Kaleem A, et al. Factors contributing to lack of interest in research among medical students. Adv Med Educ Pract. 2013;4:237–243.

 PubMedGoogle Scholar

Siemens DR, Punnen S, Wong J, et al. A survey on the attitudes towards research in medical school. BMC Med Educ. 2010;10:4.

 PubMed Web of Science ®Google Scholar

Stockfelt M, Karlsson L, Finizia C. Research interest and activity among medical students in Gothenburg, Sweden, a cross-sectional study. BMC Med Educ. 2016;16(1):226.

 PubMedGoogle Scholar