Need for microlevel reforms to promote research studies by medical college faculties and students

Scientific research is essential for improving the quality of human lives and the benefits of scientific research outweigh the harmful events. Research plays an important role in discovering new treatments, and making sure that we use existing treatments in the best possible ways. Research can find answers to things that are unknown, fill gaps in knowledge, and change the way that health-care professionals work. Doing research while in medical college/institute is known to encourage research later on by bringing out good quality research papers. It is known that research-active physicians provide better care to their patients.[¹] An interest in research shows off curiosity, maturity, and work ethic of a medical professional. Undertaking research studies demonstrates your inclination to extend the knowledge for the benefit of patients/people, enhances organizational skills, highlights your experiences in the promotion of evidence-based medicine, and all these attributes ultimately facilitate good ranking of the colleges and institutes at National and Global level, thus attracting more research funds in future.[²] Health research has very high value to society. It provides important information about disease trends and risk factors, outcomes of treatment or public health interventions, functional abilities, patterns of care, health-care costs, and services utilization patterns.[¹]

However, the ground realities in respect of research domain in medical colleges/institutions are not very encouraging. Present scenario reveals

1. Medical faculties are mainly engaged with patient care services, teaching and training activities for medical students, and other paraclinical courses
2. Even though teachers and students are expected to undertake research studies, this always remains ignored on the excuse of heavy work of patient care, teaching, and training. Compulsory research publications by PGs and faculties are a sincere attempt for promoting research but have led to several problems such as stress for medical teachers, growth of predatory journals, evolution of manuscript writing services, transgression in scientific communication, lowering the quality of research publications, and a crazy race for publications.[³]
3. Research is mandated for the faculties and PG students; however, there are no guidelines regarding how much time should be spared for this activity, quality parameters, etc.
4. There is no separate research policy set by the college/institute to provide necessary guidelines for the faculties and students who aspire to undertake research. There is tendency on the part of junior staff to complete minimum norms of research publications to fulfill eligibility criteria as recommended by the National Medical Commission, for the next level of promotion
5. There are no facilities in the majority number of medical colleges to get appropriate statistics support for the research. Only one qualified statistician appointed in the department of community medicine is unable to fulfill the need of all departments in this respect and hence sometimes known to exploit the researchers by charging heavy fees unethically
6. The number of students, submitting manuscripts for publication from the dissertation work also remains limited in many places
7. Lot of bureaucratic hassles are experienced by the faculties and students, which demotivate them from undertaking the research, for example, not granting permission, not allowing time to do extra research work, not providing support of other ancillary staff of the department, the monetary provisions to the faculties for research activities are usually not available or if available, it is very meager, not extending support to raise the funds for the research study, long duration to obtain IEC clearance, etc.
8. Lot of unethical practices experienced, such as senior faculties or HODs insisting for their name as first author on any publication by the junior staff, irrational fund management practices, for example, charging exorbitant fees on the name of institutional charges, if the research projects are funded by external agencies, not releasing the money for project-related activities because of long bureaucratic formalities
9. Turnover of junior staff, because of temporary appointments also discourages these faculties to undertake long-duration research protocols. There are no incentives for doing research or consequences for not doing research
10. It is also possible to get the manuscripts published by paying exorbitant publication charges, thus seeking unethical practices in this respect.

A publication in 2018, mentioned that between 1995 and 2015, the USA contributed to 4.19 million publications to PubMed, China to 0.91 million, and the UK to 0.90 million. India did not rank among the top 10 countries, although it has a population of 1.3 billion people and one of the largest medical and scientific workforces in the world. When core research articles such as systematic reviews, meta-analyses, clinical trials, and randomized clinical trials were considered, India ranked 17^th, 20^th, 19^th, and 18^th, respectively. Most of the publications from India come from Institutions of National Importance or major research organizations with the vast majority of graduating, postgraduating, or practicing doctors contributing only a minuscule.[⁴]

The faculty members of colleges across the country are publishing very few research papers. One of the research papers[⁵] cites that the top six colleges published more than 56% of total research papers since the 1990s. Important criticisms on nature of medical research in medical colleges in India say – papers not only pointed out poor quality of research but also academic dishonesty, plagiarism, and publications in nonindexed substandard medical journals without review.

Few macrolevel initiatives are introduced recently by Medical Council of India/National Medical Commission (NMC) to focus on research mandates of the colleges/institutes such as.

1. Online course for PG students and faculty from the academic year 2019–20 onward. Called “Basic Course in Bio-medical Research,” the 8-week course was said to be compulsory for all PG students in the country and faculty[⁶]
2. Short-term Studentship research fellowships by the Indian Council of Medical Research
3. NMC recommended, Competency-based Medical Education (CBME) for UGs, has identified competencies under the head “Biostatistics and its applications” (CM6.1–6.4), which focuses on preparedness for undertaking research studies[⁷] “Research” is one of the available electives recommended in the new CBME curriculum with effect from 2019 UG batches. However, the ability to be a researcher is still not considered a mandatory separate quality of the Indian Medical Graduate (IMG) with only clinical knowledge, professionalism, communication skills, ability to be a lifelong learner, and a member and leader of the health-care team being considered desirable attributes of the IMG[⁴]
4. Research publications in indexed journals are mandatory for academic promotion in medical colleges.

However, only macrolevel guidelines for the promotion of research in medical colleges are not sufficient unless supported by appropriate microlevel reforms at individual colleges/institutes. Thus, it is a need of an hour to look into the matter of promoting research by the faculties and students by resorting to certain measures, as detailed below, at college/institute level to ensure supportive organizational behavior in long run, with due concern to Excel in evidence-based medicine and raising the morale of new research aspirants.

1. To draft college/institute level research policy specifying – incentives for faculties and students for research work like grant for publication charges, reimbursement of expenses incurred for attending national or even international conferences, etc., workforce, money, and logistic support from the institute taking into account the importance and type of the study, academic recognition to the work by allotting credit points, which should be taken into account as additional weightage for next level promotion ahead of stipulated time frame. Institute-level research policy should also specify measures against unethical practices by senior staff, i.e. insisting for the first name in the publication, in spite of noncontribution in any form to the research work, expecting monetary favors for granting permission for research studies, etc.
King George Medical University, Lucknow and Sri Ramachandra Institute of Higher Education and Research, Chennai have their own research promotion policies[^8,9]

2. Set up separate Research Promotion Cell in the college, similar to the Medical Education Technology cell and fix up the roles and responsibilities of this cell under two broad categories, i.e. Development of Research Study Protocol and support for analysis of data and publication, as mentioned in Table 1. At present, almost all medical colleges have research societies existing; however, their work is limited to receive research proposals, discuss research protocol for providing technical support and grant monetary support with upper limit set at smaller amount and that too for very limited number of PG students. These research societies may be strengthened to take up the role of Research Promotion Cell, as a part of research policy of the institute
3. Faculty should be rewarded for publishing good quality research papers or for bringing completely funded research projects
4. Recruitment of qualified statistician in the Medical Record Department, to strengthen hospital data analysis with research perspectives
5. To facilitate interest in solving research questions, all teaching–learning activities in medical colleges in any subject should constantly draw attention to unsolved questions or raise new questions that require the solution to stimulate curiosity.

Table 1: Roles and responsibilities of proposed Research promotion cell

The COVID-19 pandemic has set enabling environment more than ever, to focus on medical research and this may steer the medical colleges/institutions to take research seriously and inculcate the culture of research in the curriculum. It usually takes about 20 years to translate research in the laboratory to apply it to medical practice. So, if we start now, we will witness some benefits only after 20 years.[⁶]