Quality research in Indian medical colleges and teaching institutions: The need of the hour

A medical teacher has multiple responsibilities including undergraduate and postgraduate teaching, clinical work, administrative assignments, assessment-related work, and being a guide for postgraduate dissertations and mentoring.[1,2] Doing quality medical research, which improves patient care, improves medical education, reduces budgetary expenditure, and benefits the society at large, is also an important responsibility, though often underrated.[2] Currently, there are about 459 medical colleges in our country along with over 120 other teaching institutions, wherein medical teachers are now expected to do quality research.[3]

Ray et al.[4] have recently reported that the research output from 579 Indian medical institutions and hospitals over 10-year period from 2005 to 2014 has been poor, averaging to only 14.5 publications per institution per year. Of these, 332 (57.3%) medical colleges had not published a single research paper over the past 10 years.[4] During the same 10-year period, the total research output of the Massachusetts General Hospital (USA) was 46311 publications and of the Mayo Clinic (USA) was 37633, accounting for more than 4.07 and 3.3 times the number of publications from the prestigious All India Institute of Medical Sciences, New Delhi, respectively.[4] In recent times, annually, there are over 22,000 postgraduate students doing a dissertation in Indian medical institutions, but the current conversion of dissertations into successful publications is abysmally low.[1,5] This research remains invisible, a loss not only to the medical community but also to society at large.[5] India accounts for about 17% of the world population, but only about 2.55% of all the published papers (PubMed) in the year 2011 had the first author affiliation from India.[2] It is worth noting that in the last decade, China has not only overtaken India in medical research, but has also now emerged as the fifth leading nation in its share of the world's scientific publications.[4,6,7]

Why Should Indian Medical Teachers Do Quality Research?

First, the current Indian population (approximately 1.2 billion) ranks next only to China, with communicable (infections) and noncommunicable (such as diabetes, hypertension, coronary aliments, psychiatric conditions, intrauterine growth retardation, and obesity) diseases entailing not only a huge disease burden but also an opportunity for doing important research relevant to our population needs. Medical teachers have an easy access to a large variety of common as well as complicated medical and surgical disorders. Further, the diseases and conditions which have been largely eliminated in developed Western countries continue to be common in our country such as tuberculosis/multidrug-resistant tuberculosis, malaria, dengue, typhoid fever/multidrug-resistant typhoid fever, cholera, Japanese encephalitis, leptospirosis, rabies, tetanus, iron deficiency anemia, and severe acute malnutrition (SAM).

Second, our mixed and varied population has unique characteristics which can influence a disease's profile/manifestations and response to therapy. For example, although Western literature talks about autosplenectomy occurring in patients of sickle cell disease by the age of 5 years, it is a common finding to have persistent splenomegaly in older Indian children and adolescents.[8] In addition, the slow acetylator status of Indians increases their risk of developing hepatotoxicity in malnourished patients on antitubercular therapy.[9] There are issues of acceptability and palatability of the ready-to-use therapeutic food (RUTF) (devised by the World Health Organization) in Indian children with SAM.[10,11] There is an acute need to develop indigenous and culturally acceptable RUTF preparations for treating Indian children.[10,11] Research on disorders such as rheumatic heart disease and the management of unoperated Tetralogy of Fallot in a schoolgoing child can only be done by our researchers.[12] In Western countries, parents are willing to give methylphenidate to their children having attention deficit hyperactivity disorder and have no issues with compliance. In contrast, Indian parents are reluctant, which results in the afflicted child missing out on the much-needed therapy.[13] Only an Indian researcher will be able to elucidate the reasons for the reluctance and find solutions to improve compliance.

Quality Medical Research Can Surely Be Done in India

Over decades, quality research has been done in India, but unfortunately from relatively few Indian medical institutions. Some examples include angiographic and pathological detailing of aortoarteritis (the middle aortic syndrome) and revealing its link to tuberculosis,[14] treating neonatal tetanus with a much-reduced cost-effective anti-tetanus serum dosage,[15] successfully treating dehydration in cholera with oral rehydration solution,[16] devising the pulse-polio immunization which ultimately helped in eradicating poliomyelitis,[17] successfully using the prosthetic heart valve for replacement surgeries in rheumatic heart disease,[18] modifying the technique for middle fossa decompression of the trigeminal sensory root for treating the unbearable pain of trigeminal neuralgia,[19] and proving the utility of clinically directed selective screening to diagnose HIV infection in hospitalized children.[20]

Facilitating Factors for Research Already Exist

Since 2009, the Medical Council of India (MCI) has recommended publications as a criterion for promotion of medical teachers and this has now changed the role of a medical teacher to a medical teacher–researcher.[2] It is necessary for medical teachers to develop independent, creative, and critical thinking to do quality research.[21] It is also being recognized that medical teachers who are active researchers not only improve their quality of teaching but also improve their quality of patient care.[4,22]

The commonly perceived hurdles for doing and publishing research include a busy work schedule, inadequate knowledge of research methods, deficiency in writing skills, and lack of funding.[1,4,5] Doing research is now being increasingly considered as the social responsibility of a medical teacher.[2] The MCI and the Maharashtra University of Health Sciences have made it mandatory that medical teachers and postgraduate degree students must undergo training in research methodology.[23] Medical writing workshops are being regularly conducted in many medical colleges and at medical conferences to facilitate research translating into publications. To ensure that young minds get attracted to doing research, the MCI has recommended that every postgraduate degree student should present a poster, read a paper at national state conference, and present a research paper which should be published/accepted/sent for publication during the 3-year training period to be eligible to appear for postgraduate degree examination.[24]

Medical teachers can apply for research grants from their college's research societies; affiliated university; and the Government of India's Indian Council of Medical Research (ICMR), Department of Science and Technology, and Department of Biotechnology. To promote interest and aptitude for research among MBBS students, the ICMR has been awarding short-term studentship (currently Rs. 10,000/-) since 1979.[25] Furthermore, postgraduate students can apply for a financial assistance of up to Rs. 25,000/- from the ICMR for doing their dissertation research project.[26]

Medicine is an ever-changing science and mandates ongoing research. Medical teachers have to accept that doing quality research and publishing is now not only a criterion for career advancement but also an ongoing important duty. We cannot expect the future generation of medical teachers to become good researchers unless the current ones set an example themselves and mentor their junior colleagues and students. It is well known that lack of an ongoing quality sports culture has severely restricted our sportspersons from getting Olympic medals. However, wherever these lacunae have been effectively tackled (as in badminton and wrestling), our sportspersons have won laurels at the Olympics. Similarly, developing a research culture in our medical institutions would ensure that trend-setting quality research will emerge from our country and India too will become a world leader in medical research.