Barriers and enablers to medical students’ engagement in research and clinical academic careers: a mixed-methods study

Abstract

Objective

To identify and understand the barriers and enablers influencing medical students’ engagement with research and consideration of academic careers.

Design

This was a mixed-methods explanatory sequential study comprising two surveys (Phase 1 and Phase 2), followed by semistructured interviews (Phase 3).

Setting

The School of Medicine at Newcastle University.

Participants

All students from all year groups at The School of Medicine, Newcastle University (UK) were invited to participate, with data collected from 343 survey respondents and 25 students in semistructured interviews.

Results

Survey responses from 188 students in Phase 1 (exploratory survey) and 155 students in Phase 2 (general student survey) identified barriers which reflect personal experience (eg, lack of knowledge and confidence), practical constraints (eg, time constraints and academic pressures) and institutional contexts (eg, insufficient research teaching and lack of formal opportunities). Enablers included mentors and other sources of information about research.

Interview data emphasised that academic mentoring relationships are often emergent rather than planned. The limited visibility of research opportunities and of mentors was a significant barrier and perpetuated a culture where research was not normalised within the curriculum. Conversely, enablers included intrinsic motivations (eg, intellectual curiosity and desire to contribute to knowledge) and extrinsic motivations (eg, career advancement). Social dynamics between peer groups emerged, whereby these could act as either a barrier or an enabler, depending on the normalisation of research within their networks.

Conclusions

To enhance engagement with research and promote the attractiveness of a clinical academic career, research should become a ‘normal’ part of undergraduate medical education. Visible integration of research into the undergraduate curriculum, providing structured mentorship programmes and ensuring equitable access to research opportunities will aid this. Addressing these factors may sustain the pipeline of students pursuing clinical academic careers.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• Quantitative analysis and content analysis of free-text data enabled a broad and thorough description of the barriers and enablers to undergraduate medical student research.

• Thematic analysis applied to interview data allowed for an in-depth exploration of these barriers and enablers, the underlying reasons behind them and proposed possible solutions.

• This study was led by medical students, providing insights and reflexivity to support interpretation of findings, under the supervision of senior clinical and non-clinical researchers to ensure reflexivity.

• Although our surveys gathered 343 responses, this reflects a relatively modest proportion of the study population and leaves potential for responder bias.

• As participants were recruited from a single large medical school in England, it is possible that the findings are not transferable to all medical schools in different geographies.

Background

Effective and safe innovation in healthcare requires rigorous research.¹ The delivery of research and its translation into practice requires medically qualified researchers and clinicians who are able to interpret and apply research findings. The UK medical regulator (the General Medical Council) stipulates that all newly qualified doctors must be proficient in understanding, applying and critiquing evidence generated from research so they can apply it to clinical practice.² Some of these doctors will pursue a clinical academic career (defined as being a practising clinician with a substantive research role within their work). Research knowledge and skills developed during undergraduate training may provide an important foundation for a future clinical academic career.³,⁵

However, the number of clinical academic positions and the proportion of clinicians who apply to them have steadily dropped within the UK between the years 2014 and 2024, causing a workforce crisis in clinical academia.⁶,⁸ In addition, there is significant under-representation of marginalised groups—including those defined by gender, ethnicity, age and sexuality—at almost every level of clinical academia in the UK and internationally.⁷⁹,¹² This suggests there exists a pool of potential clinical academics who are not being appropriately and equitably enabled to enter these careers.

The reasons for these issues are complex and multifactorial. Barriers to academic careers at the postgraduate level include systemic barriers such as a lack of protected time to pursue research and challenges in finding academic mentors. Alongside this, direct discrimination against people from marginalised groups is seen.¹³ Similar barriers have also been observed in other professional groups, such as nursing and physiotherapy.^{14 15} It is recognised that many of these barriers are present at the undergraduate level, alongside other barriers such as a lack of student knowledge of research and the career pathways of a clinical academic, alongside a perceived lack of available academic mentors.¹³ The impact of gender, ethnicity and socioeconomic status has also been observed at the undergraduate level.^{713 16},²¹

Conversely, enablers to research careers have included undergraduate experiences and mentoring, career enhancement and potential financial incentives, as well as personal interest and academic skills development.²²,²⁷

However, there is little work (qualitative or otherwise) describing any systemic factors that underpin these barriers, nor what enables student engagement with research, or how these may directly promote consideration of a clinical academic career.^{2122 28},³¹

Accordingly, this study aimed to identify the factors that influence medical students’ perceptions of research activities and their consideration of a clinical academic career. We categorised them as either barriers, which prevent engagement, or enablers, which facilitate engagement with research. We also aimed to explore the elements underpinning these factors and to propose potential solutions for removing barriers to engagement.

Methods

Study design

The study took a pragmatic approach to applied research, with an explanatory sequential study with a mixed-methods design.

This had three phases (figure 1). Phase 1 was exploratory, aiming to describe students’ feelings about their research-related experiences during medical school, and any perceived barriers or enablers to pursuing research. Findings were used to design the Phase 2 survey, which sought to build a more detailed description of the barriers/enablers and gain students’ thoughts on which barriers were most significant to them.

Figure 1. Flow chart demonstrating the study design phases, and how each phase contributed to the next.

Phase 3 involved semistructured interviews. Questions were developed drawing on free-text data from Phases 1 and 2. Questions explored students’ experiences of research, clinical academics and their perceptions of clinical academic careers within their undergraduate medical programme, with the aim to understand what underpins the barriers and enablers described in earlier phases.

Survey design

Phase 1 collected quantitative data on students’ prior research experience, satisfaction with teaching related to research, effectiveness of teaching related to research and satisfaction with exposure to research within the curriculum (all items rated on a 10-point scale from low to high). Demographic data, including year of study and gender, were also collected. Free-text responses asked participants to describe the research teaching they had received and to identify the main barriers to research they perceived.

Phase two similarly collected demographic data (adding disability status and ethnicity) and information about their prior research experience. Participants were asked to rate how likely each of the barriers identified from the Phase 1 analysis was to affect them (on a five-point scale from 1 (strongly disagree) to 5 (strongly agree)) and then to identify the single most significant barrier. Free-text questions were used to allow students to justify their responses and describe additional barriers they experienced (Box 1).

Box 1. List of free text questions used in the Phase 1 survey.

1. As there any other barriers not described above that you feel are present?

2. Are there any organisations or experiences not described above that have contributed to your knowledge of academia?

3. What has positively contributed to your knowledge of the academic career pathway?

4. Is there any more information about academic careers that would be useful to you?

5. If you have a research role model or mentor,what is your role models role in your education and how did you meet him?

The full surveys used in Phases 1 and 2 and the interview protocol are available in the online supplemental file 1.

Participants and setting

All participants were undergraduate medical students at Newcastle Medical School, located in a large, well-established, research-active university in the Northeast of England. The medical programme follows an integrated curriculum, but the location of learning falls into preclinical and clinical phases. For the first 2 years of the standard 5-year programme, learning is university-based, developing knowledge of clinical sciences and medicine through study of clinical cases through lectures and seminars, and some early exposure to patients. Years 3–5 are based in clinical settings across primary, secondary and community care. An accelerated graduate-entry programme covers years 1 and 2 content in a single year, with the final 3 years being the same across both courses.

Research-based content is mapped throughout the curriculum, with two formal assignments in years 1 and 2, and some research-related outcomes mapped in assessments in every year of the curriculum.

Recruitment

In Phase 1, an online survey was distributed to students who had attended student-led events about research and clinical academic careers, while in Phase 2, a link was distributed to all medical students in all years (total medical student population=1409 students at the time of data collection) via email and established social and multimedia channels. Phase 1 responses were collected from January 2020 to July 2020; Phase 2 from February 2021 to February 2022.

All participants who volunteered in Phase 2 were invited to participate in Phase 3 interviews. We aimed to interview approximately 25 participants, which reflected students across all year groups and a range of prior research experience levels. Other than selecting interviewees who participated in Phase 2, there was no purposeful selection of interviewees. In total, 25 students volunteered and completed interviews, which reflected students across all year groups and from a range of educational and demographic backgrounds. Interviews were conducted between February 2022 and March 2022, either online or in person, according to the participants’ preference, and lasted 45–60 min. Prior to each interview, participants were provided with a participant information sheet, and informed consent was given by each interviewee and documented through an online form. Consent was also confirmed at the start of each interview. All interviews were conducted by RB, JF, JL and SS and were transcribed by a professional transcribing service.

Quantitative analysis

Descriptive statistics are reported for quantitative data. Median and quartile data are presented in the form ‘median (lower quartile–upper quartile)’. Non-parametric statistical tests were used to examine relationships between variables (χ², Mann-Whitney U testing). Analysis was performed using R (V.4.3.2).³²

Qualitative analysis

Qualitative (free-text response) data from Phases 1 and 2 were analysed using a content analysis approach.³³ Open coding was used to sort text responses into codes to summarise initial impressions of students’ perceptions of research and clinical academic careers.³³ Codes were then simplified to develop categories of barriers and enablers, which were included in the Phase 2 questionnaire.

Interview transcripts were analysed using inductive thematic analysis.³⁴ First, transcripts were independently reviewed and potential codes developed by RB, JF, JL and SS. An agreed set of common codes was agreed between the researchers, and then applied to the transcripts. Each transcript was then analysed and coded by one researcher. Coded excerpts were then sorted and reviewed by all members of the team to develop themes that formed the basis of analytical narratives.

Reflexive considerations

At the time of the study, RB, JF, JL and SS were medical students actively pursuing research careers. Their position as medical students provided a useful contextual understanding of and insights into the curriculum experience by participants, but risked bias if personal perceptions and opinions could influence questioning and interpretation. To mitigate this, reflexive discussions were carried out between members of the full project team, which included a range of seniority (students to professors) and backgrounds (including non-medical backgrounds). Here, codes and interpretation were presented, justified and debated with members of the project team who did not have direct analytical contact with the data.

Patients and public involvement

This research did not directly involve patients or the public in the design, conduct or reporting of the study. Rather, medical students were involved in all aspects of the study.

Findings

Phases 1 and 2—surveys

Results from Phases 1 and 2 are summarised here together. In Phase 1, 188 responses were gathered, while in Phase 2, 155 responses (11% response rate of the total student cohort) were collected. Demographic data are presented in table 1.

Table 1. Summary of Phase 1 and Phase 2 demographic data.

		Phase 1		Phase 2
		Frequency	Percentage	Frequency	Percentage
Gender identity	Female	100	53.2	88	56.8
	Male	82	43.6	53	34.2
	Other	6	3.2	4	2.6
	Missing	0	0	10	6.5
Year of study	Stage 1	44	23.4	31	20.0
	Stage 2	28	14.9	37	23.9
	Graduate entry medical students (year 1)	4	2.1	0	0
	Stage 3	27	14.4	33	21.3
	Stage 4	73	38.8	39	25.2
	Stage 5	7	3.7	5	3.2
	Intercalated year	5	2.7	10	6.5
Ethnicity	White	NA		100	64.5
	Asian or Asian British			38	24.5
	Black, Black British, Caribbean or African			7	4.5
	Mixed or multiple ethnic groups			8	5.2
	Prefer not to say			2	1.3
Disability status	No disability	NA		132	85.2
	Identify as disabled			21	13.5
	Prefer not to say			2	1.3
Previous degree	No previous degree	NA		131	84.5
	Previous degree			24	15.5
Research experience	No previous research experience	100	53.2	116	74.8
	Any previous experience	88	46.8	39	25.2
Total		188	100.0	155	100.0

Data fields marked NA were not available for Phase 1 and were only collected in Phase 2 only.

Most students self-reported they had ‘no research experience’ (53% in Phase 1, 75% in Phase 2).table 2 Phase 1 respondents’ perceptions of and satisfaction with teaching on research/academic medicine are summarised in table 2. Overall distributions skewed towards the lower end of the 10-point scale. There was an association with stage of the course, with students in years 3–5 rating effectiveness (median 5 (3–6) vs 4 (2–4), p=0.047), and exposure to research (median 5 (4–6) vs 4 (3–5), p=0.002) slightly higher than students in years 1–2, although still indicating negative perceptions.

Table 2. Scale questions about research teaching asked in the Phase 1 survey.

Question	Median response (10-point scale)	IQR
Do you feel the teaching you have received has been effective in providing you with an insight into what a career in academic and research medicine is really like?	4	3–5
How satisfied are you with the teaching you have received about academic medicine and research in your course?	4	2–5
How satisfied are you with your current exposure to academic medicine in your course?	4	3–5

1=low effectiveness/satisfaction, 10=very high effectiveness/satisfaction.

In Phase 2, most students felt there were barriers to pursuing academia and research as medical student. Participants tended to disagree with the statement ‘there are no barriers to pursuing academia’, although there was a wider range of attitudes than in Phase 1 (median=1, IQR=1–5).

Participants with prior research experience (2 (1–2) versus those without research experience, 2(2–3), p=0.002) and those with disabilities (1(1–2) versus those without a disability 2(2–3), p=0.012) were more likely to disagree with the statement ‘there are no barriers to pursuing academia’. In Phase 2, participants were asked to indicate the single most significant barrier of the eight identified in Phase 1, as shown in table 3.

Table 3. Counts of the barriers students rated as most significant.

Barrier reported	Median rating (IQR). Scale 1=strongly disagree is a barrier– 5=strongly agree is a barrier	Number of students selecting barrier as ‘most significant’ (% of Phase 2 sample)
Lack of advertised opportunities	4 (3–5)	30 (19%)
Lack of prior research experience	4 (4–5)	27 (17%)
Lack of confidence in their abilities to carry out common academic tasks	4 (3–5)	16 (10%)
Lack of free time to pursue extracurricular activities	4 (3–5)	15 (10%)
Inability to access research networks	4 (3–5)	14 (9%)
Lack of academic career knowledge	4 (3–5)	13 (8%)
Lack of knowledge about research	4 (3–4)	13 (8%)
Other	NA	27 (17%)

Participants with no research experience rated ‘lack of research experience’ and ‘lack of academic career knowledge’ more strongly as barriers than those with previous experience (respectively median 4/5 (4–5) and 4/5 (3–4), p=0.003, and median 4/5 (4–5) and 4/5 (2–4), p=0.006.

Participants who identified as female were more likely to agree that ‘lack of confidence in research’ was a barrier compared with male participants (4/5 (4–5), 4/5 (2–4), respectively, p<0.001).

Analysis of free-text items

Experience of barriers

Content analysis of free-text data in the Phase 1 survey produced three common themes: institutional barriers, personal barriers and practical barriers.

We define institutional barriers as those that appear to be specific to the respondents’ medical school. Institutional barriers were most prevalent, with 91 students (48%) citing them. Examples included a lack of teaching in relevant research skills (specifically statistical analysis and critical appraisal), a lack of communication about opportunities to get involved in academic activities and limited contact with clinical academic staff who could act as supervisors or mentors (n=33, 18%). A subcategory of institutional barriers (n=44, 23%) referred to limited opportunities to develop academic skills, whether through assignments or research opportunities.

We define personal barriers (n=45, 25%) as those rooted in respondents’ self-perception of their abilities and suitability to conduct research and pursue an academic career. They included a lack of confidence, including feeling too inexperienced to engage with research, and perceptions that research may be too academically challenging. Some students cited this as a feeling of ‘intimidation’ (2nd year female medical student). No participants, however, specifically mentioned feeling intimidated by clinical academics individually; it was rather a perception of the field, not the people.

Practical barriers (n=38, 20%) were defined as external factors that students felt prevented them from participating in research opportunities. These included the perceived highly competitive nature of securing research placements (eg, summer research programmes), challenges in pursuing academic careers and a lack of free time for academic activities.

Free-text responses in Phase 2 identified some of the same barriers, and some additional ones: financial stresses associated with intercalation (n=4, 3%), and from one female intercalating student, a ‘lack of representation of women in research’ which may be interpreted as institutional, or more widely structural. Others noted poor representation of academia within the curriculum.

Overcoming barriers

Phase 2 asked participants how the barriers identified in Phase 1 could be overcome. Participants indicated they would want teaching focused on the types of research, practically what type involves. They also felt that advice on how to engage and get involved with projects and how best to contact supervisors would be helpful. Practical training, such as basic statistics, critical appraisal and academic writing, was frequently mentioned by participants. Students wanted teaching to emphasise how research influences clinical practice.

Students also recalled what had positively contributed to their knowledge of academic careers. These included the presence of role models and mentors (including senior staff from clinical placements and near-peer contacts), and external sources (such as online videos). Institutional factors such as intercalated degrees, summer research projects and career lectures hosted by the faculty were also cited. Information on academic careers provided by faculty emails was seen as a positive contributor to knowledge.

Finally, 46/155 (30%) students reported having research mentors/role models they could look to for support. These came from three main sources: from within their institution (ie, academic mentors from their course), clinical supervisors in placements and others identified through direct contact outside of the educational context (eg, from conferences or personal contacts). For students who did not have a research mentor, 72% (78/109) wanted access to one.

Phase 3

25 semistructured interviews were conducted (table 4). Five main themes were identified: (1) perceptions and stereotypes of research and academic careers, (2) why students do research, (3) barriers and enablers to research, (4) research teaching and (5) the role of mentors and peers.

Table 4. Summary of Phase 3 (semistructured interview) participant demographics.

		Frequency	Percentage
Gender identity	Female	9	36
	Male	16	64
Ethnicity	White	10	40
	Asian or Asian British	10	40
	Black, Black British, Caribbean or African	2	8
	Mixed or multiple ethnic groups	2	8
	Prefer not to say	1	4
Disability	Yes	5	20
	No	20	80
Year of study	Stage 1	1	4
	Stage 2	3	12
	Stage 3	5	20
	Stage 4	3	12
	Stage 5	10	40
	Intercalated year	3	12
Widening participation status*	From a widening participation background	8	32
	Not from a widening participation background	17	68
Prior degrees	Prior degree before starting the MBBS programme	6	24
	No prior degree before starting the MBBS programme	19	76

^*Widening participation status was defined as having entered the MBBS curriculum through the Newcastle University PARTNERS Programme (https://www.ncl.ac.uk/partners/).

Perceptions and stereotypes

Students had a range of views about what research involved and the role of a student in research activities. All participants felt that basic academic skills were needed by all doctors, even if an academic career was not the goal.

‘I think an understanding of how to approach a research paper, and understand the information it’s trying to give you, is important in order so that we as doctors can continue learning’ (11_23_3, male 4th year student)

Negative perceptions of research work were demonstrated by many students without previous experience. For example, it is slow, repetitive, labourious and often

‘involving sitting at a computer’ (6_12_2, female 5th year student)

Who does research?

Several students associated doing research with a level of academic prestige and perceived peers who engaged in research as being high-achieving or ‘more intelligent’ (5_12_18, female 5th year student) than those who did not. This suggests a common stereotype to which the participants were comparing themselves, based on anecdotal information and their perception of their peers. Being a researcher was also seen as something difficult to access, even among those with previous research experience. This difficulty was identified as both social, one student describing research as ‘horrendously cliquey’ (1-7-2, male 5th year student), and practical, with academic careers perceived as ‘extremely competitive’ (7_7_8, 4th year female student).

‘… you want your pals to do well, but you don’t really share too much because you’re still competing against them in some way […] I don’t talk about them as much because I don’t want other people to get inspiration. Maybe that might be terrible to say, but you are competing with these people, which is unfortunate, but it is the reality of it.’ (10_3_1, female 2nd year student)

Indeed, some students had already internalised this competitive mindset, influencing how they perceived collaboration and peer interactions within research activities.

Why do students do research?

Students described both intrinsic and extrinsic interests as motivators for research. These encompassed personal interests, altruism and contribution to scientific advancement. Extrinsically, there was recognition of the increasingly competitive nature of the medical jobs market, and the value which research output may add to portfolios, and subsequently speciality training applications.

Intrinsic interests

Intrinsic rewards of research work described by participants included personal interest in a specific area and a desire to explore it further, as well as an enjoyment of intellectual challenges. Many participants expressed their desire to have a wider impact on patient care by advancing medical knowledge through research.

‘I think just being able to do something a bit different knowing that you are pushing to try and improve healthcare not just directly for the patients that you work with, but also for patients in the same patient groups that you encounter. And trying to like, improve standards and learn, I think is a really rewarding part of a career’ (5_11_5, female 5th year student)

Extrinsic interests

Academic careers were perceived to provide job variation (in both the content and structure of the job), which students saw as advantageous for future careers. Professional development and portfolio enhancement were extrinsic rewards for engaging in research. This was particularly evident in those looking to enter ‘competitive’ clinical careers, even if their long-term career plans did not include an academic element.

Barriers and enablers

Barriers and enablers to engagement with research were suggested and expanded on by students.

Access to additional opportunities

Most students reported a lack of awareness about ways to engage in research activities. At an institutional level, they reported very limited signposting, which mostly came from individual staff members and supervisors within clinical placements.

‘I would like to get involved with research, but I have no idea how I would even start that or like, what sort of research is good to start with. […] No-one really lays it out’ (8_19_1, 4th year male student)

Students linked a lack of visible opportunities to their lack of knowledge of what research was, what the role of a student was and how to engage with relevant activities. For some, this combination meant that they lacked the confidence to take steps to engage in research.

‘I mean, for me the lack of confidence links a lot to the lack of knowledge. I think if I had the knowledge, I would therefore be confident to do those things. So, confidence itself on its own isn’t an issue but because of the lack of knowledge I wouldn’t feel confident, you know, being able to achieve what I needed to achieve in the time that I needed to achieve it by.’ (4_6_4, female 5th year student)

This could be improved by earlier provision of information and training so that students have time to make important career decisions, such as whether to intercalate or apply for the Specialised Foundation Programme.

Some cited limited protected time within the course to gain practical research experience, particularly during the clinical phase. High course workload was also identified as a significant barrier, and some noted that greater protected time within the course would allow them to explore academic interests and could enable engagement in research.

Research teaching

Exposure to teaching about research can be an opportunity to build knowledge, awareness and confidence in academia. Students described some teaching about research throughout the curriculum covering topics such as basic research theory and research ethics, but felt that this teaching was not challenging, referring to it as ‘superficial’, ‘vague’, ‘limited’ and of variable quality. Some felt that these perceived weaknesses contributed to a lack of confidence in research. Passionate and knowledgeable teachers were highly regarded by students, and lecturers who failed to share enthusiasm were seen as off-putting to a career in research.

I think it should really be presented by someone who’s really passionate about it, that’s the first thing. So if it’s someone who’s not passionate about it, or who at least doesn't convey that passion, then it’s not doing academic medicine any justice. Having someone younger do it it’s even better because it shows that people around my age are also looking at it and are excited for it. (3_16_9, female 5th year student)

Some felt the goal of the research teaching they received was to ‘pass assessments’, with several referring to it as being a ‘tick box’ exercise. Some felt this hindered their ability to delve deeper into a topic, with a mentality of ‘do enough to pass’ (11_12_7, 5th year female student), contributing to the superficial nature of research teaching.

The role of mentors and peers

Mentors played a significant role in how students perceived academia, including encouraging and nurturing students’ interests through facilitating research. Mentors legitimised and normalised academic careers for students.

(The academic mentor) ‘kind of showing that that is a possibility that’s open to us, it’s normal to be thinking about that.’ (9_14_3, female 5th year medical student)

Mentors were at all stages of their careers, from senior clinical academics to other (usually senior) medical students. Mentoring relationships were often informal and established outside of the course on an ad-hoc or by-chance basis. Those participants who did not have a mentor tended not to know how to get a mentor.

Near peers (medical students often in the same or more senior years) were important, and in some cases were described as ‘role model’ or mentor-like figures. They provided relatable insights into research and academic careers, and provided insight into what opportunities are available to engage in academia.

I've been lucky enough to be in contact with older students who, who themselves have gotten involved in research and from that have started to have a little glimpse about what kind of things I can get involved with like intercalating. So that’s definitely been valuable. Not necessarily in material or learning content, but just hearing about other people’s research projects. It just, it gets you thinking like, what if I could think of something like that and that’s just, for me personally that kind of motivation is very powerful. (5_7_10, 2nd year male student)

However, not all students had positive encounters with peers. Some reported no encouragement, while others suggested research could be regarded negatively. Indeed, one explained that research involvement could be seen as being motivated only by the competition of future speciality training applications, undermining intrinsic motivations. As a result of this, some did not openly discuss being involved in research due to fears of being perceived negatively.

‘I think it’s almost, people almost shunned; you hear—you hear a lot about, you know, ‘They only do academia to benefit themselves.’ (10_7_5, male 5th year student)

Discussion

This mixed-methods study has described the barriers and enablers students perceive when engaging in research and has begun to unravel what underpins these factors. This work highlights the importance of developing relevant knowledge and skills to facilitate interest in an academic career. However, opportunities for research-related activities are often not visible to students and can occur by chance, ultimately limiting the number of students who may benefit. In addition, the influence of perceived competition within clinical academia and complex role peer interactions plays an important role in shaping students' engagement with research.

What is behind the barriers and enablers students face?

Throughout this study, broad research naïveté was identified as a barrier, and this has been identified by earlier research.²² This included a lack of knowledge of what research is, what opportunities are available and what role a medical student may have in a research team. Several students directly stated that their lack of knowledge influenced their confidence to seek out research opportunities. Notably, not a single participant referenced medical education or other disciplines that involve qualitative methodologies as being potential areas of research, indicating limited awareness of the breadth, as well as the detail, of research. A lack of awareness of opportunity can shape career decisions, and our work suggests a lack of knowledge and awareness of research as an activity, and opportunities to engage in research could discourage students from considering clinical academic careers.³⁵,³⁸

Research skills were, in general, important to students. Individual motivations to engage in research included intrinsic factors such as personal interest, the potential to contribute to knowledge in a field and extrinsic factors such as job variation, and portfolio and professional development. External pressures were important for many, particularly for students looking to enter competitive specialities. With competition intensifying across postgraduate training, motivations to engage in research may shift away from intrinsic factors, increasingly prioritising tangible outputs, such as publications, over research skills. However, with changes to postgraduate recruitment processes reducing the salience of research experience (ie, intercalation), the balance of who undertakes these opportunities may shift to those with more intrinsic motivations. This could reduce overall engagement in research through supported opportunities like intercalation.^{39 40}

At the level of the medical school, students felt research was not a core part of the curriculum, there was a lack of signposting to opportunities, and teaching on research skills was perceived to be superficial. This resulted in some students not feeling supported in research compared with other areas of the curriculum and represented an important institutional barrier to considering clinical academia as a career. To address this, students suggested specific topics for formal teaching support to be included as part of the core curriculum (eg, statistical analysis and critical appraisal) that would serve as practical tools applicable to their own work, rather than aiming for deeper theoretical understanding. Institutional enablers, however, included opportunities such as summer research projects and intercalated degrees, where students were able to apply their taught knowledge to a research project.

Mentors were important for giving important insights and normalising discussions about research and clinical academic careers. These mentoring relationships were often formed under serendipitous circumstances, leaving many without. Where access to academic mentorship is straightforward and supportive, this represents a powerful enabler through providing opportunities for contact and access and supporting senior faculty to facilitate students to pursue research. To be successful, a supportive institutional culture around research and academia is needed at all levels (including that of students).⁴¹

Notably, ‘near peers’ could act as both barriers and enablers, depending on group dynamics. Normative social influence theory has been implicated in the career decision-making process for undergraduates and postgraduates in other medical specialties.^{38 42 43} This theory of conformity proposes that subjects will change their behaviour to fit into a given group, owing to a generalised desire for companionship and a positive relationship with others.^{42 43} This work suggests that if research is not normalised within a social group, students who have an interest in the field may perceive themselves as an outsider from their peer group, which then acts as a barrier to their pursuit of research. Conversely, when our participants were able to identify a supportive near-peer mentor, they felt able to conduct research and explore clinical academic careers.

Practical implications

To address research naïveté, education providers should endeavour to ensure research is visible within the curriculum. Additionally, research involvement must be an encouraged, protected and normalised part of the curriculum for all. This will enable students to fully consider a potential clinical academic career. Involving students as active partners in research through participatory methods such as coproduction can enhance student engagement and provide meaningful contributions to research initiatives, particularly in medical education.⁴⁴

Providing platforms for knowledgeable, passionate clinical academic faculty from a variety of personal and academic backgrounds to discuss their work in the context of what the students are learning could help achieve this. Mentors, drawn from senior and near-peer groups, are sources of support, knowledge and role-modelling. However, institutions and individuals must consider how to ensure equity of access to these individuals, as these relationships are often informal and sporadic. Formal mentoring schemes may be one approach, but student-led and collaborative research initiatives can provide opportunities for research experience, skills development and mentoring in a situated, authentic research context.^{45 46} Indeed, national initiatives such as the INSPIRE programmes supported by the Academy of Medical Sciences have provided financial support to student groups in leading research initiatives.⁴⁷

Strengths and limitations

The mixed-methods design enabled us to capture a broad range of perspectives on the barriers and enablers students perceive when engaging in research, and to explore the factors underpinning these. The study involved over 350 student contacts from a single large medical school in England (with approximately 1800 students in the medical degree programme).

Several limitations should be noted. The Phase 1 survey responses reflect attendees of student-led events on research and clinical academia, a group likely to have a pre-existing interest in research. In Phase 2, where a survey was distributed to all medical students, a relatively modest response rate was yielded. Taken together, these factors suggest the potential for responder bias. The inclusion of students from a single medical school throughout the study may limit the transferability of our findings, particularly as the structure and delivery of medical programmes vary widely across the UK and internationally. However, given the constraints within which UK medical curricula are designed, and wider intelligence about challenges to the clinical academic workforce, it seems unlikely that problems vary greatly within the UK, or that potential solutions should not be based on similar principles of knowledge, opportunity and support.

Findings from Phases 1 and 2 revealed differences in perceived barriers to research between genders and between students with and without disabilities. Although ethnicity data were collected in Phases 2 and 3, no significant associations emerged between ethnic group and perceptions of barriers or enablers. A limitation, however, is that ethnicity data were not collected in Phase 1. Importantly, this study was not designed to examine the intersection of gender, disability and ethnicity with barriers and enablers to research at the undergraduate level, and these factors did not emerge as themes in Phase 3 qualitative data. However, those who identified as male were over-represented. The study aimed instead to capture barriers and enablers across the student population as a whole and explore their underlying causes. Understanding the specific influence of gender, disability and ethnicity will require future dedicated studies designed for that purpose.

Conclusion

This mixed-methods study has demonstrated complex barriers and enablers influencing medical students’ engagement with research and the pursuit of academic careers. When available, senior and near-peer mentors were powerful enablers, offering insights and facilitating opportunities. However, widespread research naïveté limits engagement and fosters a culture where research is not normalised. To make research accessible for all, greater visibility of research as a core element of the undergraduate curriculum is required. This will help sustain the pipeline of new graduates entering clinical academic careers.

Data availability statement

Data are available upon reasonable request.