Keywords Developing country - medical education - medical students - publications - research
- Syria
Introduction
Research is the only known tool for the advancement of our knowledge of biology and
medical sciences. It is the only method, with proven record, which allows us to elevate
the human condition, both in sickness and health. Biomedical research activity and
production are directly associated with countries' and societies' prosperity in medical
practice and health-care delivery.[1 ] Earlier exposure to the basics of research can result in more research-intensive
careers by medical doctors.[2 ] Various studies have reported that medical students who are exposed to research
during their college years show higher research productivity during their future careers.[3 ] Unfortunately, medical students do not always have the opportunity to participate
in a research project during medical school. This missed opportunity might affect
their understanding of the importance of research and future ability to conduct research
projects on their own.
Many obstacles have been reported to hinder a student's ability to conduct research.
Some of these obstacles include lack of mentorship,[4 ] lack of time to devote to extracurricular activities, and lack of adequate research
training.[5 ],[6 ] These obstacles seem to be more prominent in developing countries.[5 ] This might be attributed to the fact that countries with limited resources remain
consumers of knowledge instead of taking a lead in producing it.[7 ],[8 ] As a result, important health care-related data are not properly investigated in
these low-resource countries, and therefore, medical clinics and hospital suffer from
a lack of evidence-based care that can improve the lives of patients.
Similar to other developing countries, Syria contributes minimally to the global wealth
of biomedical research production and knowledge. In 2011, a report indicated that
between 1980 and 2011, only 593 papers in the medical literature were published from
Syrian medical institutions.[9 ] Another report stated that since 1980, only 61 medical case reports were published
from Syria, which is considered low compared to other countries.[10 ],[11 ] Given the crisis in Syria, there is a critical need for the application of evidence-based
medical practices in emergency clinics throughout the affected area.
We believe that medical students are a vital force that can effectively participate
in establishing an extended increase in research production and activity in Syria.
We also believe that building a generation of well-educated and scientifically-oriented
physicians will help tackle the long-term health consequences of the current war.
However, boosting students' participation in research requires a further investigation
of their perspectives on the importance of research and the barriers that are inhibiting
their participation. In this study, we aim to assess the attitudes of medical students
at the University of Damascus, Faculty of Medicine, toward research. We also suggest
solutions to reduce these barriers. The findings from this study can potentially be
used to create an evidence-based approach to promote research among medical students
in Syria.
Methods
Study design and participants
A cross-sectional study was conducted at the Faculty of Medicine, Damascus University,
to investigate medical students' experiences, attitudes, and opinions about biomedical
research and scientific papers. All participants were active medical students at the
University of Damascus, Faculty of Medicine. Participants were recruited from 2nd
to 6th year of medical school using convenience sampling method. First-year students
were excluded from the study because this year is considered to be a premedical preparatory
year.
Data collection
Data collectors approached medical students during their practical learning sessions
on campus. The collection process took place over a single week period, which precludes
the chance of filling the form twice by the same person. Participants were informed
about the objectives of the study, and that participation was voluntary and anonymous.
They were asked to provide written consent to participate in the study before completing
the questionnaire.
The questionnaire
We constructed a questionnaire that addresses all areas that we aim to investigate
after reviewing a handful similar studies and consulting several experts in the field.[6 ],[12 ],[13 ],[14 ] All questions were administered to students in the Arabic language. The first part
of the questionnaire contained questions about the demographic characteristics of
the participants (gender and year of study). Other factors that were assessed included
English fluency and the availability of a reliable internet connection since these
variables may have an influence on attitudes toward research. To determine the English
fluency, participants were asked to fill out a 5-point Likert scale, ranging from
“very poor” to “very good.”
Participants were also asked about the reasons why they think research is important,
their willingness to participate in research, and whether they are encouraged by their
professors to do so. Their personal beliefs about the importance of and barriers to
research were investigated using a 5-point Likert scale (ranging from “strongly disagree”
to “strongly agree”).
In addition, we were keen to investigate two distinct research activities: participating
in research and writing scientific papers for publication. For each topic, participants
were asked about the sources of their knowledge (if any), number and types of projects
they participated in, and reasons for their participation or nonparticipation. On
the topic of scientific papers, participants were also asked about the reasons for
submitting or not submitting their work for publication, types of submitted publications,
and results of those submissions.
Overall, the questionnaire contained 37 multiple-choice questions. Eight questions
were not required since they were not applicable to all participants. Responses were
considered invalid if they were not legible, or if they contained false or contradictory
information, such as stating to have published a systematic review while choosing
zero as their number of publications. All questionnaires with invalid responses were
discarded. In the case of missing variables, participants had to complete at least
75% of the questionnaire to be included in the analysis. Because some of the variables
were missing, we added the total number of participants who completed each question
(total n) to the tables.
The questionnaire was piloted on a sample of 26 participants to test the comprehension
and relevance of the questions. The participants in the pilot study were not included
in the analysis.
Ethical issues
All procedures contributing to this work comply with the ethical standards of the
relevant national and institutional committees on human experimentation and with the
Declaration of Helsinki 1975, as revised in 2008.
Statistical analysis
Data were entered into Microsoft Excel Ver. 3. 2013. Jones, Chicago. using a Google
online survey form created by two authors, with a verification of data integrity by
a third author. Data were then imported into the Statistical Package for the Social
Sciences version 22.0 (SPSS Inc., Chicago, IL, United States) for further analysis.
Participants' characteristics were reported as frequencies and percentages. The percentages
reported were out of the total number of participants who answered each corresponding
question. For questions with the option of choosing multiple responses, we reported
the percentages of cases (participants who answered each corresponding question).
For ease of reporting in [Table 3 ], responses of “agree” and “strongly agree” in the 5-point Likert scale were grouped
together into one “agreement” group.
Mann–Whitney test was used to compare the responses of the 5-point Likert scale between
participants in their 2nd year of study and participants in their 4th–6th year of
study. A P < 0.05 was used to determine the level of statistical significance. Chi-square
and Fisher's exact tests were used to determine the associations between participation
in research projects/writing scientific papers and each of the participants' characteristics
(gender, year of study, internet connection status, English fluency, professors' level
of encouragement, and previous education/training). The level of statistical significance
was calculated using the Bonferroni correction (dividing 0.05 by the number of statistical
tests performed for each endpoint variable; which in our study was 13; yielding a
P < 0.004 to be the level of statistical significance). The measure of association
was reported as odds ratios (ORs) with 95% confidence intervals (CIs).
Results
A total of 376 participants agreed to participate in the study and completed the questionnaire.
Fifty participants provided unclear or contradictory information, and their questionnaires
were considered invalid. Three participants completed less than the 20 required questions.
Those invalid and incomplete questionnaires were excluded from the study, and the
analysis was carried out on the remaining 323 participants.
General characteristics
The sample contained a similar percentage of males and females (46.1% and 53.9%, respectively)
and a similar percentage of participants from each year of study [Table 1 ]. Only 2.2% of the participants stated that they do not have an internet connection.
The remaining participants reported either having a low-quality (50%) or a high-quality
(47.8%) internet connection. The participants' assessments of their English fluency
are summarized in [Table 1 ].
Table 1
General characteristics
Characteristics
n (%)
Total n: Total number of participants who answered the corresponding question, n:
Number of participants who chose the corresponding answer, %: Percentage of participants
who chose the corresponding answer
Gender (total n=323)
Male
149 (46.1)
Female
174 (53.9)
Year of study (total n=322)
2nd
72 (22.4)
3rd
68 (2l.l)
4th
48 (l4.9)
5th
68 (2l.l)
6th
66 (20.5)
Internet connection status (total n=322)
Do not have an internet connection
7 (2.2)
Have a low-quality internet connection
l6l (50.0)
Have a high-quality internet connection
l54 (47.8)
English language skills - writing (total n=323)
Very poor
2 (0.6)
Poor
ll (3.4)
Intermediate
9l (28.2)
Good
l49 (46.l)
Very good
70 (2l.7)
English language skills - speaking (total n=322)
Very poor
5 (l.6)
Poor
3l (9.6)
Intermediate
ll8 (36.6)
Good
ll4 (35.4)
Very good
54 (l6.8)
English language skills - reading and comprehension (total
n=323)
Very poor
4 (l.2)
Poor
6 (l.9)
Intermediate
62 (l9.2)
Good
l25 (38.7)
Very good
l26 (39.0)
Participation in clinical research (total n=323)
Not looking for opportunity to participate
35 (l0.8)
Do not know how to get an opportunity
l87 (57.9)
Actively looking for an opportunity
l0l (3l.3)
Participation in laboratory research (total n=323)
Not looking for opportunity to participate
l0l (3l.3)
Do not know how to get an opportunity
l4l (43.7)
Actively looking for an opportunity
8l (25.l)
Encouraged by professors to participate in
research? (total n=323)
No
264 (8l.7)
Yes
59 (l8.3)
Encouraged by professors to write and publish scientific
papers? (total n=3l6)
No
27l (85.8)
Yes
45 (l4.2)
Included students varied significantly in their willingness to participate in research
[Table 1 ]. The majority of respondents favored participating in clinical research over laboratory-based
research; while 31.3% of respondents stated that they are not looking for an opportunity
to participate in laboratory-based research, only 10.8% of them stated that they are
not looking for a clinical research opportunity. Over 80% of participants indicated
that they are not encouraged by their professors to participate in research or write
and publish scientific papers [Table 1 ].
Importance and barriers of research
Results of the 5-point Likert scale questions regarding the importance of research
are shown in [Table 2 ]. The majority of participants agreed or strongly agreed that the role of research
is important (96.3%). Most of them thought that it was important to participate in
research during medical school (71.2%) and that teaching research methodology should
be part of the curriculum (79.8%).
Table 2
Participant’s personal beliefs about importance and barriers of research
Total n
Strongly disagree, n (%)
Disagree, n (%)
Neutral, n (%)
Agree, n (%)
Strongly agree, n (%)
Total n : Total number of participants who answered the corresponding question, n : Number of participants who chose the corresponding answer, %: Percentage of participants
who chose the corresponding answer
Importance of research
The role of research in the medical field is important
323
1 (0.3)
l (0.3)
10 (3.1)
ll6 (35.9)
l95 (60.4)
Participating in research or publishing scientific papers during medical school is
important
323
1 (0.3)
l3 (4.0)
79 (24.5)
l47 (45.5)
83 (25.7)
Teaching research methodology should be part of the curriculum
322
2 (0.6)
l0 (3.l)
53 (16.5)
l27 (39.4)
l30 (40.4)
Research will be a part of my long-term career goals
323
6 (1.9)
45 (13.9)
109 (33.7)
94 (29.l)
69 (2l.4)
Conducting research always needs a lot of money Barriers of research
323
4 (1.2)
48 (l4.9)
85 (26.3)
l08 (33.4)
78 (24.l)
There is adequate time in medical school to pursue research
323
45 (13.9)
l22 (37.8)
110 (34.1)
33 (l0.2)
l3 (4.0)
There is adequate training in research methodology in medical school
323
83 (25.7)
l75 (54.2)
48 (14.9)
l3 (4.0)
4 (l.2)
There is adequate training in reading and evaluating scientific literature in medical
school
323
56 (17.3)
l93 (59.8)
50 (15.5)
20 (6.2)
4 (l.2)
Research mentors are easily available
323
59 (18.3)
l6l (49.8)
82 (25.4)
l5 (4.6)
6 (l.9)
There are many opportunities to participate in research in medical school
320
46 (l4.4)
154 (48.l)
93 (29.l)
25 (7.8)
2 (0.6)
There is adequate facility for research
320
67 (20.9)
l69 (52.8)
67 (20.9)
l3 (4.l)
4 (l.3)
It is easy to access medical journals and get all wanted papers through the medical
school library
321
33 (l0.3)
95 (29.6)
l0l (3l.5)
69 (2l.5)
23 (7.2)
It is easy to obtain approval for conducting research
320
49 (15.3)
l05 (32.8)
l43 (44.7)
22 (6.9)
l (0.3)
There are enough rewards/motivations to participate in research
321
73 (22.7)
110 (34.3)
ll7 (36.4)
l7 (5.3)
4 (l.2)
Participants' responses regarding why they think research is important are shown in
[Figure 1 ]. Improving the state of research in the country and relaying information were the
most frequently reported reasons (reported by 35.8% and 32.1%, respectively), while
keeping up with peers was the least frequently reported reason (reported by 3.7% of
participants).
Figure 1: Reasons why it is important to participate in research and publish scientific
papers (Total n = 321)*. Total n: total number of participants who answered the corresponding
question. *: choosing >1 option was allowed
The participants' beliefs about the barriers of research are also shown in [Table 2 ]. With over 75% of participants disagreeing or strongly disagreeing with the statement
about the presence of adequate training for research and evaluating scientific literature,
lack of such training was the most commonly reported barrier of research.
Attitudes toward the importance and barriers of research are compared between students
of basic sciences (second and third) years of study and students of clinical (fourth
through sixth) years of study [Table 3 ]. The importance of participating in research during medical school was more appreciated
among students of clinical years of study than among students of basic sciences. For
those in their clinical years of study, the availability of adequate time in medical
school to pursue research was not considered to be as significant a barrier compared
to students in their basic sciences years of study. However, a lack of adequate training,
shortage of research facilities, and unavailability of research mentors were perceived
more as barriers.
Table 3
Comparison of attitudes regarding research importance, interest, and barriers for
participants in basic sciences (2nd and 3rd) years of study and clinical (4th to 6th)
years of study
Parameter
Agreement† from basic sciences (2nd and 3rd) years of study (n =140) (%)
Agreement† from clinical (4th through 6th) years of study (n =182) (%)
P ‡
†Responses “agree” and “strongly agree” in 5‑point Likert scale were grouped as “agreement”
for reporting purposes, ‡Mann–Whitney test between responses of 5-point Likert scale,
*Significant at the level of 0.05
Importance of research
The role of research in the medical field is important
95.7
96.7
0.369
Participating in research or publishing scientific papers during medical school is
important
67.9
74.2
0.038*
Teaching research methodology should be part of the curriculum
81.3
79.1
0.494
Research will be a part of my long-term career goals
44.3
55.5
0.057
Conducting research always needs a lot of money Barriers of research
56.4
58.8
0.462
There is adequate time in medical school to pursue research
7.1
19.8
<0.001*
There is adequate training in research methodology in medical school
7.1
3.8
0.005*
There is adequate training in reading and evaluating scientific literature in medical
school
10.7
4.9
<0.001*
Research mentors are easily available
7.9
5.5
0.011*
There are many opportunities to participate in research in medical school
12.2
5.6
0.064
There is adequate facility for research
8.6
2.8
0.018*
It is easy to access medical journals and get all wanted papers through medical school
library
28.6
28.9
0.071
It is easy to obtain approval for conducting research
9.3
5.6
0.151
There are enough rewards/motivations to participate in research
5.7
7.2
0.289
Research experience
Participants' characteristics with regard to research education and experience are
summarized in [Table 4 ]. The majority of participants stated that they did not receive any education or
training in research (65.0%) and that they did not participate in any research projects
(86.4%). Medical school was the most common source for receiving such training (16.3%
of the participants). Questionnaire-based and case–control studies were the most common
types of research among those who participated (both types were chosen by 47.7% of
those who participated). For those who did not participate in research projects, the
lack of opportunities to participate and shortage of time were the most common barriers
(reported by 54% and 39.5%, respectively) [Table 4 ].
Table 4
Experience of participants regarding research
n (%)
*Choosing more than one option is allowed. Total n : Total number of participants who answered the corresponding question, n : Number of participants who chose the corresponding answer, %: Percentage of participants
who chose the corresponding answer
Sources of education/training about research (total n=320*)
None
208 (65.0)
Medical school
52 (16.3)
Online resources
26 (8.1)
Peers
32 (10.0)
Books and journal
27 (8.4)
Number of research projects participated in (total n=323)
None
279 (86.4)
One project
35 (10.8)
Two projects
5 (1.5)
Three projects
4 (1.2)
More than three projects
0
Types of research projects participated in (total n=44*)
Laboratory based
2 (4.5)
Questionnaire based
21 (47.7)
Case-control
21 (47.7)
Cohort
2 (4.5)
Randomized control trials
1 (2.3)
Reasons for not participating in research (total n=276*)
Not interested in doing research
31 (11.2)
Did not have the opportunity to take part in research
149 (54.0)
Lack of time
109 (39.5)
Lack of guidance and supervision
73 (26.4)
Lack of funding
15 (5.4)
Poor internet connection
15 (5.4)
The odds of participating in research were 5.128 (95% CI 2.590–10.154) times greater
for those who were encouraged by their professors to participate in research compared
to those who were not and 4.891 (95% CI 2.469–9.689) times greater for those who received
education/training about research compared to those who did not. Other factors, including
gender, internet access, and English language skills, did not significantly affect
the likelihood of participating in a research project [Table 5 ].
Table 5
Associations between participation in research projects/writing scientific papers
and the participant’s characteristics
Comparison
Portability (P )
OR (95% CI)
†Chi‑square test, ‡Fisher’s exact test, *Significant at the level of 0.05/13=0.004
(via Bonferroni correction). OR: Odds ratio, CI: Confidence interval
Participation in research projects (yes/no)
By gender (male/female)
0.673*
0.871 (0.459-1.654)
By year of study
<0.0011*
-
2nd year versus non-2nd year
0.002**
0.141 (0.033-0.6)
3rd year versus non-3rd year
0.0011*
3.157 (1.608-6.197)
4th year versus non-4th year
0.478*
0.701 (0.261-1.878)
5th year versus non-5th year
0.0011*
0.073 (0.010-0.542)
6th year versus non-6th year
<0.0011*
3.317 (l.686-6.526)
By internet connection status
0.514*
-
By English language skills (writing)
0.182*
-
By English language skills (speaking)
0.921*
-
By English language skills (reading and comprehension)
0.544*
-
By professors encouragement to participate in research (yes/no)
<0.001**
5.128 (2.590-10.154)
By education/training about research (yes/no)
<0.001**
4.891 (2.469-9.689)
Participation is writing scientific papers (yes/no)
By gender (male/female)
0.145*
0.6 (0.301-1.198)
By year of study
0.023*
-
2nd year versus non-2nd year
0.394*
0.689 (0.291-1.630)
3rd year versus non-3rd year
0.566*
1.253 (0.579-2.7ll)
4th year versus non-4th year
0.617*
1.252 (0.518-3.023)
5th year versus non-5th year
0.009*
0.178 (0.042-0.758)
6th year versus non-6th year
0.013*
2.434 (l.l67-4.992)
By internet connection status
1.0*
-
By English language skills (writing)
0.612*
-
By English language skills (speaking)
0.457*
-
By English language skills (reading and comprehension)
0.051*
-
By professors’ encouragement to participate in writing scientific papers (yes/no)
<0.001**
6.520 (3.ll5-l3.649)
By education/training about writing scientific papers (yes/no)
<0.001**
4.l58 (2.098-8.24l)
Writing and publishing experience
Participants' characteristics regarding writing and publishing scientific papers are
summarized in [Table 6 ]. Similar to research education and experience, the majority of participants stated
that they did not receive any education or training about writing and publishing scientific
papers (72.3%) and that they did not participate in the process of writing scientific
papers (85.8%). Similarly, medical school was the most common source for such training
(16.2% of participants). Most of the students who wrote scientific papers participated
in case reports/case series or original research papers (35.0% and 47.5% of the participants,
respectively). Those two types of papers were also the most likely to be submitted
for publication among participants (35.7% and 42.9% of the participants, respectively).
The most common reasons for the lack of participation in writing scientific papers
were the inability to participate in a research project to yield a paper and a lack
of time (52.1% and 33.5% of the participants, respectively).
Table 6
Experience of participants regarding writing and publishing scientific papers
n (%)
*Choosing more than one option is allowed. Total n: Total number of participants who
answered the corresponding question, n: Number of participants who chose the corresponding
answer, %: Percentage of participants who chose the corresponding answer
Sources of education/training about writing/publishing
scientific papers (total n=3l4*)
None
227 (72.3)
Medical school
51 (16.2)
Online resources
19 (6.1)
Peers
l7 (5.4)
Books and journals
l5 (4.8)
Number of scientific papers participated in (total n=317)
None
277 (85.8)
One project
32 (9.9)
Two projects
4 (1.2)
Three projects
3 (0.9)
More than three projects
1 (0.3)
Types of scientific papers participated in (total n=40*)
Case report/case series
l4 (35.0)
Original research laboratory-based, questionnaire-based,
l9 (47.5)
case-control, cohort, or randomized control trial
Systematic review with or without meta-analysis
0
Narrative review
4 (10.0)
Letter to the editor
1 (2.5)
Commentary
4 (10.0)
Reasons for not participating in writing scientific papers
(total n=236*)
Not interested in writing a scientific paper
36 (15.3)
Did not have the opportunity to take part in research,
123 (52.1)
therefore, have no paper
Lack of time
79 (33.5)
Lack of guidance and supervision
62 (26.3)
Poor internet connection
l4 (5.9)
Types of scientific papers submitted for publication
(total n=28*)
Case report/case series
10 (35.7)
Original research (laboratory-based, questionnaire-based,
l2 (42.9)
case-control, cohort, or randomized control trial)
Systematic review with or without meta-analysis
0
Narrative review
3 (10.7)
Letter to the editor
0
Commentary
4 (l4.3)
Main motivation to consider publication (total n=27*)
Career progression
7 (25.9)
Peer pressure
3 (ll.l)
Relay information
8 (29.6)
Personal interest
9 (33.3)
Supervisor encouragement
l (3.7)
Outcome of paper submissions (total n=3l)
None was accepted for publication
22 (7l.0)
Only few were accepted for publication
4 (l2.9)
Most were accepted for publication
2 (6.5)
All were accepted for publication
3 (9.7)
Reasons for not submitting scientific papers for
publication after writing (total n=20*)
Not interested in publishing
9 (45.0)
Lack of time
5 (25.0)
Was not encouraged to submit as a scientific paper
4 (20.0)
Lack of guidance and supervision
8 (40.0)
Poor internet connection
3 (l5.0)
The main reasons reported by respondents for considering publication were personal
interest (33.3% of participants), relay of information (29.6% of participants), and
career progression (25.9% of participants). However, the main reasons for not considering
publication after writing papers were lack of interest in publishing (45.0% of participants)
and lack of guidance and supervision (40.0% of participants). Among students who submitted
scientific papers for publication, there was a low acceptance rate with 71% of participants
reporting that none of their submitted publications was accepted.
Respondents who were encouraged by their professors to participate in writing and
publishing scientific papers were about 6.5 times more likely to participate in such
activities (OR = 6.520; 95% CI 3.115–13.649) compared to those who were not. In addition,
those who received education/training about writing scientific papers were 4 times
more likely to participate in writing a scientific paper (OR = 4.158; 95% CI 2.098–8.241).
Gender, year of study, internet connection status, and English language skills did
not have a significant effect upon writing scientific papers [Table 5 ].
Discussion
Although the importance of research is well recognized in medicine, only small numbers
of medical students [5 ],[6 ],[12 ],[15 ] and postgraduate physicians [13 ],[16 ] conduct research, as evident in our study and others. To our knowledge, this is
the first study to investigate the attitudes of medical students toward research in
Syria and to address the barriers that are inhibiting students from learning about
and conducting research.
In developing countries, research is not a high priority for health-care professionals.
This can be due to poverty, lack of resources, poor access to the literature, and
poor knowledge about the fundamentals of research practice.[17 ],[18 ] Unfortunately, this creates a large disparity in research productivity between high-
and low-income countries. For instance, medical students in Germany were listed as
authors in 28% of all medical publications in a 2-year period, with students acting
as leading authors in> 7% of the cases.[19 ] In contrast, the vast majority of Indian postgraduates had no research experience
in medical school.[16 ] Certain factors may be exacerbated in conflict zones such as Syria, where physicians
face intolerable conditions that preclude them from applying current evidence, without
the proper environment to produce new evidence that fits the needs of the current
situation. Given all these facts, we believe that it is necessary to pay more attention
to build a new generation of young doctors who are capable of bridging the gap and
elevate the current reality of biomedical research to a higher level.
The analytical process that characterizes research contributes to the development
of a medical student's critical thinking skills, ability to evaluate the literature,
and technical tools to communicate scientific data.[20 ],[21 ],[22 ] In addition, engaging in the research process also contributes to an increase in
the research productivity at the institution where the medical students are enrolled
[22 ] and encourages students to get involved in research after graduation.[21 ],[22 ],[23 ],[24 ],[25 ] Furthermore, education on writing scientific papers can increase publication productivity.[26 ] The results from our study are consistent with the literature; students who reported
receiving education about research and writing scientific papers were more likely
to participate in research projects or writing scientific articles. Furthermore, the
high percentage of students who reported not participating in practicing research
or writing scientific papers can be partially explained by the presence of a similarly
high percentage of students who reported not receiving any training in these areas.
Education about research methodology is delivered at Syrian universities through two
separate courses (Public Health and Medical Biostatistics) during the 3rd year of
study. However, only a small percentage of students in our study (about 16%) reported
that they received research and academic writing education from their medical school.
Although a proportion of those participants may not have reached those two courses
in medical school, this finding is still worrisome and may indicate inadequate training
or a lack of perceived value among the students regarding these courses. A re-evaluation
of the curriculum regarding biomedical research education may be necessary to enhance
students' understanding of this important topic in the Faculty of Medicine.
In our study, most students showed positive attitudes and a good understanding of
the importance of research and its role in medicine, and most of them indicated a
willingness to participate in research. However, the majority did not know how to
get involved in a research project. They reported many perceived barriers that are
negatively affecting their progress in the field of research, such as a lack of training,
adequate time, motivation, and mentorship. These barriers are common for medical students
and residents as they were reported in previous studies around the world.[5 ],[6 ],[12 ],[13 ],[15 ],[16 ] These findings point out the importance of allocating enough time for medical students
to conduct research and providing them with guidance and motivation, research opportunities,
and training sessions.
Medical education at Syrian Universities is taught through a 6-year program. The first
3 years are dedicated to the basic sciences and the clinical sciences are taught in
the last 3 years of the program. We compared the reported attitudes and barriers between
these two phases of study as they might affect students' perception of research. Students
in their clinical years of study showed more appreciation for the importance of research
during medical school and reported time to be less of a barrier to research compared
to students in their basic sciences years of study. However, a lack of adequate training,
adequate research facilities, and adequate mentorship was reported more as barriers
to research among them. In addition to placing more value on research and a better
understanding of its requirements, these students may have better time management
skills and may be more likely to benefit from research programs and opportunities.
Therefore, they should be given priority in any future efforts or initiatives in countries,
such as Syria, that lack the proper infrastructure for research. Furthermore, more
attention should be given to students in their basic sciences years of study to educate
them about the importance of research and its impact.
We investigated the relationship between participation in research or authoring publications
and proposed factors that might have an impact on students' research habits such as
gender, self-perceived English language proficiency, and internet access. Our findings
suggest that these factors do not play a significant role in research/publications
productivity among the population from which we recruited our study sample. However,
poor internet connection was reported as one of the reasons for not participating
in research (5.4%), not participating in writing scientific papers (5.9%), and not
submitting scientific papers for publication after writing (15%). In addition, students
in their 3rd and 6th years of study were significantly more likely to have participated
in research compared to others. Differences in the curriculum and workload between
among years of study and the presence of two courses on research principles in the
3rd year of study may have contributed to these findings.
For students who reported having participated in research, questionnaire-based and
case–control studies were the most common types of research. This finding is not consistent
with the studies from other developing countries where reviews and prospective research
projects were more dominant; for instance, in Saudi Arabia and Pakistan, it was found
that original articles represent the majority of the sample while case reports were
markedly less reported.[5 ],[27 ] One of the reasons for our finding may be due to the fact that some types of studies
require less financial resources than other studies such as cohort and randomized
controlled trials. In addition, when it comes to literature reviews, letters, and
commentaries, which constituted a relatively small percentage of the reported publication
types in our sample, they require access to publications and databases as well as
advanced mentorship and experience that Syrian medical students may lack.
Our results suggest that Syrian medical students face many difficulties regarding
publishing their work. Most participants who submitted their papers for publication
stated that none of their submissions was accepted. While further research is needed
to investigate the reasons behind this phenomenon, a few potential causes come to
mind. This includes the low acceptance rate that can be explained by the inability
of students to produce high-quality papers, low interest by medical journals in research
papers coming from Syria, lack of mentorship or guidance throughout the publication
process, and possible publication bias against authors from less prestigious institutions.[28 ] In addition, lack of interest in publishing and lack of guidance and supervision
appear to be the most common reasons for not considering publication after writing
papers. These findings suggest that providing mentorship and additional education
about academic writing and publishing are necessary.
Mentorship is crucial for research.[22 ] The lack of adequate mentorship has been reported as a main research barrier in
many studies.[5 ],[6 ],[12 ],[14 ],[15 ] As expected, we found that Syrian medical students also struggle with the same issue.
Most participants think that research mentors are unavailable, and a lack of guidance
and supervision was reported by a substantial number of participants as a reason for
not participating in research (26.4%), not writing scientific papers (26.3%), and
not submitting scientific papers for publication after writing (40.0%). This confirms
the role of inadequate mentorship as a cause of the limited involvement of medical
students in conducting research and the poor research output from Syria. We believe
that researchers and academics, especially Syrians, around the world could reduce
this barrier by volunteering to share their knowledge and provide learning opportunities
to students in Syria. This can be achieved by, for example, online education, distance-mentorship,
and project collaboration. Encouragement has also been cited as an important contributor
in motivating medical students to carry out research.[29 ] The importance of encouragement and support of professors, as part of good mentorship,
is warranted as indicated by the respondents who were encouraged by their professors
to participate in research and writing/publishing scientific papers.
Socioeconomic and political pressures can present a significant barrier to the health
and impact of research institutions through reduced funding, reduced personnel, reduced
morale, and – consequently – reduced learning opportunities and faculty engagement
in a variety of scholarly activities. In today's chaotic political environment, pockets
of threat to scholarship exist all over the world and may have lasting effects. Although
our results confirm findings produced in other countries experiencing similar pressures,[5 ],[27 ] we believe that Syrians already managed to partially tackle some of the barriers
imposed by the poor research environment in the country; several recent reports from
Syria indicated that peers effect, online courses, social media, and awareness campaigns
can play a significant role in increasing students' exposure to research and can facilitate
any mentorship program that seniors create to support juniors, even if those seniors
were in another country.[30 ],[31 ],[32 ]
For developing countries with limited resources, students can be directed toward working
on small research projects that do not need funding or highly-equipped facilities,
such as survey-based cross-sectional studies, or “fundless” cohort and case–control
studies. Students can also be taught and encouraged to participate in synthesizing
medical evidence by conducting and publishing systematic reviews and meta-analyses.
In addition, writing and publishing review articles or editorials could be a suitable
and feasible option to encourage medical students in developing countries to become
involved in academic publishing. Moreover, policymakers can adopt or learn from some
initiatives that have shown to be successful for increasing research output in certain
countries, such as creating opportunities for students to publish their research in
local academic journals [27 ] or creating specialized entities for providing research opportunities, guidance,
and encouragement.[29 ]
This study is an observational survey that gathered self-reported data. Therefore,
these findings need to be taken into account in the light of several limitations.
The results are derived from self-reported data that could not be verified. Some factors,
such as English language proficiency and internet connection, where investigated subjectively,
which may introduce bias. The same applies to many other data variables collected,
such as number of publications.
Today's medical students are tomorrow's physicians and scientists who, if well-trained,
will lead medical research and achieve health-care prosperity. Faculty, staff, and
administrators should devote more attention to enhance students' understanding of
research, hone their academic writing skills, and facilitate their early exposure
to the fundamentals of conducting research. Efforts should be made to overcome the
obstacles reported in this study. This can be achieved by refining curricula, building
proper infrastructure, providing adequate training, research opportunities, mentorship,
and encouragement.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
