Research is one of the key areas which help in
advancement of science. It ‘refreshes’ and ‘updates’ the whole knowledge
of that subject and thus paves the path for further addition,
improvement, up-gradation and introduction of discoveries and new
innovations. Research enables a person to collect and compile
information, assess them objectively, analyze it critically and finally
come with a conclusion, all of which are important in clinical
decision-making and patient care [1].
Although research has been considered traditionally
as the fiefdom of professionals and experts, there have been many
instances where students have ventured into research with substantial
outcome [2-4] (Box 1).
BOX 1
Some Achievements of Medical Students’ Research
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• Jay Mclean, a medical student working at
John Hopkins University, discovered Heparin [2].
• Lorenzo Bellini was only 19 years when he
published his discovery (1662) of the kidney tubules [3].
• Charles Herbert Best’s, a medical student
contribution to medicine nearly won him a Nobel Prize.
• Paul Langarhans in 1869 discovered the
Islets of Langarhans which bear his name [4].
• A Danish anatomist Niel Stensen was a
medical student when he discovered in 1961, the parotid duct in
sheep [4].
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In addition to medical students’ talents, chance,
luck, observation, serendipity and "sudden unexplained understanding" of
the fact, this was possible also due to proper atmosphere and
encouragement induced by their teachers [4]. While most of the medical
student researchers hailed from Western countries, there have been very
few instances where some discoveries could be attributed to the Indian
medical students. The medical education system in India concentrates
mainly on preparing more and more basic doctors who were trained in
allopathic sciences, but seldom promotes research activities. Students
in India have almost no formal pathway to become physician-scientists or
academicians [5].
The Current Scenario
Irrespective of research subjects, a total of 157
researchers per million populations were reported in India in 2010, much
less than the global average of 1023 [6]. As far as research in medical
sciences is concerned, India scored 12th position among the productive
countries of the world in medicine during 1999–2008 with a mere 1.6%
share in the world research output [7]. But most of these researches
were faculty members/scientists from reputed medical institutes, and
very little had been contributed by students [1].
There is a mandatory provision of writing a
thesis/research project during post-graduation, which give an
opportunity for conducting research, but somehow most of the their
research is just for the sake of research. Most of these theses neither
get published nor are widely disseminated once they have been submitted
to the University [8,9].
The Bachelor of Medicine and Bachelor of Surgery
(MBBS) curriculum does not provide an adequate platforms for promoting
research aptitude in under-graduates. Most of the medical college
management show very little interest in student’s research activities.
Actually, rather than a part and parcel of medical education, student’s
research is considered as an "extra- curricular" activity by most of the
medical college authorities. Also there seems to be a disparity between
the government and private medical colleges in India with respect to
funding, autonomy, and collaborations in basic research, which affects
the involvement of medical students [5]. It was estimated in a study
that in 2007, about 96% of the research publications in India emanated
from only nine medical colleges [10]. Another paper [11] estimated that
a whopping 57 % of the total medical colleges did not have a single
publication during this period!
The funding for research in general and student
research in particular is meagre or non-existent [12]. Apart from
funding, qualitative and/or quantitative insufficiency in supervision is
another important issue [13]. In India, although a lot of medical
faculty members are stalwarts in their respective fields and liked by
students at large but not all of them may have the skill required to be
a good mentor [14]. There is a visible lack of structured mentorship
programs in medical colleges in India. As there is no incentive
available for faculty members to mentor student research in form of
remuneration, credit points, promotional avenues or recognition, most of
the faculty members rarely show any interest in undergraduate students’
research activity.
Recognition of the efforts put in for research
project in form of a publication is also lacking. It is not uncommon to
find the senior-most author as the first author (even in case reports)
due to their premium position. This practice of denying credit and first
authorship to junior researchers whose contribution is often the
maximum, is disheartening to the students and thus their interest in
research starts diminishing [1,15]. In addition, the attitude of the
medical students towards research is another important aspect. Studies
have reported that most of the students considered research as waste of
time/not worth participating; some others said they did not have
interest in research [16,17]. Many students felt that research as a
career choice was neither financially rewarding nor had that ‘status’
[18].
Another dimension of students’ research is the
dilemma over mandatory inclusion of medical research in medical
academics in India. A mandatory eight week ‘Critical Enquiry’ course
attended by students at Queen’s university, Canada demonstrated that
students recognized development of critical appraisal, information
literacy, and critical thinking skills as potential benefits [19]. As a
part of its primary care clerkship, College of Medicine at Drew
University, in 1995, created a curriculum requiring medical students to
take up a research project [20]. A study on student views on Mentored
Students Project (MSP) in Indian medical colleges reported about 61% of
students agreed that MSP should be a mandatory requirement for the
completion of the MBBS program [14,21]. In India, Only 10% of the
projects funded to Indian medical colleges ended up in publications in
indexed journals [7]. Thus the compulsory research program ensures
research experience for students but it also needs a parallel process to
achieve a higher rate of publication [22].
Opportunities for Medical Research in India
Lack of a fully functioning academic committee to
promote research both within and outside the institution, and a separate
Dean for academic are other lacunae in many medical colleges in India.
Only few organizations, like Indian Council of Medical Research (ICMR),
promote research in medical sciences by providing Short Term Studentship
(STS) [23]. The Kishore Vaigyanik Protsahan Yojana (KVPY); Central
Paramilitary Forces under Ministry of Home Affairs, Government of India;
and Indian Oil Corporation (IOC) also provide financial support to
encourage students’ research in India. But these scholarships are
provided to encourage the brilliant students from the weaker
socio-economic population to join medical courses and not precisely for
research activities [24-26].
Apart from the government initiatives, some informal
groups too have initiated activities for the same cause. There is a
group known as INFORMER- The Forum for Medical Student’s Research- which
is an all India medical students’ body; created in 2009 to advocate and
promote research amongst undergraduate medical students and encourage
them to present their research work at a national level [27,28].
The Possible Solutions
Students could be encouraged to take time off from
their traditional course-work to focus on research during their medical
school training [5]. The Medical Council of India needs to make research
activity by medical students mandatory. To motivate students into
research, few marks could be linked to their internal examinations on
completion of a research project by them [5].
There could be regular discussions on recent advances
in medical science in the academic curriculum of all professional
classes, and the responsibility of its co-ordination could be handed
over to department of Medical Education. In the long run, this activity
would inculcate the research aptitude among medical students as
discussions like these would give them food for thought.
Funds should be demarcated by medical college
authorities for research just like fund demarcated for sports and
extra-curricular activities. Workshops on research methodology should be
organized utilizing these funds. Support from Government on medical
research is required as per its commitment in National Health Research
Policy which intends to promote research culture in educational
institutes so as to build a critical mass of health researchers, and
also intend to invest at least 2% of national health expenditure in
research and research capacity strengthening [10].
Promotion of inter-institutional collaborative
research is the need of the hour to promote research in a competitive
environment. Involvement of corporate houses to promote innovations in
medical sciences at under graduate and post graduate level could be
attempted by colleges/ universities. Research proposals, having the
potential to come up with useful medical / health innovation, could be
screened by corporate houses and sponsored thereafter. The medical
colleges should have co-ordination with local media so as to promote the
findings of thesis/ research of medical students which could be helpful
for modification in local health policies and programs as per the study
results. This will also encourage the students as their work will get
recognition in local area and to a wider audience [12].
Annual regional and National conference of various
associations of medical professions should have prominent focus on
undergraduate students’ research presentation, and awards [27]. Box 2
summarizes the steps required to promote undergraduate medical research
in India.
BOX 2
Suggestions to Promote Undergraduate Research
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• Additional credit in internal assessment for ICMR-STS like
research projects.
• Peer reviewed, indexed publication by
students.
• Some fee-waiver on paper presentation at
national/international level.
• Prizes to students with research
projects/publications in college annual functions.
• Regular exposure of undergraduate to recent
medical research through discussion session, newsletter etc.
• Separate fund earmarked for students’
research by college authorities.
• State, zonal and national level conferences
exclusively for medical students.
• Promotion of inter-institutional
collaborative research and corporate involvement.
• Mandatory structured mentorship programs
in medical colleges to promote research.
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There should be some incentives for the teachers
also. Publications and research projects do not earn them any credit
point. Thus to promote research by faculty and to persuade them to
become mentor for student’s research, few credit points should be given
for every peer-reviewed indexed publication by the medical teachers.
Similarly, teachers mentoring students in research projects like of
ICMR-STS should be awarded credit points and out of turn promotions
after the research project has been finally accepted by ICMR. These
steps will help in recognition of work done by the teachers and promote
research attitude among other faculty members. The need of structured
mentorship programs cannot be stressed more. There is an urgent need to
introduce mandatory structured mentorship programs in medical colleges.
In India, vast availability of experienced faculty and abundant clinical
material in medical colleges will help in creating an atmosphere of
producing future physician-scientists by implementation of these
mentorship programs [14].
Almost every medical specialty in India has their
national level associations which publishes national journal of their
specialty. These associations should come forward with one or two
special issues in a year exclusively for students (just like The Lancet
Student, International Journal of Students’ Research, Student BMJ and
The International Journal of Medical Students). This special edition for
students will help students to send their manuscripts precisely to the
journal as per the topic of their research [12].
Conclusion
There appears to be a lack of scientific temperament
in medical graduates in India. With a view to encourage research among
medical students, a structured mentored medical student research program
should be set up to introduce medical students to a potential career in
patient-oriented/community-oriented research including interdisciplinary
research.
Research-based
scholarships like STS are provided only by very few organizations like
ICMR. So various government
agencies and corporate should come forward to support new innovations
and ideas in young talented students.
Medical writing is a neglected area and comparatively
few young Indian doctors get published in the international level
medical and science journals. So there is an urgent need to develop the
scientific temperament for writing articles in medical journals at the
undergraduate level. To encourage research, students can be given credit
for research activity in medical school in the form of internal
assessment. Faculty should also be given extra incentives to mentor
research projects of students. There is an urgent need for increasing
capacity building of young health students /professionals in medical
research so as to utilize their research health data at local and
national level. This will definitely change the face of health services/
medical education in India in the long run.
Contributors: All authors have contributed
significantly, and read and approved the manuscript.
Funding: None; Competing interest: None
stated.
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