types of research medical students

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Official "Questions & Answers About Doing Research in Med School" Megathread

Hi chickadees,

The next topic for the r/medicalschool megathread series is how/when/why/where to do research in medical school. There have been a bunch of research-related questions asked recently, so we wanted to give y'all a place to give advice, ask dumb questions, etc etc. Please feel free to ask any questions you've been kicking around! I'm also going to list some common/recent questions we've seen as starter questions, so if you have answers to any of the below please copy/paste them into your comment and dispense your advice!

Starter Questions

How the heck do I find research opportunities?

Do I have to do research during M1/2 summer?

When do I start looking for research opportunities?

How do I pick what type of research to do if I don't know what specialty I want to go into?

I hate research, can I match without it?

My school doesn't have research opportunities at all/in the field I want, what do I do

What's better, clinical or bench research?

What's better, X number of publications or Y number of posters?

How do I make time for research?

I'm an M3 and don't have any research yet, what can I do to quickly churn out some pubs?

I'm an incoming M`1, wtf even is research in medical school?

Current M4s, did research matter in interviews?

ALSO for reference, here are the links to the 2016 NRMP "Charting Outcomes in the Match" data, which show the mean number of abstracts, presentations, and publications (all lumped together) for matched and unmatched applicants to each specialty.

2016 Outcomes for US Allopathic Seniors

2016 Outcomes for US Osteopathic Seniors

2016 Outcomes for International Medical Graduates

Edit: Reddit 2018 Match Results Spreadsheet

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How to Get Research Experience

New section.

Working in a research setting can help make you a competitive medical school applicant and help you to determine if a career in medicine or medical research is right for you

How do I find a research position?

If you’re currently in college, check with your institution’s science or undergraduate research websites for opportunities to assist with faculty research projects. You can also review faculty bio pages and lab websites for more information. Next, reach out to your immediate network: express your interest in assisting with a research project to your science professors, academic advisor, and your pre-health advisor.

Try exchanging ideas with your peers and upper-classmen for advice on research opportunities at your institution. You can also ask peer advisors, resident advisors, or any fellow premedical students for introductions to principal investigators (PIs). You might even try the “Undergrad-Grad-PI” method. This is where you first reach out to undergraduate students in research labs to learn about their responsibilities; they oftentimes are more responsive. Then, reach out to the graduate or post-doc students to learn about the research question being investigated. After this, read the most recent paper or abstract the lab published. Once you complete these steps, you can approach the PI more confidently and more effectively demonstrate your commitment to and understanding of their project.

Your school’s career center or student employment office may know about research job openings, and they can also offer resume help and go over interview tips and techniques. Remember, opportunities may be on or off campus, full- or part-time, paid or unpaid, or part of a summer program. Once you find a position, you can connect with your school’s fellowships or awards office to inquire about research funding opportunities.

If you’ve already graduated, consider looking into open positions. Research hospitals, universities, and biotech companies are always looking for lab technicians or clinical research coordinators (CRC). Job opportunities are typically posted on the career pages of their websites.

When should I begin gaining research experience in college?

Some premedical students begin their research experiences during their first year of college, and others begin research positions after they have already graduated. On average, most students secure a research position junior or senior year. There are three big factors that will impact this:

• Your level of interest in pursuing research. If you are really excited to investigate a question under a mentor, you might find yourself reaching out to professors early and often. Other students may focus on gaining clinical experience, and therefore wait later in their academic career to start research.
• Readiness for the research project. Different PIs will have different expectations for preparation. A research project might require you to first take coursework in basic lab sciences, statistics, or another advanced topic specific to the project. Other PIs may prefer to train you “on-the-job” through their graduate or post-doc students. This will impact when you are ready to join a project.
• Finding the right research project. There is a process of reviewing different PIs and research projects to find the right fit for you. What subject do you want to investigate? Do you want your research project to take place in a lab or non-lab setting? Is there an independent question you want to investigate with the help of a mentor?

When is the best time to look for a position?

According to Kate Stutz, Ph.D., Director of Pre-Health Advising at Brandeis University, if you’re interested a research position during the academic year, the best time to look for positions is at the very beginning of the semester. There also tend to be a lot of research opportunities in the summer, both paid and volunteer, through set programs like the National Science Foundation’s Research Experience for Undergraduates (REUs). It’s best to start applying for summer research positions in December-February for the upcoming summer. Remember, typically there are more applicants than available spots so get your applications in early. Each undergraduate institution will be different, therefore make sure to connect with your advisors and peers for feedback on when to start looking.

What’s the best way to apply?

The outreach email message that you send to potential research faculty is very important. This message should include a formal introduction of yourself, evidence that you are familiar with their research project(s), and a clear, specific ask. Identify what you hope to contribute to the project. Do you want to clean the glassware or analyze lab findings? Consider attaching your resume as well. Dr. Stutz stresses that networking and persistence are crucial to finding a position. Make sure you’re using all of your network, including your peers and professors, to find open positions. Don’t be afraid to send follow up emails; faculty are very busy and often overlook emails. Sometimes, it can be even more effective to stop by a professor’s office hours to hand deliver your materials and indicate your interest in person.

How should I prepare for an interview?

With any interview, it’s important to make a good impression. Be sure to dress appropriately. Come prepared with a resume. Use your campus career center for advice on proper attire and resume best practices.

Often during interviews, you’ll be asked about your career goals. It’s helpful to be able to speak about the steps you plan to take to meet those goals. Talk about classes you’ve taken, especially upper-level science courses. Speak about your skills, your knowledge of techniques, and the equipment you’ve used throughout your coursework. Be prepared to discuss the lab experiments you’ve completed. If you’ve done any sort of research—even in your coursework—keep track of it. This shows you have experience. Lastly, interviewers often ask candidates if they have any questions. Dr. Stutz suggests asking something that indicates you’ve done your own research into their project. You could ask where they see their research going in the next three years or what challenges they anticipate. You could also ask about expectations for undergraduate researchers; do they expect you to work 20+ hours a week? Full time over the summer? Do they require you to have work study or to sign up for research credits? Asking these questions ahead of time can help you plan ahead and determine if this position is the best fit for you. Check out these  interview resources  for more tips.

Does research experience have to be in a wet lab?

No! Research can be performed in any field or subject. We’ve had successful applicants with research in classics, sociology, history, and policy, as well as applicants with research in biology, biochemistry, and neuroscience. Medical schools value all types of research. Research can take place in a scientific lab that requires advanced devices and procedures to obtain data for analysis. Research can also take place in the humanities or social sciences where participant interviews or surveys are needed to obtain an individual's life perspective. The clinical research field is constantly investigating patient outcomes and how to improve care through clinical trials or analysis of patient data. As a premedical student, consider what question you want to investigate further. Do you want to learn more about how health inequities impact disadvantaged communities in your area, or perhaps you want to know more about the protein channels involved in memory cognition? Once you choose a direction, you can then partner with a research PI for guidance on how to navigate your question. Sierra Perez, Pre-Health Advisor at Brandeis University, shares not to be afraid to get creative with your research question. She has been impressed by the medical school applicants who have created independent questions that address the community needs. “Applicants are recognizing the critical needs of specific populations, such as homelessness, LGBTQ+, veterans, youth with disabilities, etc.,” she stated. “There is also a demand for translational researchers, or individuals who can take complicated bench topics and apply it to the clinical world.”

Is research experience required to be accepted to medical school? 

It depends. Some medical schools are very research focused; they may require a research thesis or have research time built into the curriculum. Other schools are more community or clinically focused; they would rather have an applicant work in a healthcare setting or volunteer at their local soup kitchen than be at the bench moving clear liquids from one test tube to another. Research experience (in whatever discipline) is helpful for developing some of the Premed Competencies , such as critical thinking, quantitative reasoning, scientific reasoning, as well as teamwork and oral communication skills. How much you should engage in research depends on how much you enjoy it once you try it!

The majority of accepted medical school applicants have some form of academic or clinical research at the time they apply. Competence in research has become increasingly important in the medical field to improve patient care outcomes.

You can also review medical school mission statements to see if research is a focus at a particular school. You can read each school’s mission, and the number of accepted students in their most recent class who had research experience, in the  Medical School Admission Requirements . Remember, it’s best to pursue experiences that you’re genuinely interested in, rather than just to check a box, but you may not know if research is for you until you give it a try.  

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Chapter 3:  Types of Studies in Clinical Research—Part I: Observational Studies

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Introduction, research design and studies.

• STUDIES OF RISK ASSESSMENT: OBSERVATIONAL STUDIES
• Full Chapter
• Supplementary Content

When you have completed this chapter, you will be able to understand:

Types of studies and their relation to the research objectives

The different types of studies

The difference between primary and secondary studies

The different types of primary studies

Descriptive and analytical observational studies

Various descriptive observational studies and their functions

Various analytical observational studies and their functions

The advantages and disadvantages of observational studies

The previous chapter described the various steps of planning and conducting a research study. This chapter briefly introduces the reader to the different types of studies and then elaborates on the observational studies. In observational studies, the researcher observes the involvement of the participants and collects data by simply observing events as they happen, without playing an active part in what takes place. In interventional, or experimental, studies, the investigator exposes the participants to some kind of intervention and tries to find a relation between the intervention and the outcome. Observational studies can be descriptive, like the case studies and case series, but are more commonly analytical (cross-sectional, case–control, and cohort studies). Descriptive observational studies describe characteristics of a population and usually do not have a hypothesis; they are sometimes hypothesis-generating studies. An analytical observational study, in addition, tries to find a causal relationship between two or more comparable groups (variables) and has a hypothesis to prove.

A study design is a road map or blueprint based on the type of research to be carried out. It starts with development of the research question, formulating a hypothesis and research objectives, and subsequent planning for carrying out the research. The research objectives of the proposed study determine the type of study to be undertaken.

Types of Studies

Type of studies in medical research can be broadly classified into primary and secondary studies. Primary studies are those that are actually performed by the investigators, while secondary studies summarize the results of different primary studies in the form of systematic reviews and meta-analyses without actually performing the studies. 1 Primary studies can be put into three groups based on the type of research undertaken: basic medical or experimental studies, epidemiologic studies, and clinical studies. Basic medical studies include research in animal experiments, cell studies, biochemical, genetic and physiologic investigations, and studies on the properties of drugs and materials. Epidemiologic studies investigate the distribution and historical changes in the frequency of diseases and the causes for these diseases, while clinical studies involve research in human subjects. However, it may be difficult to classify individual studies into one of these three main categories. 1 A more practical way to classify the types of research studies based on their function is to group them into observational and interventional (experimental) studies; the former can be further subclassified into descriptive and analytical studies ( Figure 3-1 ).

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Types of Study Design

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Introduction

Study designs are frameworks used in medical research to gather data and explore a specific research question .

Choosing an appropriate study design is one of many essential considerations before conducting research to minimise bias and yield valid results .

This guide provides a summary of study designs commonly used in medical research, their characteristics, advantages and disadvantages.

Case-report and case-series

A case report is a detailed description of a patient’s medical history, diagnosis, treatment, and outcome. A case report typically documents unusual or rare cases or reports  new or unexpected clinical findings .

A case series is a similar study that involves a group of patients sharing a similar disease or condition. A case series involves a comprehensive review of medical records for each patient to identify common features or disease patterns. Case series help better understand a disease’s presentation, diagnosis, and treatment.

While a case report focuses on a single patient, a case series involves a group of patients to provide a broader perspective on a specific disease. Both case reports and case series are important tools for understanding rare or unusual diseases .

Advantages of case series and case reports include:

• Able to describe rare or poorly understood conditions or diseases
• Helpful in generating hypotheses and identifying patterns or trends in patient populations
• Can be conducted relatively quickly and at a lower cost compared to other research designs

Disadvantages

Disadvantages of case series and case reports include:

• Prone to selection bias , meaning that the patients included in the series may not be representative of the general population
• Lack a control group, which makes it difficult to conclude  the effectiveness of different treatments or interventions
• They are descriptive and cannot establish causality or control for confounding factors

Cross-sectional study

A cross-sectional study aims to measure the prevalence or frequency of a disease in a population at a specific point in time. In other words, it provides a “ snapshot ” of the population at a single moment in time.

Cross-sectional studies are unique from other study designs in that they collect data on the exposure and the outcome of interest from a sample of individuals in the population. This type of data is used to investigate the distribution of health-related conditions and behaviours in different populations, which is especially useful for guiding the development of public health interventions .

Example of a cross-sectional study

A cross-sectional study might investigate the prevalence of hypertension (the outcome) in a sample of adults in a particular region. The researchers would measure blood pressure levels in each participant and gather information on other factors that could influence blood pressure, such as age, sex, weight, and lifestyle habits (exposure).

Advantages of cross-sectional studies include:

• Relatively quick and inexpensive to conduct compared to other study designs, such as cohort or case-control studies
• They can provide a snapshot of the prevalence and distribution of a particular health condition in a population
• They can help to identify patterns and associations between exposure and outcome variables, which can be used to generate hypotheses for further research

Disadvantages of cross-sectional studies include:

• They cannot establish causality , as they do not follow participants over time and cannot determine the temporal sequence between exposure and outcome
• Prone to selection bias , as the sample may not represent the entire population being studied
• They cannot account for confounding variables , which may affect the relationship between the exposure and outcome of interest

Case-control study

A case-control study compares people who have developed a disease of interest ( cases ) with people who have not developed the disease ( controls ) to identify potential risk factors associated with the disease.

Once cases and controls have been identified, researchers then collect information about related risk factors , such as age, sex, lifestyle factors, or environmental exposures, from individuals. By comparing the prevalence of risk factors between the cases and the controls, researchers can determine the association between the risk factors and the disease.

Example of a case-control study

A case-control study design might involve comparing a group of individuals with lung cancer (cases) to a group of individuals without lung cancer (controls) to assess the association between smoking (risk factor) and the development of lung cancer.

Advantages of case-control studies include:

• Useful for studying rare diseases , as they allow researchers to selectively recruit cases with the disease of interest
• Useful for investigating potential risk factors for a disease, as the researchers can collect data on many different factors from both cases and controls
• Can be helpful in situations where it is not ethical or practical to manipulate exposure levels or randomise study participants

Disadvantages of case-control studies include:

• Prone to selection bias , as the controls may not be representative of the general population or may have different underlying risk factors than the cases
• Cannot establish causality , as they can only identify associations between factors and disease
• May be limited by the availability of suitable controls , as finding appropriate controls who have similar characteristics to the cases can be challenging

Cohort study

A cohort study follows a group of individuals (a cohort) over time to investigate the relationship between an exposure or risk factor and a particular outcome or health condition. Cohort studies can be further classified into prospective or retrospective cohort studies.

Prospective cohort study

A prospective cohort study is a study in which the researchers select a group of individuals who do not have a particular disease or outcome of interest at the start of the study.

They then follow this cohort over time to track the number of patients who develop the outcome . Before the start of the study, information on exposure(s) of interest may also be collected.

Example of a prospective cohort study

A prospective cohort study might follow a group of individuals who have never smoked and measure their exposure to tobacco smoke over time to investigate the relationship between smoking and lung cancer .

Retrospective cohort study

In contrast, a retrospective cohort study is a study in which the researchers select a group of individuals who have already been exposed to something (e.g. smoking) and look back in time (for example, through patient charts) to see if they developed the outcome (e.g. lung cancer ).

The key difference in retrospective cohort studies is that data on exposure and outcome are collected after the outcome has occurred.

Example of a retrospective cohort study

A retrospective cohort study might look at the medical records of smokers and see if they developed a particular adverse event such as lung cancer.

Advantages of cohort studies include:

• Generally considered to be the most appropriate study design for investigating the temporal relationship between exposure and outcome
• Can provide estimates of incidence and relative risk , which are useful for quantifying the strength of the association between exposure and outcome
• Can be used to investigate multiple outcomes or endpoints associated with a particular exposure, which can help to identify unexpected effects or outcomes

Disadvantages of cohort studies include:

• Can be expensive and time-consuming to conduct, particularly for long-term follow-up
• May suffer from selection bias , as the sample may not be representative of the entire population being studied
• May suffer from attrition bias , as participants may drop out or be lost to follow-up over time

Meta-analysis

A meta-analysis is a type of study that involves extracting outcome data from all relevant studies in the literature and combining the results of multiple studies to produce an overall estimate of the effect size of an intervention or exposure.

Meta-analysis is often conducted alongside a systematic review and can be considered a study of studies . By doing this, researchers provide a more comprehensive and reliable estimate of the overall effect size and their confidence interval (a measure of precision).

Meta-analyses can be conducted for a wide range of research questions , including evaluating the effectiveness of medical interventions, identifying risk factors for disease, or assessing the accuracy of diagnostic tests. They are particularly useful when the results of individual studies are inconsistent or when the sample sizes of individual studies are small, as a meta-analysis can provide a more precise estimate of the true effect size.

When conducting a meta-analysis, researchers must carefully assess the risk of bias in each study to enhance the validity of the meta-analysis. Many aspects of research studies are prone to bias , such as the methodology and the reporting of results. Where studies exhibit a high risk of bias, authors may opt to exclude the study from the analysis or perform a subgroup or sensitivity analysis.

Advantages of a meta-analysis include:

• Combine the results of multiple studies, resulting in a larger sample size and increased statistical power, to provide a more comprehensive and precise estimate of the effect size of an intervention or outcome
• Can help to identify sources of heterogeneity or variability in the results of individual studies by exploring the influence of different study characteristics or subgroups
• Can help to resolve conflicting results or controversies in the literature by providing a more robust estimate of the effect size

Disadvantages of a meta-analysis include:

• Susceptible to publication bias , where studies with statistically significant or positive results are more likely to be published than studies with nonsignificant or negative results. This bias can lead to an overestimation of the treatment effect in a meta-analysis
• May not be appropriate if the studies included are too heterogeneous , as this can make it difficult to draw meaningful conclusions from the pooled results
• Depend on the quality and completeness of the data available from the individual studies and may be limited by the lack of data on certain outcomes or subgroups

Ecological study

An ecological study assesses the relationship between outcome and exposure at a population level or among groups of people rather than studying individuals directly.

The main goal of an ecological study is to observe and analyse patterns or trends at the population level and to identify potential associations or correlations between environmental factors or exposures and health outcomes.

Ecological studies focus on collecting data on population health outcomes , such as disease or mortality rates, and environmental factors or exposures, such as air pollution, temperature, or socioeconomic status.

Example of an ecological study

An ecological study might be used when comparing smoking rates and lung cancer incidence across different countries.

Advantages of an ecological study include:

• Provide insights into how social, economic, and environmental factors may impact health outcomes in real-world settings , which can inform public health policies and interventions
• Cost-effective and efficient, often using existing data or readily available data, such as data from national or regional databases

Disadvantages of an ecological study include:

• Ecological fallacy occurs when conclusions about individual-level associations are drawn from population-level differences
• Ecological studies rely on population-level (i.e. aggregate) rather than individual-level data; they cannot establish causal relationships between exposures and outcomes, as the studies do not account for differences or confounders at the individual level

Randomised controlled trial

A randomised controlled trial (RCT) is an important study design commonly used in medical research to determine the effectiveness of a treatment or intervention . It is considered the gold standard in research design because it allows researchers to draw cause-and-effect conclusions about the effects of an intervention.

In an RCT, participants are randomly assigned to two or more groups. One group receives the intervention being tested, such as a new drug or a specific medical procedure. In contrast, the other group is a control group and receives either no intervention or a placebo .

Randomisation ensures that each participant has an equal chance of being assigned to either group, thereby minimising selection bias . To reduce bias, an RCT often uses a technique called blinding , in which study participants, researchers, or analysts are kept unaware of participant assignment during the study. The participants are then followed over time, and outcome measures are collected and compared to determine if there is any statistical difference between the intervention and control groups.

Example of a randomised controlled trial

An RCT might be employed to evaluate the effectiveness of a new smoking cessation program in helping individuals quit smoking compared to the existing standard of care.

Advantages of an RCT include:

• Considered the most reliable study design for establishing causal relationships between interventions and outcomes and determining the effectiveness of interventions
• Randomisation of participants to intervention and control groups ensures that the groups are similar at the outset, reducing the risk of selection bias and enhancing internal validity
• Using a control group allows researchers to compare with the group that received the intervention while controlling for confounding factors

Disadvantages of an RCT include:

• Can raise ethical concerns ; for example, it may be considered unethical to withhold an intervention from a control group, especially if the intervention is known to be effective
• Can be expensive and time-consuming to conduct, requiring resources for participant recruitment, randomisation, data collection, and analysis
• Often have strict inclusion and exclusion criteria , which may limit the generalisability of the findings to broader populations
• May not always be feasible or practical for certain research questions, especially in rare diseases or when studying long-term outcomes

Dr Chris Jefferies

• Yuliya L, Qazi MA (eds.). Toronto Notes 2022. Toronto: Toronto Notes for Medical Students Inc; 2022.
• Le T, Bhushan V, Qui C, Chalise A, Kaparaliotis P, Coleman C, Kallianos K. First Aid for the USMLE Step 1 2023. New York: McGraw-Hill Education; 2023.
• Rothman KJ, Greenland S, Lash T. Modern Epidemiology. 3 rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008.

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Research Article

Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis

Affiliations Faculty of Medicine, Cairo University, Cairo, Egypt, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan

Affiliation Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan

Affiliation European Institute of Oncology (IEO), Milano, Italy

* E-mail: [email protected]

Affiliation National Cancer Institute, Cairo University, Cairo, Egypt

• Mohamed Amgad, 
• Marco Man Kin Tsui, 
• Sarah J. Liptrott, 

• Published: June 18, 2015
• https://doi.org/10.1371/journal.pone.0127470
• Reader Comments

Despite the rapidly declining number of physician-investigators, there is no consistent structure within medical education so far for involving medical students in research.

To conduct an integrated mixed-methods systematic review and meta-analysis of published studies about medical students' participation in research, and to evaluate the evidence in order to guide policy decision-making regarding this issue.

Evidence Review

We followed the PRISMA statement guidelines during the preparation of this review and meta-analysis. We searched various databases as well as the bibliographies of the included studies between March 2012 and September 2013. We identified all relevant quantitative and qualitative studies assessing the effect of medical student participation in research, without restrictions regarding study design or publication date. Prespecified outcome-specific quality criteria were used to judge the admission of each quantitative outcome into the meta-analysis. Initial screening of titles and abstracts resulted in the retrieval of 256 articles for full-text assessment. Eventually, 79 articles were included in our study, including eight qualitative studies. An integrated approach was used to combine quantitative and qualitative studies into a single synthesis. Once all included studies were identified, a data-driven thematic analysis was performed.

Findings and Conclusions

Medical student participation in research is associated with improved short- and long- term scientific productivity, more informed career choices and improved knowledge about-, interest in- and attitudes towards research. Financial worries, gender, having a higher degree (MSc or PhD) before matriculation and perceived competitiveness of the residency of choice are among the factors that affect the engagement of medical students in research and/or their scientific productivity. Intercalated BSc degrees, mandatory graduation theses and curricular research components may help in standardizing research education during medical school.

Citation: Amgad M, Man Kin Tsui M, Liptrott SJ, Shash E (2015) Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis. PLoS ONE 10(6): e0127470. https://doi.org/10.1371/journal.pone.0127470

Academic Editor: Emmanuel Manalo, Kyoto University, JAPAN

Received: April 1, 2014; Accepted: April 15, 2015; Published: June 18, 2015

Copyright: © 2015 Amgad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Data Availability: All data are included within the manuscript

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The education of health professionals has seen two revolutions over the past century. The first revolution-marked by what is known as The Flexner Report in 1910- was the effective integration of basic sciences into health education. The second revolution, initiated by the Welch-Rose report in 1915, introduced the concept of problem-based learning into medical education. In 2010, a special report was published by a global commission, The Commission on Education of Health Professionals for the 21 st Century, aimed at updating the standards of an ideal medical curriculum. The committee strongly recommended a new medical educational model that emphasized flexibility and adaptability of traditionally rigid curricula to local and community needs [ 1 ]. Despite these educational advances, there are certain aspects of medical education that remain unstructured and largely variant between medical schools; among these is medical student participation in research. Moreover, there is an alarming decline in the number of physician-scientists in the US, which threatens the progress of translational medicine in the upcoming era [ 2 – 4 ].

In the U.S., outstanding students willing to enter medical school may apply for the National Institute of Health (NIH) funded Medical Scientist Training Program (MSTP) [ 5 ]. This program offers students the opportunity to get a good feel for what a physician-scientist career entails through a funded MD/PhD. The value of those MD/PhD programs is well established; a 2010 study by Brass et al, investigating the outcomes of half of all NIH-funded MD/PhD programs (24 programs in total) found that these programs were very successful at reaching their goals of training future physician-scientists. In fact, 81% of MD/PhD graduates landed academic positions and 82% of them were actively engaged in research [ 6 ]. Nevertheless, due to limited funding, MD/PhD graduates only constitute 3% of the US medical student population, highlighting the value of alternative pipelines for the creation of research-active physicians [ 7 ]. Moreover, organizational and contextual factors might make the support of costly MD/PhD programs difficult to implement in other countries.

Several other programs have also been devised to offer medical and health sciences students the chance to participate in research [ 8 – 13 ]. One of the common forms of medical student research engagement is Intercalated Bachelor of Science (iBSc) degrees. These are particularly common in the UK, and are characterized by research time-out periods between the basic and clinical years of medical school. Students who take intercalated degrees graduate with an extra BSc beside their medical degree. The value of such short-term research placements should not be underestimated. In fact, the benefits of undergraduate research have been discussed richly in the literature, though there were relatively fewer papers focusing primarily on medical student research [ 14 – 16 ]. Unlike many other degrees, a medical degree is at the interface of science and social service. It is therefore expected that the benefits of, and motivations behind, medical student participation in research are different from those of non-medical students [ 17 ].

A 2005 systematic review of the literature by Straus et al investigated the factors that influence career choice in academic medicine among residents, fellows and staff physicians [ 18 ]. Their review found a positive effect of having dual degrees or fellowships beside the medical degree, and of publishing research conducted during medical school. Further, the review highlighted the role of mentorship and desire to teach. Despite the presence of a large body of evidence investigating the impact of, and factors related to, medical student research, a systematic analysis of this evidence is missing. This makes the data seem conflicting and disorganized, and undermines the apparent overall strength of evidence.

This paper is a mixed-methods systematic review and meta-analysis of published studies investigating various aspects of medical student research, including its impact on the development of research-active physicians, difficulties faced by medical students performing research and potential solutions to overcome these difficulties. Our hope is that this work serves to complement the review by Straus et al, and helps provide a thorough overview of the evidence needed for curricular and educational policy reforms [ 18 ].

We aimed to satisfy the following objectives in this review:

Primary Objectives: (a) To examine the short- and long- term influence of curricular and extracurricular undergraduate medical research on the scientific productivity of medical students, measured by the number of published manuscripts, research awards or attainment of faculty rank. (b) To describe the influence of curricular and extracurricular medical student research on the career choice of medical students.

Secondary Objectives: (a) To explore the current forms in which medical students are engaged in research projects, as well as the prevalence of non-mandatory research exposure among medical students. (b) To identify the factors related to medical student engagement in research projects. (c) To investigate miscellaneous issues of relevance, including the pros and cons of research time-out periods (with a focus on Intercalated Bachelor of Science degrees), differences between countries with developing and developed economies and gender equality in medical student research engagement, perceptions and productivity.

Developing economies were identified according to the International Monetary Fund's World Economic Outlook Report [ 19 ]. We counted as a "medical student" anyone who is enrolled in the core medical school program, regardless of program duration, and whose graduation would guarantee the degree Bachelor of Medicine, Bachelor of Surgery (MBBS) or its equivalent (MD, in the US, for example). It should be noted that in the US model of medical education, admission into medical school is on a graduate-entry basis by default, and the first medical degree earned is called the "MD". In the non-graduate entry model, on the on the other hand, the term "MD" is reserved for higher research degrees (postgraduate degrees) in clinical medical and surgical disciplines. Graduate-entry medical students were included, but not MD/PhD students, residents or postgraduate students. The reasons behind excluding studies focusing on MD/PhD students is that this sub-population is considered to be different from the general student population, especially that their enrollment in the medical program was–by definition- meant to prepare them for physician-scientist careers. It may be argued that graduate-entry medical students who had a higher degree (MSc or PhD) at the time of matriculation also constitute a separate sub-population. Hence, we addressed any reported differences between these sub-populations in our results. "Medical student research" was defined as any activity performed by medical students that is driven by inquiry or hypothesis and that legitimately incorporates basic principles of the scientific method. This includes original research, review articles, case reports etc.

We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement guidelines in this systematic review and meta-analysis, and the relevant checklist can be found as S1 File [ 20 ]. Between March 2012 and September 2013, periodic searches were performed in the following databases for potentially relevant studies: MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Cochrane Methodology Register (CMR), Educational Resources Information Center (ERIC), Center for Reviews and Dissemination (CRD), ISI Web of Science and Google Scholar. Further, we searched the bibliographies of the included studies for other potential publications on the subject. Our search strategy included the following keywords in various combinations: medical student; medical students; undergraduate; medical; research; intercalated; bachelor; BSc; iBSc; theses; thesis; developing. The search strategy used for PubMed was as follows: ((((((medical student research) OR undergraduate research) OR medical thesis) OR intercalated bachelor) OR intercalated BSc) OR iBSc) OR undergraduate research developing.

Inclusion criteria: All study designs, including cross-sectional, prospective, retrospective and interventional studies, randomized controlled trials and qualitative studies.

Exclusion criteria: Studies containing inadequate information about the participants and type of study; studies in languages other than English; studies assessing outcomes unrelated to medical student research; theses or commentaries; studies aimed at postgraduates or undergraduates other than medical students; studies whose main population was MD/PhD students. Graduate-entry medical students, nonetheless, were not excluded from this review.

Two of the authors independently reviewed the studies that met these criteria and any disagreements were resolved by consensus. Basic data extraction tables were then used to extract the main finding and characteristics of each of the included studies. Quantitative studies (reporting odds ratios (OR's), p-values, percentages or other statistical measures) were separated from qualitative studies in order to improve the judgment of cumulative evidence.

Qualitative studies were included in order to help contextualize the quantitative outcomes and to provide insights and entry points for future research. Qualitative studies were defined as those studies which satisfied the following criteria: a) Their aims did not include the extraction of quantitative outcomes and thus did not perform any statistical analysis; b) They present original research with clearly-defined study populations; c) They utilize qualitative research methods, including semi-structured and unstructured interviews, open-ended survey questions, focus groups and examination of records and documents.

An integrated methodology was utilized to assimilate quantitative and qualitative outcomes into a single mixed-methods synthesis [ 21 , 22 ]. After relevant studies have been identified, a thematic analysis was performed. The literature search and article inclusion/exclusion strategy was aimed at retrieving all articles relevant to the subject of medical students' research, without prior conceptions or theories about expected outcomes. Hence, our thematic analysis was data-driven (as opposed to being theory-driven) [ 22 ]. Quantitative and qualitative outcomes were discussed together under relevant thematic subject headings.

Two types of quantitative outcomes were used for meta-analysis: percentages (for explorative outcomes) and odds ratios (for interventional/associative outcomes). Whenever relevant or needed, the corresponding authors (or, if unavailable, other authors) of included studies were contacted to get the raw data needed for meta-analysis. In some cases, other outcomes beside the ones mentioned in the original paper were identified in the raw data and used for the meta-analysis.

Further details about the methodology used in this paper, including outcome-specific quality assessment, statistical methods used and the strategy used to tackle study heterogeneity and potential publication bias can be found in our supporting information ( S2 File ).

Results and Discussion

Our search returned 31,367 records in the various databases. After reviewing the abstracts, 31,111 were excluded because they were either duplicates in various databases or satisfied one or more of the exclusion criteria mentioned earlier. 256 articles met (or were suspected to meet) our inclusion criteria upon reviewing their abstract and were thus retrieved for full-text assessment. Eventually 79 articles were found to match the selection criteria and were included in this review. More details about the article selection process can be seen in Fig 1 .

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Of the 79 articles retrieved, 71 were of quantitative nature, seven were of qualitative nature and one had both quantitative and qualitative components. Fifty-two articles were self-reported questionnaire studies with response rates ranging from 7.9% to 100%. Ten survey-based articles had response rates less than 60%. Twenty-three studies used a more objective research strategy that relied on searching institutional databases and records, two used both questionnaires and objective database searching and two had an unknown/undisclosed methodology. There were 47 cross-sectional studies, 25 retrospective studies, three prospective studies, three intervention studies and one study with an unknown/undisclosed design. Fifty-seven studies were performed in a single institution (including four qualitative study) and 22 studies involved multiple institutions (including four qualitative studies). Further, there were 14 studies that reported the effects of certain research programs or initiatives, whose study population might or might not be affiliated with multiple institutions. Sixteen studies assessed the value of intercalated BSc's (iBSc's) and 14 studies were carried out in developing countries.

After thematic analysis was performed, the resultant themes and sub-themes, outlined in Fig 2 , also served as the scaffold for writing this paper. The data extraction and quality assessment worksheet and the relevant sensitivity plots can also be found in the supporting information files ( S3 and S4 Files , respectively) [ 7 , 8 , 10 , 11 , 23 – 90 ].

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Assessing the current situation

We assessed the current state of medical student research by focusing on two main outcome measures: interest in- and exposure- to research among the medical student population. Both of these outcomes are explorative in nature (rely on proportions rather than odds ratios) and have been quantitatively pooled to yield a weighed estimate value. The results have been summarized in Fig 3 [ 7 , 10 , 26 , 28 , 32 , 47 – 49 , 52 , 54 , 55 , 58 , 63 , 67 – 69 , 71 – 75 , 80 – 82 , 85 , 90 – 92 ] .

Forest Plot symbols: * The axis, not the data, is shown in logit scale for aesthetic purposes. Table symbols: * Mandatory exposure (in the form of curricular components or graduation theses) was excluded from this analysis. Abbreviations used: D, developing countries; H, higher commitment to a research career; I, intercalated Bachelor of Science degree (iBSc). Dates are shown beside studies that may be confused with others referenced in this review having the same similar first-author names.

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Interest in research among medical students.

While the only reliable method for probing interest in medical research is assessing actual voluntary research involvement, survey data (self-reported interest) may provide insights into any discrepancies between interest and actual involvement. To avoid pooling survey data that are too heterogeneous, we made a distinction between survey questions that ask about general interest in research and those specifically asking medical students about their interest in making commitments to research during their future careers.

I1a: Interest in performing research: A pooled weighed estimate of 72% of medical students reported having interest in performing research (0.72, 0.57–0.83). One particularly high estimate was that reported by De Olivera and colleagues, which showed that 90% of its 1004 student sample had interest in performing research [ 74 ]. However, even when this study was excluded from the analysis as a possible exception, the pooled weighed estimate remained fairly high (0.67, 0.53–0.79) ( S4 File ).

I1b: Interest in a career involving research: The single best estimator of career intentions of US medical graduates is probably the Graduation Questionnaire (GQ), developed by The Association of American Medical Colleges (AAMC) in 1978 [ 7 ]. In 2013, 63% of the 13,180 respondents indicated intentions to become somewhat-to-exclusively involved in research during their medical careers, including 17% who planned "significant" or "exclusive" future involvement. This huge sample size approaches a true census, with 81.8% of the US fresh medical graduate population being covered.

Upon quantitative pooling of our included studies, we found that about 31% of medical students (0.31, 0.19–0.46) were interested in a career involving research, and 12% (0.12, 0.07–0.21) showed interest in "significant" (higher) commitment to research during their future careers. One particularly important, high-quality study was that of McManus and colleagues, showing that 6.9% of UK medical students planned to pursue academic careers (or found them to be very appealing) [ 85 ]. When we calculated the pooled outcome excluding MacManus et al or the AAMC data, the pooled proportion was not markedly changed ( S4 File ).

It should be noted that there is considerable variation in the proportions reported in our included studies. This may reflect inherent (true) variability in students' research interests due to diversity of settings and study populations (as has been discussed in S2 File ). We also believe that there are other potential contributors to this variability, most notably the ambiguity of wording of survey questions. For example, many studies did not make a clear distinction between interest in an academic (university faculty) medicine career, and interest in a career involving some research outside of academia.

I2. Medical students’ exposure to research.

Even today there is no consistent way in which undergraduate medical students are incorporated into research. For example, students may be engaged in research through summer research electives [ 9 , 45 ], mandatory curricular study modules [ 90 ], extracurricular research activities [ 93 ], or they might decide to intercalate for one or more years to obtain a BSc beside their medical degree. In Germany, it is mandatory for medical students to submit a thesis outlining the results of a research project in order to graduate with the title "Doctor" [ 30 ]. This requirement has also been reported in Peru, Finland, France and some U.S. universities such as Yale [ 24 , 27 , 76 , 94 ]. The AAMC 2013 Graduation Questionnaire shows that 68.2% of US medical graduates participated in a research project with a faculty member on a mandatory or volunteer basis and 41.7% co-authored a research paper [ 7 ].

If we exclude papers describing medical schools asking for mandatory graduation theses or research modules, we find that a little less than one third of medical students participated in research projects (0.31, 0.22–0.41). The proportion exposed to “prolonged” periods of research (>6 weeks) is even less (0.22, 0.16–0.28).

In the U.S., different medical schools have different research expectations, and the exposure of medical students to non-mandatory research seems to be largely dependent on medical school influence. Duke University, for example, incorporates students into summer-long research projects [ 95 ]. On the other hand, Stanford University, the University of Pittsburg and Warren Alpert Medical Schools incorporate students into longitudinal research projects in parallel with their academic studies [ 95 – 97 ]. This longitudinal approach may help in solving some of the reported problems of time-out research, such as the reluctance of medical students towards detachment from their colleagues and financial worries about spending extra time in college. Indeed, the success of Stanford is particularly evident, with 90% of medical students participating in research projects [ 91 ].

We found that the pooled proportion of medical students reporting some interest in research is higher than that of students who were actually involved in research projects. This may be due to: a) self-reported interest may not necessarily reflect serious willingness to pursue research; or b) lack of opportunities to meet students’ interest due to lack of funding, supervision and encouragement or inflexible curricula that leave little or no time for research ( S5 File ) [ 45 , 47 – 50 , 52 , 55 , 57 , 68 , 74 ].

II. Factors related to- or affecting medical student research

We identified four main factors affecting medical student research: previous research experience, academic success, having a higher degree (MSc or PhD) at the time of matriculation and financial factors. The effects of the first three factors were reported using odds ratios due to the presence of untreated groups ( Fig 4 ) [ 32 , 47 , 52 – 55 , 58 , 62 , 63 , 67 , 79 , 81 , 92 , 98 ], while the fourth factor (financial influence) was pooled using proportions from survey studies ( Fig 5 ) [ 55 , 57 , 59 , 67 , 82 ]. Moreover, we discuss the results of various studies reporting other relevant factors that could not be meta-analyzed, including the role of mentorship and competitive residencies in shaping medical students’ perceptions about- and attitudes towards research.

Forest Plot symbols: * The axis, not the data, is shown in log scale for aesthetic purposes. Abbreviations used: D , developing countries; I , intercalated Bachelor of Science degree (iBSc); M , motivation to perform research; K , research knowledge or skills; C , confidence in research competencies; In , interest in research. For some studies, odds ratios and 95% confidence interval values were reported, but not the raw numbers.

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II1. Effect of previous research experience.

Students who participated in research projects during medical school were over three times as likely to report interest in research involvement during their future careers (OR = 3.55, 1.84–6.83). Two studies [ 92 , 98 ], which were not included in the pooled weighed estimate, reported paired outcomes, with non-significant differences in research career interests after research exposure. Additionally, we found that medical school research involvement has no significant correlation with attitudes or motivation towards research (OR = 2.05, 0.99–4.24).

It is difficult to conclude that self-reported interest is a direct effect of exposure to research, since reverse causality cannot be excluded. That is, it is logical to assume that a fairly large proportion of students who had pre-existing interest in a career in research decide to participate in research projects. As a matter of fact, students in two of the included studies agreed that research participation strengthened pre-existing interest in a research career [ 90 , 91 ]. These findings also make sense in light of the fact that over half of all medical students reported having some interest in a career involving research ( Fig 3 ). Another possible explanation for the above results is that students who have had prior research experience have better research knowledge and skills, and are therefore more confident about their ability to succeed were they to undertake research projects during their future careers. Indeed, in a series of interviews conducted by Jones et al, students who undertook an intercalated BSc in primary healthcare reported a positive influence of the experience on their appreciation of the research process [ 99 ]. Similarly, a thematic analysis of 905 SSC (Student Selected Component) projects by Murdoch-Eaton et al provided by medical students at six UK medical schools revealed gain of various research-related skills [ 90 ]. These results are also supported by eleven quantitative studies, summarized in S5 File [ 11 , 37 , 39 , 40 , 46 , 47 , 55 , 64 , 82 , 89 , 91 ].

II2. Effect of having a higher degree (MSc or PhD) prior to medical school.

II2a: Having a higher degree is associated with involvement in- (or planned involvement in-) research: Siemens et al report that medical students who had a higher degree prior to enrolment in medical school were almost four times more likely to perform research during medical school (OR = 3.95, 2.22–7.01) [ 52 ]. However, data provided by Cruser et al showed no significant difference between the two groups regarding their planned involvement in future research (OR = 1.01, 0.57–1.79) and Gerrard et al actually reported the reverse trend, with higher degree graduate-entry medical students actually being less likely to pursue an iBSc [ 54 , 81 ]. This is consistent with data we obtained from Mahesan et al, which shows that graduate-entry medical students (having any degree prior to matriculation) were almost ten times less likely to pursue an intercalated degree (OR = 0.01, 0.00–0.13) [ 62 ].

Since career progress (especially the pursuit of competitive residency) is a major motive behind medical student research, it may be argued that medical students with a higher degree view this aspect of their Curriculum Vitae (CV) as being “complete enough” and hence devalue the pursuit of another degree. In fact, to the medical student with a prior degree, an iBSc will almost always result in degree duplication, even if the skills and knowledge base of the iBSc course were completely different from those of the other degree already gained by the student.

II2b: Other advantages of having a higher degree (MSc. or PhD.): There is no significant correlation between having a higher degree prior to medical school enrolment and research interest or motivation. However, as might be expected, higher degree graduate-entry medical students were more knowledgeable about research, showed better research skills and had higher confidence in their research competencies ( Fig 4 ). This is expected, given that almost all higher degrees have a compulsory research component.

II3. Effect of academic success.

II3a: Academic success is associated with attitudes towards basic medical sciences or medical research: The data we obtained from Hren et al shows an association between higher Grade Point Average (GPA) and attitudes towards research (OR = 1.83, 1.42–2.36) [ 79 ]. Cruser et al’s data, on the other hand, shows no significant difference between highest MCAT (Medical College Admission Test) scores and attitude scores [ 54 ]. Perhaps GPA during medical school, but not before admission, is a factor that influences attitudes. However, we believe the evidence in favor or against this hypothesis is weak and further investigation is needed in the future.

II3b: Academic success is associated with involvement in- (or planned involvement in-) research: The weighed pooled odds ratio from four included studies shows no association between academic success and involvement (or planned involvement) in research projects (OR = 1.00, 0.62–1.64). The only study showing a significant correlation was Brancati et al, which asserts that students who were academically successful (top third of their class) were more likely to choose an academic career (OR = 2.11, 1.30–3.42) compared to their less successful peers (lower third) [ 32 ]. However, this study investigates choice of an academic career rather than involvement (or planned involvement) in research during or right after medical school. Hence, it may be argued that this study should be excluded from the analysis as it measures a different outcome, in which case the pooled odds ratio remains non-significant (0.82, 0.59–1.15). We suggest further investigation into this issue using studies with more favorable, preferably prospective, designs.

II4. Financial factors affect the appeal of research to medical students.

About half of medical students who chose not to get involved in research reported being deterred by financial factors (0.50, 0.46–0.54) ( Fig 5 ) [ 55 , 57 , 59 , 67 , 82 ]. Nicholson et al and Stubbs et al both show that about half of medical students who choose not to intercalate do so for financial reasons [ 59 , 82 ]. In addition, Galletly et al also reported that about half (48%) of medical students asserted that perceived lower salaries of academicians was an important factor behind their decision not to pursue an academic career [ 55 ]. The consistency of the findings by the former two studies with the latter one suggests that it's not just the short-term financial burden of pursuing an intercalated degree that deters medical students from getting involved in research, but a general long-term financial concern. Financial worries, particularly the fear of running out of grant money and the financial stress of academic careers, were indeed cited by students interviewed by O'Sullivan et al among the deterrents to academic career pursuit [ 100 ].

Similarly, Yamazaki et al and Kumar et al both showed that a considerable fraction of the general medical student population displayed concerns about the financial stability of a research career (45% and 12%, respectively) [ 57 , 67 ].

II5. Career progression is a main motive behind performing research during medical school.

The result from seven included studies indicate that career progression is a main motive (if not the main motive) behind performing research during medical school. These results indicate that in a large fraction of cases, medical students perform research for purely pragmatic reasons (related to their residencies or further post-graduate education), rather than pursuing research for the value it has in and of itself ( Table 1 ) [ 48 , 49 , 52 , 54 , 55 , 82 , 86 ].

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Four studies mentioned the role competitive residencies play in driving medical students to perform research, and in fact students in three of those studies believed that seeking competitive residency was–explicitly- the main motive to perform research during medical school. The results from a qualitative study by Shapiro et al support this conclusion by showing that the motives behind research participation include (but are not limited to) pragmatic targets such as improving the students' relationship with faculty [ 101 ].

These conclusions are consistent with other results reported here showing that: a) there is a discrepancy between interest in clinical practice and interest in a research career ( S5 File ) [ 45 , 51 , 56 , 57 ] and b) there is a correlation between interest in academia or basic medical sciences and interest in research ( S5 File ) [ 55 – 57 ].

Combined, these findings indicate that any policies aimed at boosting medical students’ engagement in research have to align research involvement with the career progress and success of students. In much the same way that peer-reviewed publications are a key competitive edge in academia and in competitive residency applications, it must become clear that research is more than just an accessory when it comes to ordinary clinical practice.

II6. Other factors related- to or affecting medical student research.

As Reynolds has discussed, it is simply not enough to match students with professors in research projects, as good quality research requires real mentorship [ 102 ]. Research instructors also act as role models to encourage students to pursue careers in academic medicine. Further, finding the right mentor is important to ensure that students provide a working and intellectual input into the research projects, rather than simple assistantship in lab work or data collection ( Table 2 ) [ 48 , 52 , 57 , 58 , 82 ].

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This is not always going to be easy; the results from two qualitative studies show that the complexity of ethical approval procedures (whether in terms of time or paperwork) is a major difficulty facing supervisors and students alike [ 90 , 103 ]. Further, the absence of clear, well-structured research governance may result in some aversion to faculty-mentored student research. This was the case in two qualitative studies, where students cited problems with approachability of faculty members and expressed concerns about being used as "free labor" on research projects [ 90 , 101 ].

In fact, Murdoch-Eaton et al's aforementioned project content analysis, while revealing some gain in useful research skills, also highlighted the failed attainment of a balanced skill-set; the majority of student projects involved information gathering and data processing, while fewer projects involved actual student engagement in research methodology development or critical analysis of data [ 90 ].

It may be presumed that the relatively short duration of the undergraduate research experience could limit its publication or citation potential. Indeed, Dyrbye et al found that graduates with a 17–18 week-long research experience published significantly less papers in which they appeared as first authors than their peers who spent 21-weeks doing research [ 29 ]. Further, Fede et al showed that the annual Undergraduate Medical Congress of ABC foundation (COMUABC) had a smaller proportion of abstracts accepted for publication in peer-reviewed journals in comparison to conferences of practicing physicians [ 70 ]. Conversely, Van Eyk et al. reported that the average number of citations of Dutch medical student publications was actually higher than the average citations for papers in the same field. [ 41 ]

A number of studies investigated factors that prevent medical students from being involved in research. Poor mentorship, lack of role models and perceived lower salaries of academic physicians were among the key factors cited ( S5 File ) . The previous findings were also supported by four qualitative studies ( Table 3 ) [ 17 , 45 , 90 , 99 – 101 , 103 , 104 ] .

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In addition, institutional influence as well as the type and length of available research opportunities were found to be relevant factors in determining whether students choose to engage in research [ 51 , 53 ]. McLean and co-authors provided an excellent set of tips to bolster the involvement of students in academic medicine projects and potentially overcome some the aforementioned limitations [ 105 ].

. The importance of psycho-cognitive factors in determining medical students' motivation towards- and engagement in- research was also highlighted in the qualitative literature. One of the most important motives behind performing research is curiosity. Not only is curiosity a main motive behind pursuing research while in medical school (as has been shown by Shapiro et al [ 101 ]), it is one of the very early psycho-cognitive predictors of persistence into scientific or research disciplines even before enrolment into medical school [ 17 , 104 ]. Conversely, perceived lack of competence may deter medical students from pursuing research-active careers [ 45 ].

III) Assessing the impact and effect of medical student research

We assessed three main outcomes that reflect the short- and long- term impact of medical student research: 1) the proportion of research performed during medical school that culminates in a peer-reviewed journal publication, 2) the effect of medical school research on the career choice and future research involvement of medical students, and 3) the effect of medical student research on long- term success in academia. The first outcome has been summarized in Fig 6 [ 10 , 24 , 25 , 27 , 29 – 31 , 37 , 38 , 41 , 49 , 64 , 75 , 76 , 93 , 106 ] and the latter two are shown in Fig 7 [ 8 , 25 , 26 , 31 , 43 , 44 , 66 , 68 , 81 , 83 , 85 , 90 ].

Since the duration of research exposure will almost always affect the publication outcome, it has been shown too. Forest Plot symbols: * The axis, not the data, is shown in logit scale for aesthetic purposes. Table symbols: * The duration is probably prolonged (possibly months long); ** 20–40 European medical school credits; || For published projects, the average duration was 18 months. D , developing countries; I , intercalated Bachelor of Science degree (iBSc); HQ , relatively high quality publication (indexed in Medline, Scopus or Medic), HF , first-author publication in a relatively high quality journal. Dates are shown beside studies that may be confused with others referenced in this review having the same similar first-author names.

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Forest Plot symbols: * The axis, not the data, is shown in log scale for aesthetic purposes. Table symbols: * at least one first-author publication; ** at least one citation; || more than 20 citations. For some studies, odds ratios and 95% confidence interval values were reported, but not the raw numbers.

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III1. Medical student research results in a publishable product.

Peer-reviewed journal publications are generally considered to be the best indicator of research productivity, and it may be viewed as a major metric (though not the only one) of the “return on investment” in supporting and funding medical student research. An average of 30% (0.30, 0.19–0.44) of research performed by medical students resulted in a peer-reviewed journal publication. When only higher quality publications were included in the analysis (indexed in Medline, Scopus or Medic), the proportion remained more or less the same (0.31, 0.18–0.47). Subgroup analysis of studies investigating the research productivity of graduation theses revealed that 26% (0.26, 0.10–0.52) of graduation theses result in higher quality publications.

As expected, all studies reporting first -authored peer-reviewed publication by medical students described instances of prolonged research exposure. An average of 13% (0.13, 0.06–0.27) of medical student research resulted in a first-authored peer-reviewed publication. The pooled outcome remained the same when only higher quality publications (Medline-, Scopus- or Medic- indexed) were included in the analysis (0.13, 0.05–0.30).

A few initiatives, aimed at propping up medical student publication output, have gained popularity over the last few years. Those initiatives include a number of student-run journals and journal spaces dedicated solely for medical student research publications [ 107 – 110 ]. A subset of these journals is Medline-indexed and some even involve undergraduates in the peer-review process. Similarly, the Yale Journal of Biology and Medicine annually publishes Yale's student thesis abstracts [ 111 ]. These initiatives, we suppose, will help in promoting student participation in research and comfort students about publication issues. To our knowledge, there is no systematic investigation in the literature so far regarding the quality of research published in medical student research journals in comparison to field-specific journals. Hence, we would like to take a conservative stance whenever we see such hierarchical "segmentation" of the scientific enterprise; the stringency of research assessment, in our opinion, should be indiscriminant to the identity of the study authors.

It is important to note that the failure of publication of medical student research may be reflective of other factors beside the success and relative contribution of the student. For example, Weber et al showed that 55% of the papers submitted to a medical specialty conference did not reach the stage of publication five years later [ 112 ]. Similarly, Riveros et al found that half of the clinical trials reporting results in ClinicalTrials.gov had no corresponding journal publication [ 113 ]. Keeping this in mind, the results by Cursiefen et al should not be surprising; showing that medical students were among the authors of 28% of the papers produced by a German medical faculty, even though only 66% of medical student research resulted in a publication [ 30 ].

III2. Research during medical school is associated with later involvement in research projects.

Students who took part in research projects during medical school were more likely to get involved in (or report planned involvement in-) research later in their careers (OR = 3.58, 1.82–7.04). When a subgroup analysis was performed to include only studies that explicitly refer to academic careers (as opposed to brief research encounters), students who performed research during medical school were over six times as likely to pursue academic careers (OR = 6.42, 1.37–29.98) than their “untreated” peers.

With one exception, none of the included studies had a prospective design; hence reverse causality cannot be excluded, and is in fact very likely (students planning academic medicine careers choosing to get involved in research during medical school). Indeed, the only prospective study included (McManus et al [ 85 ]) showed that at the time of application to medical school, students who later chose to take an intercalated degree were already significantly more likely to report definite or highly likely choice of academic medicine careers (OR = 1.37, 1.13–1.66). Just before graduation, however, this likelihood had a substantial increase (OR = 3.45, 2.27–5.24). Together, these results indicate that medical school research strengthens pre-existing interest in an academic career.

A qualitative study by O'sullivan et al emphasized the value of early research exposure in giving medical students the opportunity to entertain the thought of pursuing academic careers [ 114 ]. Such exposure, they concluded, may sometimes even discourage students from pursuing academia, but is necessary nonetheless given the lack of sufficient free time during post-graduation residency to experience research.

III3. Research during medical school is associated with long-term success in academia.

Three studies showed that physicians who performed research during medical school were more likely to attain faculty rank long after graduation [ 8 , 32 , 66 ]. While this has implications on the decision of individual medical students to pursue research, we argue that it has little bearing on policy decision-making, since faculty positions are awarded on a competitive basis. Indeed, Brancati et al showed that this effect was dependent on the publication status of research performed during medical school [ 32 ]. In other words, students who did not publish their research were not significantly more likely to attain higher faculty rank on the long run. Hence, the fact that medical student research is associated with higher likelihood of attaining faculty positions has little implications regarding the systematic incorporation of research into medical curricula.

Students who performed research during medical school were more than twice as likely to author at least one peer-reviewed publication later in their career (OR = 2.31, 1.88–2.83). This remained true after the exclusion of Chusid et al [ 25 ] (which correlates successful publication of graduation theses with long-term publication success) from the analysis (OR = 2.26, 1.83–2.77). They were also twice as likely to acquire first-authorship (OR = 2.21, 1.56–3.13). The total number of publications and ability to secure grants, too, was reported to be significantly higher among students with medical school research experience [ 81 ]. Evered et al, on the other hand, found no significant difference in either of those measures between both groups [ 66 ]. Moreover, students who performed research during medical school were more likely to be cited at least once [ 66 ], had a higher total citation count [ 81 ], were more likely to be cited more than 20 times [ 66 ], and had higher odds of receiving awards [ 8 , 81 ] later in their careers.

While this data provides strong evidence of a correlation between medical school research and long-term success in academia, a causal relationship cannot be established since students who decide to perform research may already have a keen interest in research. Nonetheless, a causal relationship is quite likely since early research experience (especially if it culminates in a first-authored publication) would naturally enhance the career prospects and significantly improve the CV’s of early career medical graduates. Overall, we believe that the long-term impact of medical school research is inadequately assessed, and that further evidence is needed using prospective study designs with proper adjustment for baseline status.

III4. Research during medical school is correlated with career choice of- (or interest in a career in-) the same or related specialty as the research project.

Three of the studies that met the broad inclusion criteria reported results from control or “untreated” groups. Other studies reported results only from treated groups and hence were excluded from the analysis. Overall, students are 2.7 times as likely to be interested in careers in the same (or related) clinical specialty as the research project they got involved in during medical school. As with many other conclusions in this review, a causal relationship cannot be determined from this apparent correlation. This is especially true in the case of competitive residencies (and is particularly relevant to US residencies), where research experience in the same specialty gives recent graduates a competitive edge over their peers without such experience.

The relationship between medical school research and clinical practice was also touched upon in two of the included qualitative studies. Shapiro et al showed that many faculty members mentored student research in family practice in order to attract students to the same specialty [ 101 ]. Indeed, students interviewed by Jones et al believed an iBSc in primary healthcare provided them with deeper insights into patient care and a more thorough understanding of evidence-based clinical practice [ 99 ].

IV) Miscellaneous topics related to medical student research

In the following section of this review we discuss a number of miscellaneous topics relevant to medical student research. Three of these topics were discussed in light of quantitative data, and are summarized in Fig 8 [ 28 , 29 , 47 – 49 , 53 , 54 , 58 , 59 , 62 , 63 , 67 , 71 , 79 , 81 , 83 , 88 , 89 , 92 ] and Fig 9 [ 24 , 27 , 33 , 37 , 38 , 50 , 64 , 70 ]. Though they did not pass our inclusion criteria, four of the citations screened were personal perspectives provided by medical students, and are worth mentioning for enriching the discussion. They discussed the importance of the research experience on their medical career [ 115 , 116 ], the importance of medical students' research in increasing national research output [ 117 ] and the relevance of lab research involving animals to appreciation of human anatomy and physiology [ 118 ].

Forest Plot symbols: * The axis, not the data, is shown in log scale for aesthetic purposes. Abbreviations used: D, developing countries; I, intercalated Bachelor of Science degree (iBSc); FC , studies measuring final year academic performance and controlling for baseline performance. Dates are shown beside studies that may be confused with others referenced in this review having the same similar first-author names. For some studies, odds ratios and 95% confidence interval values were reported, but not the raw numbers.

https://doi.org/10.1371/journal.pone.0127470.g008

https://doi.org/10.1371/journal.pone.0127470.g009

IV1. Effect of prolonged research time-off on subsequent academic performance.

One of the issues discussed in the literature is the effect of prolonged research time-off amid the medical program on subsequent clinical knowledge. This question has been assessed in the context of iBSc degrees in a recent review [ 119 ]. All but one of our included studies investigated the effect of taking an intercalated degree on subsequent academic performance. The results have been conflicting; two studies that either matched groups by previous performance or adjusted for pre-clinical scores found no evidence of improvement in scores [ 88 , 120 ]. All five other studies that met our inclusion criteria reported an improvement in academic performance.

Due to heterogeneity in academic assessment methods and high possibility of confounding, we only pooled the studies for which we could extract odds ratio values that: a) measure final year academic scores and b) control for previous academic performance. Three studies met these two inclusion criteria, all of which reported the effect of iBSc degrees. On average, students who took some time off to perform research were twice as likely to outperform their peers (OR = 1.99, 1.39–2.84), even after adjustment for previous academic performance. It is noteworthy that all pooled studies investigated research time-off that was around one year in duration (iBSc), and that the positive effect of research time-off on subsequent academic performance may actually be reversed if the research delays are prolonged. Dyrbye et al pinned down a critical period of three years, after which medical students start to lose clinical knowledge and skills by the time they return to the core medical program [ 28 ].

IV2. Gender equality in medical student research.

There is no apparent gender difference regarding the following outcomes: Interest in a career in research ; involvement in research during medical school ; attitudes towards research ; interest in- or motivation towards- performing research ; research knowledge or skills. However, on average, males seem to be significantly more likely to publish (or submit for publication) the research they performed during medical school (OR = 1.59, 1.26–2.01). The reasons behind this gender gap in publication are unclear to us, and have been inadequately researched. Since there is no apparent gender difference in research perceptions, attitudes, motivations or knowledge, we suspect that the gender difference in publications is due to factors unrelated to research such as the overall academic environment or psychosocial factors. Indeed, these findings are consistent with a 2006 study by Jagsi et al showing a generalized gender gap in the authorship of academic medical articles in six major medical journals. Whatever the reasons behind gender differences in publication, they underlie a general issue not specific to medical school research [ 121 ].

IV3. Type and field of research performed by medical students.

The majority of medical student research is original in nature (as opposed to literature reviews). We were interested in finding out what percentage of these research projects were in the basic sciences, since this issue is of particular relevance to translational research. We found that the proportion was highly variable between different studies. In four of the five included studies less than half of medical student research was lab-based basic research, and the pooled weighted estimate was 0.32, 0.14–0.49. Given the relevance of research to competitive residency applications, it should not come as a surprise that lab-based projects do not constitute the majority of medical student research. Nonetheless, these results indicate that efforts directed at increasing the number of physician scientists involved in translational research should not only be directed at bolstering research involvement, but also improving the appeal of basic lab-based research to medical students.

IV4. Compulsory vs. elective medical school research.

The question of whether undergraduate medical research should be made compulsory or elective has been discussed in the literature, and is a matter of debate [ 37 , 97 , 122 ]. Arguments in favor of mandatory incorporation revolve around the ever-increasing importance of evidence-based clinical practice, while arguments against it revolve around the importance of focusing on clinical skills education. Diez et al. recommended against Germany's dissertation requirement, due to the steady decline in the number of successful dissertations [ 123 ]. Our results tell a similar story; the fraction of graduation theses resulting in a first-authored higher quality publication was smaller than the overall average (0.07, 0.03–0.14). At first, this may seem counterintuitive, as one may predict that the systematic incorporation of research as a necessary graduation requirement would raise the fraction culminating in a first-authored higher quality publication. However, one needs to bear in mind that since graduation theses are an obligatory requirement, a fraction of those students performing research may not be interested at all in what they are doing. Taking this into consideration, it should not come as a surprise that percentages as high as 34% (Cohen et al [ 38 ]) and 31% (Dyrbye et al [ 29 ]) of voluntary medical student research were reported to result in first-authored Medline-indexed publications. Weihrauch et al and Pabst et al, on the other hand, reported favorable results in terms of the personal and professional value of the German dissertation requirement [ 124 , 125 ].

IV5. The situation in countries with developing economies.

We retrieved studies that were performed in India [ 67 , 72 ], Uganda [ 68 ], China [ 69 ], Brazil [ 70 , 74 ], UAE [ 71 ], Croatia [ 73 , 79 ], Pakistan [ 75 , 77 , 80 , 86 ], Peru [ 76 ], and Turkey [ 78 ].

The number of medical schools and the research budget in developing countries are alarmingly mismatched with their needs [ 1 ]. This disparity, we believe, reflects naturally on the status of medical student research. In fact, medical student research might be even more important in developing countries than in developed countries, due to the pressing need to adapt international standards to local community needs.

Medical students in developing countries arguably face a set of extra challenges and are influenced by a number of different factors in comparison to developed countries [ 126 ]. For example, the high student-to-teacher ratio makes it increasingly difficult for medical students to have mentors and role models. Even research based on statistical analysis of patient records is often difficult to perform in many medical schools, due to suboptimal Information and Communications Technology (ICT) infrastructure in hospitals and in teaching premises in countries with developing economies [ 127 ]. While excellent research may of course be performed in resource-poor countries, it is preferable that any reform in research funding is coupled with a well-developed educational and managerial infrastructure; otherwise the research output may be largely suboptimal [ 128 ]. Worryingly, an essay by Silva et al. reported a decrease in the ratio of Undergraduate Student Research Assistant Programs (USRA's) to the number of undergraduates in Brazil over the past years [ 129 ].

Students’ interest in research was higher in countries with developing economies than in developed countries (0.82, 0.67–0.91 vs. 0.47, 0.26–0.69). One possible explanation for this finding is that the lack of opportunities causes higher eagerness to perform research. Another, possibly more likely, explanation is higher career-related anxiety in lower-income settings, with a resultant boost in research interest. Indeed, students in developing countries were not significantly less exposed to research, a result which may be reflective of the higher interest rates, bolstering research engagement despite inadequacies in resources. These results are supported by the findings of Baig et al, showing that 40% of Pakistani medical students viewed research as a tool to secure competitive residencies in the US [ 86 ].

Conclusions and Future Directions

Overall, our review shows that there’s considerable variability in medical student research exposure, engagement and productivity among different medical schools. A large proportion of the medical student population is interested in research, but is deterred by practical difficulties, including the lack of opportunities and funding. The benefits of research exposure on the short- and long-term scientific productivity is well documented in the literature, and a clear correlation is identified between medical school research engagement and later engagement in research projects (including the choice of an academic career). However, the number of well-controlled, high-quality prospective studies on the topic is limited and it is difficult to exclude reverse-causality. Existing evidence suggests that medical school research does have a positive effect on the choice of an academic career, but it does so through strengthening pre-existing interest. Financial worries, gender, having a higher degree (MSc or PhD) before matriculation and perceived competitiveness of the residency of choice are among the factors that affect the engagement of medical students in research and their scientific productivity.

Another potential limitation of this review is publication bias. It is conceivable that medical schools where students had a positive experience with research rush to publish their results, whereas others with experiences that were not so positive blamed it on the design of the program without publishing their results. It is also clear that there are plenty of successful undergraduate research programs that do not publish their results.

We suggest that more studies are done to assess the different structural and managerial aspects of standardized undergraduate medical research, as well as the differences between compulsory research components, elective research components, intercalated BSc's and extracurricular research in terms of academic, professional and psycho-cognitive effects. Further, we recommend more investigation into the quality and citation potential of published medical student research in comparison to that of established researchers and physicians.

Supporting Information

S1 file. prisma guidelines checklist..

https://doi.org/10.1371/journal.pone.0127470.s001

S2 File. Supplementary methodology file.

https://doi.org/10.1371/journal.pone.0127470.s002

S3 File. Quality assessment and quantitative data extraction sheet.

Abbreviations used: D, developing countries; I, intercalated Bachelor of Science degree (iBSc); X, Cross-sectional; R, Retrospective; I , Interventional; Pro , Prospective; Q, questionnaire; DS , database search; IN, interview.

https://doi.org/10.1371/journal.pone.0127470.s003

S4 File. Sensitivity plots for the pooled effect size values calculated.

https://doi.org/10.1371/journal.pone.0127470.s004

S5 File. Supplementary tables accompanying the main text.

https://doi.org/10.1371/journal.pone.0127470.s005

Acknowledgments

We would like to acknowledge with gratitude the following authors (and their co-authors) for sending us raw numbers to be used in our meta-analysis: Dr Nishanthan Mahesan, Dr des Anges Cruser, Dr Louise Burgoyne, Dr Neel Halder, Dr Cherrie Galletly, Dr Tracy Air, Dr Anna Chur-Hansen, Dr Craig Ziegler, Dr Ruth B. Greenberg, Dr Darko Hren, Dr Robert Siemens and Dr Matko Marusic.

Author Contributions

Conceived and designed the experiments: MA MMKT SJL ES. Performed the experiments: MA MMKT ES. Analyzed the data: MA MMKT SJL ES. Contributed reagents/materials/analysis tools: MA MMKT SJL ES. Wrote the paper: MA MMKT SJL ES.

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Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis

Affiliations.

• 1 Faculty of Medicine, Cairo University, Cairo, Egypt; Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan.
• 2 Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan.
• 3 European Institute of Oncology (IEO), Milano, Italy.
• 4 National Cancer Institute, Cairo University, Cairo, Egypt.
• PMID: 26086391
• PMCID: PMC4472353
• DOI: 10.1371/journal.pone.0127470

Importance: Despite the rapidly declining number of physician-investigators, there is no consistent structure within medical education so far for involving medical students in research.

Objective: To conduct an integrated mixed-methods systematic review and meta-analysis of published studies about medical students' participation in research, and to evaluate the evidence in order to guide policy decision-making regarding this issue.

Evidence review: We followed the PRISMA statement guidelines during the preparation of this review and meta-analysis. We searched various databases as well as the bibliographies of the included studies between March 2012 and September 2013. We identified all relevant quantitative and qualitative studies assessing the effect of medical student participation in research, without restrictions regarding study design or publication date. Prespecified outcome-specific quality criteria were used to judge the admission of each quantitative outcome into the meta-analysis. Initial screening of titles and abstracts resulted in the retrieval of 256 articles for full-text assessment. Eventually, 79 articles were included in our study, including eight qualitative studies. An integrated approach was used to combine quantitative and qualitative studies into a single synthesis. Once all included studies were identified, a data-driven thematic analysis was performed.

Findings and conclusions: Medical student participation in research is associated with improved short- and long- term scientific productivity, more informed career choices and improved knowledge about-, interest in- and attitudes towards research. Financial worries, gender, having a higher degree (MSc or PhD) before matriculation and perceived competitiveness of the residency of choice are among the factors that affect the engagement of medical students in research and/or their scientific productivity. Intercalated BSc degrees, mandatory graduation theses and curricular research components may help in standardizing research education during medical school.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Fig 1. Flow diagram of the citation…

Fig 1. Flow diagram of the citation screening and article selection process followed in this…

Fig 2. Themes and sub-themes resulting from…

Fig 2. Themes and sub-themes resulting from the thematic analysis of included quantitative and qualitative…

Fig 3. Assessing the current situation: Interest…

Fig 3. Assessing the current situation: Interest in- and exposure- to research among medical students.

Fig 4. Factors related to- or affecting…

Fig 4. Factors related to- or affecting medical student research (i)–Effects of previous research experience,…

Fig 5. Factors related to- or affecting…

Fig 5. Factors related to- or affecting medical student research (ii)–The effect of financial factors…

Fig 6. The proportion of medical student…

Fig 6. The proportion of medical student research resulting in a peer-reviewed journal publication.

Fig 7. The impact of medical student…

Fig 7. The impact of medical student research–Impact of medical student research on career choice…

Fig 8. Miscellaneous topics related to medical…

Fig 8. Miscellaneous topics related to medical student research.

Fig 9. Characterizing the research performed by…

Fig 9. Characterizing the research performed by medical students.

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A How To Guide For Medical Students

• © 2024
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• Andrea Gillis 0 ,
• Cary B. Aarons 1

Department of General Surgery, University of Alabama at Birmingham, Birmingham, USA

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Division of Colon and Rectal Surgery, Columbia University Irving Medical Center, New York, USA

• A thorough exploration of career planning for a medical student interested in surgery
• An updated discussion on applying for and deciding on a residency program
• Shows how to build strong clinical skills, research profile, mentorship team, and social media presence for a successful career

Part of the book series: Success in Academic Surgery (SIAS)

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About this book

This book will provide a guide for medical students to self-reflect, build a portfolio, and select a career path equipped with the knowledge to make an informed decision that is the best for them. 

The editors comprise a diverse spectrum from background, stage of training, type of practice, to career path. This is a timely update taking into account new situations such as the virtual environment for residency applications, the spotlight on residency wellness, and incorporating diversity, equity, and inclusion in our personal and institutional missions.

• Career in Academic Surgery
• Developing Research Portfolio
• Leadership Skills
• Learning Surgery
• Program Director
• Residency Programs
• Successful Surgeon
• Surgical Education
• Medical Education
• Diversity, equity, and inclusion
• Residency recruitment
• Career development

Table of contents (25 chapters)

Front matter, exploring surgical specialties and practice settings, assessing your interests, skills, and values.

• Amir A. Ghaferi

Choosing a Surgery Training Environment: Military Programs

• Suzanne Gillern

Choosing a Surgery Training Environment: Independent Programs

• Jonathan Dort

Choosing a Surgery Training Environment: Rural Surgery Programs

• Kristen Laaman, Joon K. Shim

Choosing a Surgery Training Environment: University-Based Programs

• Jesse Passman, Major Kenneth Lee IV

Overview of the Surgical Subspecialties: Plastic and Reconstructive Surgery

• Robert George, Samuel Poore

Overview of the Surgical Subspecialties: Vascular Surgery

• Benjamin J. Pearce, William D. Jordan Jr

So you Want to Be a Cardiothoracic Surgeon?

• Islam Hasasna, Paul Rothenberg, J. W. Awori Hayanga

Maximizing the Clinical Years in Medical School: A Fourth Year Student’s Perspective Preparing for Surgical Training

• Noah Tocci, Kennedy Jensen

Navigating the Residency Application Process

Developing a competitive residency application.

• Jessica Zagory, Vikas Dudeja, Tania K. Arora

Navigating the Residency Application Process: Understanding the Updates to the Recruitment Process

• Hayley Reddington, Jennifer LaFemina

Navigating the Residency Application Process: Preparing for Both Virtual and In-Person Residency Interviews

• Deanna L. Palenzuela Rothman, Sophia K. McKinley

Navigating the Residency Application Process: A Recent Applicant’s Perspective on Choosing a Residency Program

• Ofelia Negrete Vasquez

Excelling in Surgical Training

Developing clinical and technical skills.

• Rebecca Moreci, Gabrielle Moore, Tania K. Arora

Utilizing Technology and Simulation-Based Training

• Sophie E. Mayeux, Catherine McManus

Strategies for Succeeding During Intern Year: Perspectives from Recent Surgical Interns

• Courtney Rentas, Chukwuma Eruchalu

Editors and Affiliations

Andrea Gillis

Cary B. Aarons

About the editors

Andrea Gillis  is an Assistant Professor in the Division of Breast and Endocrine Surgery at the University of Alabama at Birmingham. After receiving her M.D. from Columbia University and completing surgical residency at Albany Medical Center in New York. She completed endocrine surgery fellowship training at the University of Alabama at Birmingham where she began her career. Her clinical interests include thyroid cancer, benign thyroid disease, hyperparathyroidism, adrenal disease, and surgical treatment of inherited endocrine syndromes. Dr. Gillis is a health outcome disparities and translational science researcher working in the field of epigenetics, specifically examining differences in gene expression in neuroendocrine tumors by race. She is extramurally funded in order to pursue this work. She is also passionate about surgical education and shoring up the pipeline of talented academic surgeons, she serves as the Associate Clerkship Director in this capacity.

Cary B. Aarons  is a Professor of Surgery at Columbia University Irving Medical Center, where he is also currently the Program Director for the General Surgery Residency. He received his undergraduate degree from Harvard University and his medical degree from Howard University College of Medicine in Washington, DC. He then completed his general surgery training at Boston University Medical Center followed by his colorectal surgery fellowship at the Mayo Clinic in Rochester, Minnesota. Dr. Aarons has held several roles in education leadership and has a record of research scholarship in surgical education.

Bibliographic Information

Book Title : A How To Guide For Medical Students

Editors : Andrea Gillis, Cary B. Aarons

Series Title : Success in Academic Surgery

DOI : https://doi.org/10.1007/978-3-031-66011-5

Publisher : Springer Cham

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Copyright Information : The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2024

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• Volume 14, Issue 8
• Exploring the link of personality traits and tutors’ instruction on critical thinking disposition: a cross-sectional study among Chinese medical graduate students
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• LingYing Wang 1 ,
• WenLing Chang 2 ,
• http://orcid.org/0000-0002-1507-7890 HaiTao Tang 3 ,
• WenBo He 4 ,
• http://orcid.org/0000-0002-6682-8279 Yan Wu 3 , 5
• 1 Critical Care Medicine Department, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University , Chengdu , China
• 2 School of Population Health & Environmental Sciences , King’s College London , London SE1 1UL , UK
• 3 Department of Postgraduate Students, West China School of Medicine/West China Hospital, Sichuan University , Chengdu , China
• 4 Institute of Hospital Management, West China Hospital, Sichuan University , Chengdu , Sichuan , China
• 5 College of Marxism, Sichuan University , Chengdu , China
• Correspondence to Yan Wu; wuyan{at}wchscu.cn

Objectives This study aimed to investigate the associations between critical thinking (CT) disposition and personal characteristics and tutors’ guidance among medical graduate students, which may provide a theoretical basis for cultivating CT.

Design A cross-sectional study was conducted.

Setting This study was conducted in Sichuan and Chongqing from November to December 2021.

Participants A total of 1488 graduate students from clinical medical schools were included in this study.

Data analysis The distribution of the study participants’ underlying characteristics and CT was described and tested. The Spearman rank correlation coefficient was used to evaluate the correlation between each factor and the CT score. The independent risk factors for CT were assessed using a logistic regression model.

Results The average total CT score was 81.79±11.42 points, and the proportion of CT (score ≥72 points) was 78.9% (1174/1488). Female sex (OR 1.405, 95% CI 1.042 to 1.895), curiosity (OR 1.847, 95% CI 1.459 to 2.338), completion of scientific research design with reference (OR 1.779, 95% CI 1.460 to 2.167), asking ‘why’ (OR 1.942, 95% CI 1.508 to 2.501) and team members’ logical thinking ability (OR 1.373, 95% CI 1.122 to 1.681) were positively associated with CT while exhaustion and burn-out (OR 0.721, 95% CI 0.526 to 0.989), inattention (OR 0.572, 95% CI 0.431 to 0.759), Following others’ opinions in decision-making (OR 0.425, 95% CI 0.337 to 0.534) and no allow of doubt to tutors (OR 0.674, 95% CI 0.561 to 0.809) had negative associations with the formation of CT disposition in the fully adjusted model.

Conclusions Factors associated with motivation and internal drive are more important in the educational practice of cultivating CT. Educators should change the reward mechanism from result-oriented to motivation-maintaining to cultivate students’ CT awareness.

• risk factors
• public health

Data availability statement

Data are available on reasonable request.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2023-082461

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STRENGTHS AND LIMITATIONS OF THIS STUDY

Our study focused on postgraduate medical students, and the sample size was relatively large.

Previous research on critical thinking has focused primarily on Europe, the USA and Japan. Hence, researching critical thinking in Chinese populations is a valuable addition to this area.

Given the traditional limitations of cross-sectional studies, the findings of this study cannot be used as direct evidence of a causal relationship between potential influences and outcomes. Nevertheless, they can provide clues to reveal causal relationships.

Introduction

Critical thinking (CT) is reasoned, reflective thinking that decides what to believe or do. The emphasis is on reasonableness, reflection and decision-making. 1 CT is even more important in the medical field, where a lack of CT can lead to delayed or missed diagnoses, incorrect cognition and mismanagement. The centrality of CT is reflected in the competency framework of health professions and is a core skill of healthcare professionals. 2–6 Six crucial skills have been proposed to operationalise the definition of CT: interpretation, analysis, evaluation, inference, explanation and self-regulation. Specifically, interpretation involves comprehending the significance of information and conveying it effectively to others. Analysis requires piecing together fragmented data to decipher their intended purpose. Inference entails identifying and leveraging relevant information to formulate logical conclusions or hypotheses. Evaluation necessitates assessing the trustworthiness of a statement or information. Explanation aims to clarify shared information to ensure its comprehensibility to others. Finally, self-regulation pertains to regulating one’s thoughts, behaviours and emotions. 7–9

The role of CT in assisting medical students in navigating complex health scenarios and resolving clinical issues through sound decision-making is paramount. Extensive research has established positive correlations between CT and clinical proficiency, 10 11 academic excellence 12 and research capabilities. 13 Consequently, the Institute for International Medical Education has emphasised ‘CT and research’ as one of the seven crucial competencies that medical graduates must possess, as outlined in the Global Minimum Essential Requirements. 14 Similarly, the Ministry of Education in the People’s Republic of China has underscored the importance of ‘scientific attitude, innovation and CT’ as essential requirements for Chinese medical graduates. 15

Research on CT in medical students has been carried out to varying degrees in Western countries and many Asian countries. 16 17 Some scholars have pointed out that Western methods, including CT and clinical reasoning, are used in thinking skills education worldwide. However, there are significant differences between Chinese and Western culture, especially educational culture while cultural differences affect ways of thinking 17 18 ; therefore, previous research may not be able to reflect the actual situation of Chinese students and teaching methods may not apply to them. Most Western students tend to possess assimilating learning styles, enabling them to excel in student-centred learning environments. Conversely, Eastern students often exhibit accommodating learning styles that align more with teacher-centred instruction. 19 The discipline-based curriculum in China may not adequately foster the development of CT dispositions among Chinese medical students. This curriculum typically comprises isolated phases (theory, clerkship and internship), limited faculty–student interaction and a knowledge-focused evaluation system. 20

Previous research has suggested that a range of personal characteristics, including gender, major, blended learning methods, increased self-study hours, heightened self-efficacy in learning and performance, exposure to supportive environments and active participation in research activities, contribute to varying degrees of CT dispositions and skills. 21–24 A study conducted in Vietnam revealed that age, gender, ethnicity, educational level, health status, nursing experience, tenure at the current hospital, familiarity with ‘CT’ and job position all influence CT ability. 25 Furthermore, teacher support is paramount to learners’ mental and psychological development. This support encompasses educators’ empathy, compassion, commitment, reliability and warmth towards their students. 26 According to Tardy’s social support paradigm, 27 teacher support is defined as providing informational, instrumental, emotional or appraisal assistance to students, irrespective of their learning setting. Supportive teachers prioritise fostering personal relationships with their students and offering aid, assistance and guidance to those in need. 28 Practical teacher assistance can make students feel comfortable and inspired, motivating them to invest more effort in their studies, engage more actively in educational pursuits and achieve superior educational outcomes. 29

Current CT research on mainland Chinese medical students focuses on the impact of undergraduates’ experiences and classroom instruction. However, for postgraduates, their tutors play a more critical role in education and cultivation. According to Wosinski’s study, 30 tutors should be trained to effectively guide the teamwork of undergraduate nursing students during the problem-based learning (PBL) process to achieve their goals. There is no analysis of the influencing factors of CT focused on medical postgraduates.

Therefore, assessing the tutor’s effect on postgraduates’ CT disposition. This study investigated the associations between CT disposition and personal characteristics and tutors’ guidance among medical graduate students, which may provide a theoretical basis for cultivating CT.

Study design and participants

Study design.

This was a cross-sectional observational study. The project team sent 1525 electronic questionnaire links to WeChat groups of full-time medical graduate students in higher medical institutions in Sichuan and Chongqing between November and December 2021. After removing incomplete and duplicate questionnaires, a total of 1488 valid questionnaires were returned for an effective rate of 97.57%.

Sampling procedure

We employed a random sampling method to select medical graduate students carefully and used PASS V.15.0 software to calculate the sample size for different analyses and outcome scenarios. In the estimation of the sample size with the proportion of CT disposition as the primary outcome, we considered p=0.5, adopted the two-sided Z value under the significance level of a=0.05, and the sample size was the largest when the sampling error was 3%, which was 1067. Moreover, estimating of sample size with the correlation coefficient as the primary outcome, we considered r=0.1 according to the results from the prestudy, and the test power was 0.9; thus, we obtained n=1048. The sample size should be at least 1334 considering a 20% non-response rate.

The inclusion criteria were as follows: (1) full-time medical graduate students (clinical medicine, medicine technology, integrative Chinese and Western medicine, medical laboratory, nursing and so on) in higher medical institutions in Sichuan and Chongqing and (2) after reading the introduction to the research, participants voluntarily agreed to participate and electronically signed the study’s informed consent form. The exclusion criterion was a refusal to participate in the study.

Procedure and data collection

The electronic questionnaire we used consisted of a condensed version of the Critical Thinking Measurement Scale, which was used to evaluate participants’ scores on CT disposition and a Potential Influencing Factors Questionnaire, which investigated participants’ underlying information, personal factors and education-related factors. To increase the response rate, we told the students how long it might take to fill out this questionnaire when we sent the questionnaire link to WeChat groups. Moreover, our participants all had master’s degrees or above whose understanding ability and compliance were better. We also sent reminders to all invited participants three times, and the survey lasted approximately 1 month.

Critical Thinking Measurement Scale

We used the Chinese version of the short-form critical thinking disposition inventory (SF-CTDI-CV), which is based on the CTDI-CV reported by Huang. 31 The CTDI-CV includes seven subscales, namely Truth Seeking, Open-mindedness, Analyticity, Systematicity, Critical Thinking Self-confidence, Inquisitiveness and Cognitive Maturity, which have good reliability and validity (0.90 for the overall Cronbach’s alpha and 0.89 for the overall Content Validity Index). 32 Huang removed ineffective questions based on the CTDI-CV and obtained a simplified scale with 18 items of three factors, which increased the proportion of total explained variation and had better reliability and validity than the original version. Huang selected items according to important indicators in factor analysis, including factor loading and communality. Specifically, Huang removed items whose factor loading was less than 0.4 or whose commonality was less than 0.3. Each item of the SF-CTDI-CV has six options (Likert scale) from 1 to 6 (1 means complete agreement and 6 means disagree entirely); the higher the score is, the stronger the CT tendency. 31 The Kaiser-Meyer-Olkin (KMO) value for SF-CTDI-CV is 0.90 while the p value of Bartlett’s test is less than 0.05, indicating that this short-form inventory has ideal structural validity. A total score of 72 or more indicates a CT disposition, and all participants were divided into two groups according to whether they possessed essential characteristics of thinking.

Potential Influencing Factors Questionnaire

The Potential Influencing Factors Questionnaire was based on previous research and interviews. The interviewees including senior education practitioners and invited medical postgraduate students, focused on their experiences and feelings regarding medical education in China. We compiled an interview outline and invited a total of 22 professionals, including 9 doctoral candidates, 5 doctoral supervisors, 2 counsellors and 6 young backbone teachers, to participate in the interviews. The interview schedule is flexible, but to ensure efficiency, we controlled the interview duration for each participant to within 40 min. After the interviews, we used professional NVivo V.11.0 software to analyse the collected interview data thoroughly.

The Potential Influencing Factors Questionnaire consists of 10 questions in the essential information section, 35 questions in the influencing factors section and 3 flexible questions, for 48 valid entries. The essential information section includes gender, age, secondary education background, higher education major, level of education, type of degree, full-time work experience, type of household registration, the highest level of parental education and whether the respondent was from an only child family. The influencing factors section can be grouped into two main areas: ‘personal factors’ and ‘educational factors’, with personal factors including the individual characteristics section. The educational factors include the practice and training, tutor and team, and educational environment section. This study defines every potential factor as an ordinal variable, with greater rank, depth and frequency of the corresponding factors. For reliability, Cronbach’s alpha=0.795 indicates that the questionnaire’s reliability is good enough for investigation. The content validity of the questionnaire was tested to determine whether the content met the objectives and requirements of the study. Most of the items of the influencing factors questionnaire were selected from previous literature, and the content validity was good. The KMO values and p values for the Bartlett’s test of sphericity for every aspect indicate that the structural validity of the questionnaire is good (see more details in online supplemental table S1 ).

Supplemental material

In the questionnaire design process, we first formed a preliminary framework concerning previous qualitative and quantitative research. Then we conducted interviews with educators, doctoral supervisors and representatives of medical postgraduate students according to the initial framework to understand their work experience in the practice of medical postgraduate education in China. Then, the questionnaire was supplemented according to the frequently mentioned items in the interviews. Finally, a questionnaire focusing on whether personal and educational pathways influence the formation of CT disposition was developed, as well as the key points of CT cultivation.

Data collection and organisation

The project team designed the electronic questionnaire based on the Influencing Factors Questionnaire and Critical Thinking Measurement Scale. Excel 2019 collated the raw data exported from the electronic questionnaire platform. Using the electronic questionnaire platform, answer completion settings rule out the possibility of logical anomalies. Samples with missing answers on the Critical Thinking Inventory were eliminated. Participants who were missing other information were asked to fill in as much as possible through the telephone number they had left. Those who were unable to do so were eliminated. Each factor in the influencing factors section was assigned a value in steps of 1 from lowest to highest (eg, the four categorical variables were assigned values of 1, 2, 3, and 4; 1 for never and 4 for always).

Students and public involvement

Former students were involved in the preparatory phase of this study. They reviewed the informed consent form and provided feedback.

Statistical analysis

The data were analysed by using SPSS V.24.0 software. The distribution of the study participants’ underlying characteristics and CT were described and tested. Continuous variables are described as the mean±SD, and t-tests or one-way analysis of variance (ANOVA) were used for hypothesis tests. Categorical variables are expressed as composition ratios and χ 2 tests are used for hypothesis tests. Correlation analysis: The Spearman rank correlation coefficient was used to evaluate the correlation between each factor and the CT score. Difference analysis: Trend ANOVA was used to test whether there was a trend change in CT scores at different levels of each potential influencing factor. A t-test was used to compare the differences in the levels of influencing factors between different CT trait groups. Factors with differences between groups were included in a multivariate unconditional logistic regression model. We fitted several multivariate logistic regression models to evaluate potential confounding variables. By comparing the χ 2 value, the −2-likelihood ratio, the Akaike information criterion, and the practical meanings of this study’s interesting factors, the final model in which X variables could explain most of the Y variables (CT scores) was chosen. The above tests were performed at 0.05, and a p<0.05 was considered statistically significant.

Essential characteristics

A total of 1488 medical graduate students were included in this study, with an average age of 26.63±3.72 years. Most of the participants had a science background in high school (96.84%), a higher education major in clinical medicine (78.43%) and had never participated in full-time work (71.91%). Most of the participants were female (65.93%), lived in urban areas (61.69%), had parents with junior school education or below (39.18%), were not the only child in the family (51.48%), scientific graduate students (51.61%) and had a master’s degree (55.51%). Among all the research subjects, the average total CT score was 81.79±11.42 points, and the proportion of CT (score ≥72 points) was 78.9% (1174/1488). The essential characteristics of the included subjects are shown in table 1 .

• View inline

Participants’ essential characteristics and the distribution of critical thinking dispositions

Distribution of CT disposition

Table 1 demonstrates the distribution of CT disposition among the study participants. For the essential CT scores, participants with urban residence, higher parental education, only-child families, a science background before admission, science-based graduates, longer full-time employment and higher education levels had significantly greater CT scores (p<0.05). According to the CT questionnaire used in this project, subjects with a score more excellent than 72 points were considered to have an apparent CT disposition. The results showed that among our participants, women (80.80% vs 75.10%), science students (79.50% vs 61.70%) and PhD students (81.60% vs 76.80%) had a more significant proportion of CT disposition (p<0.05).

CT scores are linearly correlated with impact factor scores

Table 2 shows the correlation between each factor and the CT scores. The Spearman correlation coefficients suggested that most terms related to personal factors were correlated with CT scores (p<0.001). Sense of achievement (r=0.324), curiosity (r=0.480) and following others’ opinions in decision-making (r=−0.292) were strongly correlated with CT scores. Regarding educational factors, all factors in the practice and training section, all factors in the tutor and team section, and most factors in the educational environment impacted CT scores (p<0.001). Factors in the tutor and team section were more strongly related to CT scores, such as teaching students according to their aptitude (r=0.247) and tutors asking heuristic questions (r=0.242). Only no allow of doubt to tutors hurt the CT scores (r=−0.179, p<0.001).

The correlation between the potential influencing factors and the score of critical thinking

Factors influencing CT disposition

Univariate analysis.

The influencing factors associated with CT disposition are presented in table 3 . Univariate analysis revealed that in terms of personal factors, a sense of achievement, curiosity and interpersonal skills were all possible facilitators of CT disposition (p<0.05), and the group with CT disposition had higher average scores. In contrast, fatigue and burn-out, inattention and following others’ opinions in decision-making were possible hindering factors. Regarding educational factors, most factors in the ‘practice and training’ section, all factors in the ‘tutor and team’ section, and some factors in the ‘educational environment’ section were impact factors on CT disposition. In the practice and traning section, academic performance (p<0.001), number of intensively reading (p<0.001), paper writing (p=0.001), participation in academic conferences (p=0.009), completion of scientific research design with reference (p<0.001), time for extracurricular reading (p=0.006), summarisation and reflection (p<0.001), asking ‘why’ (p<0.001) and knowledge of critical thinking (p<0.001) were all positively related to CT disposition. For the tutor and team section, participants with CT disposition had higher scores for the following factors (p<0.01): tutors sharing thinking methods, communicating learning and life with tutors, tutors asking heuristic questions, encouragement of using ‘possible’ and ‘potential’, advocation of logical thinking training and lifelong learning, teaching students according to their aptitude and team members’ logical thinking skills. No allow to doubt tutors hurt CT disposition (p<0.001). The use of multifunctional classrooms (p<0.001) and having active classes (TBL class, flipped class, p=0.006) in the educational environment section were also correlated with CT disposition.

Impact factors

Multivariate logistics regression analyses

Multivariate logistics regression analysis demonstrated that female (OR 1.405, 95% CI 1.042 to 1.895), curiosity (OR 1.847, 95% CI 1.459 to 2.338), completion of scientific research design with reference (OR 1.779, 95% CI 1.460 to 2.167), asking ‘why’ (OR 1.942, 95% CI 1.508 to 2.501) and team members’ logical thinking ability (OR 1.373, 95% CI 1.122 to 1.681) were the promoting factors for the development of CT disposition after adjusting for other confounding factors. However, exhaustion and burn-out (OR 0.721, 95% CI 0.526 to 0.989), inattention (OR 0.572, 95% CI 0.431 to 0.759) and following others’ opinions in decision-making (OR 0.425, 95% CI 0.337 to 0.534) and no allow of doubt to tutors (OR 0.674, 95% CI 0.561 to 0.809) may be hindering factors for the formation of CT disposition in the fully adjusted model ( table 4 , adjusted R 2 =0.323).

Multifactor regression model

This cross-sectional study explored the factors influencing the CT disposition of Chinese medical graduate students in terms of both personal and educational factors. A total of 78.9% of the participants in this study had positive CT dispositions (score ≥72, 1174/1488), and women were 40.5% more likely than men to have CT dispositions (OR 1.405, 95% CI 1.042 to 1.895). Multivariate logistics regression analysis revealed that among personal factors, curiosity was the promoting factor while exhaustion and burn-out, inattention and following others’ opinions in decision-making may be the hindering factors. For educational factors, completing the scientific research design with reference, asking ‘why’ and the high logical thinking ability of team members were associated with CT disposition. However, no allow of doubt to tutors may hinder the disposition of CT.

According to our demographic information, our study revealed a greater prevalence of CT disposition among women, aligning with Zhai’s findings. 22 Several factors may contribute to this observed gender disparity. A systematic review established that men tend to engage more with objects while women prefer interpersonal interactions. 33 Women are more inclined to engage in dialogue and foster their understanding through collaborative learning, often exhibiting a more receptive mindset. Second, a study using fractional anisotropy measures derived from diffusion tensor imaging in 425 participants, including 118 males, revealed that divergent thinking in females correlates positively with fractional anisotropy in the corpus callosum and the right superior longitudinal fasciculus. 34 Conversely, it correlates with fractional anisotropy in the right tapetum in males. Zhang et al ’s 34 research sheds light on the sex-specific structural connectivity within and between hemispheres that underpins divergent thinking. These gender differences in creativity may reflect the inherent diversity between males and females in society. However, Faramarzi and Khafri 35 reported contrasting results. They concluded that although the results differed between the sexes, the likely cause was females’ higher education level rather than a difference due to gender. Several studies concur that self-esteem is a principal determinant of CT. 22 35 Barkhordary et al , 36 in their study of 170 third-year and fourth-year nursing students in Yazd, identified a significant link between CT and self-esteem. Pilevarzadeh et al further demonstrated that students with higher self-esteem exhibit more robust CT skills. 37 Self-esteem is defined as ‘an individual’s overall subjective emotional assessment of their worth’. 38 Bleidorn et al 39 conducted a groundbreaking large-scale, cross-cultural study with an internet sample of 985 937 participants, examining gender and age differences in self-esteem across 48 nations. They discovered significant gender differences, with males consistently reporting higher self-esteem levels than females, which may influence their responses to negative feedback to some degree.

In the section on personal factors, the results of this study on personal internal and external environmental factors such as curiosity, burn-out and inattention are consistent with previous studies. 40–45 The relationship between these internal and external environmental factors and cognitive capacity has been described in cognitive load theory, 46 particularly the role of ‘working memory’, the capacity to process information. Specifically, researchers 47 reported on a consensus on CT teaching, assessment and faculty development compiled by a high-level team recommended by 32 medical schools across the USA. Learners’ personal attributes, characteristics, perspectives and behaviours are critical components of their motivation to prepare for and engage in deeper learning and laborious clinical reasoning. Distractions and interruptions, on the other hand, can reduce attention to important issues, affecting learners’ ability to engage in clinical reasoning and their CT skills. 48 Making decisions based on the opinions of others in this study may reflect the participants’ interdependent view of self, which was identified by Futami et al 49 as a negative factor for CT dispositions.

Regarding the educational factors, learning methods and research group membership characteristics were more strongly associated with CT disposition than learning frequency and learning form. Completing the scientific research design with reference and asking ‘why’ are learning methods that promote the formation of CT for medical graduate students. Research 50 suggests that CT requires a persistent effort to test any belief or supposed form of knowledge according to the evidence supporting it and the further conclusions it tends to help. Completing scientific research design with reference is the specific manifestation of evidence-based reasoning in the scientific research field, which may be why it affects the formation process of CT. Furthermore, similar to our research, much research has explored the crucial role that questioning or problem-based thinking plays in CT. 47 51–53 Our research also suggested that the teaching style of the group supervisor and the logical thinking ability of other group members also impacted CT dispositions. Although no previous research has explored the role-specific behaviours of subject mentors and peers in CT disposition from a quantitative perspective, Futami et al 49 reported higher CT scores for subjects who had connections with research experts, suggesting a positive influence of research mentors on CT. Self-esteem positively affects CT, and overbearing instructors may undermine students’ self-esteem and, thus, their CT disposition. Moreover, several authors 47 53 54 have argued that professors’ encouragement of students to express uncertainty, to question and assess the quality of knowledge learnt, and to improve team members’ logical thinking skills are all positively associated with CT, consistent with our findings.

The CT scores in our study were lower than those in several Western countries among medical students, 55 56 possibly because of differences in educational culture and methods. In China, medical education comprises three stages: primary medical education, clinical education and internships. Primary medical education introduces students to the medical world. The delivery of traditional courses used to be prescribed and even dull simply because teachers were accustomed to a conventional teaching style and were afraid of making changes to course delivery. 57 The strategies to develop reflective and CT in nursing students in eight countries indicated that reflexive CT was found in most curricula, although with diverse denominations. The principal learning strategies used were PBL, group dynamics, reflective reading, clinical practice and simulation laboratories. The evaluation methods are the knowledge test, case analysis and practical exam. 58

The importance of early clinical exposure is universally acknowledged, particularly in developing countries where its value is profoundly esteemed. For instance, the South African Health Professions Council has spearheaded educational reforms for medical professionals, enabling first-year medical students to participate in healthcare visits. These visits aim to enrich the comprehension of future professional environments and foster a more profound passion for medicine. 59 Notably, most students perceived these visits as invaluable learning experiences, leaving them better prepared for medical practice. Similarly, Chinese medical colleges offer comparable programmes spanning 1–2 weeks. A Peking University study using questionnaires and reports revealed that all students benefited from these activities, gaining perceptual knowledge of clinical work. Remarkably, 61.5% of students reported that their early clinical exposure had significantly assisted them. 60

Interestingly, there was a more significant proportion of PhD students with a CT disposition in our study. This may be because doctoral research is more in-depth and complex, requiring students to engage in more detailed, rigorous and innovative thinking based on their existing knowledge. During the research process, doctoral students must constantly question, analyse, evaluate and reconstruct knowledge, which undoubtedly exercises and enhances their CT abilities. 61 However, this does not imply that master’s students possess lower CT skills than doctoral students. The master’s programme also emphasises cultivating CT, although possibly differing in depth and breadth. Both stages have unique development paths and manifestations in terms of CT. Regardless of the stage, graduate students should focus on developing their CT skills to address challenges in academic research and life.

Our research revealed that factors influencing CT motivation appear to be more closely linked to CT tendencies in personal and educational components. Miele and Wigfield 50 suggested that the factors affecting students’ critical analytical thinking motivation can be divided into two aspects: quantity and quality, the quantitative relationship between motivation and CT, that is, whether students have sufficient motivation to make high-level spiritual efforts. This is reflected in our study regarding curiosity, burn-out, distraction, an interdependent self-view and influence by research team members. The qualitative relationship is the willingness of students to engage in CT, which corresponds to the desire to ask ‘why’ and to refer to existing evidence to complete a research design in this study. This suggests that internal motivation may play an essential role in CT and that educators should focus more on maintaining students’ motivation and building awareness than on the frequency of rigid external research training and curriculum formats. Students are actively promoted and encouraged to apply CT in practice. At the same time, the existing overly outcome-oriented reward mechanism is changed, and assessment criteria are enriched, for example, by including ‘whether you ask interesting questions’ as one of the criteria for classroom assessment to motivate people to become more proactive learners. Recently, medical education has garnered considerable attention and traditionally assumes that medical students are inherently motivated by their dedication to specialised training and a highly focused profession. However, motivation plays a crucial role in determining the quality of learning and ultimate success. Its absence may provide a plausible explanation for why teachers occasionally encounter medical students who appear discouraged, have lost interest or abandon their studies, feeling a sense of powerlessness or resignation. 62

To foster CT among medical students, educational reform should encompass several key aspects: (1) Encouraging active learning and exploration: Teachers must urge students to engage actively in the learning process, providing resources and guidance to kindle their intellectual curiosity. This will empower students to seek out challenges, pose inquiries and address them through a critical lens. 63 (2) Implementing heuristic learning and case studies: Educators should incorporate case studies, enabling students to hone their CT, discriminatory skills and decision-making abilities by analysing authentic or hypothetical scenarios. 64 65 (3) Stressing the mastery of professional knowledge: It is imperative to ensure that students grasp the fundamental theories and principles of the medical field, along with proficiency in practical medical skills. 66 (4) Nurturing teamwork skills: Group discussions, collaborative projects and similar activities should be used to cultivate teamwork among medical students. This teaches them to listen attentively, manage team dynamics, and allocate resources effectively, enhancing their CT and problem-solving capabilities. 67 (5) Providing clinical practical experience: Early exposure to clinical practice is crucial in developing students’ analytical and problem-solving skills through firsthand observation and participation in real-life case management. 68 (6) Shifting teachers’ roles: Educators must evolve into mentors and role models for CT, leading by example and inspiring students through their practices and teachings. 69 Collectively, these recommendations for educational reform will empower medical students to address intricate issues they may encounter in their future medical careers, ultimately increasing the quality and safety of healthcare services.

It is worth noting that our questionnaire incorporated many potential entries with high reliability. It mostly also showed differences between the two groups with or without CT disposition in univariate analysis but were not ultimately presented in the regression models. These factors are meaningful for the development of CT but taking into account the simplicity and informativeness of the model, other entries in the model may have represented them. Our model explained more of the variance in CT than regression models from previous studies. 49 70 71

Strengths and limitations

This study has particular strengths. First, the questionnaire for this study was scientific and practice based. The findings of previous studies on personal and educational factors were extensively referenced, and in-depth interviews were also conducted. Second, our study focused on postgraduate medical students and the sample size was relatively large. Postgraduate medical students are the key group for CT development, and the findings obtained among postgraduate medical students are more relevant and better reflect the thinking characteristics of postgraduate medical students. Research from China has considerably enriched the worldwide sample of CT influencing factors. It has been suggested that cultural context strongly influences CT, 72 but previous research on CT has mostly focused on Europe, the USA and Japan. Therefore, researching CT in Chinese populations is a valuable addition to this area. In addition, this study is the first to quantitatively explore the impact of tutor and team on CT disposition. For Chinese postgraduates, tutors and their scientific research teams are the people who have the most contact during their studies. In our previous interviews, educators, tutors and postgraduates all recognised the vital role of tutors in postgraduate education, especially in the cultivation of thinking. Based on interviews and literature extraction, we summarise the specific influence of tutors and teams and present them as numerical indicators to refine the influence of tutors on educational factors to make them more comprehensive and exact.

There are several limitations to our study. First, given the traditional constraints of cross-sectional studies, the findings of this study cannot be used as direct evidence of a causal relationship between potential influences and outcomes. Still, they can provide clues to reveal causal relationships. Second, some influencing factors, such as participation in project submissions, participation in CT courses, attempts at innovation and entrepreneurship, and exchange abroad may need to be revised when measured due to limited educational resources. The lack of opportunity for most students to participate in the projects mentioned above, even if they had the will to do so, may help obscure the correlation between CT and these factors. Our regression models did not include other factors of the same type with higher coverage, such as article writing. This suggests that specific formal factors do not significantly influence CT disposition and that bias may not affect the overall results. In addition, we did not use the CTDI-CV scale. Given the busy workload of postgraduate medical students and the fact that online surveys are challenging to monitor and quality control, to avoid as much as possible the impact of too many questions on the quality of the study and to increase the recall rate, we used a condensed version of the Critical Thinking Scale, which has a greater total explained variance than the CTDI-CV scale and has good reliability and validity.

Conclusions

In conclusion, this study provides a comprehensive scientific assessment of the factors influencing the CT disposition of Chinese medical postgraduates in terms of personal and educational factors. Being curious, completing the scientific research design with reference, asking ‘why’, and having high logical thinking ability among team members were positively associated with CT. Exhaustion and burn-out, inattention, following others’ opinions in decision-making and not allowing to doubt tutors were negatively associated with CT scores. These findings suggest that we pay more attention to factors related to motivation and internal drive in our educational practice, shift from an outcome-focused reward mechanism and focus on motivation maintenance to build students’ CT awareness.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

The research team collected data after obtaining their consent and signatures on the study’s informed consent form. The Ethics Committee of West China Hospital (tertiary), Sichuan University, approved the study in 2021 (Ethics No. 980).

Acknowledgments

The authors want to acknowledge the medical students who participated in this study.

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LW and WC contributed equally.

Contributors LW and WC were involved in designing the study, reviewing the literature, designing the protocol, developing the questionnaire, collecting the data, performing the statistical analysis and preparing the manuscript. TH and W-BH were involved in searching and collecting the data. YW was involved in interpreting the data and critically reviewed the manuscript. YW is responsible for the overall content as the guarantor . All the authors have read and approved the final manuscript.

Funding This study was supported by the Sichuan University Postgraduate Education Reform project (GSSCU2021038).

Competing interests None declared.

Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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• Open access
• Published: 04 September 2024

Insights into research activities of senior dental students in the Middle East: A multicenter preliminary study

• Mohammad S. Alrashdan 1 , 2 ,
• Abubaker Qutieshat 3 , 4 ,
• Mohamed El-Kishawi 5 ,
• Abdulghani Alarabi 6 ,
• Lina Khasawneh 7 &
• Sausan Al Kawas 1  

BMC Medical Education volume  24 , Article number:  967 ( 2024 ) Cite this article

Metrics details

Despite the increasing recognition of the importance of research in undergraduate dental education, limited studies have explored the nature of undergraduate research activities in dental schools in the Middle East region. This study aimed to evaluate the research experience of final year dental students from three dental schools in the Middle East.

A descriptive, cross-sectional study was conducted among final-year dental students from three institutions, namely Jordan University of Science and Technology, University of Sharjah (UAE), and Oman Dental College. Participants were asked about the nature and scope of their research projects, the processes involved in the research, and their perceived benefits of engaging in research.

A total of 369 respondents completed the questionnaire.  Cross-sectional studies represented the most common research type  (50.4%), with public health (29.3%) and dental education (27.9%) being the predominant domains. More than half of research proposals were developed via discussions with instructors (55.0%), and literature reviews primarily utilized PubMed (70.2%) and Google Scholar (68.5%). Regarding statistical analysis, it was usually carried out with instructor’s assistance (45.2%) or using specialized software (45.5%). The students typically concluded their projects with a manuscript (58.4%), finding the discussion section most challenging to write (42.0%). The research activity was considered highly beneficial, especially in terms of teamwork and communication skills, as well as data interpretation skills, with 74.1% of students reporting a positive impact on their research perspectives.

Conclusions

The research experience was generally positive among surveyed dental students. However, there is a need for more diversity in research domains, especially in qualitative studies, greater focus on guiding students in research activities s, especially in manuscript writing and publication. The outcomes of this study could provide valuable insights for dental schools seeking to improve their undergraduate research activities.

Peer Review reports

Introduction

The importance of research training for undergraduate dental students cannot be overstressed and many reports have thoroughly discussed the necessity of incorporating research components in the dental curricula [ 1 , 2 , 3 , 4 ]. A structured research training is crucial to ensure that dental graduates will adhere to evidence-based practices and policies in their future career and are able to critically appraise the overwhelming amount of dental and relevant medical literature so that only rigorous scientific outcomes are adopted. Furthermore, a sound research background is imperative for dental graduates to overcome some of the reported barriers to scientific evidence uptake. This includes the lack of familiarity or uncertain applicability and the lack of agreement with available evidence [ 5 ]. There is even evidence that engagement in research activities can improve the academic achievements of students [ 6 ]. Importantly, many accreditation bodies around the globe require a distinct research component with clear learning outcomes to be present in the curriculum of the dental schools [ 1 ].

Research projects and courses have become fundamental elements of modern biomedical education worldwide. The integration of research training in biomedical academic programs has evolved over the years, reflecting the growing recognition of research as a cornerstone of evidence-based practice [ 7 ]. Notwithstanding the numerous opportunities presented by the inclusion of research training in biomedical programs, it poses significant challenges such as limited resources, varying levels of student preparedness, and the need for faculty development in research mentorship [ 8 , 9 ]. Addressing these challenges is essential to maximize the benefits of research training and to ensure that all students can engage meaningfully in research activities.

While there are different models for incorporating research training into biomedical programs, including dentistry, almost all models share the common goals of equipping students with basic research skills and techniques, critical thinking training and undertaking research projects either as an elective or a summer training course, or more commonly as a compulsory course required for graduation [ 2 , 4 , 10 ].

Dental colleges in the Middle East region are not an exception and most of these colleges are continuously striving to update their curricula to improve the undergraduate research component and cultivate a research-oriented academic teaching environment. Despite these efforts, there remains a significant gap in our understanding of the nature and scope of student-led research in these institutions, the challenges they face, and the perceived benefits of their research experiences. Furthermore, a common approach in most studies in this domain is to confine data collection to a single center from a single country, which in turn limits the value of the outcomes. Therefore, it is of utmost importance to conduct studies with representative samples and preferably multiple institutions in order to address the existing knowledge gaps, to provide valuable insights that can inform future curricular improvements and to support the development of more effective research training programs in dental education across the region. Accordingly, this study was designed and conducted to elucidate some of these knowledge gaps.

The faculty of dentistry at Jordan University of Science and Technology (JUST) is the biggest in Jordan and adopts a five-year bachelor’s program in dental surgery (BDS). The faculty is home to more than 1600 undergraduate and 75 postgraduate students. The college of dental medicine at the University of Sharjah (UoS) is also the biggest in the UAE, with both undergraduate and postgraduate programs, local and international accreditation and follows a (1 + 5) program structure, whereby students need to finish a foundation year and then qualify for the five-year BDS program. Furthermore, the UoS dental college applies an integrated stream-based curriculum. Finally, Oman Dental College (ODC) is the sole dental school in Oman and represents an independent college that does not belong to a university body.

The aim of this study was to evaluate the research experience of final year dental students from three major dental schools in the Middle East, namely JUST from Jordan, UoS from the UAE, and ODC from Oman. Furthermore, the hypothesis of this study was that research activities conducted at dental schools has no perceived benefit for final year dental students.

The rationale for selecting these three dental schools stems from the diversity in the dental curriculum and program structure as well as the fact that final year BDS students are required to conduct a research project as a prerequisite for graduation in the three schools. Furthermore, the authors from these dental schools have a strong scholarly record and have been collaborating in a variety of academic and research activities.

Materials and methods

The current study is a population-based descriptive cross-sectional observational study. The study was conducted using an online self-administered questionnaire and targeted final-year dental students at three dental schools in the Middle East region: JUST from Jordan, UoS from the UAE, and ODC from Oman. The study took place in the period from January to June 2023.

For inclusion in the study, participants should have been final-year dental students at the three participating schools, have finished their research project and agreed to participate. Exclusion criteria included any students not in their final year, those who have not conducted or finished their research projects and those who refused to participate.

The study was approved by the institutional review board of JUST (Reference: 724–2022), the research ethics committee of the UoS (Reference: REC-22-02-22-3) as well as ODC (Reference: ODC-MA-2022-166). The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [ 11 ]. The checklist is available as a supplementary file.

Sample size determination was based on previous studies with a similar design and was further confirmed with a statistical formula. A close look at the relevant literature reveals that such studies were either targeting a single dental or medical school or multiple schools and the sample size generally ranged from 158 to 360 [ 4 , 8 , 9 , 10 , 12 ]. Furthermore, to confirm the sample size, the following 2-step formula for finite population sample size calculation was used [ 13 ]:

Wherein Z is the confidence level at 95% =1.96, P is the population proportion = 0.5, and E is the margin of error = 0.05. Based on this formula, the resultant initial sample size was 384.

Wherein n is the initial sample size = 384, N is the total population size (total number of final year dental students in the 3 schools) = 443. Based on this formula, the adjusted sample size was 206.

An online, self-administered questionnaire comprising 13 questions was designed to assess the research experience of final year dental students in the participating schools. The questionnaire was initially prepared by the first three authors and was then reviewed and approved by the other authors. The questionnaire was developed following an extensive review of relevant literature to identify the most critical aspects of research projects conducted at the dental or medical schools and the most common challenges experienced by students with regards to research project design, research components, attributes, analysis, interpretation, drafting, writing, and presentation of the final outcomes.

The questionnaire was then pretested for both face and content validity. Face validity was assessed by a pilot study that evaluated clarity, validity, and comprehensiveness in a small cohort of 30 students. Content validity was assessed by the authors, who are all experienced academics with remarkable research profiles and experience in supervising undergraduate and postgraduate research projects. The authors critically evaluated each item and made the necessary changes whenever required. Furthermore, Cronbach’s alpha was used to assess the internal consistency/ reliability of the questionnaire and the correlation between the questionnaire items was found to be 0.79. Thereafter, online invitations along with the questionnaire were sent out to a total of 443 students, 280 from JUST, 96 from UoS and 67 from ODC, which represented the total number of final year students at the three schools. A first reminder was sent 2 weeks later, and a second reminder was sent after another 2 weeks.

In addition to basic demographic details, the questionnaire comprised questions related to the type of study conducted, the scope of the research project, whether the research project was proposed by the students or the instructors or both, the literature review part of the project, the statistical analysis performed, the final presentation of the project, the writing up of the resultant manuscript if applicable, the perceived benefits of the research project and finally suggestions to improve the research component for future students.

The outcomes of the study were the students’ research experience in terms of research design, literature review, data collection, analysis, interpretation and presentation, students’ perceived benefits from research, students’ perspective towards research in their future career and students’ suggestions to improve their research experience.

The exposures were the educational and clinical experience of students, research supervision by mentors and faculty members, and participation in extracurricular activities, while the predictors were the academic performance of students, previous research experience and self-motivation.

The collected responses were entered into a Microsoft Excel spreadsheet and analyzed using SPSS Statistics software, version 20.0 (SPSS Inc., Chicago, IL, USA). Descriptive data were presented as frequencies and percentages. For this study, only descriptive statistics were carried out as the aim was not to compare and contrast the three schools but rather to provide an overview of the research activities at the participating dental schools.

The heatmap generated to represent the answers for question 11 (perceived benefits of the research activity) was created using Python programming language (Python 3.11) and the pandas, seaborn, and matplotlib libraries. The heatmap was customized to highlight the count and percentage of responses in each component, with the highest values shown in red and the lowest values shown in blue.

Potentially eligible participants in this study were all final year dental students at the three dental schools (443 students, 280 from JUST, 96 from UoS and 67 from ODC). All potentially eligible participants were confirmed to be eligible and were invited to participate in the study.

The total number of participants included in the study, i.e. the total number of students who completed the questionnaire and whose responses were analyzed, was 369 (223 from JUST, 80 from UoS and 66 from ODC). The overall response rate was 83.3% (79.6% from JUST, 83.3% from UoS and 98.5% from ODC).

The highest proportion of participants were from JUST ( n  = 223, 60.4%), followed by UoS ( n  = 80, 21.7%), and then ODC ( n  = 66, 17.9%). The majority of the participants were females ( n  = 296, 80.4%), while males represented a smaller proportion ( n  = 73, 19.6%). It is noteworthy that these proportions reflect the size of the cohorts in each college.

With regards to the type of study, half of final-year dental students in the 3 colleges participated in observational cross-sectional studies (i.e., population-based studies) ( n  = 186, 50.4%), while literature review projects were the second most common type ( n  = 83, 22.5%), followed by experimental studies ( n  = 55, 14.9%). Longitudinal studies randomized controlled trials, and other types of studies (e.g., qualitative studies, case reports) were less common, with ( n  = 5, 1.4%), ( n  = 10, 2.7%), and ( n  = 30, 8.1%) participation rates, respectively. Distribution of study types within each college is shown Fig.  1 .

Distribution in percent of study types within each college. JUST: Jordan University of Science and Technology, UOS: University of Sharjah, ODC: Oman Dental College

The most common scope of research projects among final-year dental students was in public health/health services ( n  = 108, 29.3%) followed by dental education/attitudes of students or faculty ( n  = 103, 27.9%) (Fig.  2 ). Biomaterials/dental materials ( n  = 62, 16.8%) and restorative dentistry ( n  = 41, 11.1%) were also popular research areas. Oral diagnostic sciences (oral medicine/oral pathology/oral radiology) ( n  = 28, 7.6%), oral surgery ( n  = 12, 3.2%) and other research areas ( n  = 15, 4.1%) were less common among the participants. Thirty-two students (8.7%) were engaged in more than one research project.

Percentages of the scope of research projects among final-year dental students. JUST: Jordan University of Science and Technology, UOS: University of Sharjah, ODC: Oman Dental College

The majority of research projects were proposed through a discussion and agreement between the students and the instructor (55.0%). Instructors proposed the topic for 36.6% of the research projects, while students proposed the topic for the remaining 8.4% of the projects.

Most dental students (79.1%) performed the literature review for their research projects using internet search engines. Material provided by the instructor was used for the literature review by 15.5% of the students, while 5.4% of the students did not perform a literature review. More than half of the students ( n  = 191, 51.7%) used multiple search engines in their literature search. The most popular search engines for literature review among dental students were PubMed (70.2% of cases) and Google Scholar (68.5% of cases). Scopus was used by 12.8% of students, while other search engines were used by 15.6% of students.

The majority of dental students ( n  = 276, 74.8%) did not utilize the university library to gain access to the required material for their research. In contrast, 93 students (25.2%) reported using the university library for this purpose.

Dental students performed statistical analysis in their projects primarily by receiving help from the instructor ( n  = 167, 45.2%) or using specialized software ( n  = 168, 45.5%). A smaller percentage of students ( n  = 34, 9.4%) consulted a professional statistician for assistance with statistical analysis. at the end of the research project, 58.4% of students ( n  = 215) presented their work in the form of a manuscript or scientific paper. Other methods of presenting the work included PowerPoint presentations ( n  = 80, 21.7%) and discussions with the instructor ( n  = 74, 19.8%).

For those students who prepared a manuscript at the conclusion of their project, the most difficult part of the writing-up was the discussion section ( n  = 155, 42.0%), followed by the methodology section ( n  = 120, 32.5%), a finding that was common across the three colleges. Fewer students found the introduction ( n  = 13, 3.6%) and conclusion ( n  = 10, 2.7%) sections to be challenging. Additionally, 71 students (19.2%) were not sure which part of the manuscript was the most difficult to prepare (Fig.  3 ).

Percentages of the most difficult part reported by dental students during the writing-up of their projects. JUST: Jordan University of Science and Technology, UOS: University of Sharjah, ODC: Oman Dental College

The dental students’ perceived benefits from the research activity were evaluated across seven components, including literature review skills, research design skills, data collection and interpretation, manuscript writing, publication, teamwork and effective communication, and engagement in continuing professional development.

The majority of students found the research activity to be beneficial or highly beneficial in most of the areas, with the highest ratings observed in teamwork and effective communication, where 33.5% rated it as beneficial and 32.7% rated it as highly beneficial. Similarly, in the area of data collection and interpretation, 33.0% rated it as beneficial and 27.5% rated it as highly beneficial. In the areas of literature review skills and research design skills, 28.6% and 34.0% of students rated the research activity as beneficial, while 25.3% and 22.7% rated it as highly beneficial, respectively. Students also perceived the research activity to be helpful for the manuscript writing, with 27.9% rating it as beneficial and 19.2% rating it as highly beneficial.

When it comes to publication, students’ perceptions were more variable, with 22.0% rating it as beneficial and 11.3% rating it as highly beneficial. A notable 29.9% rated it as neutral, and 17.9% reported no benefit. Finally, in terms of engaging in continuing professional development, 26.8% of students rated the research activity as beneficial and 26.2% rated it as highly beneficial (Fig.  4 ).

Heatmap of the dental students’ perceived benefits from the research activity

The research course’s impact on students’ perspectives towards being engaged in research activities or pursuing a research career after graduation was predominantly positive, wherein 274 students (74.1%) reported a positive impact on their research perspectives. However, 79 students (21.5%) felt that the course had no impact on their outlook towards research engagement or a research career. A small percentage of students ( n  = 16, 4.4%) indicated that the course had a negative impact on their perspective towards research activities or a research career after graduation.

Finally, when students were asked about their suggestions to improve research activities, they indicated the need for more training and orientation ( n  = 127, 34.6%) as well as to allow more time for students to finish their research projects ( n  = 87, 23.6%). Participation in competitions and more generous funding were believed to be less important factors to improve students` research experience ( n  = 78, 21.2% and n  = 63, 17.1%, respectively). Other factors such as external collaborations and engagement in research groups were even less important from the students` perspective (Fig.  5 ).

Precentages of dental students’ suggestions to improve research activities at their colleges

To the best of our knowledge, this report is the first to provide a comprehensive overview of the research experience of dental students from three leading dental colleges in the Middle East region, which is home to more than 50 dental schools according to the latest SCImago Institutions Ranking ® ( https://www.scimagoir.com ). The reasonable sample size and different curricular structure across the participating colleges enhanced the value of our findings not only for dental colleges in the Middle East, but also to any dental college seeking to improve and update its undergraduate research activities. However, it is noteworthy that since the study has included only three dental schools, the generalizability of the current findings would be limited, and the outcomes are preliminary in nature.

Cross-sectional (epidemiological) studies and literature reviews represented the most common types of research among our cohort of students, which can be attributed to the feasibility, shorter time and low cost required to conduct such research projects. On the contrary, longitudinal studies and randomized trials, both known to be time consuming and meticulous, were the least common types. These findings concur with previous reports, which demonstrated that epidemiological studies are popular among undergraduate research projects [ 4 , 10 ]. In a retrospective study, Nalliah et al. also demonstrated a remarkable increase in epidemiological research concurrent with a decline in the clinical research in dental students` projects over a period of 4 years [ 4 ]. However, literature reviews, whether systematic or scoping, were not as common in some dental schools as in our cohort. For instance, a report from Sweden showed that literature reviews accounted for less than 10% of total dental students` projects [ 14 ]. Overall, qualitative research was seldom performed among our cohort, which is in agreement with a general trend in dental research that has been linked to the low level of competence and experience of dental educators to train students in qualitative research, as this requires special training in social research [ 15 , 16 ].

In terms of the research topics, public health research, research in dental education and attitudinal research were the most prevalent among our respondents. In agreement with our results, research in health care appears common in dental students` projects [ 12 ]. In general, these research domains may reflect the underlying interests of the faculty supervisors, who, in our case, were actively engaged in the selection of the research topic for more than 90% of the projects. Other areas of research, such as clinical dentistry and basic dental research are also widely reported [ 4 , 10 , 14 , 17 ].

The selection of a research domain is a critical step in undergraduate research projects, and a systematic approach in identifying research gaps and selecting appropriate research topics is indispensable and should always be given an utmost attention by supervisors [ 18 ].

More than half of the projects in the current report were reasonably selected based on a discussion between the students and the supervisor, whereas 36% were selected by the supervisors. Otuyemi et al. reported that about half of undergraduate research topics in a Nigerian dental school were selected by students themselves, however, a significant proportion of these projects (20%) were subsequently modified by supervisors [ 19 ]. The autonomy in selecting the research topic was discussed in a Swedish report, which suggested that such approach can enhance the learning experience of students, their motivation and creativity [ 20 ]. Flexibility in selecting the research topic as well as the faculty supervisor, whenever feasible, should be offered to students in order to improve their research experience and gain better outcomes [ 12 ].

Pubmed and Google Scholar were the most widely used search engines for performing a literature review. This finding is consistent with recent reviews which classify these two search systems as the most commonly used ones in biomedical research despite some critical limitations [ 21 , 22 ]. It is noteworthy that students should be competent in critical appraisal of available literature to perform the literature review efficiently. Interestingly, only 25% of students used their respective university library`s access to the search engines, which means that most students retrieved only open access publications for their literature reviews, a finding that requires attention from faculty mentors to guide students to utilize the available library services to widen their accessibility to available literature.

Statistical analysis has classically been viewed as a perceived obstacle for undergraduate students to undertake research in general [ 23 , 24 ] and recent literature has highlighted the crucial need of biomedical students to develop necessary competencies in biostatistics during their studies [ 25 ]. One obvious advantage of conducting research in our cohort is that 45.5% of students used a specialized software to analyze their data, which means that they did have at least an overview of how data are processed and analyzed to reach their final results and inferences. Unfortunately, the remaining 54.5% of students were, partially or completely, dependent on the supervisor or a professional statistician for data analysis. It is noteworthy that the research projects were appropriately tailored to the undergraduate level, focusing on fundamental statistical analysis methods. Therefore, consulting a professional statistician for more complex analyses was done only if indicated, which explains the small percentage of students who consulted a professional statistician.

Over half of participating students (58.4%) prepared a manuscript at the end of their research projects and for these students, the discussion section was identified as the most challenging to prepare, followed by the methodology section. These findings can be explained by the students’ lack of knowledge and experience related to conducting and writing-up scientific research. The same was reported by Habib et al. who found dental students’ research knowledge to be less than that of medical students [ 26 ]. The skills of critical thinking and scientific writing are believed to be of paramount importance to biomedical students and several strategies have been proposed to enhance these skills especially for both English and non-English speaking students [ 27 , 28 , 29 ].

Dental students in the current study reported positive attitude towards research and found the research activity to be beneficial in several aspects of their education, with the most significant benefits in the areas of teamwork, effective communication, data collection and interpretation, literature review skills, and research design skills. Similar findings were reported by previous studies with most of participating students reporting a positive impact of their research experience [ 4 , 10 , 12 , 30 ]. Furthermore, 74% of students found that their research experience had a positive impact on their perspectives towards engagement in research in the future. This particular finding may be promising in resolving a general lack of interest in research by dental students, as shown in a previous report from one of the participating colleges in this study (JUST), which demonstrated that only 2% of students may consider a research career in the future [ 31 ].

Notably, only 11.3% of our students perceived their research experience as being highly beneficial with regards to publication. Students` attitudes towards publishing their research appear inconsistent in literature and ranges from highly positive rates in developed countries [ 4 ] to relatively low rates in developing countries [ 8 , 32 , 33 ]. This can be attributed to lack of motivation and poor training in scientific writing skills, a finding that has prompted researchers to propose strategies to tackle such a gap as mentioned in the previous section.

Finally, key suggestions by the students to improve the research experience were the provision of more training and orientation, more time to conduct the research, as well as participation in competitions and more funding opportunities. These findings are generally in agreement with previous studies which demonstrated that dental students perceived these factors as potential barriers to improving their research experience [ 8 , 10 , 17 , 30 , 34 ].

A major limitation of the current study is the inclusion of only three dental schools from the Middle East which my limit the generalizability and validity of the findings. Furthermore, the cross-sectional nature of the study would not allow definitive conclusions to be drawn as students’ perspectives were not evaluated before and after the research project. Potential confounders in the study include the socioeconomic status of the students, the teaching environment, previous research experience, and self-motivation. Moreover, potential sources of bias include variations in the available resources and funding to students’ projects and variations in the quality of supervision provided. Another potential source of bias is the non-response bias whereby students with low academic performance or those who were not motivated might not respond to the questionnaire. This potential source of bias was managed by sending multiple reminders to students and aiming for the highest response rate and largest sample size possible.

In conclusion, the current study evaluated the key aspects of dental students’ research experience at three dental colleges in the Middle East. While there were several perceived benefits, some aspects need further reinforcement and revision including the paucity of qualitative and clinical research, the need for more rigorous supervision from mentors with focus on scientific writing skills and research presentation opportunities. Within the limitations of the current study, these outcomes can help in designing future larger scale studies and provide valuable guidance for dental colleges to foster the research component in their curricula. Further studies with larger and more representative samples are required to validate these findings and to explore other relevant elements in undergraduate dental research activities.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to acknowledge final year dental students at the three participating colleges for their time completing the questionnaire.

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Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, P.O.Box: 27272, Sharjah, UAE

Mohammad S. Alrashdan & Sausan Al Kawas

Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan

Mohammad S. Alrashdan

Department of Adult Restorative Dentistry, Oman Dental College, Muscat, Sultanate of Oman

Abubaker Qutieshat

Department of Restorative Dentistry, Dundee Dental Hospital & School, University of Dundee, Dundee, UK

Preventive and Restorative Dentistry Department, College of Dental Medicine, University of Sharjah, Sharjah, UAE

Mohamed El-Kishawi

Clinical Sciences Department, College of Dentistry, Ajman University, Ajman, UAE

Abdulghani Alarabi

Department of Prosthodontics, Faculty of Dentistry, University of Science and Technology, Irbid, Jordan

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M.A.: Conceptualization, data curation, project administration; supervision, validation, writing - original draft; writing - review and editing. A.Q: Conceptualization, data curation, project administration; writing - review and editing. M.E: Conceptualization, data curation, project administration; validation, writing - original draft; writing - review and editing. A.A.: data curation, writing - original draft; writing - review and editing. L.K.: Conceptualization, data curation, validation, writing - original draft; writing - review and editing. S.A: Conceptualization, writing - review and editing.

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Correspondence to Mohammad S. Alrashdan .

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The current study was approved by the institutional review board of Jordan University of Science and Technology (Reference: 724–2022), the research ethics committee of the University of Sharjah (Reference: REC-22-02-22-3) and Oman Dental College (Reference: ODC-MA-2022-166).

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Alrashdan, M.S., Qutieshat, A., El-Kishawi, M. et al. Insights into research activities of senior dental students in the Middle East: A multicenter preliminary study. BMC Med Educ 24 , 967 (2024). https://doi.org/10.1186/s12909-024-05955-5

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DOI : https://doi.org/10.1186/s12909-024-05955-5

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Study Habits of Highly Effective Medical Students

Khalid a bin abdulrahman.

1 Department of Medical Education, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia

Ahmad M Khalaf

Fahad b bin abbas, omran t alanazi.

Study habits have been the most significant indicator of academic performance and play a unique role in students’ academic accomplishment. The study is aiming to determine the most common study habits of highly successful medical students and their relation to academic achievement.

A cross-sectional observational study was conducted from September to December 2019 among medical students of both gender from six medical colleges in Saudi Arabia. The students answered the standardized questionnaires to study the different learning habits among medical students, including learning prioritization, knowledge retention strategies, motivation, daily hours of studying, study learning resources.

Six hundred and seventy-five medical students enrolled themselves electively into the study. The results showed a significant correlation between study habits and students’ academic accomplishments. The top ten study habits of highly effective medical students are managing their time effectively, they get rid of interruptions (phone, family, friends) that disrupt their daily work, they use goal-setting to determine their most important activities, their daily study hours is ranging between 3 and 4 hours, they study alone for knowledge retention of medical information, learn from multiple sources and invest in technology with high efficiency, they contribute to the teaching of their peers, they study the main lecture slides with notes when no exam is coming, and they study lecture slides with notes and previous exam questions when preparing for upcoming exams; finally, they maintained motivation for self-gratification and fulfillment of their family dreams.

This study’s outcomes consolidate general study practices that can be credited to learning achievement and expand recognition to inspire less accomplished students by investigating and exploring factors that have enhanced and worked for many accomplished students.

Introduction

Every year, tens of thousands of elite high school graduates compete for limited places in Saudi medical schools. There is no doubt that most of those admitted to medical colleges are students who have proven their ability and willingness to adapt to the study of medicine and overcome the challenges of successive exams and long study hours, especially since the medium of instruction in Saudi medical colleges in the English language. 1–3 Although many Saudi medical colleges have developed their curricula, some have even adopted modern curricula and methods in medical education that focus on active learning, problem-based learning, vertical and horizontal integration. It also allows the student to learn and participate in solving community health problems. 4–7 All this to maximize and improve the student’s experience and ease the tension and pressures students complain about in the old curricula. Some studies have indicated that successful students in medical schools can define their learning styles and use them in a way that makes them adapt to different circumstances, manage their time effectively, learn from multiple sources, invest in technology with high efficiency, and contribute to the education of their peers. 8–16

Medical college presents a specific difficult task to undergraduates because of the patent volume and broadness of data students who recently performed scholastically in college are confronted with. They are therefore compelled to devise better approaches to study adequately and advantageously. Deciding on powerful techniques to study in medical school is of utmost significance. 17

Subsequently, a comprehension of the kinds of study habits that are best in medical school is imperative, as the early realization of the study habits that are associated with progress can assist students in reaching their maximum capability and accomplishing proficiency during the pre-clinical and clinical years, which will help them in the residency selection program. 18 , 19

One of the core academic aims has always been the enhancement of student success. Several studies have been conducted to classify factors that affect students’ performance and achievement (positive or negative). It is a very complex process defining these variables and the connection between them. 20 It has been observed that participant attributes, behavior, learning environment, and educational activities affect their performance and achievement. 16 It has also been found that there are associations between academic performance and study skills, study habits, research attitudes, and motivation.

A study showed that medical students were significantly affected by academic burnout and engrossed in a literary adaptation. Medical students with significant intellectual flexibility will experience less academic burnout, more engrossment in learning, and better educational performance. Examining academic adaptability and approaches to upgrade such habits may help medical schools improve such skills and commitment. 21 A previous study showed that most medical students prefer to study lecture handouts containing what the teacher says. 15 Moreover, high GPA students enjoy learning more than lower GPA students (85.52–83.80%) and use textbooks more often (12.50–6.66%). 15 Nonetheless, another study on medical students elucidated that internal motivation is an essential stimulus for self-regulation strategies and better academic performance. 22

This study aims to determine the everyday study habits of highly effective medical students and examine their correlation with their academic achievement.

Materials and Methods

Study design.

This was a cross-sectional institutional-based observational study conducted among medical students at various medical colleges in Saudi Arabia. The study was conducted after approval from the IMSIU IRB committee number 68–2019 dated 17 November 2019.

Participants and Sampling

All medical students of either gender with a high GPA (4 and above out of 5) of the pre-clinical and clinical years were invited by email through the vice-dean of academic affairs of the six medical colleges in Saudi Arabia. Two reminder email messages were sent to enhance the response rate. The data was collected from the responded medical students in the six medical colleges, namely Imam Mohammad Ibn Saud Islamic University (IMSIU), King Abdulaziz University, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Qassim University, Alfaisal University, and King Saud University.

Study Questionnaire

The questionnaire was designed to study medical students’ learning habits, including time management and study resources. The students were informed about the purpose of the study. Instructions regarding the questionnaires were provided to volunteering students. The confidentiality of information was also ensured. Once students voluntarily signed the informed consent, they were requested to fill the study questionnaires. The questionnaire was adapted from different resources and manuscripts, which made it suitable for our study. The questionnaire was subjected to piloting testing by 25 students; some questions were modified accordingly. All students were emailed to participate and been reminded by emails and via an SMS web link. The Institute Review Board at Imam Mohammad Ibn Saud Islamic University had approved the study and it was according to the declaration of Helsinki.

The medical students’ prioritization was measured employing five indicators. However, the students’ overall perceived prioritization was calculated using the first four items’ mean. The multiple response dichotomy analysis was employed to describe the students’ preferred methods for memorization.

Statistical Data Analysis

The means and standard deviations were employed to describe the continuous variables, frequency, and percentages for categorical variables. Cronbach’s alpha test was used to evaluate the reliability of medical students’ measured prioritization indicators. One item among the four indicators (measuring the students’ procrastination) was reversed before computing the total prioritization mean score. The SPSS IBM V20 was employed for data analysis, and the statistical significance alpha level was considered at a level of 0.050. Microsoft Excel Program was used for creating figures and depictions.

Six hundred and seventy-five medical students enrolled themselves electively into the study. Table 1 summarizes the demographic characteristics and the daily study hours of medical students who participated in the study. The descriptive analysis of the medical students’ perceived indicators of prioritization of studies and activities are shown in Table 2 . The students’ mean collective prioritization was rated as 3.41/5, SD=0.78 points, denoting that the students prioritized between medium and high on average; if expressed as a percentage, it is 3.41/5 X 100= 68.2% out of hundred percent prioritization ability in general. The commonest used study method was studying alone according to 85.3% of the medical students, followed by group study according to 34% of the medical students, followed by teaching another student according to 26.4% of the medical students, and discussion with the course teacher according to 12% of the medical students Table 3 .

The Medical Students’ Sociodemographic and Academic Characteristics N=675

The Descriptive Analysis of the Medical Students’ Perceived Indicators of Prioritization of Studies and Activities

The Medical Student’s Used Methods of Knowledge Retention of Medical Information N=675

The students were also asked to select from a list of all the study methods they used when no exams approached Table 4 . More than 83.0% of the medical students used main lecture slides with notes, 76.1% used video software like YouTube and Osmosis.

The Studying Methods Used by Medical Students When Exams Were Not Expected N=675

Medical students were asked to indicate their best methods of studying when they had exams approaching. The most used study method by the students was main lectures according to 92.4% of the students, 74.8% of the student’s used previous exam questions, 34.4% used multiple-choice questions (MCQ) exam review books, 17.9% of the students also used self-assessment MCQ tests from the internet, 62.1% of the students used video software like YouTube and Osmosis, 35.7% used reference textbooks, 14.4% of the students used additional relevant medical books. Furthermore, the students were asked to suggest their best sources of motivation for success. The highest motivation according to the medical students was self-gratification and fulfillment of their family dreams, followed by maintaining a high level of educational status according to 62.8% of the students, followed by getting prepared to satisfy the requirements for joining the competitive medical residency program according to 52.9% of the medical students, and recognition of the fact that being a doctor may bring high income according to 43.6% of the medical students. However, 22.6% of the medical students were motivated by the reward of being highly distinctive students. Figure 1 summarizes the top ten study habits of highly effective medical students. Regarding the social status of the students, high GPA students were introverted primarily (66.2%), and the low GPA group was also predominantly introverted (62.2%) (p=0.330). The high GPA students also indicated that they were somewhat satisfied with their social life (44.9%) than 40.8% in the low GPA group. 37.8% of high GPA students were satisfied than 36.7% in the low GPA group (p=0.286).

The top ten study habits of highly effective medical students.

Decent time management strategies and skills improve academic achievement. 10 Students who do not design their time adequately use up all available time to overcome and master the content. In this regard, giving assistance and aid to students in time management should help them utilize their study time more productively and adequately. This measure ought to improve their educational performance. 13 In our study, most participants preferred to study alone (85.3%) as it is the most common method of knowledge retention regardless of their total GPA. Other students also used different medical information retention techniques like peer tutoring (26.4%) and group study (24%). This finding may indicate that most of the students’ overall study method is studying alone, which was also the same result obtained in a study that compared male and female medical students’ study habits. 15 When there were no exams expected, the majority of participants used the main lecture slides with their notes (83.4%), followed by videos such as YouTube and Osmosis (76.1%) and reference textbooks (46.1%). Similarly, when exams were close, the studying methods did not change drastically. Most of the study members used main lecture slides with their personalized notes (92.4%) and videos (62.1%). Surprisingly, most students utilized previous exam questions as a studying method (74.8%). Homogeneous results have also shown that most medical students prefer to study lecture handouts containing what the teacher says. 15 It is striking that most students rely on lecture slides and student notes in their daily study, especially to prepare for the various exams, and they ignore reading from reference books. Perhaps the explanation for this is that students focus on the sources that revolve around the content of the exams. This is undoubtedly an unhealthy phenomenon that students avoid reading from reference books, and their biggest concern is to get the highest scores on exams only. Here, we advise professors of medical colleges to devise methods and strategies that direct and motivate students to read from reference books and selective medical articles. Most students’ concept of motivation was to satisfy themselves and their family (75.4%), other students opined that their motivation was to maintain a high level of educational status (62.8%), having a good income as doctors (43.6%), and getting rewarded for being one of the top students in the class (22.6%). Students with superior study techniques have more active and dynamic learning styles and are more engaged in educational subjects; they will also have better retaining and memory capacities. 23 Furthermore, high GPA students enjoy studying more than lower GPA students (85.52–83.80%) and use textbooks more often (12.50–6.66%). 15 Regarding the study hours per day, students with higher GPAs studied on average 3–4 hours daily (45.5%) than lower GPA students (38.3%) regardless of whether the exam is close or not, with no statistical difference detected. Another comparable study on 257 medical students showed that 43% of students with high GPA study 10–14 hours close to the final exam, and 50% in the lower GPA group. Furthermore, 47% of female students preferred studying 10–14 hours close to the final assessments compared to 44% of the male group. For study hours not close to the final exam, 75% of students with high GPAs chose to study 1–4 hours daily compared to 65% of the lower GPA group. Also, 64% of female students favored studying 1–4 hours each day compared to 78% (p=0.050). 15 It appears that their students, whether in the high or low GPA group, either male or female, invested only the energy required to meet the least requirements, which implies that they express more surface learning. 24 Although this does not apply to our students due to the increase in study hours. Regarding the social status of the students, high GPA students were introverted primarily (66.2%), and the low GPA group was also predominantly introverted (62.2%) (p=0.330). The high GPA students also indicated that they were somewhat satisfied with their social life (44.9%) than 40.8% in the low GPA group. 37.8% of high GPA students were satisfied than 36.7% in the low GPA group (p=0.286). Another study that was conducted on 640 Latino adolescents to find out if there is any relationship between academic performance and loneliness revealed that just about a fourth of the Latino adolescents struggled to find their ideal position, thus, suffering from chronic or increasing loneliness, which had impending ramifications for their future educational achievement. 25 This study’s outcomes consolidate general study practices that can be credited to learning achievement and expand recognition to inspire less accomplished students by investigating and exploring factors that have enhanced and worked for many accomplished students.

Limitations

The current study has a few limitations. For instance, factors investigated here were of potential associations and not intended to imply causation implicitly. Consequently, the investigation report provided here was established on the bivariate comparison (high versus low GPA). Another limitation is that a student may comprehend each question distinctly, and it should be noted that the GPA and other components of the questionnaire were self-reported. It is also crucial to recall that what works for one student may not work for another, so students should also be urged to discover study habits that work efficiently and effectively for them. The habits introduced here are intended to be a guide that might be of aid to students whose current study habits are not working efficiently and effectively.

The top ten study habits of highly effective medical students are; managing their time effectively, they get rid of interruptions from (phone, family, friends) that disrupt their daily work, they use goal-setting to determine their most important activities, their daily study hours is ranging between 3–4 hours, they study alone for knowledge retention of medical information, learn from multiple sources and invest in technology with high efficiency, they contribute to the teaching of their peers, they study the main lecture slides with notes when no exam is coming, and they study lecture slides with notes and previous exam questions when preparing for upcoming exams; finally, they maintained motivation for self-gratification and fulfillment of their family dreams.

The authors reported no conflicts of interest for this work.

Rising popularity of nicotine pouches among youth raises concerns

• Download PDF Copy

About half of adults can identify cigarettes and e-cigarettes, but just one in four would recognize oral nicotine pouches, and these easily available products are growing increasingly popular among teens and young adults, according to a recent study commissioned by The Ohio State University Comprehensive Cancer Center – Arthur G. James Hospital and Richard J. Solove Research Institute (OSUCCC – James).

Oral nicotine pouches are small packets filled with a flavored powder containing nicotine and other chemicals that are tucked between the lip and gums. Researchers at the OSUCCC – James Center for Tobacco Research are concerned that these oral nicotine pouches are so appealing and easy to use that they could be a gateway to future tobacco product addiction for Gen Z.

Epidemiologist Brittney Keller-Hamilton, PhD, says these products are available in low- and high-nicotine concentrations, making them appealing to both new users and people who are already addicted to nicotine. 

"We're starting to hear from college students that they find it easier to use nicotine pouches at work or in class because they are easier to conceal. They also do not require you to spit excess saliva like older tobacco oral products (dip, snuff)," said Keller-Hamilton, who studies nicotine pouch use and regulation at the Center for Tobacco Research. "One of my biggest concerns with nicotine pouches is that as youth experiment with these products, they might not find them to be satisfying enough to continue to meet a growing nicotine craving and then might transition to more harmful products. " 

She notes that regulation of these products is minimal, and that removing flavorings, prohibiting online sales, and increasing the price could discourage youth experimentation and, therefore, reduce their risk of becoming addicted to nicotine. 

As students go back to school, Keller-Hamilton cautions parents to pay attention to what is in their teenagers' backpacks.

Many products are cleverly packaged to conceal the real content – vapes as highlighters or pens, oral nicotine pouches as mints. Unfortunately, due to loose industry regulation, they are very easy to obtain for underage youth, and they are far from harmless. We know that when people start using any nicotine product, including nicotine pouches, before their brain is finished developing, it primes their brain for a stronger nicotine addiction and also primes their brain for addiction to other substances. It's really important for parents to talk with their kids about the dangers of these products and seek help from their pediatrician if they're concerned about nicotine addiction." Brittney Keller-Hamilton, PhD, Epidemiologist

Study results and methods

For this survey, 1,000 adults aged 18 or older were asked about their ability to recognize nicotine products with and without the visual aid of packaging, as well as their perceptions about the health effects of these products.

Related Stories

• Hormonal treatment could delay biological aging among postmenopausal females
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• New review highlights top strategies for smoking cessation

Ohio State's recent survey showed that 70% of adults believe nicotine pouches are harmful to health and lead to addiction, but just 25% say they could identify a nicotine pouch out of its container or packaging. The survey also found that those between the ages of 18-29 are more likely to know someone who uses nicotine pouches, as opposed to older adults.

This study was conducted on behalf of the OSUCCC – James by SSRS on its Opinion Panel Omnibus platform. The SSRS Opinion Panel Omnibus is a national, twice-per-month, probability-based survey. Data collection was conducted from July 19-22, 2024, among a sample of 1,008 respondents. The survey was conducted via web (n=976) and telephone (n=32) and administered in English. The margin of error for total respondents is +/- 3.5 percentage points at the 95% confidence level. All SSRS Opinion Panel Omnibus data are weighted to represent the target population of U.S. adults ages 18 or older. 

Ohio State University Wexner Medical Center

Posted in: Medical Research News | Healthcare News

Tags: Addiction , Brain , Cancer , Chemicals , Heart , Hospital , Nicotine , Nicotine Addiction , Pharmacist , Research , Smoking , Smoking Cessation , students , Tobacco , Vascular

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