key: cord-0765208-70xzhgpp
authors: Saha, Shruti; Gogtay, Nithya Jaideep
title: Research, residents, and registrars – getting it right
date: 2022-04-06
journal: Perspect Clin Res
DOI: 10.4103/picr.picr_252_21
sha: d97ded9d28ec8cae442032fd69d37d3f5ae01aa5
doc_id: 765208
cord_uid: 70xzhgpp

nan

Editorial At the time of writing this editorial, the COVID-19 pandemic continues its relentless march. Despite vaccination and dropping caseloads in several countries, severe disease-related deaths continue to be reported. [1] The one thing that this pandemic has ensured is the importance of research and clinical trials and this has been understood and appreciated by the average person worldwide. Against this backdrop, it was interesting to review a paper in the present issue of the journal that reports a study by Igbokwe et al. where the authors have looked at engagement with research among postgraduate students (medical and dental) in Nigeria. The outcomes were profiles, perceptions, barriers, and predictors of this engagement. [2] Registrars (2-3 years into residency) and senior registrars (beyond 3 years) in surgical and nonsurgical disciplines were chosen. Among the 438 participants studied, funding (lack thereof), insufficient time, inadequate research methodology training, and the onerous nature of research have been identified as key challenges to doing research. The present paper is part of a larger studying called the CHARTING study that has looked at early career doctors and challenges of residency training. [3] This study brings to fore why research is needed in the first place. The question that postgraduate students need to ask themselves is why is research an integral part of the medical curriculum? At entry into the course, they are told that a thesis is a must and many universities mandate a thesis defense at the time of the final examination. One can safely assume that the first 6 months of any course are "settling in" time while the next one to one and a half years are devoted to the thesis while balancing clinical and teaching responsibilities. The joy of doing research in these years can easily become a tiresome and worrisome chore that needs to be "checked off " a long list. This is clearly borne out by the use of the term onerous by the participants in the study. [2] If we are teachers or policymakers, the question that we need to ask is why was research built into the medical and dental curriculum in the first place and what purpose does it serve today? During the Second World War, a physician in the United States could enter practice after just 3 years of accelerated training. [3] Today, it is at least 6 years of training to become a family physician in India and usually more than 8 years to emerge as a specialist anywhere in the world. Not just this, courses such as research methodology, good clinical practice, and pharmacovigilance among others form an integral part of the curriculum in many universities. There is a clamor for rigorous training in biostatistics. [4] This road of medicine is hard for the teacher and harder for the taught.

How do we address this? The answer lies in understanding the need for research and changing its perception. If one were to perceive research as something joyous, the outcome and output would be vastly different. Research fundamentally helps with day-to-day problem solving. Understanding of research methods helps with appreciating and applying evidence-based medicine, leads to an in-depth understanding of a subtopic in one's own subject, and finally, helps one grow into a well-rounded person. If these are borne in mind, and with a good attitude towards research, high-quality postgraduates will be produced from any country. A key feature here is the role of the mentor who can mold these young postgraduates into clinician-researchers at the end of their tenure. The relationship with some mentors which could start as early as undergraduate days can easily endure a lifetime. Mentors can also show how variability is an integral part of medicine and teach students to accept ambiguity, equipoise, and see the world as a far more complex place than it appears to be.

The findings aside, there are some aspects of the study that have not been fleshed out adequately by the authors. One example is the gender skew. Seventy-two percent of the respondents were male. It is not clear if this is an indication of more males entering the medical colleges in the country and subsequently opting for postgraduate courses or a selection bias in the study process itself with fewer women responding to the questionnaire. The second is the use of proportion of work-related stress among physicians in developing countries (approximately 50%) as the basis for sample size calculation among what appear to be primarily postgraduates. Third, the classification of work hours more than 40 and <40 h is not easily understood as the benchmark in the institute for working hours for surgical and nonsurgical residents is not stated. Furthermore, the lumping of these residents to surgical and nonsurgical does not lend any insight into the actual nature of the work done by them in the absence of a clear statement of which surgical (or nonsurgical disciplines) they belonged to. Logistic regression analysis has been mentioned but there appear to be multiple dependent variables. It would have been interesting to know if this study was done during the pandemic and whether that was factored in as a variable in the questionnaire.

As the study has been done in a lower-and middle-income country, some insights into how other countries address these issues may help. In India, in an attempt at fostering research temperament among medical graduates, the Indian Council of Medical Research (ICMR) has a fellowship scheme for a period of four to 5 years with a total of 25 fellowships available annually. Medical graduates who have completed their MBBS degree and opt for an MD/MS degree through a national examination will be provided financial support for a 5-year period with research being an important component of this scheme. Selected candidates in the first 3 years will be given a Junior Resident salary followed by a senior resident salary for the next 2 years. Potentially, an MD + PhD is also possible at the end of 5 years. [5] In addition, agencies such as the ICMR also have scholarships under their Short Term Studentship (STS) scheme for undergraduate medical students. This could help inculcate a spirit of research right from entry into the medical college. [6] Finally, the ongoing pandemic actually gives us the greatest insight into the importance of research. It is only research and research alone that has made sure that we have understood the need for masks, have vaccines available in record time, repurposed drugs that saved lives worldwide, and introduction of antivirals and monoclonal antibodies in the recent months that may help mitigate the impact of the pandemic as we move into 2022. The learning for mentors, mentees, and decision-makers in medical education could come from the words of the Japanese physicist Sumio Iijima-Research can be undertaken in any kind of environment, as long as you have the interest. I believe that true education means fostering the ability to be interested in something.

An exploration of profile, perceptions, barriers, and predictors of research engagement among resident doctors: A report from CHARTING study

Comprehensive history of 3-year and accelerated US medical school programs: a century in review

Is there need for a transformational change to overcome the current problems with postgraduate medical education in India