Need to navigate undergraduate medical curriculum towards developing research skills

Abstract

India is coming up as a leader in medical research in recent times and consequently, requires a plethora of medical personnel trained in research. The foundation of sound research sense can be laid down during the undergraduate level and the medical curriculum should include research as one of its important component. In India, there is insufficient exposure to scientific research in medical education as research techniques and methodologies are currently not an integral component of the undergraduate medical curriculum. Undergraduate medical students in India have limited opportunities to participate in research. This is largely due to the fact that the focus of medical education in India, as such, is more on clinical practice and direct patient care and research training is still a neglected element. Moreover, prior research experience and publications do not figure in the selection procedure for post-graduation, unlike in developed countries where an experience in research and a couple of publications makes the resume stand out. In India, undergraduates can hardly foresee any advantage of involving themselves in research, neither in monetary terms nor in terms of academic advantage. It is the need of the hour that undergraduate curriculum should make a niche for training in research and this is essential to produce well informed doctors and an adept researcher. The current paper defines the contours of the areas which could be worked upon in order to promote undergraduate research learning. Editorial WHY FOCUS ON RESEARCH AND WHY MEDICAL DOCTORS? Research is required to discover new knowledge, help in the refinement of current knowledge and essentially in the advancement of science. According to World Health Organization, research leading to evidence and reliable information are the foundation for sound health policies [1]. This is the era of evidence-based medicine and demands that physicians are well versed with conducting research as well as critically absorbing research findings from latest research in various medical fields. Immersion into research would nurture a plethora of essential skills such as critical appraising, problem troubleshooting, novel idea generation and thoughtful judgement. Getting involved in research early in their career would help in sensitizing promising doctors to the ethical issues involved in patient care and research. This will possibly get reflected in their attitude not only towards research but also in the way they approach their patients. HOW DEVELOPED NATIONS ARE BETTER OFF IN RESEARCH INVOLVING MEDICAL UNDERGRADUATES The foundation for building of sound medical health research environment should be laid from the undergraduate period. Developed countries have strongly knit research programs for medical students in academics. For instance, Case Western Reserve University School of Medicine (CWRU) in the US implements a mandatory four months research block for undergraduate students where these students are required to work fulltime with a mentor, starting from identifying research questions to finally concluding with a write up and communicating the findings through either publications or conference(s) [2,3]. The University of California in United States nurtures the University of California, San Diego (UCSD) Research Associate Program to incorporate undergraduates with emergency medicine research [3,4]. University of Western Ontario, Canada introduced a rural summer studentship program which provides students with the opportunity to immerse themselves in rural health research [5]. Research training is provided to all undergraduate students in the Leiden University Medical Center (LUMC) in Netherlands, where the critical appraisal of scientific reports is an essential element in the undergraduate curriculum [6]. WHERE DOES INDIA STAND?TARDY YET PROMISING PROSPECTS In India, there is insufficient exposure to scientific research in medical education as research techniques and methodologies are currently not an integral component of the undergraduate medical curriculum. Undergraduate medical students in India have limited opportunities to participate in research. This is largely due to the fact that the focus of medical education in India, as such, is more on clinical practice and direct patient care and research training is still a neglected Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. Address for correspondence: Ravi Prakash Upadhyay, Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, Pin – 110029, ravi.p.upadhyay@gmail.com Received: November 26, 2015 Accepted: January 17, 2016 Published: April 7, 2016 Bhilwar, et al.: Research in undergraduate curriculum J Contemp Med Edu ● 2016 ● Vol 4 ● Issue 1 19 element. Although in their vision 2015 document, the Medical Council of India has proposed to include research methodology as one of the electives of undergraduate medical course, it does not call for a mandatory exposure to research [7,8]. Also, attainment of adequate research capabilities does not even figure in the list of skills a medical graduate should possess. Indian medical education system relies largely on marks and there are no credits for research [9]. This could be a strong factor to dissuade students to devote their time to research. Moreover, prior research experience and publications do not figure in the selection procedure for post-graduation, unlike in developed countries where an experience in research and a couple of publications makes the resume stand out. In India, undergraduates can hardly foresee any advantage of involving themselves in research, neither in monetary terms nor in terms of academic advantage [9]. Consequently, the lack of enthusiastic students in research is strikingly felt. Studies conducted in medical colleges across the country among the undergraduates show that most of the students have positive attitude towards research and most are willing to take research as career option in future but lack of research component in the curriculum, lack of adequate knowledge about research methodology, inadequate mentoring, insufficient funding and laboratory facilities prevents them to do so [10-12]. A study done in Melaka Manipal Medical College, Manipal, India documented that mentoring undergraduate students in health research through a structured “Mentored Student Project programme” successfully fostered positive attitudes among medical students towards scientific research [13]. More such mentorship programmes could potentially attract interested undergraduates to health research. Moreover, interest of medical students in undertaking research activities may be catalysed through efforts aiming to develop research-based competencies and nurturing inquisitiveness. Indian Council of Medical research (ICMR) has appreciated the fact that research exposure should be provided to medical undergraduates and in lieu of this, ICMR-STS (Short Term Studentship) scheme has been started [14]. The Indian Council of Medical Research initiated the Short Term Studentship Program in 1979 with the aim to uphold interest and aptitude for research among medical undergraduates. The main objective of this program is to provide an opportunity to undergraduate medical students to familiarize themselves with research methodology and techniques under a skilled mentorship, on ongoing research program or by undertaking independent projects. Students are free to choose any topic related to medical research depending on their interest. The topic needs to be relevant and should lead to creation of new knowledge or help in gaining new knowledge or skills by the student. The value of the studentship is Rs. 5,000/per month for 2 months duration and is meant to be a stipend for the student. This is paid only after completion of research and approval of final report. Costs of research must be borne by Institution/ Medical College where research is conducted. Gore CR et al conducted a study among the undergraduate medical students to assess the impact of short term studentship program on attitude of undergraduate medical students toward future research. They found an increase in knowledge and confidence, orientation toward data collection, analysis, its presentation or publication, and understanding the importance and contribution of research in patient care [12]. Another good initiative is the Kishore Vaigyanik Protsahan Yojana (KVPY) [15]. It is an on-going National Program of Fellowship in Basic Sciences, initiated and funded by the Department of Science and Technology, Government of India. The problem with this initiative is that it is not well publicized and thus, it does not find too many applications from medical undergraduates when compared to programmes like the ICMR-STS. Moreover, the process of securing the fellowship is time consuming -starting from general screening of applications, followed by an aptitude test and then concluding with an interview. Further, as the website does not clearly identify the type of projects that are likely to be funded, it is hard for the students to make out the exact requirement of the scholarship. This calls for the process of funding to undergraduate research to be made more undemanding and realistic. There are other sources of support as well such as the Jawaharlal Nehru Centre for Advanced Scientific Research offering a Summer Research Fellowship Programme (JNCASRSRFP); ICMR–CRI– UConn–Imperial College research workshop; TIFR, IISc and NCBS Bangalore programs etc [16] Interestingly, a student body organization has also taken the initiative to promote research based activities among undergraduate students. INFORMER is an all India medical students’ body, formed in 2009, aimed at advocacy and promotion of research amongst undergraduate medical students [17]. They also organize a national level annual conference which