Barriers and challenges in researches by Iranian students of medical universities

Abstract

Background:

Health sciences research (HSR) is an essential part of improving health care which plays a critical role in the field of medicine and clinical practice. The aim of the current study was to assess barriers to the research by students of medical sciences as well as to find out effective strategies for management of student researches in Iranian universities.

Materials and Methods:

This study utilized a hybrid design with quantitative and qualitative analytical approaches conducted on 627 students in six schools of medical sciences in two universities in Central Province in Iran from April to December, 2012. Questionnaires were distributed among researcher and non-researcher students to find barriers to the research. These barriers were approved and validated by similar studies and strategies using the Delphi technique on 36 students.

Results:

The most important barriers among researcher students were institutional barriers (3.3 ± 1.3), but in non-researcher students they were individual barriers (3.6 ± 1.7). The majority of barriers to involvement in the research among researcher students appeared to be time, lack of access to electronic resources and prolongation of the process of buying equipment. In addition, the greatest barriers among non-researcher students included the lack of time, scientific writing skills, and access to trained assistants.

Conclusion:

The results showed the issue of attitudes towards compulsory research as a component of critical scholarship in the curriculum of medical courses. Moreover, employment of the research experts can be helpful for research training in schools of medical sciences.

BACKGROUND

Health sciences research (HSR) is an essential part of improving health care and plays a critical role in the field of medicine and clinical practice.[1] Advances in health care and medicine including disease surveillance, diagnosis, treatment and prevention all rely heavily on the quality of researches as well as health policy[2] The quantity and quality of research papers are considered the most important indicators of scientific development in any country.[1] Since medical students play an important role in production of knowledge, health-related research training and evidence -based scientific knowledge are a fundamental part of medical education.[1,3,4] Studies have shown that early involvement in the research promotes a tendency to continue research in later stages of the medical profession.[5,6] Also, early research education enables the students to develop critical appraisal skills,[7] along with encouraging them to pursue their career in basic medical sciences or clinical research.[8] In addition, the ability of evaluating the literature provides lessons in teamwork and brings about experience in writing and practice in communicating data with the scientific field.[9] Literature shows that medical students' involvement in research projects has declined in recent years.[10,11] Silcox showed that 75% of the postgraduate students prefer to engage in other scholarly activities compared to the research.[12] Studies have verified that medical students' involvement in research is highly associated with postgraduate research works.[6,13] The role of undergraduate research assistants becomes thus ever more important.[6,14] Furthermore, another study in Calgary University depicted that introducing a formal research workshop caused a significant upward trend in submission of medical researches by students from 11% to 59%.[15,16]

Research findings have shown that the majority of undergraduate medical students are interested in doing research, but that some official and educational factors turn out to be barriers and challenges in doing it. These factors include previous training and skills in research,[1] inexpert faculty staff,[17] motivationally worthwhile environment at the institution,[16] official procedure, lack of time, arduousness, intense workload, poor guidance and inadequate financial repayment.[15,16,18,19] Besides, in the primary care field, most studies found that time, financial constraints,[1] hard clinical practices,[20] and lack of interest[21] and financial inducements and infrastructure support are the key factors in promoting research.[22]

According to a recent study in Iran, 70% of medical sciences students are not willing to do research due to barriers and challenges in the research.[23] Therefore, it is important that students of medical sciences - including Medical, Nursing, Midwifery and Allied Health Sciences - should have positive attitude towards the role of research on health. However, problems in medical curricula, financial and logistical barriers could create challenges in involvement of students in HSR. As such, the aim of the current study was to assess barriers of execution of research projects by Iranian medical students as well as to investigate the effective strategies for management of student researches.

MATERIALS AND METHODS

This analytical study was conducted on six schools of medical sciences of two universities in Central Province in Iran between April and December of 2012. The subjects for the study were selected by stratified random sampling method based on the field of study and gender from schools of Medicine, Nursing and Midwifery and Allied Health Sciences in Azad University (private sector), and University of Medical Sciences (public sector). Overall, 277 students were from University of Medical Sciences and 350 were from Azad University. The inclusion criteria were: (1) the academic year: 2 years or above; (2) place of education; they should have been studying only in these universities, so students from other universities and guest students from other universities (if they had studied less than two semesters at the guest university) were excluded; (3) research activities: students were divided into two groups, researchers and non-researchers. Researcher students were defined as the students who had at least one research project or academic paper. In this study, 19 students were excluded. Therefore, 572 students were non-researcher and 36 ones were labeled as researcher students. Ethical approval was obtained from each institutional review board and explanations for the objectives of the study and assurance of confidentiality were distributed among the students responding to the survey.

The barriers and limitations of the research between researcher and non-researcher students were assessed by means of two questionnaires (containing 35 and 25 close-ended questions, in two different dimensions including the institutional and individual barriers to research, respectively). The first 7 questions of the survey assessed demographic information and research background for the students being surveyed. The remaining 28 questions for researcher students and 18 questions for non-researcher students were in Likert's scale format and addressed the above -mentioned objectives. It should be mentioned that the students' opinions about strategies for promotion in management of student researches, the weaknesses, and the strengths of carrying out research in these universities were assessed by 5 open-ended questions. The validity of questionnaires was approved through focus group, and their reliability was examined using Cronbach's Alpha (0.89). In the second phase of study, a thorough search was carried out on Medline, Proquest, and CINAHL online journals and 30 articles were identified to provide effective strategies for management of student researches in Iran. A questionnaire was developed on the basis of the searched literature and student opinions about the mechanisms of removing barriers. This questionnaire included strategies based on structure, process, and output. Strategies with a schematic view were validated by Delphi technique. For this purpose, the questionnaire was sent to 36 experts. The scores of this questionnaire were classified as strongly disagree (1), disagree (2), neutral (3), agree (4) and strongly agree (5). The average scores were calculated according to the formula: Z = [(X/n) − P0)/√(P0(1 − P0)/n], P0 ≥ 75%, n = 36, P < 0/05, H1:P0 > 75%, H0:P0 ≤ 75%. If computed Z was over +1.64 or less than -1.64, the component of strategy would be approved and was valid, but if Z was calculated between (+1.64) and (−1.64) the component would be disapproved and was not valid.

RESULTS

All in all, 627 participants eligible for the study were taken into account 608 of whom responded to the questionnaires (response rate was 97%). In this study, 35.8% of students were in the school of medicine, 21.2% of students in school of Allied Health sciences, and 43% of students in school of Nursing and Midwifery [Table 1].

Table 1.

Demographic characteristics of the students in universities of medical sciences and Azad universities

An almost equal number of male and female students participated in the study (44/7% and 55/3%, respectively). In this study, 94.1% of students did not have a research project or scientific paper, and had not collaborated on projects. The barriers of non-researcher students were individual barriers (3.68 ± 1.98) but those of researcher students were institutional barriers (3.5 ± 2.48) [Table 2].

Table 2.

The mean and standard deviation of the research barriers between universities of medical sciences and Azad universities in Iran

The most important barriers to research evaluated from the perspective of researcher students in Schools of Medicine were insufficient funds (4.8 ± 1.04), but the barriers of non-researcher students in these schools were the lack of research use in the community (4.25 ± 0.95). This study showed that the barriers to the research from the perspective of researcher students in Nursing and Midwifery Schools were lack of using research results in community and lack of experts and trained research assistants (4.75 ± 1/4), but the barriers to research by non-researcher students in this schools were lack of experts and trained research assistants (4.8 ± 1.04). The barriers to the research from the perspective of researcher students in Schools of Allied health Sciences were lack of using research results in the community (4.75 ± 0.95), but the barriers of non-researchers in these schools were lack of experts and trained research assistants (4.8 ± 1.04). Lack of access to electronic resources (4.6 ± 1/4) and prolongation of equipment purchase (4.6 ± 1.5) were the most important problems for researcher students in the domain of institutional barriers, and as regards the individual barriers lack time for research was the most important cause [Table 3].

Table 3.

The mean and standard deviation of research problems of “researcher students”

Lack of experts and assistants for cooperation with students and unfamiliarity with digital libraries were the most important problems for non-researcher students in the domain of institutional barriers [Table 4].

Table 4.

Comparing the mean and the standard deviation research problems of “non-researcher students”

In this study there were differences among institutional barriers in schools and between non researcher students. Students of schools of Allied Health Sciences faced with more institutional barriers in comparison with other schools (P = 0.001). There was no significant difference (P = 0.37) between sex and level of students in the schools. In comparative study on barriers in the articles, 40 articles showed individual barriers to be weakness in value, skill and research knowledge; 24 articles emphasized lack of research knowledge and institutional barriers were barriers related to the research field including: 38 articles showed lack of time to do research, 20 articles pointed to the low quality of research, one article showing contradiction in clinical research, and 36 articles depicted incomprehensible statistical analysis. Finally, student research management model included strategy structures, processes and outputs [Table 5].

Table 5.

Management strategies for the promotion of research by students

DISCUSSION

This study is the first attempt in Iran that looked at barriers to research in different academic settings both in private and public universities (Azad and Medical Sciences Universities). This study is also the first attempt to highlight differences in barriers in the research ward of different schools and between researcher students and non-researcher ones. On the whole, the majority of students sampled were not involved in the research. However, the number of students currently involved in research was similar to some studies done before.[1,4] Researcher students were faced with institutional barriers but non researcher students with individual barriers. This finding is in line with that of some studies.[17,24] Prolongation of the equipment purchase was the most important problem for researcher students in the domain of institutional barriers. While doing research in the field of medical science is necessarily of empirical nature and interventional research, which necessitates the purchase of equipment and laboratory animals, any delay in the purchase of supplies for researchers, in addition to reducing motivation, can cause changes in the cost of laboratory equipments because of the imbalance in the market.

Weaknesses in research methodology were another type of barriers. Our findings are comparable with the results of a study conducted in Iran, regarding the medical students' perspectives on the teaching of medical statistics in the undergraduate medical curriculum, which emphasized that biostatistics should be taught early in the curriculum, but there is a need to reinforce such skills throughout the graduating years.[23] The other barrier was the lack of use of research results in the community. Lack of a comprehensive plan of research in universities is one factor which leads to a decrease in motivation to do research. Vodopivec et al., showed students' knowledge and attitude towards health research significantly improved with increasing years of education at medical school.[24] This indicates a relatively satisfactory contribution of medical curriculum in developing research skills among medical students through well-structured concentrated courses.[9] The results were consistent with those of a survey conducted by Siemens et al. A study in Pakistan showed barriers to the research participation included the access to research mentors and available time.[25] Compulsory involvement in the research projects has been shown to improve students' knowledge and attitudes towards research.[23,26]

It is believed that encouragement in students of medical sciences can improve the physician scientists and help developing countries to achieve self-reliance in HSR.[3] However, according to our results and other literature, research training is an important part of medical education.[1] Moreover, while a major proportion of medical students are internet-addicted for game and entertainment, training in the research is essential in the medical curriculum to prevent waste of time.[17,27] Furthermore, due to some lacks in graduated and under graduated students, a movement initialized towards conducting early research experience in medical students,[11,24,28] and research methodology within the school of medicine curriculum to facilitate the doctors understanding of published medical literature is indispensible.[29,30,31,32,33,34]

CONCLUSION

Increasing the quality of the research at universities needs better infrastructure work. Having assistants for cooperation with students as well as integration of research into the undergraduate curriculum are strategies for removing some research barriers. Besides, improvement in the quality and quantity of undergraduate medical research is essential. Therefore, investment for development of medical curriculum is a superior and robust method in catering for the health -related research demands of the society.