Scholarly research training programs are valued components of undergraduate medical education; these programs allow students the opportunity to develop skills related to critically evaluating new information, communicating and disseminating research findings, and contributing to and advancing medical knowledge.1 To support medical trainees in enhancing research skills that they may require in their future careers, medical schools have implemented curricula and/or a framework to integrate research skills into the medical curriculum.2 For instance, the medical schools at Duke University and Stanford University developed research programs in the 1960s to provide an investigative counterpart to traditional instruction, to broaden students’ scientific training, and to recruit students to careers in academic medicine.3 In the United Kingdom, research opportunities have become mandatory to help students develop critical appraisal skills that they can later apply through practicing evidence-based medicine.2 Further, the Royal College of Physicians and Surgeons of Canada has initiated the Canadian Medical Education Directives for Specialists (CanMEDS) framework, which outlines seven roles that embody the competencies physicians are required to master during their medical education and then to put into practice so as to provide improved patient care.1 According to the CanMEDS framework, physicians should demonstrate a lifelong commitment to reflective learning in the role of scholar. As a scholar—as the role is formally defined—a physician should both critically evaluate information and its sources and contribute to the creation, dissemination, application, and translation of new medical knowledge.1
The majority of medical educators who attended the 2001 International Association of Medical Science Educators Conference indicated that they believed scientific education is critical to the development of clinician–scientists and/or general clinicians.4 Nonetheless—despite the perceived importance of research as part of medical training—investigators have noticed a decrease in physicians interested or engaging in research in Europe, the United States, and Canada.5–9
To develop a new cadre of physician researchers, medical schools have introduced opportunities for students to explore research through summer programs, electives, or mandatory curricula.3,5,10,11 Currently, many, if not all, medical schools provide students with formal and informal opportunities to engage in research and develop scholarly research-related skills and abilities. Although developing research-related competencies is a goal of the educators who institute these training programs, how meaningful they are to students, in terms of providing productive, rewarding research experiences is unclear. The ultimate benefit of such undergraduate research experiences may be the long-term promotion and enhancement of scholarly research engagement during later stages of the careers of the participants. To date, however, the typical benefits that such research programs confer have yet to be established. Further, whether these benefits typically justify the resources used to maintain such programs is also currently unclear. Investigating students’ opinions on research during medical school, thus, could aid in identifying factors that may constitute an effective research curriculum. We therefore conducted this literature review to characterize undergraduate medical students’ experiences with, activities and productivity related to, and attitudes toward research, both to begin to characterize the universal benefits of such research programs and to inform the development of effective strategies and components for programs in undergraduate medical schools that promote scholarly competencies in students.
Method
We ran searches on several databases to identify studies that evaluated medical students’ experiences with, perceptions of, and productivity related to research activities. We ran separate searches in PubMed (seeking reports published from 1950 to June 2013), Scholars Portal (1960 to June 2013), and ProQuest Academic OneFile (1950 to June 2013). We examined all articles indexed with the medical subject heading or expert key words shown in Table 1.
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Table 1: Search Terms and Corresponding Query Translation of Databases, June 2013
We manually searched journals that commonly publish articles related to medical education—Medical Education Online, BMC Medical Education, Academic Medicine, Perspectives on Medical Education, and Teaching and Learning in Medicine—seeking articles published between 1990 and June 2013. Finally, in the summer of 2013, we searched Google Scholar, Dogpile, and other nonspecialist search engines. Table 2 shows the search history results obtained from our PubMed search as an example of our search strategy.
Table 2: Search Strategy and Results (1950 to June 2013), Applied to PubMed, June 2013
We included studies that met the following criteria: (1) they investigated medical students’ interest and engagement in, and/or attitudes toward, research; (2) they were available through our institution; and (3) they were written in English. As we were interested in primary sources that included student-reported data, we excluded articles without data and articles that were purely review. We further excluded studies that focused on postgraduate students such as residents or those earning a joint MD–PhD and reports that evaluated overall curricula without specifically assessing research components.
After the completion of the key word searches, titles and abstracts were screened by the primary author (Y.C.). Both authors discussed and agreed upon the excluded articles and on the reasons for excluding them. Both authors confirmed the articles that met the inclusion criteria described above by reading their full-text versions. Figure 1 shows the steps involved in the literature review.
Figure 1: Number of publications obtained in the search process, reasons for exclusion, and the final number included in a review of literature on students’ experiences with, perceptions of, and outcomes related to research programs during medical school (1950–June 2013).
Variables extracted from the articles comprise the following:
- the research program(s) in which the medical student participants were involved,
- the experiences, including activities, that students participated in,
- the motivation and skills students obtained,
- the attitudes toward and perception of research the students demonstrated, and
- the outcomes of students’ experiences with research (e.g., authorship on publications).
The authors determined these parameters of interest, a priori, based on internal discussions regarding the characterization of research programs at their institution.
Results
Included studies
Twenty studies met the inclusion and were included in the study (see Appendix 1). Seven studies assessed mandatory research programs only,2,3,12–16 8 studies assessed elective research programs,5,17–23 and 5 assessed both optional and mandatory programs.24–28 Of these 20 studies, 1 was conducted in Brazil,22 4 in Europe,2,17,24,27 and 15 in the United States and/or Canada.3,5,12–16,18–21,23,25,26,28 Below, we report our analyses of the results of the 20 studies (see also Appendix 1).
Outcomes
Of all the 20 studies reviewed, 15 reported data on participants’ experiences with research,2,3,12–14,17,18,20,21,23–28 another 15 focused on participants’ attitudes or perceptions,3,5,12–14,16,19,21–28 and 12 covered research outcomes.3,5,13–17,21,23–25,28
Experience with research
Self-reported data on students’ experiences with research indicate that research is not new to some students. Griffin and Hindocha24 surveyed students from seven British medical schools and reported that 49% of respondents had had experience with research before medical school. Another study showed that experience with research prior to medical school was associated with a greater likelihood of pursing research as a medical student.26 The authors of this study reported that 87% of respondents enrolled in Canadian medical schools had been involved in research prior to medical school.26 Additionally, 43% of these respondents did not engage in research as “significantly” during medical school as they had before.26 These students attributed this decline to perceived barriers such as too little time, a paucity of available mentors, and a lack of adequate acknowledgment for their research efforts.26 In contrast, a study conducted at Stanford University reported higher research engagement during (compared with before) medical school.28 Further, 80% of these 73 respondents planned to do research during medical school, and 90% had actually performed research before matriculating at Stanford.28
Discouraging and motivating factors
Through our review of the literature, we identified factors that both deterred students from and motivated them to pursue research experiences. According to a study conducted at Queen’s University, interaction with faculty was a motivating factor for 75% of participants.14 Increased faculty interaction was also a motivating factor for Stanford University medical students who participated in research.28 A majority (62%) of the students at Queen’s University who participated in research were motivated to do so because they believed that the experience would help them decide which field of medicine they might pursue; a minority of Queen’s students (47%) were motivated by the opportunity to present their work.14 Similarly, third-year medical students at Mayo reported that increased familiarity with a research area allowed them to become more confident about their residency positions.13 Some institutions provide an incentive, such as funding or a formal distinction conferred with the medical degree, to encourage students to engage in research.21,23 According to at least one report, students perceive a financial incentive as a motivating factor.25 Likewise, the lack of incentives altogether may discourage students from exploring research.22
Benefits of research
Participants from different research programs felt that research allowed them to experience and develop both interpersonal and research-specific skills.2,12,14,18,27 For instance, a study by Burgoyne and colleagues27 states that 92% of respondents reported having developed acumen in both independent and collaborative research ability. According to studies by Jacobs and Cross28 and Houlden and colleagues,14 students reported an increased sense of confidence in several skills and abilities including formulating research questions, understanding research methodology, conducting research, learning new techniques, analyzing data, writing manuscripts, and critically appraising published literature.
Attitudes and perception
Medical students’ perceptions of research, typically characterized after the research experiences end, are largely positive. Students perceive that their research experiences contributed to their career progression, helped them to define their career paths and select their specialties,16,28 increased their confidence regarding placing in their desired residency positions,13 and provided an opportunity to integrate and apply their findings into their practice.23,25,27,28 They report that their positive attitudes toward research not only increased their interest in research25 but also encouraged them to continue their scholarly activities after graduation.3,5,14,16 Influenced by such positive perceptions of research, 98% of participating medical students at Yale University were in favor of possibly including research in the formal curriculum.12
Although most studies indicated that most students view scholarly research programs positively, 13% of respondents from University College Cork did not find research appealing.27 Specifically, these respondents felt that research was overly challenging, unstimulating, and generally uninteresting.27 A small proportion of them (3%) mentioned a previous negative experience that contributed to their negative perception of research.27 Students also cited limited time,26,28 unreasonably high expectations,28 a paucity of mentors or faculty guidance,24,26,28 and the perceived lack of acknowledgment for their contributions26 as factors negatively affecting their research experience in medical school.
Research outcomes
We found that tangible research outcomes were typically used as indices of research success or productivity. Types of research outcomes included generating a comprehensive list of useful resources from the literature,14 written reports,13,14,21 publications,3,5,13,15,17,21,23–25,28 manuscripts prepared for possible publication,17,28 and presentations.3,5,13,15,16,21,23,25,28
Regardless of whether a research experience was voluntary or mandatory, publications or written reports and presentations at scientific meetings and conferences were the most common measures of research productivity. For instance, Jacobs and Cross28 report that about 75% of students coauthored at least one published article based on research they conducted during medical school. Research day poster presentations were also common.25 A unique, tangible outcome for students completing two elective research programs was a distinction conferred with their diplomas that specifically noted their research achievement.21,25
One group of investigators, Dyrbye and colleagues,15 examined the level of research productivity as a function of research program length. Mayo Medical School featured a mandatory research program but offered students the choice of one of three different research experience durations: 13 weeks, 17 or 18 weeks, or 21 weeks. Whereas first authorship occurred less often for students experiencing the shorter duration of research activity (17 or 18 weeks), other metrics related to research outcomes (secondary author publications, abstract and conference presentations) did not vary in relation to the time allotted.15 Another study by Solomon and colleagues5 was unique in that it evaluated the longitudinal impact of a research program on future research productivity; the authors noted that such programs are successful in provoking interest in medical students toward research and academic careers.
Discussion
Medical educators promote the inclusion of research into medical student training to develop physicians who not only excel in clinical practice but who can also critically evaluate new research and/or contribute to the creation of new knowledge.1 In spite of this advocacy, the proportion of physicians engaging in research has declined.5–9 To determine possible mechanisms to optimize the research experiences of medical students, we conducted a review of the literature to characterize medical students’ experiences with, outcomes related to, and attitudes toward/perceptions of research. Our review revealed that the majority of medical students viewed their research experiences positively, which may have contributed to an increased interest in conducting further research in the future.5 Increased medical student interest does not, however, translate to increased numbers of physicians conducting research later in their careers.5–9 Unreasonably high expectations on medical student participants despite limited time,26,28 as well as a lack of mentorship24,26,28 and appropriate acknowledgment,26 were characterized as discouraging factors.
Notably, several of these factors, including lack of time and mentorship, also act as barriers to performing research during residency.29 An intervention implemented specifically to address these barriers in one residency research program led to increased rates of national presentations, publications, and fellowship placements among participants.30 A similar approach, targeting specific barriers to undergraduate medical student research, may yield similar benefits with regard to tangible outcomes.
Given Siemens and colleagues’ finding that students who participated in research prior to medical school were more likely to elect to participate in research during medical school,26 early research experiences may be a motivating factor for pursing research as a medical student. Additionally, individuals who have early, positive research experiences may likewise be more likely to seek out and engage in research experiences at later stages of their training.26 Optimizing the research experience for medical students, by addressing perceived barriers or facilitating more rewarding experiences, could lead to better outcomes and to students who are invested in future, and perhaps lifelong, scholarly activity.
Students in voluntary/elective research programs were more satisfied with their research experiences than those in mandatory programs (74%–85% versus 45%–51%, respectively). This higher level of satisfaction appears to be unrelated to research outcomes, as mandatory and elective research programs feature similar rates of student presentations and publications.13,15,17,21,24,28 This higher level of satisfaction may be related, at least in part, to the likelihood that voluntary research programs include self-selected populations of students who have strong interests in and positive perceptions regarding research. Another factor to consider is that some elective programs provide funding or/and a distinction acknowledging students’ involvement in research21,23,25; these incentives may also enhance student satisfaction.
The length of both mandatory and elective programs varied. The impact of research experience duration on students’ perceptions of the experience and on research outcomes has not been well defined in the literature. One study did indicate that rates of first authorship increase as students devote longer periods of time to the research program15; however, other metrics (such as overall publication rate) were not influenced by program duration. The increased rates of first authorship may indicate that longer periods of research time may facilitate higher levels of student contribution to the research project, including taking a larger role in manuscript preparation. This greater role may result in a more complete and fulfilling research experience, given students’ reported appreciation for both being able to disseminate their work26 and being able to develop scientific writing skills.14 It is therefore possible that increasing the duration of the research experience may increase the rate of student first authorship and, in turn, enhance students’ perceptions of their research program experience.
A common theme we noticed in terms of factors motivating students to pursue research was distinction. Students believed that a research experience would distinguish them from others as a result of the networks they could build, the exposure to different specialties they might gain, the additional credits on diplomas they could earn, and the increased opportunities they would have to present and publish their work. Similarly, we noted a belief that research experience may enhance a student’s chance of getting into a specific residency position. Indeed, some investigators have reviewed the profiles of students successfully matched to the residency of their choice, which showed that research experience does increase the likelihood of matching success.31–33 More studies are required to better characterize students’ perceptions of and the actual value of research experiences to future scholarship and academic advancement/success.
Common benefits of medical student research programs are the self-reported enhancement of research skills (e.g., critically appraising literature, writing for scholarly journals).14 Whereas most of these skills pertain to the CanMEDS role of scholar, skills gained from research training may transfer to other CanMEDS roles as well (e.g., Collaborator and Communicator). However, to date, the reported enhancements of medical student competencies attributed to research participation have been subjective in nature.2,14,16,18,25,27,28 Future research, using more objective measures (e.g., academic contributions such as publications, metrics regarding how often published research was cited or accessed, conference presentations, invited seminars, and competitive grants or awards earned), may help determine whether undergraduate medical research programs support the development of student competencies related to both scholar and nonscholar roles; positive findings may solidify the justification and value of such programs.
Despite some detriments, the general attitudes and perceptions of medical students toward research have been notably positive. Implementing a mandatory research program could introduce students to research and allow them to benefit from the generally positive effects reported. Such a program may mitigate the current decrease in physician–scientists. Medical educators could use this review, including the factors that students noted as incentives and detriments, to optimize any research program (mandatory or otherwise). Specifically, the program should provide clear and reasonable expectations of the student, plenty of mentor/faculty interaction, sufficient time for students to devote to their research, and mechanisms for students to earn appropriate acknowledgment for their work. A longer research program would allow students to devote more time to their research, and faculty members would likewise have increased time to engage and mentor students. Further, students would likely have more time to obtain results that could be published, which could conceivably lead to increased productivity and satisfaction.
We found that productivity in the form of publications and presentations was the most frequent measure of research outcomes. Generally, the majority of participants in research programs published at least one article and presented their findings at meetings. The level of productivity appeared to be similar for both mandatory and voluntary research programs. Information on the duration required for manuscript preparation was not reported in the studies. It would be of great interest to examine how the frequency of publication influences students’ attitudes toward current and future engagement in research.
Solomon and colleagues5 determined that many students participating in the undergraduate research programs at the University of Tennessee and Vanderbilt University medical schools went on to conduct research later in their medical careers. However, none of the other studies we reviewed addressed whether medical student research programs and experiences actually led to increases in research activity and productivity (e.g., grant funding, publications, presentations, or simply conducting research) later in physician careers. Although gathering such metrics over long periods of time is admittedly challenging, the resulting data are vital for determining the value of current research programs, optimizing ongoing programs, and initiating new programs. We suggest that medical schools follow the example of Solomon and colleagues5 and survey former participants about their current and postprogram research activity to begin to characterize long-term effects of their research program investments. Alternatively, characterizing the early research experiences (during medical school or otherwise) of established physician–scientists who actively maintain successful research programs can also help inform current research training programs for medical students.
Although many medical schools offer formal programs that engage undergraduate medical students in research, the scope of our study was limited to the fraction of these programs that have been characterized in the literature. For example, our own institution, the University of Ottawa, has both a long-standing biomedical research program and a relatively new medical education research program, but neither of these programs has been assessed formally, not even internally. The broader dissemination by more schools of information regarding their programs would benefit medical educators, students, and future researchers. Another limitation of our review was that our search criteria (reports that were accessible in full text and available through our institution in English) could have eliminated potential articles of interest. Further, the studies we reviewed encompass research programs from different countries and different eras and, therefore, may be subject to differential societal and cultural values regarding scholarly research in medical training. Notably, 15 of the 20 programs we reviewed were located within U.S. or Canadian medical schools, and only 7 included data from the last decade. As such, our findings may be less relevant to more recent medical school research programs and programs from other regions.
Conclusions
A review of the literature evaluating the research activity of undergraduate medical students has revealed that students seem to have positive attitudes toward research and are in favor of having research as part of curricula, either required or elective. Mandatory and elective research programs do not differ in effects they have on students’ experiences with, perceptions of, and outcomes related to research.
Overall, most measures discussed in this literature review (e.g., publication rates and attitudes toward/perception of research) are typically not characterized longitudinally through later stages of the participants’ careers and cannot illuminate participants’ future research engagement and productivity. Similarly, longitudinal evidence is needed to support the notion that students who participate in research during their undergraduate medical training become more accomplished physician–researchers (in terms of articles published or grants funded). To assess whether undergraduate medical student research programs truly facilitate the development of scholars, longitudinal follow-up of participants through residency and early into their clinical careers would be very valuable.
Given the generally positive experiences described in the studies we reviewed, maximizing student exposure to research and using their feedback to optimize research program structure may help mitigate the decrease in physician–scientists.
Appendix 1: Reviewed Reports (1950–June 2013) on Students’ Experiences With, Outcomes Related to, and Perspectives on Research Experiences During Medical School
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