Adapting a Longitudinal Structured Program to Enhance Research Skills in Undergraduate Medical Students: A Key Advancement in Competency-Based Medical Education

Abstract

Background:

Abundant literature signifies the imperative role of evidence-based research in the health sector which underpins the importance of training medical graduates in research skills early in their medical journey. Low awareness, less knowledge, and minimal practical involvement of undergraduates (UGs) in research have been identified all over India. The lack of structured delivery of research curriculum in the UG period has been the basis of uptaking this project with the aim of developing research competency in medical UGs.

Materials and Methods:

The study was conducted as a participatory action research with a mixed-method approach in the department of community medicine at a medical college. A structured validated module was developed by the core committee and then pilot tested. The 5 years’ journey through module development, pilot testing, longitudinal delivery, and then adapting it into a value-added course program at the university curriculum level was attempted.

Results:

“UG Medical Research” has been adopted as value-added course in the curriculum of MBBS in the university. The research program is being run in a longitudinal structured manner with all MBBS UGs being trained using the “Module for UG Medical Research” module followed by research mentoring by faculty and subsequently academic scholarships in Electives Research Block 1. Interdisciplinary voluntary faculty pool has been created for research mentoring of UG students. The research environment of the institute has improved in terms of the increase in the number of research projects being carried out by UG students, Short Term Studentship (STS) Indian Council of Medical Research (ICMR) research scholarships, conducting annual UG research exhibition/conferences in the campus, awards for best research works, and providing intramural research grant for UGs.

Conclusions:

The longitudinal structured research program was successfully incorporated into the UG curriculum which enabled UG students to demonstrate acquisition of research competency.

Introduction

Scientific research, a methodical approach to acquiring novel knowledge following established protocols, has garnered increasing attention in recent years in all educational fields. Evidence-based research plays a pivotal role in guiding decision-making within the health-care sector, informing the development of policies aimed at disease prevention, diagnosis, and treatment.[1,2] Competency in research is crucial for practicing physicians as it improves their capacity to critically evaluate evidence and address health issues within communities. There have been many studies indicating the need of involvement of all health professionals in understanding and applying research skills in their professional roles.[3,4,5,6,7,8]

The National Medical Commission (NMC) has broadened the scope of roles for Indian medical graduates from five to seven, acknowledging “researcher” as a fundamental role.[9] The NMC’s decision to require MBBS students to engage in faculty research, community, and epidemiological surveys, or conduct their own research projects during their initial elective period is commendable. However, this requirement is currently limited to a short elective period of 15 days to 1 month, which may not be feasible in practice.[10] While medical research has been a compulsory component of postgraduate studies, it remains absent from the standard undergraduate (UG) curriculum in India. Even at places where research is taught, it is merely restricted to the knowledge domain, and assessment is limited to theory questions. The wholesome competency attainment of a UG student to be researcher is neither aimed for nor assessed. Sadly stating, this competency has not even been enlisted in the certifiable skills of any subject of UG curriculum released by NMC under the revised competency-based curriculum.[11]

Studies conducted among medical students have revealed that despite possessing some knowledge of research, their awareness levels are limited, and their practical involvement in research activities is notably low. Several barriers contribute to this, including the extensive curriculum, insufficient exposure and hands-on experience, lack of adequate mentorship, insufficient motivation, and limited funding opportunities.[12,13,14,15,16]

Based on our institution’s data spanning the last decade, only 0.03 % of medical UGs have actively participated in research endeavors. Moreover, these projects predominantly occur within a limited number of departments, primarily medicine and community medicine. The prevalence of minimal publications, presentations, and grant applications underscores the dearth of research inclination among medical students. This highlights a significant gap in research awareness and opportunities during the UG phase, compounded by the absence of structured instruction in research skills. Consequently, it was evident that there was a deficiency in research engagement and interest among UG students. This trend is likely common in many medical colleges, with few exceptions being central and research-focused institutes, where UG research activities may be more prevalent.

Given this context, the current study was planned with the objectives to (1) Develop a structured longitudinal program using a validated module and use it for providing training in research skills to UG medical students and (2) Evaluate the impact on various stakeholders and assess the sustainability and replicability of the program.

Materials and Methods

The study was initiated in the year 2020 as an educational interventional project as a part of the Foundation for Advancement of International Medical Education and Research (FAIMER) at CMC, Ludhiana, and has now transformed into a course program. The detailed intervention plan and outcomes chain are represented in Figure 1.

Figure 1.

Matrix used to plan the intervention to achieve desired outcomes

Study design

Educational interventional study design with participatory action research adopting mixed method approach.

Setting

Department of Community Medicine.

Participants

Interns, MBBS students, Faculty.

Sampling

Universal sampling. All the students of the batches posted in community medicine from 2020 till date, i.e., 2019, 2020, 2021, and 2022 were included in the study. There were no exclusion criteria. In case, students have failed in their current profession, they were included with the subsequent batch.

Research and Ethics approvals were obtained from Institutional Research Committee vide letter no. AIMSR/MC/Estt/438 dt 27.02.2020 and Ethics Committee of the University vide letter no.AU/EC/FM/14/2020 dt 25.03.2020.

In year 2020, the project was conducted in a phased manner. During the planning and development phase, the contents of the module[17] were decided based on inputs from alumni students through two rounds of e-Delphi. Focused group discussions with institutional research committee members provided further insights on topics and methodology. A core committee (CC) of 11 members, including faculty from the department of community medicine and six FAIMER fellows, was formed. The CC was sensitized, and individual consents were obtained. Preliminary drafts were compiled. In the Validation phase, the module underwent internal validation by the CC, followed by compilation by the main researcher. The final module was then sent to 10 external experts for further validation and modification, ensuring it suited online delivery. The module was shared with resource faculty, and data collection tools, including feedback questionnaires and assessment forms, were prepared, and validated internally by the CC, and then externally. The finalized “Module for UG Medical Research” (MUMR) was created for training. During the implementation in the Pilot phase, the module was delivered through workshops to two groups: intern students for onsite delivery and 2^nd-year MBBS students for online delivery due to the COVID-19 lockdown. The MUMR module was provided to all students, and data collection forms were administered and collected. Forty-six students who attended the entire workshop were included in the data analysis, and 11 CC resource faculty members conducted the workshop. In the Evaluation phase, feedback was collected from students on the last day of the workshop after explaining the study and obtaining written informed consent. A retrospective pre-post self-efficacy questionnaire was administered to gather honest and critical feedback. Deferred assessment forms were distributed, explained, and collected after 2 weeks, then graded by faculty. Feedback from resource faculty and the CC was also collected using a faculty feedback questionnaire at the workshop’s completion, following written informed consent.

In the year 2021, the module was delivered to all 150 students of the 2019 batch during their Phase 2 in onsite mode. This was accomplished through six workshops, each attended by 25 students, conducted by CC members over 5 months during the clinical posting. Feedback was collected from both students and faculty to make further improvements to the module and the program. The first edition of the module was subsequently published and utilized by both students and faculty.

In the year 2022, the students of the 2019 batch, now in Phase 3 Part 1, were mentored by community medicine faculty mentors, with 25 students assigned to each mentor. They developed research protocols and conducted research projects, forming 36 groups with 2–5 students per group, each guided by a faculty mentor. Throughout the year, continuous monthly sessions during community medicine small group learning (SGL) sessions allowed faculty mentors to address student issues and provide further guidance on their projects. These students were also trained and mentored in scientific writing, resulting in project reports and research posters. Simultaneously, all 150 students of the 2020 batch, now in Phase 2, were trained in research skills using the same approach.

In the year 2023, the students of the 2020 batch, now in Phase 3 Part 1, were mentored by community medicine faculty mentors, with 25 students assigned to each mentor. In addition, 20 faculty mentors from various disciplines were inducted and assigned to students based on their chosen research areas. The students developed research protocols and conducted research projects, forming 42 groups with 2–5 members each and 1–2 faculty mentors. Continuous monthly sessions during community medicine SGL sessions were held throughout the year, allowing faculty mentors to address student issues and provide further project guidance. These students were also trained and mentored in scientific writing, resulting in project reports and research posters. Simultaneously, all 150 students of the 2021 batch, now in their Phase 2, were trained in research skills using the same approach.

In the year 2024, the module underwent revision and updating based on feedback and experiences from the past 4 years, leading to the preparation and publication of the second edition. Training of all 150 students of the 2022 batch, now in Phase 2, has been completed using this updated module. The students of the 2021 batch, now in Phase 3 Part 1, are being mentored by community medicine faculty, with 25 students assigned to each mentor. In addition, 30 faculty mentors from various disciplines have been inducted and assigned to students according to their chosen research areas. These students are currently conducting their research projects. Continuous monthly sessions during community medicine SGL sessions are being held throughout the year to address student issues and provide further guidance. These students will also be trained and mentored in scientific writing, resulting in project reports and research posters.

Results

In the year 2020, i.e., 1^st year the structured and validated module “MUMR” was created for training UG students in research skills. The module was found to have face validity of >90% and the overall content validity index of the module was established at 0.975 and universal agreement at 0.75. The overall satisfaction with the workshop was 96% while the overall rating of the module was 83% by the students. The overall satisfaction with the workshop as well as the rating of the module was 100% by faculty. The students reported that the preferred mode of delivery was onsite (only 4% preferred for the online platform) while it was suggested that a combination of onsite and online modes, i.e., a hybrid model can be tried. The preferred timing for the start of delivery was reported to be the Second phase. The performance of students measured on the basis of developing research question/hypothesis for selected research topics ranged from satisfactory to excellent. The themes that emerged from thematic analysis of feedback obtained from students and faculty regarding their perceptions are represented in Figure 2.

Figure 2.

Thematic analysis of feedback

In the year 2021, all the 150 students of Batch 2019 were trained using the module in their second phase of MBBS. A high satisfaction was reported from both students and the resource faculty. The scores of research knowledge and skills were found to be significantly higher on all variables postworkshop with P ˂ 0.001 and large effect size (>0.5). The module was published and permission was obtained to train further batches at the institute. (ISBN 978-93-5205-490-9, Unistar Books Pvt Ltd. 2021).

In the next year, i.e., 2022, the batch 2019 which was trained in the Second phase and now in their Phase 3 Part 1, grouped themselves and conducted research projects. A total of 36 groups submitted project reports which were evaluated and group feedback was given by faculty. A full day 1^st UG research exhibition (Poster) was held in the college auditorium and the students were awarded with best 1^st, 2^nd, and 3^rd posters by the Dean. The students of all other batches visited the exhibition and provided peer-learning opportunities. On the opening of STS-ICMR applications, eight students submitted their applications, and one was selected for the ICMR-STS scholarship.

In the year 2023, students of Batch 2020, who were trained conducted 42 student projects in groups. On the opening of STS-ICMR applications, 28 students submitted their applications and 3 were selected for ICMR-STS scholarship. The module was adopted as value-added course GRI.300 in the university curriculum for UGs with 40 credit hours at the university level. Faculty–student research mentoring program with a pool of around 20 faculty mentors was launched. UG research exhibition/conference was approved as an annual event and the 2^nd UG research exhibition was held, students were awarded best poster awards for 1^st, 2^nd, and 3^rd positions. The university launched intramural grants for UG research work and three projects were awarded Rs. 5000/-each after selection by the expert committee. E-certificates to all students for poster presentations were awarded. In addition, the module was suitably adopted for Electives Research Block 1 to further train the students for academic writing.

In the year 2024, students of Batch 2021, who were trained are in the process of developing and conducting student projects. The second edition of the module has been published and distributed to all the students under the value-added course in the university curriculum for UGs. (ISBN 978-93-5205-490-9, Unistar Books Pvt Ltd. 2024). Faculty–student research mentoring program pool has further enlarged to around 45 faculty mentors.

The final value-added course is being delivered in the format, as outlined in Web Table 1.

Web Table 1.

Plan of delivery of undergraduate research program

Time	Sessions	Topics	Credit hours
Phase 1/2		Introduction to the program	Total credits=18 h
	Day 1 (3 h)
	Session 1	Research in UG phase - need and benefits
	Session 2	A smooth transition from nurtured UG to self-reliant researcher
	Day 2 (3 h)
	Session 3	Steps in research
	Session 4	Identifying research topic and designing the research question
	Day 3 (3 h)
	Session 5	Epidemiological study designs in biomedical research
	Day 4 (3 h)
	Session 6	Fundamental biostatistics for biomedical research
	Day 5 (3 h)
	Session 7	Ethics in research
	Session 8	Scientific Writing-I
	Day 6 (3 h)	Assessment and feedback
Phase 2	Session 1 (3 h) (1st month)	Recap of previous work, group formations and mentor allotments (preparation of research proposals) Group work and discussions with mentors - 1	Total credits=22 h
	Session 2 (3 h) (3rd month)	Institutional research and ethics approvals Group work and discussions with mentors - 2
	Session 3 (3 h) (5th month)	Plan and start data collection Group work and discussions with mentors - 3
	Session 4 (3 h) (9th month)	Plan and start data analysis Group work and discussions with mentors - 4
Phase 3 part 1	Session 1 (3 h) (1st month)	Scientific Writing-II Guidelines for project report and poster preparation
	Session 2 (full day=7 h) (7th month)	Project assessment and poster display
Total credits=40*
Elective posting (Block 1)	15 days (as per NMC guidelines)	Academic scholarships - Scientific writing/Publications/Scientific presentations outside the Institute	Optional

*Hours of individual data collection and analysis not included. NMC: National Medical Commission; UG: Undergraduate

Further as committed, the program has been under continuous evaluation since inception by various stakeholders. Figure 3 depicts the program evaluation using Kirkpatrick’s model.

Figure 3.

Program evaluation using Kirkpatrick’s model

Discussion

Many need assessment studies have reported low scores for knowledge of concepts and methodology related to research highlighting barriers of nonawareness and lack of structured program in UG period. Following these highlighting issues, attempts at delivering research through 1–2 days workshops have gained satisfactory and encouraging feedbacks from students. They also reported improvement in perceived knowledge and skills and opined the research project to be included as a mandatory requirement for completion of MBBS, so as to enhance the importance of these skills.[14,15,16,18,19,20,21,22,23]

There have also been attempts at offering research methodology through competency-based modules wherein students reported enhancement of perceived knowledge and skills, high satisfaction, and felt motivated to do further research.[24]

Research competency development programs being offered during UG medical education and faculty development to boost scholarly productivity have been reported in Western countries.[25] However, we could find only one study in South India where the UG research program is being run as a longitudinal program and has yielded promising outcomes.[26]

The novelty of the current project is that no structured methodology for training UG students in research skills was being adopted by the institute. Hence, the module was developed by the core committee suiting the requirements and has now been formally adopted in the university UG MBBS curriculum as a longitudinal program. The research skills training is now being imparted as a 40 credit hours value-added course with the assessment of research skills. Very few colleges all over India are taking up formal research skills training for all UG students.

The project has been run as a collaborative effort with multistakeholder involvement. The educational project was started as a part of the FAIMER fellowship program by the main author under CMC Ludhiana FRI in January 2020. The research skills training is being imparted by the department of community medicine along with volunteer faculty from all departments of the Institute under the value-added course. A program of faculty–student research mentorship has been launched with a pool of faculty mentors from all disciplines. The university has started an intramural research grant for students and is a partner to strengthen this initiative.

The sustainability and replicability of the current model are supported by several points. “UG Medical Research” has been adopted as a value-added course (GRI.300) in the MBBS curriculum at the university, with a credit value of 40. Consequently, all MBBS UGs will be trained in research skills using the “MUMR,” followed by research mentoring by faculty. An interdisciplinary voluntary faculty pool has been established for research mentoring of UG students. The “MUMR” module is available for use in UG training at any medical institute upon request to the main author, and the second edition of the module has been published. An UG research exhibition/conference has become an annual event, with the three best research projects awarded by the UG Research Cell. The university has also announced an intramural research grant for UG research, to be awarded to three student projects each year. In addition, the module is being used effectively for training in Electives Research Block 1, “Research Methodology and Biostatistics.”

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.