International Journal of Advanced Medical and Health Research

EDITORIAL
Year
: 2020  |  Volume : 7  |  Issue : 1  |  Page : 1--2

Promoting research for undergraduates of medicine in India – A critical necessity


N Ananthakrishnan 
 Department of Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry, India

Correspondence Address:
Prof. N Ananthakrishnan
Department of Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry - 607 402
India




How to cite this article:
Ananthakrishnan N. Promoting research for undergraduates of medicine in India – A critical necessity.Int J Adv Med Health Res 2020;7:1-2


How to cite this URL:
Ananthakrishnan N. Promoting research for undergraduates of medicine in India – A critical necessity. Int J Adv Med Health Res [serial online] 2020 [cited 2020 Nov 24 ];7:1-2
Available from: https://www.ijamhrjournal.org/text.asp?2020/7/1/1/292393


Full Text

It has been estimated that there has been a COVID-like increase in medical knowledge in the past 50 years. The doubling time of medical knowledge was 50 years in 1950; it fell to 7 years in 1980, 3.5 years in 2010, and is likely to be 73 days in 2020.[1] The implications are enormous. A medical graduate of 1950 would have retired from service without any change in medical knowledge he learnt in medical school; one who graduated in 1980 would have had at least one doubling in his service time, those who joined in 2010 would have seen doubling of knowledge almost twice during their undergraduate (UG) program and those enrolled in 2020 would almost have five doublings of knowledge within one year! Evaluating new knowledge and keeping up to date with relevant and reliable new knowledge after proper evaluation is the essential basis of evidence-based medical practice.

There is yet another disturbing fact. Although, there are no accurate methods of estimating the research output of a country, the number of scientific publications from that country can be used as an indirect index. A publication in 2018, mentioned that between the years 1995 and 2015, the USA contributed to 4.19 million publications to PubMed, China to 0.91 million, and the UK to 0.90 million.[2] India did not rank among the top ten countries, although it has a population of 1.3 billion people and probably one of the largest medical, scientific workforces in the world. When core research articles such as systematic reviews, meta-analysis, clinical trials and randomized clinical trials were considered, India ranked 17th, 20th, 19th, and 18th, respectively.[2] Most of the publications from India come from the Institutions of National Importance or major research organizations with the vast majority of graduating, post-graduating, or practicing doctors contributing only a minuscule.

Research has never found a prime place in the medical curriculum. There are no credits for doing research, and there are no dual degrees combining medicine and research as in other countries. These facts make it mandatory that awareness of medical research and its implications, ability to evaluate published data and sift the grains from the chaff and a mental and scientific preparedness to try and answer existing or new medical questions by generating new data must all form the fundamental basis of medical education. There is evidence that doctors who have received scientific training in research are at an advantage in clinical decision making.[3] Unfortunately, the reality is far from the truth in India. It is time that attention is focused right from the entry of the UG student to the medical course till the end of training of a postgraduate resident to create an ambience, an interest, and an inclination for research and allow for sufficient time in the curriculum to enable this.

After a gap of more than two decades after the last revision in 1997, the MCI made a major revision in the UG curriculum in Medicine in India and introduced the competency-based medical education pattern from the batch of 2019.[4] However, the ability to be a researcher was still not considered as a mandatory separate quality of the Indian Medical Graduate (IMG) with only clinical knowledge, professionalism, communication skills, ability to be a lifelong learner and a member and leader of the healthcare team being considered as desirable attributes of the IMG.

To catch up with the rest of the world, it is necessary that familiarity with research becomes a part of the UG curriculum and runs as a continuous core course throughout the program. This can be easily accomplished by including research as part of the Attitude Ethics and Communication Module (AETCOM) of the Medical Council of India.[5] All UG s must be introduced to the elements of research, basic information on the ethics of research, the process of collection, recording, analysis, and documentation of data, comprehending the significance of one's work and presentation of data to peers. The syllabus for this should be carefully planned so that it does not become overwhelming. This has to be done from the 1st year itself. The syllabus should also include a discussion on the evaluation of published data.

It is better that this training is imparted by the local faculty itself. Having visitors to carry out this function will reduce credibility and confidence in the local faculty, and besides, the support from faculty has to continue as prolonged mentorship. Instead of large group teaching activity, small workshops can be more motivating and more conducive to active learning. They can be arranged to familiarize the students with research, show them examples of small projects done by previous batches, introduce them to research ethics, show them examples of poor research ethics from the literature, raise some research questions and ask them to try and plan a study for finding out the answer, etc. This is best accomplished by dividing them into small groups and giving them time to raise a research question, plan a study, collect data, and present their results to their peers. Learning by doing is likely to leave a more lasting learning impression. Each small group can be attached to a mentor from the faculty.

These exercises can be started during their field visits in the first MBBS itself so that they learn to communicate at the same time. By working in small groups with a mentor, one can keep the process active and still manageable, considering that as many as 250 students are admitted every year to the MBBS course in some institutions. Institutions must provide financial support for this activity and efforts of the students may be recognized in the form of certificates or other academic recognitions. It may be even more encouraging if participation in such projects finds a weightage in the formative assessment. Financial support from the management for purchase of kits, transportation, stationery, statistical help, and cash awards for good projects during the annual day celebrations are necessary. Besides, the faculty mentors should also receive recognitions in their annual appraisal to keep them motivated. One such small project every year would give them an experience of at least four projects over the course. If the work has sufficient information, they may be encouraged to publish the same. Such mandatory requirements exist in the curriculum of UGs in many countries.[6],[7],[8] Including “Research” as one of the available electives recommended by the new curriculum would add to impact.

The short-term summer scheme of the ICMR, being far too few, cannot serve the purpose by itself as very few students get selected for the same and the selected students have to do individual projects. The current proposal would, at the same time, teach them how to work in groups. To facilitate interest in solving research questions, all teaching-learning activity in medical colleges in any subject should constantly draw attention to unsolved questions or raise new questions that require the solution to stimulate curiosity.

There are lessons to be learned from other countries from other models practiced by them. Any of these can be adopted in India. Once the foundation is laid during the UG course, it can be further strengthened during the postgraduate residency period by making the dissertation a much more meaningful activity than it is at present.

“Research is formalized curiosity. It is poking and prying with a purpose” – Zora Hurston. This is what will keep the medical force in India constantly updated and competent.

References

1Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc 2011;122:48-58.
2Fontelo P, Liu F. Review of Recent publications trends from top publishing countries. Syst Rev BMC 2018;7:147. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161455/. [Last accessed on 2020 May 10].
3Core Committee, Institute for International Medical Education. Global minimum essential requirements in medical education. Med Teach 2002;24:130-5.
4Medical Council of India. Competency Based Undergraduate Curriculum for the Indian Medical Graduate. Vol. 1-3. Available from: https://www.mciindia.org/CMS/wp-content/uploads/2020/01/UG-Curriculum-Vol-I.pdf. [Last accessed on 2010 May 10].
5Medical Council of India. AETCOM – Attitude, Ethics and Communication. Available from: https://www.mciindia.org/CMS/wp-content/uploads/2020/01/AETCOM_book.pdf. [Last accessed on 2020 May 10].
6Office for undergraduate Research, Emerging Scholars' Program. University of Alabama, USA. Available from: https://undergraduateresearch.ua.edu/emerging-scholars-program. [Last accessed on 2019 Jan 28].
7Independent Scholarly Project, Georgetown University School of Medicine, USA. Available from: https://som.georgetown.edu/independentscholarly. [Last accessed on 2019 Jan 28].
8Graduate Program in Biochemical Sciences, Summer Undergraduate Research Program. Albert Einstein College of Medicine, NY, USA. Available from: https://www.einstein.yu.edu/education/phd/the-summer-undergraaduate-research-program.aspx. [Last accessed on 2019 Jan 28].