Benefits and pitfalls of scientific research during undergraduate medical education

Medical Students' Acquaintance with Core Concepts, Institutions and Guidelines on Good Scientific Practice: A Pre- and Post-questionnaire Survey

German medical students are not sufficiently introduced to the ethical principles and pitfalls of scientific work. Therefore, a compulsory course on good scientific practice (GSP) has been developed and implemented into the curriculum of medical students, with the goal to foster scientific integrity and prevent scientific misconduct. Students' knowledge and attitudes towards GSP were evaluated by a pre-post-teaching questionnaire survey (n = 239). Most participants initially had startling knowledge gaps in the field. Moreover, they were not acquainted with core institutions on GSP, the office of ombudsperson and the nationally binding guidelines on GSP. The pre-post-teaching comparison showed statistically significant improvement in all areas tested; moreover, after the course participants confided more trust in GSP institutions. Applying ethical rules into practice can be challenging; therefore, students need to learn to work independently with guidelines on GSP and should be introduced to institutions providing further guidance. As our study has shown, students are very willing to pursue a scientific career based on integrity and honesty, however, they lack the knowledge how to do so. In light of our results, we therefore recommend to integrate courses on GSP already at an early time into the mandatory curriculum of medical students.

How confident are medical students about making clinical decisions relying on the evidence? A cross-sectional questionnaire study

Objective: Giving information and providing advice on diagnostic tests is one of the tasks physicians must carry out personally. To do so, they must evaluate the evidence and integrate their findings into everyday practice. Clinical decisions should be based on evidence. How well current medical education prepares for such evidence-based clinical decision-making is largely unclear. Therefore, it was examined how confident medical students are in clinical decision-making based on evidence using epidemiological data. It was examined whether the decision-making confidence increases the higher the semester. Further questions were whether scientifically active medical students show higher decision-making confidence and whether the representation of figures as pictograms rather than tables positively influences the decision-making confidence. Methods: An online survey of the medical students of the Friedrich-Alexander-University Erlangen-Nürnberg was carried out. Respondents were presented with three clinical decision-making situations in random order for evaluation in the form of screening scenarios. In each case, the decision-making confidence also had to be specified. The scenarios contained only epidemiological data on existing screening tests. For each scenario, the numbers were presented as a table or a pictogram in a random fashion. In order to avoid false confidence resulting from preconceived opinions neither the illnesses nor the screening tests were mentioned by name. Results: Answers from 171 students were evaluated. Decision-making confidence in dealing with the numbers does not increase in higher semesters (r_Pearson =0.018, p=0.41). Scientific work is not associated with a higher decision-making confidence (t(169)=-1.26, p=0.11, d=-0.19). Presentation as a pictogram leads to a higher decision-making confidence compared to tables (Pictogram: M=2.33, SD=1.07, Table with numbers: M=2.64, SD=1.11, t(511)=3.21, p<0.01, d=0.28). Conclusions: Medical students from higher semesters show no higher decision-making confidence compared to medical students from lower semesters. Curricular events and scientific work, such as a doctoral thesis, do not seem to strengthen the required skills sufficiently. If evidence is presented in the form of pictograms, this seems to improve student confidence in decision-making.

Perceived enablers and constraints of motivation to conduct undergraduate research in a Faculty of Medicine and Health Sciences: What role does choice play?

Background

Enhancing evidence-based practice and improving locally driven research begins with fostering the research skills of undergraduate students in the medical and health sciences. Research as a core component of undergraduate curricula can be facilitated or constrained by various programmatic and institutional factors, including that of choice. Self-Determination Theory (SDT) provides a framework for understanding the influence of choice on student motivation to engage in research.

Aim

This study aimed to document the enablers and constraints of undergraduate research at a South African Faculty of Medicine and Health Sciences (FMHS) and to explore how the presence or absence of choice influenced students’ engagement with research in this context.

Methods

An exploratory descriptive design was adopted. Undergraduate students who had conducted research and undergraduate programme staff were recruited through purposive sampling. Semi-structured interviews were transcribed and thematically analysed. Findings were interpreted using SDT, focusing on how choice at various levels affects motivation and influences research experiences.

Results

Many of the programmatic and institutional enablers and constraints–such as time and supervisory availability–were consistent with those previously identified in the literature, regardless of whether research was compulsory or elective. Choice itself seemed to operate as both an enabler and a constraint, highlighting the complexity of choice as an influence on student motivation. SDT provided insight into how programmatic and institutional factors–and in particular choice–supported or suppressed students’ needs for autonomy, competence, and relatedness, thereby influencing their motivation to engage in research.

Conclusion

While programmatic and institutional factors may enable or constrain undergraduate research, individual-level factors such as the influence of choice on students’ motivation play a critical role. The implication for curriculum development is that research engagement might be enhanced if levels of choice are structured into the curriculum such that students’ needs for autonomy, competence, and relatedness are met.

Knowledge of Postgraduate Medical Trainees Regarding Epidemiology

Introduction An understanding of epidemiology is fundamental for designing research and understanding evidence-based medicine (EBM). The purpose of our study was to determine the knowledge of epidemiology among postgraduate medical trainees. Methods We carried out a cross-sectional study from January 2017 to June 2017 at the Regional Centre Islamabad, College of Physicians and Surgeons Pakistan. About 204 postgraduate medical trainee were enrolled in the study after taking written consent. All of the participants were working as a postgraduate medical trainee in different hospitals of Rawalpindi and Islamabad. A self-designed structured questionnaire containing 20 multiple choice questions regarding knowledge of epidemiology was given to all the participants. Knowledge of epidemiology was measured and compared with gender, hospital, and previous history of research. Statistical Package for the Social Sciences (SPSS), version 21.0 (IBM, Armonk, NY) was used for data analysis. Results Out of 204 participants, 46.1% participants were males while 53.9% were females. The mean age of the participant was 28.5 ± 2.5. Majority fo the trainees (33.8%) were training in an Internal Medicine residency program. Most of the trainees (76%) had average knowledge of epidemiology while 18.6% of the trainees had good knowledge. Only 17.6% had some experience of research projects in the past, but this was not related to knowledge of epidemiology (p > 0.05). Conclusion Only 18.6% of the postgraduate trainees had good knowledge regarding epidemiology and 76% had average knowledge. This knowledge did not relate to their gender, hospital settings, and previous experience of conducting research proposals and articles.

Supervisors' perspective on medical thesis projects and dropout rates: survey among thesis supervisors at a large German university hospital

OBJECTIVES

To identify underlying causes for failure of medical thesis projects and the constantly high drop-out rate in Germany from the supervisors' perspective and to compare the results with the students' perspective.

SETTING

Cross-sectional survey. Online questionnaire for survey of medical thesis supervisors among the staff of Charité-Universitätsmedizin Berlin, Germany. Published, earlier longitudinal survey among students for comparison.

PARTICIPANTS

1069 thesis supervisors participated.

DATA EXTRACTION AND SYNTHESIS

Data are presented using descriptive statistics, and the χ² test served to compare the results among supervisors with the earlier data from the longitudinal survey of doctoral students.

PRIMARY AND SECONDARY OUTCOMES

Not applicable. This survey is an observational study.

RESULTS

Of 3653 potential participants, 1069 (29.3%) supervising 3744 doctoral candidates participated in the study. Supervisors considered themselves to be highly motivated and to offer adequate supervision. On the other hand, 87% stated that they did not feel well prepared for thesis supervision. Supervisors gave lack of timeliness of doctoral students and personal differences (p=0.024 and p=0.001) as the main reasons for terminating thesis projects. Doctoral students predominantly mentioned methodological problems and difficult subjects as critical issues (p=0.001 and p<0.001). Specifically, students felt ill prepared for the statistical part of their research-49.5% stated that they never received statistical assistance, whereas 97% of supervisors claimed to help their students with statistical analysis.

CONCLUSIONS

The authors found that both thesis supervisors and medical students feel ill prepared for their roles in the process of a medical dissertation. Contradictory reasons for terminating medical thesis projects based on supervisors' and students' self-assessment suggest a lack of communication and true scientific collaboration between supervisors and doctoral students as the major underlying issue that requires resolution.

Teaching research: a programme to develop research capacity in undergraduate medical students at the University of KwaZulu-Natal, South Africa

BACKGROUND

Improved research ability is a core competency to achieve in health professionals. The Selectives is a three-year, longitudinal, community-based programme within the undergraduate curriculum which aims to develop research capacity in all medical students during the prescribed curriculum. In relation to the programme, the authors describe the types of studies conducted by students, conditions that facilitated their learning, how the experience improved students' knowledge of research and public health and their development of reflective learning practices.

METHODS

A cohort of 212 students completed the Selectives Programme in 2014, and 69 (32 %) completed an anonymous online evaluation thereafter. Data collected include students' perceptions of the research component of Selectives; its impact on their knowledge of research and a documentary analysis of their research protocols and posters. Ethical approval for the ongoing evaluation of the Selectives was sought and obtained from the institutional Biomedical Research Ethics Committee.

RESULTS

During Selectives, 75 groups of 2-4 students conducted research studies of primary health care problems in community settings. Each group is assessed on their presentation of research findings as a scientific poster. The Selectives facilitated learning for the majority of the cohort. Students reported positive learning experiences about the research process, including ethics; protocol writing; data processing; dissemination of findings and results; and their use in informing a health promotion intervention. Students reported having gained a better understanding of their strengths and weaknesses through reflective learning from this academic activity. The Selectives is scheduled adjacent to the students' mid-year vacation. This scheduling together with the placement in the students' home community minimizes travel and accommodation costs associated with working outside the academic teaching platform and therefore makes it a cost-effective model in a low resource context.

CONCLUSIONS

The Selectives has proven beneficial to develop a range of generic and practical research competencies for a full cohort of students enrolled in the undergraduate medical curriculum. The Selectives research process is integrated with learning about population health and the social determinants of health in a primary health care setting.

Importance and benefits of the doctoral thesis for medical graduates

INTRODUCTION

The majority of medical graduates in Germany complete a doctorate, even though a doctoral degree is not necessary for the practice of medicine. So far, little is known about doctoral candidates' view on the individual benefit a doctoral thesis has for them. Consequently, this is the subject of the present investigation.

METHOD

Data from surveys with graduates of the five medical faculties of Baden-Württemberg from the graduation years 2007/2008 (N=514) and 2010/2011 (N=598) were analysed.

RESULTS

One and a half years after graduating 53% of those interviewed had completed their doctorate. When asked about their motivation for writing a doctoral thesis, participants answered most frequently "a doctorate is usual" (85%) and "improvement of job opportunities" (75%), 36% said that an academic career has been their primary motive. Less than 10% responded that they used their doctoral thesis as a means to apply for a job. The proportion of graduates working in health care is equally large among those who have completed a thesis and those who have not. Graduates who pursued a thesis due to scientific interest are also currently more interested in an academic career and recognise more opportunities for research. An implicit benefit of a medical thesis emerged with regard to the self-assessment of scientific competences as those who completed a doctorate rated their scientific competencies higher than those who have not.

DISCUSSION

Although for the majority of physicians research interest is not the primary motivation for completing a doctorate, they might nevertheless achieve some academic competencies. For graduates pursuing an academic career the benefit of completing a medical thesis is more obvious.

Motivating medical students to do research: a mixed methods study using Self-Determination Theory

BACKGROUND

It is widely accepted that all medical graduates should understand the uses and methods of rigorous research, with a need to promote research to graduates who will pursue an academic career. This study aimed to explore, identify and explain what motivates and demotivates medical students to do research.

METHODS

A convergent parallel mixed methods study was conducted. Cross-sectional quantitative survey data (n = 579) and qualitative semi-structured interview findings (n = 23) data were separately collected and analysed. Informed by Self-Determination Theory (SDT), quantitative and qualitative findings were integrated to develop a model for the factors associated with medical students' expressed motivation to do research, and related to clinical and research learning activities at different stages in an undergraduate medical program.

RESULTS

Only 7.5% of students had research experience prior to entering the program. Survey results revealed that students who had experienced exposure to the uncertainties of clinical practice through clerkships (Pre-Clinical (48%) vs Clinical Years (64%), p < 0.001), and a sense of achievement through supported compulsory research activities which were conducted as a team (Pre- Community Research (51%) vs Post-Community Research (66%), p < 0.001), were more likely to view future research activities positively. When integrated with qualitative findings using the three SDT domains of autonomy, competence and relatedness, eight major themes were identified: Self & Time, Career, Bureaucracy, Financial, Confidence, Clinical Relevance, Research as a Social Activity, and Personal Relevance. The findings suggest that motivation to do research is associated with increasing internalization of intrinsic motivators; in particular those associated with competence (Confidence) and relatedness (Clinical Relevance, Research as a Social Activity).

CONCLUSIONS

SDT is useful for understanding the motivation of individuals and how curriculum can be designed to optimise motivation. Study findings suggest that well supported compulsory research activities that incorporate group learning and elements of choice may promote motivation to do research, and potentially, careers in research, even in a research naive student body.

Medical students and research: Is there a current discrepancy between education and demands?

This article refers to a correspondence letter recently published in The Lancet, describing successful student-led research initiatives in Latin America, which were introduced because of low support from universities and governments. As a final-year medical student with keen interest in science, the topic of student engagement in research activities caught my interest. Literature shows that while junior doctors are required to perform research on their own and face intense pressure to publish, formal training in principles of research and scientific writing is often neglected by medical schools. This contrast is worrying, as the progression of the medical profession and the quality of patient care depend on high-quality research and on future generations of physician-scientists being both enthusiastic and competent. Hence, this article summarizes suggestions to increase both students' research proficiency and participation in scientific activities, and offers a critical view on this important topic, as medical schools without curricular research education and without active student integration should urgently consider revising their policies.