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Whisking Research into Medical Curriculum
The need to integrate research in undergraduate medical education to meet the future challenges.
Vinod Scaria
Executive Editor
Calicut Medical Journal
Address for Correspondence:
Dr Vinod Scaria
Perumcheril,33/4711,Malaparamba
Calicut 673009
Kerala,India
E-Mail: vinodscaria@yahoo.co.in
Web: www.drvinod.netfirms.com
Introduction:
Medical education is undergoing sea changes worldwide with new innovative concepts being integrated to meet the challenges of the rapidly changing Medical scenario. The need to attain self-reliance in Healthcare is seen as a priority policy of many developing nations including India. This needs immense effort from the already functioning research network, which needs to be beefed up by talent and expertise from the vibrant young generation. This is where integrating Research and innovation gains prime importance in Medical Education.
The need to promote research among Medical students:
The economic and market led demands have led to an ever increasing shortage of Physician scientists worldwide. The scenario is even more acute and worse in Developing countries like India Many developed countries have already started initiatives to fill this gap by motivating Medical students to undertake a career in research [1].To this end, many teaching schools in developing countries have undertaken initiatives to promote research among undergraduates[2],
[3]. Moreover a scientific temper is very much essential in addressing problems in clinical practice and to solve problems in relation to the patients and society at large.
Why Medical Students:
Medical students are obviously the best population to target given their immense exposure to the needs of the society at large, and to the patients in specific. They are often the first to encounter a problem situation and are often the best bet to address it in a different and innovative perspective. Research would also add to the quality of healthcare by addressing relevant problems and medical students have a mighty role in this context.
Inculcating the spirit of investigation would do wonders, as pointed out by the experiences with the 'Problem Solving for Better Health [PSBH]' initiative(vide infra). Similar projects worldwide have shown similar results with high satisfaction rates [4].
A career as a Medical researcher is often considered rewarding in terms of prestige. A research exposure during undergraduate period was also seen to be correlating with research involvement during a person's further career.[5].Through group projects like PSBH(vide infra), the spirit of teamwork and scientific inquiry can be imparted to the younger generation.
Medical Research among Medical Students: Quantifying the data.
To enumerate the region-wise breakup of papers authored by Medical Students, we surveyed literature indexed in PubMed/Medline
[ ] using the query string "Medical Student [Affiliation]". The query returned 41 hits. Futher analysis and weeding off non-medical student articles, we gathered 32 abstracts. The author's/Co-author's region was tabulated and analysed [Fig1]
Fig.1 Analysis of PubMed Indexed papers authored by Medical Students.[Tot No=32]
The results were obvious. The United States of America dominated the scenario, while Africa lagged far behind with no paper published by Medical Students. Even though the Asian figure looks fine, one single country -Japan, dominated the entire group, with no paper published from India. Though this quantification may appear superfluous, in the sense that only Pubmed Indexed papers were considered and other affiliations of Medical Students may have interfered with the analysis, it neverthless offers quick comparison of available data.
Why Don't we have many Student Researchers?
The reasons responsible for the low number of Physician-Scientists in developing countries like India- are the lack of the four Is- Impulse, Initiative, Incentive, and Idols.
The lack of Impulse [ Motivation ] is closely related to the lack of exposure to research environment and how to scientifically tackle problems -clinical or otherwise. This is the one big factor amenable to immediate intervention through training programs and workshops. Studies have shown that courses on research methodology have been effective in motivating Medical students to scientifically tackle problems and to undertake careers in research [6]
The lack of Idols [ Role Models ] is a well-recognized factor. Students and physicians often stated that faculty role models influenced specialty choices, and there is some evidence that faculty composition is related to students' career choices. [7]
Initiative and incentive similarly figured prominently in many studies on research careers of Medical students [7].
What can we do about it?
Everything cannot be changed in a single move. Since the entire problem has multiple dimensions involved, Multi-pronged and Multi-centered initiatives are the need of the hour. The following immediate steps are suggested.
1)Making the Medical curriculum more flexible, which would enable students to take extra courses, that suits best to their inclinations. This would also let them have time to undertake extensive research on their topic of interest.
2)Increase exposure to Medical Research. This should be a long-term initiative to improve access and utilisation of Biomedical literature. There should also be regular tie-ups with research institutions and setting up of research centers within departments working on relevant problems. This needs extensive strengthening of infrastructure.
3)Faculty improvement and involving faculty in research projects and research tie-ups with research centers and industry. This would enable effective research based on needs and will gain valuable income to support other projects by consultancy services.
What is already happening in India
Though there have been isolated initiatives to enhance scientific thinking among Medical students, most of them failed to make remarkable impact. The Government of India has launched various schemes to promote research among Medical students through grants to medical students through the Indian Council for Medical research and other Initiatives. Incentives are also in place through various individual projects in many Medical schools.
Problem Solving for Better Health [ PSBH ]-a novel initiative
Problem Solving for Better Health (PSBH) is a global program initiated by the Dreyfus Health Foundation (DHF), New York, which is now shared by a sizeable number of health professionals in several countries and regions of the world. The program is designed to encourage and train health professionals at every level, to solve local health problems with available resources and to communicate those solutions to the broader world around them so that progress toward 'Health for All' can be accelerated. During the last twelve years, the program has grown and has now reached over 30 countries [8].
The PSBH program in India is delivered through the Health Action by People [HAP][9], a Not for Profit organisation. The first PSBH workshop in India was conducted in 1993. The PSBH program in India devotes its energy entirely toward sensitizing medical students to the problem-solving philosophy. In a two-day workshop, conforming to the guidelines of the PSBH guidebook issued by DHF, every objective of the PSBH workshop is accomplished. Each student develops a protocol related to his/her research question. Nearly a third of the projects are selected for implementation. Rather than individual implementation, group activity is encouraged, thus promoting teamwork. Over 2000 medical students from around India have been extensively trained through this initiative[10].This program have been widely appreciated and acclaimed by many institutions.[11]
And miles to go…
The initiatives in place though impressive,are far from adequate, though the impact is just beginning to be visible. Given the enormous Medical student population India hosts, a number of such initiatives- involving different agencies need to be undertaken. Moreover the initiatives need to be streamlined to effectively utilize resources and minimize wastage. We hope this editorial would attract significant thought, research and resources in this direction.
References:
[1] Bickel J, Morgan TE Research opportunities for medical students: an approach to the physician-investigator shortage Academic Medicine 55: 567-573 (1980)
[2] Undergraduate and Medical Student research. Cincinnati Children's Hospital Medical Center
http://www.cincinnatichildrens.org/ed/research/med/default.htm
[3] Zier K,Stagnaro-Green A. A Multifaceted Program to Encourage Medical Students' Research .Academic Medicine (2001) 76: 743-747.
[4] Elwood JM, Pearson JC, Madeley RJ, et al Research in epidemiology and community health in the medical curriculum: students' opinions of the Nottingham experience Journal of Epidemiology and Community Health, Vol 40, 232-235
[5] Segal S, Lloyd T, Houts PS, Stillman PL, Jungas RL, Greer RB The association between students' research involvement in medical school and their postgraduate medical activities. Academic Medicine 65: 530-533 (1990)
[6] Di Fang , Meyer E R.Effect of Two Howard Hughes Medical Institute Research Training Programs for Medical Students on the Likelihood of Pursuing Research Careers. Academic Medicine (2003) 78: 1271-1280.
[7] Campos-Outcalt D, Senf J, Watkins AJ , Bastacky S .The effects of medical school curricula, faculty role models, and biomedical research support on choice of generalist physician careers: a review and quality assessment of the literature. Academic Medicine 70: 611-619 (1995)
[8] Problem Solving for Better Health (PSBH) India URL: http://www.hapindia.org/psbhindia.htm
[9] Health Action by People URL: www.hapindia.org
[10] PSBH India: Accomplishments URL: http://www.dhfglobal.org/PSBH/psbh_india.html
[11] Anonymous.Smt. NHL Municipal Medical College PSBH: our experience at URL:
http://www.nhlmmcgym.com/psbhworkshop.htm
| This
is a non-peer reviewed article. Accepted for publication on
January 2,2004
Cite
as:
Scaria V. Whisking Research into Medical Curriculum:
The need to integrate research in undergraduate medical education to meet the future challenges.
Calicut
Medical Journal 2004;2(1):e1
URL: http://www.calicutmedicaljournal.org/2004/2/1/e1/index.html
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