From Hurdles to Highlights: The Need for Research Integration in UG Medical Curriculum

Dear Editor,

Medical research is substantial in advancing healthcare and improving diagnostic outcomes. Early exposure to research fosters the development of systematic problem-solving techniques and the habit of critical thinking. It aids in expanding knowledge transcending the bounds of textbook teaching. Chatterjee et al ¹ in their recent study also found that 80.3% of undergraduate (UG) medical students acknowledged the importance of research in enhancing their clinical skills. Despite the vitality, UG medical students often encounter formidable obstacles to engage in research activities. The UG medical training (MBBS) in India spans for a period of 5.5 years, with 4.5 years of academic and clinical training followed by 1 year of compulsory rotatory internship in various clinical specialties. ² Demanding medical curriculum seldom leaves students with limited time for extracurricular activities, including research. A study by Sharma et al ³ found that 76% of medical students cited lack of time as a primary barrier to participating in research activities. As per the revised UG MBBS curriculum, inclusion of foundation course is necessary for developing a strong base. Implementation of early clinical exposure, Attitude, Ethics and Communication module (AETCOM) and elective postings have had a positive impact on the development of problem-solving skills among medical students resulting in better patient interactions. ⁴ But according to a study conducted by Patil et al, ⁵ 65% of students stated that the current curriculum is stressful and time consuming. Similar study was conducted among UG medical students in Rajasthan, in which, 81.8% of the participants have admitted that scarcity of time due to educational activities formed a major barrier to involve in research. ⁶

The Indian undergraduate curriculum mandates research within the Community medicine framework but lacks provisions for independent research activities and comprehensive research training opportunities. Torre et al ⁷ found that 62.6% of students felt that professors do not encourage them enough to participate in research activities. A considerable number of 4th and 6th year medical students (74.6%) felt unmotivated to engage in research compared to 2nd-year students (40.7%). ⁷

Mentorship forms a cornerstone in fostering research skills among students. Narayan et al ⁸ in their recent survey found that 50.6% of medical students felt they lacked adequate access to research mentors. Low self-esteem and preconceived conceptions were the main reasons why preclinical and paraclinical students felt communication hurdles, especially “breaking the ice” with mentors. ⁸ In addition, factors like limited access to research facilities and funding further hampers student research activities. Overworked academicians often cannot manage time to guide UG students, leading enthusiastic students to abandon research pursuits.

The Indian Council of Medical Research (ICMR) introduced the “Short-term Studentship” (STS) program which is a funded research program in which a undergraduate student under the guidance of a senior faculty work on original research (including data collection and report submission), but the relatively lower approval rate of submissions discourages students due to lack of funding and recognition. Along with the ICMR-STS program, IAP-ICP (Indian Academy of Pediatrics and Indian College of Pediatrics) provide grants to encourage undergraduate medical students pursuing research on pediatric health issues. Premier institutions in India, such as the Indian Institute of Science (IISc), Bangalore, and the Centre for Cellular and Molecular Biology (CCMB), Hyderabad, etc, offer exclusive research internships for medical students. These programs comprise laboratory training, training in research methods, scientific writing, and orientation to research ethics specifically for undergraduates. These internships provide hands-on experience, mentorship, and exposure to state-of-the-art facilities that would significantly enhance their research skills and ignite a passion for scientific inquiry. The MedSRT program conducted by CCMB is a great opportunity for young learners to strengthen their research capabilities and expand their academic and professional networking opportunities.

Some students view research as irrelevant to their future clinical careers. Research motivation was shown to be lower by Harsha Kumar et al ⁹ when they discovered that 37.8% of participants wanted to be “clinician only” and 32.4% were unwilling to pursue research as a future career option. The widespread belief that research is mostly lab-focused and has little relevance to patients is a major barrier. This belief is frequently solidified during medical school. ⁸ It is indispensable that this misperception be refuted to motivate and promote future physician-scientists. ⁸

A recent study done in Karnataka, India among UG medical students concluded that several factors such as lack of awareness (53%), scarcity of funds (62%), inadequate time (59%), and difficulty in patient follow up (67%). ¹⁰ Chellaiyan et al ¹¹ identified difficulty in topic selection (41.6%), data collection (40.7%), and time allocation (45.9%) as barriers, with 38.7% found it difficult to get permission from the review board.

Research not only helps in identifying the risk factors, prevalence of a particular disease but also assists to design effective treatment and prevention strategies to tackle emerging public health challenges, particularly relevant in global health crises such as the COVID-19 pandemic, where research has played a pivotal role in developing interventions, policies and life-saving vaccines. To effectively integrate research into the UG medical curriculum, several key recommendations should be implemented. Students should also be made aware of the importance of research and actively encouraged to engage in it, as understanding its value and receiving support can significantly enhance their research involvement and skills. Arrangements of hands-on workshops under the proper guidance of mentors will serve as a catalyst to help in developing a strong and affirmative interest toward medical research. Workshops are essential for understanding critical concepts, improving practical skills like data analysis, software use, and shaping the ability of students to overcome research-oriented problems. Strengthening of communication skills and early mentor-student contact is essential in engaging medical students in research activities. Along with mandatory research projects in Preventive and Social Medicine, optional research electives for other subjects, and tasking specific mentors who can be reallocated to assist the student may help balance the time constraints between research activities and the medical curriculum. Melaka Manipal Medical College in Karnataka, India initiated a Mentored Student Project to instill research among UG medical students; 80% of the respondents reported valuable mentorship and 61% were in favor of its implementation in the MBBS curriculum. ¹² Developing comprehensive modules for research training in study design, data analysis, and scientific writing boosts the self-confidence and competence of the students in conducting research.

Establishing structured mentorship programs linking students with experienced researchers provides essential guidance, support, and inspiration. A student-led research council named “ASPIRE” (Association for Support and Propagation of Innovation, Research and Education), formed by UG medical students and faculties of Seth Gordhandas Sundardas Medical College and King Edward Memorial Hospital of Mumbai, India had a crucial role in evolving a culture of research among young learners via peer-based teaching sessions, module-wise learning and mentoring and discussion sessions, etc. ¹³ Apart from this, oral and poster presentation competitions will create a highly motivating environment by providing platforms to students to showcase their research activities as well as help to improve their communication skills. Organizing intracollege and intercollege competitions by medical institutions will stimulate research interest among students. Several health universities and private organizations have also taken initiatives to foster research activities among medical students, but the number of approvals varies according to their own norms. Proper efforts should be taken by the institution to make the students aware of all the available research grants and clarify all doubts relating to the application process to bridge the communication gap. In addition to this, provision for financial aid and access to research facilities by creating specific institutional funds for the research projects of the students and getting the required materials has to be done to support a vibrant research culture.

Changing the curriculum in medical schools strategically would support the culture of research and innovation; eventually, it would benefit the students, the medical profession, and society itself.