Education for Health

STUDENT CONTRIBUTION
Year
: 2013  |  Volume : 26  |  Issue : 2  |  Page : 117--121

Reasons behind the increase in research activities among medical Students of Karachi, Pakistan, a low-income Country


Shoukat Ali Baig1, Syed Askari Hasan1, Syed Mustajab Ahmed1, Kiran Ejaz2, Sina Aziz3, Nava Asad Dohadhwala1,  
1 Final Year Medical Student, Dow Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
2 Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
3 Department of Pediatrics, Karachi Medical and Dental College, Abbasi Shaheed Hospital, Karachi, Sindh, Pakistan

Correspondence Address:
Shoukat Ali Baig
Final Year Medical Student, Dow Medical College, Dow University of Health Sciences, Karachi, Sindh
Pakistan

Abstract

Context: Previously, in a low-income country with limited resources like Pakistan, biomedical research was conducted mostly by individuals working in private organizations. Recently, there has been an upsurge in the number of medical students conducting research in both private and public medical colleges of Karachi, Pakistan. We investigated student perceptions of the reasons behind the increase in biomedical research among medical students of private and public medical colleges in Karachi, Pakistan. Methods: This cross-sectional study was conducted at four medical universities of Karachi, using structured data collection tool. Participants included medical students who stated that they were interested in medical research. We assessed how many had been involved in research or stated that they intended to be, and tallied students«SQ» stated reasons why they were involved in research. Chi-square analyses were used to assess if year of training, institution, and other factors were associated with the likelihood of past or current actual research involvement. Results: Out of the 398 students with research interest who participated in the study, 349 (88%) stated that they intended to do research projects in their undergraduate years. At the time of the study, only 202 (51%) reported that they had actually conducted research. The reasons given for engaging in research for a minority included personal interest (n = 136; 34%), while majority stated that their motivation was to improve their curriculum vitae (75%) and/or to be more competitive for a residency in the United States (43%). The reasons students gave for involvement in research were related to whether their schools were public versus private and to their year of study. Discussion: According to students«SQ» reports, improving one«SQ»s curriculum vitae to get a strong residency in the USA appeared to be a principal reason for the increase in biomedical research in Karachi. The challenges of research, such as lack of good mentors and increased work-load were reported to affect few students«SQ» ability to engage in research.



How to cite this article:
Baig SA, Hasan SA, Ahmed SM, Ejaz K, Aziz S, Dohadhwala NA. Reasons behind the increase in research activities among medical Students of Karachi, Pakistan, a low-income Country .Educ Health 2013;26:117-121


How to cite this URL:
Baig SA, Hasan SA, Ahmed SM, Ejaz K, Aziz S, Dohadhwala NA. Reasons behind the increase in research activities among medical Students of Karachi, Pakistan, a low-income Country . Educ Health [serial online] 2013 [cited 2023 Feb 4 ];26:117-121
Available from: https://educationforhealth.net//text.asp?2013/26/2/117/120705


Full Text

 Context



Globally, exposure of medical students to biomedical research has been on the rise. In Canada, 42% of second year medical students expressed an interest in pursuing a career in research after completing mandatory electives. [1] Germany is also nurturing fresh minds as 28% of publications from one of its premier institutions were authored by medical students. [2] Developing countries preferentially spend their limited resources in ways viewed as more important, like for academic scholarships for students. Medical training in general in South Asia does not emphasize the importance of research to medical practice. [3] In one Indian study, for example, 91% of interns reported no research experience during their years in medical school.

Factors affecting this students' interest in research have not been studied in depth. Some promoters and barriers have been identified such as the lack of skilled research mentors. [5],[6] Other barriers are lack of time for research given, the time required for routine studies and exams to learn clinical skills. [7] Medical colleges in Pakistan and elsewhere seem to have evolved their curriculum to overcome these barriers, which has led to an increase in the number of publications for institutions and individuals. [6],[8] We investigated students' perceived reasons behind the increase in biomedical research activities among medical students of private and public medical colleges in Karachi, Pakistan.

 Methods



This cross-sectional study involved medical students from four medical colleges of Karachi. The private institutions were The Aga Khan University (AKU) and Ziauddin Medical University (ZMU), while the public institutions were Dow University of Health Sciences (DUHS) and Karachi Medical Dental College (KMDC). Data collection was carried out in early 2012 after obtaining approval from research ethics review boards of all the four institutions.

For this study, we defined research activities as per the Clifford Woody's description, "Research comprises defining and redefining problems, formulating hypothesis or suggested solutions; collecting, organizing and evaluating data; making deductions and reaching conclusions; and at last carefully testing the conclusions to determine whether they fit the formulating hypothesis." [9] This definition for research activity was explained to the 478 medical students we approached. Those students who reported that they were either currently involved or were previously engaged in a research project that met this definition were included in the study, while those who had no interest in research activities when interviewed were excluded.

The minimum sample size of 372 was calculated using OpenEpi, giving a 95% confidence interval and assuming that 41% of the students from Karachi have an interest in research. [5] A total of 478 students were approached out of which 35 expressed no interest while 45 refused to become part of the study. Hence a total of 80 students were excluded, who apparently had no interest in research at the time this study was conducted

Convenience sampling was employed within schools, but equal proportions were collected from each medical college. Within each college, students were randomly approached for participation. Data was collected through a data-collection tool, which comprised three sections: The consent; information regarding the year of training and the institution; and indicators of participation in research and perceived reasons why. As a first step in developing the data-collection tool, the literature was reviewed. Subsequently, questionnaire items were designed and reviewed separately by an expert in medical research and a statistician. A draft data-collection tool was pretested with 50 students from a medical school other than those taken in the sample. The questionnaire was then amended and again reviewed by the experts before being used in the actual study. The data collection tool was used to interview the participants on whether they had intention to do research, whether they had previous research experience, their satisfaction with research, their incentives for doing research and suggestions to improve research activities in their institutions. The latter two questions were open ended. Students' perceived reasons for engaging in research were queried in the items questionnaire with response options drawn from the literature. Students were asked to fill out the data-collection form after signing informed written consent for participation. Incomplete data rendered was ineligible for analysis. Data was double-entered and analyzed in Statistical Package for Social Sciences 19.0 (SPSS, Inc., Chicago, IL, USA). Categorical data was presented as frequencies and percentages. The reasons for their inclination towards research were tallied; participants were allowed to indicate more than one reason. Chi-square analysis was used to test the associations between various factors - year of study, institution, and interest in research - and whether students had conducted one or more research projects. A P < 0.05 was taken as the level of statistical significance. This study was granted exemption from further ethical review by the institutional review board of the DUHS.

 Results



A total of 398 students participated in this study, of which one-quarter (n = 99 or 100) were from each of the four schools. Most participants were female (n = 243; 61%). A gradual increase in the percentage of students involved in research was observed from the first to the final year among students of private medical universities, while an opposite trend was observed at the public universities [Table 1].{Table 1}

Out of the 80 students of first year, 29 (36.2%) had previous experience of research and subsequently, among the students of other years of medical school, the figures are as follows: Second year 24 (30%), third year 52 (66.7%), fourth year 55 (68.8%), and final year 42 (52.5%) (P < 0.001; Chi-square 67.60) [Table 1]. Besides, majority (n = 71; 35%) were from the private-sector AKU, followed closely by the public-sector DUHS (n = 61; 30%). The ZMU (private) and KMDC (public) followed with 36 (18%) and 34 (17%), respectively (P < 0.001; Chi-square 40.50). Most of the 202 students (n = 187; 93%) successfully stayed focused on their respective projects despite the hardships, while a few (n = 15; 7%) lost interest (P = 0.003; Chi-square 9.07).

Of the total, 349 (88%) stated that they intended to do research in their undergraduate years. However, as of the time of this study, only 202 (51%) had carried out one or more research projects. Of these, 115 (57%) had completed a single project, 75 (37%) had worked on more than one, and 12 (6%) were currently working on their first project. As for the reasons behind conducting research, the desire for a better curriculum vitae (CV), need for postgraduate studies in the United States, and personal motivation were the most common reasons given [Figure 1].{Figure 1}

[Table 2] compares motivation for research for students at various years of study, at the four institutions, by their initial intention to participate in research and final level of satisfaction. For students of all the years of medical training, the need to have a strong CV was the most commonly stated reason for keeping students motivated towards research. This was especially true for students in the later years. This was the main reason given for research at AKU and DUHS, while personal interest was seen among 26% of KMDC students. At the ZMU, 38% students were inclined towards research due to its importance in qualifying for the United States Medical Licensing Examination (USMLE). Overall, 152 (96%) of the 159 students cited the USMLE as one of their reasons to opt for research [Table 3].{Table 2}{Table 3}

Out of the 202 students, 93 (46%) were satisfied with what they were doing in terms of research. Almost half of the students, (n = 216; 54%) were of the opinion that there would be better research awareness among medical students if the subject was incorporated in the medical school curriculum from the first year of study. Others (n = 156; 39%) thought that research training sessions arranged by nongovernment organizations had a significant role to play in raising this awareness. Still others (n = 140; 35%) wanted to have biannual research exhibitions in their respective colleges to promote research, and several (n = 123; 31%) were in favor of including research work in the students' internal evaluation policy by the institutions. Two students (0.5%) wanted to have specific research platforms for students keen on conducting research.

 Discussion



This multi-site study was conducted in leading medical universities of Karachi, Pakistan, a low-income country. It assessed possible reasons for increasing research activities among medical students. We found that personal interest in research was high in students' earlier years of medical studies. Those who were keen to do research reported that they were prompted by the desire to improve their CVs, especially to help them gain residency positions in the US. Students from both the public and private medical universities who wanted to pursue research as a career and those who had personal interest in conducting research were most satisfied with their involvement in research projects. Students' opinions about biomedical research varied by whether they were studying in a private institution and their year of study.

The lack of proper administrative and curricular guidance reportedly compelled some students to seek guidance from senior students. Ten percent of students reported that they were induced to do research by peer pressure. According to Aslam et al., getting a research project published has always been inspiring for students, but hardships, such as lack of good mentors, the work of data-collection and entry, and responding to reviewers' comments from journals, together made research a difficult experience for the students in low-income countries. If good mentors could make these difficult but necessary tasks enjoyable and explain the rationale behind each step of research, they would make it more motivating for students. At every level, students are keen to learn the correct ways to conduct relevant studies. Even if doing research does not lead to a publication, the experience itself can help enhance students' skills in searching and critically appraising medical literature, critical thinking, formulating a hypothesis, independent learning and working, and writing research papers. [3],[10]

Most students stated that they were interested in carrying out a research in their undergraduate years, and most had already carried out one or more projects. However, only 26% were satisfied with the research they had carried out. Lack of time for the project, numerous errors, and lack of supervision have been previously identified in other studies as important reasons behind dissatisfaction with students' research experience. [6] This study's students' opinion about how to improve the current local standard of research provided potentially useful ideas for potential curriculum designers. Half of the students were in favor of research being included in the curriculum from the first year of medical college, just as medical students in Germany are required to write a research thesis to acquire the title of medical doctor. [2] In addition, 35% were in favor of biannual research exhibitions in their institutions, as a study from the USA stated that organizing events like "Research Day" increases the students' interests in research and motivates under-represented groups to come forward. [11] Interest at the institutional level has proven to promote research among such students. Moreover, research experience under close supervision for students serves other purposes, including the development of critical appraisal and information literacy. It provides students with insight to help them select specialties for postgraduate training. Locally, even institutions that have added research to the curriculum still face problems from lack of skilled and dedicated supervisors, which sometimes lead students to resort to unethical means to complete their research tasks. [12] Consequently, as observed in local conferences and research competitions, most student research uses surveys to assess subjects' knowledge, attitude and practices, which has limits in what in can contribute to mainstream medical literature. In contrast, standard research aimed at bringing some change to society or providing grounds for further research are currently conducted at a much lower rate locally. Research is required in the curriculum for the 4 th year medical students in all the four universities included in the study, but it is assigned to groups of students. Unfortunately, not all students in these groups participated equally. This may mean that some individuals do not learn how to carry out research.

All these hardships can affect students. In line with the remarks by Harsha et al. that fewer students were interested in pursuing a research career in the future, [13] our study reached the same conclusion. In a developing country like Pakistan, it is pivotal to encourage medical students to pursue research. This is important as regional reference values for many medical examinations, local culture-based solutions to health problems and public health personnel are currently insufficient in Pakistan as is the case with other South Asian countries. [14]

The strength of this study is that it involved four institutions from both private and public sectors in a developing country with limited resources. Limitations included the use of convenience sampling and the potential for bias in how people understand and reported the reasons for their behaviors. The number of students participating from each medical institution was unequal, due to lower response from their students. Those who did not consent to participate and who were not inclined towards research could have given more and better insight into the reasons for students feeling discouraged to do biomedical research.

 Conclusion



Most students in these four Karachi medical schools stated that they were doing research to improve their CVs in order to get into strong residencies in the US. The year of study and being from a private institution were factors statistically associated with students' opinion about biomedical research. Reported hardships, including lack of time, numerous errors the make in their projects and lack of supervision were also significantly related to students' willingness to engage in research.

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