Abstract
Objectives
This study aimed to assess the potential benefits, barriers and mentorship process of undergraduate research experience at the Faculty of Medicine, University of Khartoum.
Methods
This study used a mixed quantitative–qualitative approach. The quantitative part was observational, descriptive cross-sectional study design with 900 participants from three classes. The qualitative part used focus group discussions with thematic analysis.
Results
From 950 students total of the three classes, 900 filled the questionnaire with a 94.7% response rate. The mean age of the participants was 24.7, with 69% females. The most important benefits were understanding the research process in the medical field (mean = 3.42), learning to work independently (mean = 3.35), and ability to read and understand primary literature (mean = 3.31). Accomplishing these benefits is wedged with many challenges which include lack of research knowledge and skills (44%), then mentorship (24%), followed by time management obstacles (21%), and lastly unavailability of funds (5%). Most of our participant's mentors were college or university professors. When evaluated by students; 35% were rated as above average or outstanding, 28.9% were rated about average, and 25% below average or not good mentors.
Conclusions
Undergraduate research experiences had many well-established benefits. However, many challenges were encountered by students when conducting medical research. These challenges need to be addressed properly in order to maximize the outcomes. Nevertheless, mentorship is a defining feature and can determine the outcome of the whole research experience among undergraduates, which necessitates paying further attention to this factor.
Introduction
Research is a systematic investigation designed to make a contribution for filling a gap in knowledge, undergraduate research – as defined by the Council on Undergraduate Research – is an “inquiry or investigation conducted by an undergraduate student that makes an original intellectual or creative contribution to the discipline.” 1 Studies stated that undergraduate research could be regarded as the purest way of learning, and a cornerstone in the integration of research and education.2,3 Undergraduate research has many well-demonstrated benefits,4,5 research projects initiated by undergraduates are motivational active-learning processes, providing students with skills of searching and reading literature, formulating research questions and testing their hypothesis. It is being more about doing rather than studying science that makes undergraduate research more valued by students.6,7
With all the demonstrated benefits, yet it is not without costs. Undergraduate students face many challenges during their research work. The faced obstacles could include time constraints, finding available mentors who are willing to supervise, and funding issues. Of all the mentioned obstacles, time unavailability was the most cited barrier. 8 Students in developing countries face more obstacles than their peers in developed countries. 9 Africa as a developing continent with many continent-level problems like economical and financial obstacles as well as conflicts and political instability, which puts an extra-load on medical research institutes. A review article that included 27 countries in Africa concluded that internet access and mentorship are among the most important barriers. 10 The well-demonstrated benefits of undergraduate research are heavily dependent on good mentorship. In fact, mentorship could be regarded as a rate-limiting step in the research experience.7,11 A study pointed out that students’ evaluation of their mentors is the strongest predictor of their evaluation of the overall research experience. 12
We observed many challenges facing undergraduates during their research experience and up to our knowledge combined with extensive literature search, there is no study investigating the benefits, barriers, and mentorship process of the mandatory graduation research program (every student should submit an independent study project) at the faculty of medicine, University of Khartoum. There is an evident gap considering the uniqueness of this program being a mandatory graduation requirement, and the individualized project conducted by every single student rather than group projects. Therefore, we planned this research project to fill this knowledge gap by providing local data through an in depth look at this experience both quantitatively and qualitatively in order to assess this program, thus enhancing medical education in our faculty and our country.
This study aimed to assess the undergraduate research experience in terms of benefits, barriers, and mentorship from medical student's perspectives at the University of Khartoum, Sudan.
Material and Methods
The details of the study methodology were provided in this section, following Strengthening the Reporting of Observational Studies in Epidemiology Statements (STROBE) guidelines. 13
Study Design and Participants
This study was designed following a mixed quantitative–qualitative approach. The quantitative part was an observational descriptive cross-sectional study, while the qualitative part was a deductive study that included focus group discussions with thematic analysis.
The study was conducted at the Faculty of Medicine, University of Khartoum, and included the finalists of the fifth- and the sixth-year students who already submitted their graduation thesis as an obligatory requirement of the Bachelor degree. The curriculum at the faculty of medicine-university of Khartoum includes an extensive research methodology course at the beginning of the fourth year of medical school, after which students are supposed to submit a proposal of their research projects by the end of the year. During fifth year students start collecting data, writing their thesis and submit it for evaluation and discussion by the mentors. This graduation thesis is mandatory to sit for exams and pass to the final sixth year thus every student is obligated to successfully submit his/her own independent thesis.
The data collection was done throughout two consecutive years (July 2020 to July 2022) including three classes. Participants were recruited via an online form that was sent to all students (census approach/total coverage), and participation was totally voluntary in nature with no consequences from refusal to participate. The inclusion criteria were being a medical student in the fifth or sixth year of college, who successfully submitted his/her graduation thesis. The only exclusion criteria were refusal to participate received from students.
Sample Size and Sampling
For the quantitative part, the sample size was calculated as the total number of students from the three classes under the study which was 950 students, from which 900 filled the questionnaire, with 94.7% response rate. A total coverage/census approach was followed to cover the pooled number of the three classes over 2 years. This approach was followed to ensure adequate representation of all students.
For the qualitative part, a total of six focus group discussions were conducted (two groups from each class) with 4–6 participants within each group (purposive sampling). Diversity was guaranteed among the six focus groups with equal representation from the three included classes until saturation point was reached.
Data Collection and Analysis
For the quantitative part, a structured, pre-validated questionnaire which is named Survey of Undergraduate Research Experience (SURE) was used. 11 The SURE questionnaire consists of demographic data questions, 21 questions to assess the benefits of undergraduate research experience on five Likert scales, one question intended to investigate the most important barrier that students faced, and a couple of other questions to evaluate their mentors and to assess their overall satisfaction with this research experience. Data were collected using an electronic Google form then extracted as an excel spreadsheet and transformed to Statistical Package for Social Science (SPSS)® version No. 26 software for statistical analysis. Data was kept confidential through the whole process in accordance with the Helsinki Declaration. Nevertheless, upon conducting analysis of the quantitative data, numerical data were reported as means and standard deviation, while categorical data were reported as percentages and proportions, and statistical significance level was set as p-value less than .05. The analysis of data was conducted using mainly descriptive methods, analytic methods were used less frequently. Correlation and cross-tabulation (chi-square) were also conducted to assess the association between different numerical and categorical variables under study. Data visualization was shown using different graphical representations including – but not limited to – Pie charts, Bar charts and histograms.
For the qualitative part, structured questions were used for more in depth assessment of benefits, barriers and mentorship of the research process. After taking informed consent from all participants, an audio record was conveyed for every focus group then transcripts were made to convert the audio into text. Data was then checked for accuracy and clarity by revising the text with the audio records. The analysis was done using ATLAS.ti 9 software, data were analyzed for generating themes that represent and sum up the collected qualitative data from the six focus groups that were conducted.
Results
Respondent's Characteristics
From the 950 total population of the three classes, 900 students filled the questionnaire (n = 900/950), with a 94.7% response rate. The mean age of our participants was 24.7, with 69% females. Respondents were almost having equal distribution among classes under the study. A summary of the important participant's characteristics was provided in Table 1.
Important Participant's Characteristics, Publication Status and Research Funding.
The majority of students (77.2%) conducted their research as facility-based studies, mostly at hospitals and universities. Among the three studied classes only 7.7% of the participants published their work.
Prior Research Experience
Upon questioning about students’ prior research experience, 75.1% of our participants declared that the mandatory graduation thesis was their first exposure to the research field and that they don’t have any prior research experience, while less than 20% were previously exposed to research areas as illustrated in Figure 1.
Participant's prior research experience before the graduation thesis.
Research and Post-Graduation Education
We investigated the effect of research experience on participant's plans for academic careers; most undergraduate students (69.1%) reported plans for further post-graduates science education. Participants were asked how the research experience influenced their plans for post-graduate education, almost 98.1% sustained their plans for post-graduates education with only 1.9% changed their plans away from scientific post-graduate education.
Benefits of Undergraduate Research Experience
From a list of twenty-one potential benefits of undergraduate research programs we asked our participants to rate them on a scale from 1 (no gain) to 5 (very large gain). The most cited items were: understanding the research process in the medical field (mean = 3.42), learning to work independently (mean = 3.35), and ability to read and understand primary literature (mean=3.31). On the other hand, the least ranked items were: learning laboratory techniques (mean =1.87), clarification of career path (mean =2.22), and confidence in their potential to be science teachers (mean =2.70). The details of the rating of the whole items – expressed in means and standard deviations – were illustrated in Table 2.
The Mean of Rating for Twenty-One Potential Gains of Undergraduate Research Experience.
Upon conducting thematic analysis of the qualitative data generated from the focus groups regarding undergraduate research benefits, three holistic themes emerged with subsequent sub-themes:
Research knowledge and skills: A. Research methodology, B. Scientific presentation and results dissemination, C. Research ethics, D. Statistical analysis and SPSS software techniques, E. Scientific writing skills. Soft skills: A. Time management, B. Stress and emergency management, C. Commitment and patience, D. Communication skills, E. Confidence. Scientific / Academic paradigm: A. Scientific thinking, B. Academic careers interest, C. Appreciating the importance of science and research.
For example, a student said “I understand the importance of the researches … Maybe when we are students we are not evaluating its importance very well … I also learned that your undergraduate research is better to be in your future career if you have already determined it.. And I learned more about how to conduct scientific researches…” another student mentioned “for me, I learned how scientific research is done, appreciating the importance of research itself and I became so much interested, it was like a hidden world that I didn't discover and also I started realizing its importance to my CV and the clinical career, I enjoyed it indeed, it was a nice experience overall, I get out from it with a passion of doing another researches.” A student stated “apart from knowledge, for me personally my research was in hospitals, and I get benefited from contact with doctors and patients.”
Barriers Toward Conducting Undergraduate Research
We asked our participants to indicate the most important barrier or challenge they faced during the whole research experience, nearly half of the students (n = 400) which represents 44% of the study participants pointed out “lack of research knowledge and skills” as the most important obstacle they faced, 222 students (24.7%) selected mentorship as the top challenge they faced, and the remaining students choose time management (21.8%) and research funding (5%) as the most important barrier they faced during their research experience.
When assessed qualitatively during focus group discussions almost the same pattern of barriers were obtained as will be illustrated by a word cloud in Figure 2. The word “supervisor” was mentioned 19 times/out of 6 focus groups as different problems related to supervision were raised by participants including – but not limited to – unavailability, late response, and not providing support. A student mentioned “the major obstacle we faced was regarding supervision, they don't give enough knowledge and there was very poor monitoring and follow up….” Another student stated: “I remember once I send to my mentor the questionnaire to comment on it before I start the data collection, she replied after 15 days while the whole data collection period was assumed to be one month. At the end I have to deal with it by myself.” Moreover, knowledge was a major obstacle coded12 times/out of 6 focus groups by our participants. A student said when asked about the challenge they faced “to some extend the finance. And the skills of how to use the analysis software like the SPSS we didn’t be in through this before and no one teach us how to use it, so we have to try alone or with help of colleagues; peers and seniors.”
A word cloud of the major undergraduate research barriers as raised by participants during focus groups.
Mentorship Process During Undergraduate Research Experience
The mentors description by students revealed that 52% of our participants had a mentor who is a college or university professor, 24.8% had a mentor who is a professional researcher or practitioner, 5.9% worked with a graduate student as their primary mentor, while only 5.5% had a postdoctoral mentor. We asked our participants to evaluate their primary mentor, the responses were variable yet a considerable percentage (28.9%) indicated that their mentors were about average, 19.2% rated their mentor as above average, and about 10.8% indicated that their mentors were below average, the detailed responses of participant's evaluation of their mentors are summarized in Table 3.
Participant's Evaluation of Their Primary Mentor.
We investigated the association between student's evaluations of their mentors and their evaluation of the overall research experience, these two variables were moderately correlated (r = .3; P = .000). Moreover, there is a significant positive correlation between mentor's evaluation and students’ tendency to choose another research experience as undergraduates (r = .2; P = .000). Nevertheless, mentor evaluation also correlates with the overall benefits from the research experience (r = .2; P = .000).
Thematic analysis of the qualitative data from the conducted focus groups regarding mentor's reflective evaluation by students generated four themes:
Available and Helpful (coded 10 times/6 focus groups) Available but Not helpful (coded 2 times/6 focus groups) Not available but Helpful when available (coded 7 times/6 focus groups) Not available, not helpful (coded 3 times/6 focus groups).
From the positive evaluation, a student said: “if I get out with only one good thing from this experience it will be that I was so lucky with my direct supervisor… Even when I lost your interest in the middle of the way she was supporting and guiding me… She was even more caring about the research than me… I may be in my home and she calls me asking about the progression in the research… She would correct every mistake, even the spelling mistakes and ordering of sentences… she was so supportive (supportive as a supervisor; teacher and even as a mom) and she was trying to get out the best from us.” Another student said “My co-supervisor was really good, she provided me with everything, she was available, and even provided us social and emotional support, I didn't had that much contact with the main supervisor himself.”
Evaluation of the Overall Research Experience
We asked our participants to evaluate their current feelings regarding the expectations they had about the experience before conducting their research. 15.2% said the experience met their expectations, 37.9% indicated that the experience was better than their expectations, while 41.3% admitted that the experience was actually worse than the expectations they had before starting their research work. The details of this assessment were further elaborated in Figure 3. There was a significant association between student's evaluation of the overall research experience and their tendency to choose another research as undergraduates (r = .3; P = .000). However, student's evaluation of their satisfaction from research experience and the overall benefits were found to be significantly correlated (r = .4; P = .000).
Participant's assessment of the research experience compared to the expectations they had before conducting their research.
Upon asking participants to evaluate their overall sense of satisfaction from their research experience and whether they will choose to have another research experience as undergraduates, 68.5% of them were satisfied with this experience or at least neutral about it. Nevertheless, over 69.2% were likely to go for another research experience.
Discussion
This study aimed to assess the benefits, barriers and mentorship of undergraduate research experience from medical student's perspectives. With an overall response rate of 94.7% (n = 900), participants mean age was 24 and majority were females (69%). Most of the study participants conducted their research as facility-based (which include hospitals, universities and health centers) (77.2%), while only (22.8%) pursued community-based studies.
Undergraduate Research and Post-Graduate Study
The effect of undergraduate research experience on students’ decisions to pursue academic careers is interesting. Most of our participants (69.1%) reported having plans for postgraduate education. The influence of the research experience on their plans was evident as 98.1% sustained or increased their plans for post-graduate education, and only 1.9% changed their plans away from post-graduate education. These results are consistent with another study, which pointed out that 91% of undergraduates sustained or increased their plans and 4.7% changed their plans away from post-graduate education after their research experience. 11 These comparable results indicate an overall positive effect of undergraduate research experiences in encouraging students for post-graduate education and academic careers, which is a good indicator, making the undergraduate research programs worthy of investment to retain students in the academic fields, thus creating more scientists and physicians who practice based on evidence.
Benefits of the Undergraduate Research at National and International Level
From a list of 21 potential benefits of undergraduate research programs, the most cited among our participants were: understanding the research process in the medical field (mean = 3.42), learning to work independently (mean = 3.35), and ability to read and understand primary literature (mean = 3.31), on the other hand the least cited were: learning laboratory techniques (mean =1.87), clarification of career path (mean =2.22), and confidence of students in their potential to be science teacher (mean = 2.70). Comparing these results with the first findings of SURE by Dr. Lopatto, some disparities emerged. His study found that: Understanding of the research process in your field (mean = 4.13), Readiness for more demanding research (mean = 4.03), Understanding how scientists work on real problems (mean = 4.0), and Learning laboratory techniques (mean = 4.0) were the highest rated items, while Learning ethical conduct in your field (mean = 3.15), Skill in science writing (mean = 3.32), Skill in how to give an effective oral presentation (mean = 3.42) and Clarification of a career path (mean = 3.42) were the least rated among all possible benefits. 11 As both studies used the same data collection tool (SURE questionnaire), when compared, we can observe that the general overall rating among participants in Dr Lopatto's study is higher than the rating of benefits by our participants. The dispersion is clearer with the rating of the item “learning laboratory techniques”; our participants’ mean rating for this item is (mean =1.87), clearly less than the mean rating in Dr Lopatto's study (mean = 4.0). This could be attributed to fewer lab-based studies conducted by undergraduates in low-income countries like Sudan; due to the limited availability of research laboratories and difficult accessibility by students who can’t afford the payment, coupled with no funds granted toward undergraduate research, which leads students to choose topics away from lab-based studies and thus results in less knowledge in this area. This is also evident in a multi-national study conducted at the level of many Arabic countries, where “Lack of access to lab equipment for lab-based studies” was indicated as a major obstacle by 68.1% of the study participants; Sudan was part of this large study together with many similar low-income Arabic countries. 4
Challenges Facing Undergraduate Research in Sudan, Africa, and the Middle East
The most important undergraduate research barriers as cited by our participants were: lack of research knowledge and skills (44%), then mentorship (24%), followed by time management obstacles (21%), and lastly unavailability of funds (5%). The challenge spectrum is almost the same in most African and Arabic countries. In Africa, these challenges range from poor infrastructures of research, scarcity of local African journals, to lack of proper supervision and research funding. 14 A study conducted in Arabic countries also demonstrated a similar picture, where the reported obstacles included: difficulty in access to research laboratories (68.1%), medical curricula that give education the priority over research with pressure-provoking academic activities (66.8%), and time unavailability attributed to academic tasks (66.1%). 4 In a review article, Ella Bah et al. proposed some solutions to these barriers, especially in the context of developing African countries. Their recommendations included: organizing research courses at the undergraduate level, increasing the networking opportunities by holding high-quality national and international medical conferences, in addition to establishing accessible scientific journals. 10 These solutions align with the finding of this study, organizing courses for research would solve the lack of knowledge and skills, and establishing open access free journals might decrease the need for funds.
Assessing the Mentorship Process
Most of our participants’ mentors (52%) were college or university professors, while 24.8% were professional researchers or practitioners, 5.9% were graduate students, and only 5.5% were postdoctoral mentors. When evaluated by students, 35% were rated as above average or outstanding, 28.9% were rated about average, and 25% below average or not good mentors. Comparing these results to the SURE survey findings, where students were also asked to evaluate their mentors and their responses came as follows: 78% rated their mentors as above average or outstanding, 13.7% about average, and 6.7% rated them as below average or not good mentors. Therefore, the mentorship process is a very critical factor in the success of undergraduate research experience; it could determine the outcomes of the whole experience. We found that students’ evaluation of the overall research experience is correlated with their evaluation of their mentors (r = .31) in our study and (r = .39) in Dr Lopatto's study. 11
Limitations and Recommendations for Further Studies
This study, despite applying quantitative and qualitative methods to assess undergraduate research experience, is limited by the inability to widely generalize its implications to other medical institutes that have different undergraduate research programs. Nevertheless, the study provides a first investigation of this vital part of medical education, and can be used for further expanding studies about undergraduate research and medical education issues in Sudan. Thus, the authors recommend further studies that look into undergraduate research programs from faculty perspectives, planning national surveys including different medical schools, and launching medical education curriculum studies; for a better understanding and enhancing undergraduate research programs all over the country.
Conclusion
Undergraduate research experiences have many well-established benefits, including understanding the research process in the medical field, learning to work independently, and the ability to read and understand primary literature. These appreciated benefits of undergraduate research are not without cost, as many challenges were encountered by students when conducting medical research. These barriers range from lack of research knowledge and skills, to mentorship, followed by time management obstacles, and lastly unavailability of research funds. Mentorship is a defining feature and can determine the outcome of the whole research experience among undergraduates. Most of our participants’ mentors were college or university professors. When evaluated by students; 35% were rated as above average or outstanding, 28.9% were rated about average, and 25% below average or not good mentors.
Footnotes
Abbreviations
Acknowledgements
I would like to express my sincere gratitude to my supervisor, Dr Haiedr Abu Ahmed for his guidance and support. My deepest appreciation to the data collection team: Rayyan Esmail, Alaa Hussien, Reem Abdelazzem, Manal Ahmed, Elaf Mohamed, Afrah Humidan, Asrar Omer, Shaza Eltaib, Aisha Mohammed. I am thankful to Dr Arwa Babiker for her guidance through qualitative data collection and analysis. Special appreciation for Dr Lopatto for designing and disseminating Survey of Undergraduate Research Experience (SURE). My great thanks go to all participants who provided their time and valuable inputs both during focus groups and by filling the questionnaire.
Ethical Approval
This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (IRB) at the Department of community medicine, University of Khartoum. Since this research is done as a complementary requirement and under the supervision of the community medicine department, studies that don't involve patients or interventions were waived from acquiring an IRB number. Participation was voluntary, and participants were all above 18 years old medical students who gave informed consent for participation before starting the questionnaire and the focus groups. Since the study involved humans but no intervention, written consent is not required by the research unit-community department. Reporting of the study was conducted using the required guidelines.
Authors’ Contributions
Conception or design, acquisition, analysis, or interpretation of data, drafting the work, or revising: HAA.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Availability of Data and Materials
All datasets used and/or analyzed in this study are available upon request from the corresponding author. The data can’t be made available publically due to concerns about confidentiality of the qualitative data used in this study.