My view is that although the curricula are hectic there should contain more research opportunities. The other barrier I think is the individual and their willingness to be involved which not also the case especially for students perhaps because they don't have time.

Very good topic of discussion! Policymakers should workout to eliminate the problems faced by the UG medical students in involvement of research. Ethical issues, subjects' health security, populations' compliance, working environment, responsibility shouldering maybe some hindrances concerned.

Eleftherios - in my mind, there are two main barriers. One is that medical curricula are already intense and full just with learning the fundamentals of clinical practice and care. Secondly, medical research is highly competitive. There is often a culture that there is a research hierarchy - and that the 'trade' is learnt through competition - rather than it being an offered part of training.

Here in the Philippines, one barrier towards research is increased number of clinical instruction. Increased clinical fieldwork for students, as good as it may seem, may foster a an attitude on only focusing on clinical work. Research activity is sometimes overlooked.

My view is that although the curricula are hectic there should contain more research opportunities. The other barrier I think is the individual and their willingness to be involved which not also the case especially for students perhaps because they don't have time.

I agree, clinical fieldwork should not be a barrier to foster research interest among students.

Thank you all for your kind answers. I think that although medical students are interested in research, they often have to deal with time insufficiency due to the heave schedule they must follow in medical school. Many students also do not know how to start or they don't get the proper training to do research. Apart from this, some students often also struggle finding the right mentor.

I am unsure if what you mean by "research" is Basic Science research, Clinical/Chart Review research or research based in Literature Review. So here's a summary for each of them:

Basic Science

In this case, the runway for meaningful contribution is typically very long, i.e. becoming proficient in the techniques required to acquire samples (grow cells, handle mice, extract fluids, section tissues) and prepare them to extract meaningful data (pipetting, freezing, slicing, staining, blotting, measuring, imaging, etc.) can take months to years. There is generally not enough time built into medical education to accommodate the training required for individual students to master even one technique, let alone see a project through to completion. Also, exploration is inherently risky. Negative results are common in the quest for better knowledge and there is no guarantee of anything useful coming out of a given period of work. For a time-pressured medical student, four months of failed experiments would feel like a terrible waste of time. For undergraduate students, there may not be a terribly strong incentive to dedicate the time required for mastery of a technique. The combination of learning new skills and perseverance through repeated failures is typically the domain of graduate students, who have 4-7 years to learn the skills and gain the experience they need to successfully complete a research project. In many US schools, medical students may have the opportunity to work with graduate students on their projects during the summer between first and second year. This can have mixed results. In some cases, medical students make a meaningful contribution and may lead to an abstract, poster, talk or even authorship on a paper. In other cases, medical students may feel they have wasted a summer on negative results, or an unwary graduate student may lose 6 weeks worth of very expensive mouse tissue samples to an inexperienced medical student who claimed to know how to pipette. [True story that happened to a lab mate.] Similar mishaps can occur when graduate students entrust work to eager but possibly under-trained undergrads. Graduate students thus burned may be very resistant to taking on students in the future. Thus, Basic Science research is a high-barrier, high-risk, variable yield undertaking for both undergrad and medical students.

Clinical/Chart Review

The barriers to this type of research are lower for most medical students, but higher for undergrad students. Many opportunities exist to become involved at various points in medical education. At most US medical schools, students may have the opportunity to participate in chart review research in capacities ranging from collating charts for a specific patient population to data entry, basic statistical analysis and even developing figures to present the data. Like basic science, chart reviews may or may not yield positive, publishable results. Many physicians at educational hospitals encounter interesting case studies, and may be open to having a student assist in taking medical photographs, making diagrams or writing the case report. There may even be some minor role that a medical student could be trained to fulfill in a large clinical trial, but in this case the likelihood of being included as an author is very low. For undergrad students, the barriers are significant. For a variety of systemic and personal reasons, a physician may not be willing to take an undergraduate on a project with real patient data. Probably the most common reason for this is trust. If an undergrad messes up some mouse tissues, the damage is limited to the mouse, the graduate student and the lab where they are working. If an undergraduate student does something foolish with patient data, the entire institution is open to litigation. That alone would most likely probably preclude undergrad involvement in clinical research. Thus, Clinical and Chart Review research is a low-barrier, moderate-risk, variable yield endeavor for medical students but an extreme barrier may entirely exclude undergrads.

Literature Review

This is an area where undergraduate students could excel, even beyond the abilities of medical students who are typically hyper-focused on "high yield" testable material to the exclusion of most other sources. With appropriate training in where and how to find appropriate research articles and development of critical evaluation skills, a bright undergrad would be able to read, score and summarize published work. There are actually some resources for this available on the internet. Solid literature review skills can be a significant asset in approaching both Basic Science and Clinical research. If an undergrad student approaches a physician and asks if they have any interesting cases that they would like to have worked up as a literature review, few physicians would turn down a summarized list of 10-15 related papers. All that would be needed is a short list of keywords provided by the physician. The same goes for graduate students, who may appreciate a similar approach. One drawback is that an undergraduate student will not, in most cases, have the experience to determine relative importance of the articles they read. They may however, become adept at evaluating the quality of research and leave the judgement of importance to whomever receives their summaries. In an extension of this skill set, available as coursework in a limited number of institutions, medical students function as Wikipedia editors. As a course, students work under the guidance of a professor to evaluate sources, write clearly without plagiarizing, give and receive peer review, interact with non-student editors and experience meaningful "assignments" that result in improving the open access medical information that is often the first stop for patients and fellow students. Thus, Literature Review is a low-barrier, low-risk, high-yield skill set that can be developed by both undergrad and medical students.

Dear Tanya Cupino ,

Thank you very much for your elaborated answer.

Best regards,

Eleftherios

I think because they are involved lately in the research methodology course. I recommend implementation of the research course early from the first year.

Early participation in research is very important for students in all fields, not only in medicine. The challenges are that students do not have research skills, and that their research culture is low.

Thanks Tanya Cupino.

Research can be anything (eg: study on use of internet among medical students) which a student finds interesting to investigate. It may not be only the 'lab work' or some complex project designed to analyse a complex syndrome. Best way to go about would be to identify the student's interest and proceed further. Time may not be a critical factor, as summer vacations / annual breaks of 2-3 months exist in most Institutions. Finding mentors may be difficult at times, but again a resourceful / enthusiastic student may find a way to get the right mentor. Most faculty are helpful and do definitely guide motivated students to do some student projects. With so much resources available online and grants welcoming the willing students, channelizing the ideas into a viable project is not that great a challenge. At the undergraduate level, doing a project, however small, comes as a big boost to the confidence and does real good to take up something later on.

Dear Dr. Eleftherios Beltsios ,

There is no doubt that early participation in research has many advantages for all students and not only for medical students, because it has important advantages in developing many skills they have in thinking, research, self-reliance and continuous learning. But, of course, there are some major obstacles that students face, including poor research skills, lack of financial side, etc.

My impression is that medical students need to be educated in statistics in order to become interested in research. They are also motivated by so many external factors that seem to me more rewarding in the long run. https://eduimed.usm.my/EIMJ20201202/EIMJ20201202_03.pdf

In India, postgraduates theses have to be submitted as paper (published or accepted) before appearance in final exam in many states. It is witnessed that this poses unnecessary pressure to finish the work and publish it fast in mostly 'predatory' journals to meet the deadline. This happens more so in

colleges with inadequate faculty. Many students in this process learn that publishing is easy and can be done without academic rigour. This notion has to be nipped in bud as many shall become faculties in medical colleges and involve in similar practices. Although not many fall prey to these but the value of honest work and the patience it requires is important.

Lack of guidance by faculty and lack of support by institutions are major contributors.