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How to get involved in research as a medical student

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• Peer review
• Anna Kathryn Taylor , final year medical student 1 ,
• Sarah Purdy , professor of primary care and associate dean 1
• 1 Faculty of Health Sciences, University of Bristol, UK

Participating in research gives students great skills and opportunities. Anna Taylor and Sarah Purdy explain how to get started

This article contains:

-How to get involved with research projects

-Questions to ask yourself before starting research

-What can you get published? Research output

-Advice for contacting researchers

-Different types of research explained

-Stages of research projects

Students often go into medicine because of a desire to help others and improve patients’ physical and mental wellbeing. In the early years of medical school, however, it can seem as if you are not making much difference to patient care. Involvement in research can provide exciting opportunities to work as part of a team, improve career prospects, and most importantly add to the evidence base, leading to better outcomes for patients.

Research is usually multidisciplinary, including clinical academics (medical doctors who spend part of their working life doing research), nurses, patients, scientists, and researchers without a medical background. Involvement in such a team can improve your communication skills and expand your understanding of how a multidisciplinary team works.

Participating in research can also help you to develop skills in writing and critical appraisal through the process of publishing your work. You may be able to present your work at conferences—either as a poster or an oral presentation—and this can provide valuable points for job applications at both foundation programme and core training level. This is particularly important if you are considering a career in academia. You will also develop skills in time management, problem solving, and record keeping. You might discover an area of medicine in which you are keen to carry out further work. For some people, getting involved in research as a medical student can be the first step in an academic career.

Kyla Thomas, National Institute for Health Research clinical lecturer in public health at the University of Bristol, says, “my first baby steps into a clinical academic career started with a research project I completed as a medical student. That early involvement in research opened my eyes to a whole new world of opportunities that I never would have considered.

“Importantly, participating in undergraduate research sets students apart from their colleagues. Applying for foundation posts is a competitive process and it is a definite advantage if you have managed to obtain a peer reviewed publication.”

Getting involved with research projects

Although it is possible to do research at medical school, it is important to be realistic about how much free time you have. It might be possible to set up your own research project, but this will require substantial planning in terms of writing research protocols, gaining ethical approval, and learning about new research methodologies. Other opportunities for research that make less demands on your time include:

Intercalated degrees—these often have time set aside for research in a specific area, so it is important to choose your degree according to what you might like to do for your dissertation (for example, laboratory-based work in biochemistry, or qualitative research in global health. Some subjects may have options in both qualitative and quantitative research).

Student selected components or modules can provide a good opportunity to be involved in an ongoing study or research project. If you have a long project period, you might be able to develop your own small project.

Electives and summer holidays can also provide dedicated time for research, either within the United Kingdom or in another country. They can allow you to become established in a research group if you’re there for a few weeks, and can lead to a longstanding relationship with the research group if you continue to work with them over your medical school career.

If you don’t know what to do, contacting the Student Audit and Research in Surgery (STARSurg), 1 the National Student Association of Medical Research (NSAMR), 2 or your medical school’s research society may be a good place to start.

The INSPIRE initative, 3 coordinated by the Academy of Medical Sciences, gives support and grants to help students take part in research. Some UK medical schools have small grants for elective and summer projects, and organise taster days for students to get an idea of different research areas.

You may also be able to access other grants or awards to support your research. Some of the royal colleges, such as the Royal College of General Practitioners and the Royal College of Psychiatrists, offer bursaries to students doing research in their holidays or presenting at conferences. Other national organisations, such as the Medical Women’s Federation, offer bursaries for elective projects.

Box 1: Questions to ask yourself before starting research

What are you interested in? There is no point getting involved in a project area that you find boring.

How much time do you have available? It is crucial to think about this before committing to a project, so that your supervisor can give you an appropriate role.

What do you want to get out of your research experience? Do you want a brief insight into research? Or are you hoping for a publication or presentation?

Do you know any peers or senior medical students who are involved in research? Ask them about their experiences and whether they know of anyone who might be willing to include you in a project.

Box 2: Research output

Publication —This is the “gold standard” of output and usually consists of an article published in a PubMed ID journal. This can lead to your work being cited by another researcher for their paper, and you can get up to two extra points on foundation programme applications if you have published papers with a PubMed ID.

Not all research will get published, but there are other ways to show your work, such as presenting at conferences:

Oral presentation —This involves giving a short talk about your research, describing the background, methods, and results, then talking about the implications of your findings.

Poster presentation —This involves creating a poster, usually A1 or A2 in size, summarising the background, methods, and results of your research. At a conference, presenters stand by their poster and answer questions from other delegates.

Contacting researchers

Most universities have information about their research groups on their websites, so spend some time exploring what studies are being carried out and whether you are interested in one of the research topics.

When contacting a member of the research group, ask if they or someone else within their team would be willing to offer you some research experience. Be honest if you don’t have any prior experience and about the level of involvement you are looking for, but emphasise what it is about their research that interests you and why you want to work with them. It’s important to have a flexible approach to what they offer you—it may not initially sound very exciting, but it will be a necessary part of the research process, and may lead to more interesting research activity later.

Another way to make contact with researchers is at university talks or lectures. It might be intimidating to approach senior academics, but if you talk to them about your interest they will be more likely to remember you if you contact them later on.

Box 3: What can students offer research teams?—Views from researchers

“Medical students come to research with a ‘fresh eyes’ perspective and a questioning mindset regarding the realities of clinical practice which, as a non-medic myself, serves to remind me of the contextual challenges of implementing recommendations from our work.”

Alison Gregory, senior research associate, Centre for Academic Primary Care, University of Bristol, UK.

“Enthusiasm, intelligence, and a willingness to learn new skills to solve challenges—bring those attributes and you’ll be valuable to most research teams.”

Tony Pickering, consultant anaesthetist and Wellcome Trust senior research fellow, University of Bristol, UK.

Box 4: Different types of research

Research aims to achieve new insights into disease, investigations, and treatment, using methodologies such as the ones listed below:

Qualitative research —This can be used to develop a theory and to explain how and why people behave as they do. 4 It usually involves exploring the experience of illness, therapeutic interventions, or relationships, and can be compiled using focus groups, structured interviews, consultation analysis, 5 or ethnography. 6

Quantitative research —This aims to quantify a problem by generating numerical data, and may test a hypothesis. 7 Research projects can use chemicals, drugs, biological matter, or even computer generated models. Quantitative research might also involve using statistics to evaluate or compare interventions, such as in a randomised controlled trial.

Epidemiological research —This is the study of the occurrence and distribution of disease, the determinants influencing health and disease states, and the opportunities for prevention. It often involves the analysis of large datasets. 4

Mixed methods research —This form of research incorporates both quantitative and qualitative methodologies.

Systematic reviews —These provide a summary of the known evidence base around a particular research question. They often create new data by combining other quantitative (meta-analysis) or qualitative (meta-ethnography) studies. They are often used to inform clinical guidelines.

Box 5: Stages of research projects

Project conception—Come up with a hypothesis or an objective for the project and form the main research team.

Write the research protocol—Produce a detailed description of the methodology and gain ethical approval, if needed.

Carry out the methodology by collecting the data.

Analyse the data.

Decide on the best way to disseminate your findings—for example, a conference presentation or a publication—and where you will do this.

Write up your work, including an abstract, in the format required by your chosen journal or conference.

Submit . For conference abstracts, you may hear back swiftly whether you have been offered the chance to present. Publication submissions, however, must be peer reviewed before being accepted and it can take over a year for a paper to appear in print.

Originally published as: Student BMJ 2017;25:i6593

Competing interests: AKT received grant money from INSPIRE in 2013.

Provenance and peer review: Not commissioned; externally peer reviewed.

• ↵ STARSurg. Student Audit and Research in Surgery. 2016. www.starsurg.org .
• ↵ NSAMR. National Student Association of Medical Research. 2016. www.nsamr.org .
• ↵ The Academy of Medical Sciences. About the INSPIRE initiative. 2016. www.acmedsci.ac.uk/careers/mentoring-and-careers/INSPIRE/about-INSPIRE/ .
• ↵ Ben-Shlomo Y, Brookes ST, Hickman M. Lecture Notes: Epidemiology, Evidence-based Medicine and Public Health. 6th ed . Wiley-Blackwell, 2013 .
• ↵ gp-training.net. Consultation Theory. 2016. www.gp-training.net/training/communication_skills/consultation/consultation_theory.htm .
• ↵ Reeves S, Kuper A, Hodges BD. Qualitative research methodologies: ethnography. BMJ 2008 ; 337 : a1020 . doi:10.1136/bmj.a1020   pmid:18687725 . OpenUrl FREE Full Text
• ↵ Porta M. A Dictionary of Epidemiology. 5th ed . Oxford University Press, 2008 .

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Peer-reviewed

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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https://doi.org/10.1371/journal.pone.0127470.g001

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 ].

https://doi.org/10.1371/journal.pone.0127470.g002

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.

https://doi.org/10.1371/journal.pone.0127470.g003

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.

https://doi.org/10.1371/journal.pone.0127470.g004

https://doi.org/10.1371/journal.pone.0127470.g005

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 ].

https://doi.org/10.1371/journal.pone.0127470.t001

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 ].

https://doi.org/10.1371/journal.pone.0127470.t002

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 ] .

https://doi.org/10.1371/journal.pone.0127470.t003

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.

https://doi.org/10.1371/journal.pone.0127470.g006

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.

https://doi.org/10.1371/journal.pone.0127470.g007

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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Teaching Medical Research to Medical Students: a Systematic Review

Affiliations.

• 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
• 2 Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore.
• 3 Liver Transplantation, National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore.
• 4 Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
• 5 Division of Colorectal Surgery, Department of Surgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore.
• PMID: 34457935
• PMCID: PMC8368360
• DOI: 10.1007/s40670-020-01183-w

Phenomenon: Research literacy remains important for equipping clinicians with the analytical skills to tackle an ever-evolving medical landscape and maintain an evidence-based approach when treating patients. While the role of research in medical education has been justified and established, the nuances involving modes of instruction and relevant outcomes for students have yet to be analyzed. Institutions acknowledge an increasing need to dedicate time and resources towards educating medical undergraduates on research but have individually implemented different pedagogies over differing lengths of time.

Approach: While individual studies have evaluated the efficacy of these curricula, the evaluations of educational methods and curriculum design have not been reviewed systematically. This study thereby aims to perform a systematic review of studies incorporating research into the undergraduate medical curriculum, to provide insights on various pedagogies utilized to educate medical students on research.

Findings: Studies predominantly described two major components of research curricula-(1) imparting basic research skills and the (2) longitudinal application of research skills. Studies were assessed according to the 4-level Kirkpatrick model for evaluation. Programs that spanned minimally an academic year had the greatest proportion of level 3 outcomes (50%). One study observed a level 4 outcome by assessing the post-intervention effects on participants. Studies primarily highlighted a shortage of time (53%), resulting in inadequate coverage of content.

Insights: This study highlighted the value in long-term programs that support students in acquiring research skills, by providing appropriate mentors, resources, and guidance to facilitate their learning. The Dreyfus model of skill acquisition underscored the importance of tailoring educational interventions to allow students with varying experience to develop their skills. There is still room for further investigation of multiple factors such as duration of intervention, student voluntariness, and participants' prior research experience. Nevertheless, it stands that mentoring is a crucial aspect of curricula that has allowed studies to achieve level 3 Kirkpatrick outcomes and engender enduring changes in students.

Supplementary information: The online version contains supplementary material available at 10.1007/s40670-020-01183-w.

Keywords: Curricula; Dreyfus model; Medical undergraduates; Research education; Skill acquisition.

© International Association of Medical Science Educators 2021.

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Teaching Medical Research to Medical Students: a Systematic Review

• Published: 08 January 2021
• Volume 31 , pages 945–962, ( 2021 )

Cite this article

• Gabriel Sheng Jie Lee 1 ,
• Yip Han Chin 1 ,
• Aimei Amy Jiang 1 ,
• Cheng Han Mg 1 ,
• Kameswara Rishi Yeshayahu Nistala 1 ,
• Shridhar Ganpathi Iyer 2 , 3 ,
• Shuh Shing Lee 4 ,
• Choon Seng Chong   ORCID: orcid.org/0000-0003-0669-7307 1 , 5 &
• Dujeepa D. Samarasekera 4  

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Research literacy remains important for equipping clinicians with the analytical skills to tackle an ever-evolving medical landscape and maintain an evidence-based approach when treating patients. While the role of research in medical education has been justified and established, the nuances involving modes of instruction and relevant outcomes for students have yet to be analyzed. Institutions acknowledge an increasing need to dedicate time and resources towards educating medical undergraduates on research but have individually implemented different pedagogies over differing lengths of time.

While individual studies have evaluated the efficacy of these curricula, the evaluations of educational methods and curriculum design have not been reviewed systematically. This study thereby aims to perform a systematic review of studies incorporating research into the undergraduate medical curriculum, to provide insights on various pedagogies utilized to educate medical students on research.

Studies predominantly described two major components of research curricula—(1) imparting basic research skills and the (2) longitudinal application of research skills. Studies were assessed according to the 4-level Kirkpatrick model for evaluation. Programs that spanned minimally an academic year had the greatest proportion of level 3 outcomes (50%). One study observed a level 4 outcome by assessing the post-intervention effects on participants. Studies primarily highlighted a shortage of time (53%), resulting in inadequate coverage of content.

This study highlighted the value in long-term programs that support students in acquiring research skills, by providing appropriate mentors, resources, and guidance to facilitate their learning. The Dreyfus model of skill acquisition underscored the importance of tailoring educational interventions to allow students with varying experience to develop their skills. There is still room for further investigation of multiple factors such as duration of intervention, student voluntariness, and participants’ prior research experience. Nevertheless, it stands that mentoring is a crucial aspect of curricula that has allowed studies to achieve level 3 Kirkpatrick outcomes and engender enduring changes in students.

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Acknowledgments

The authors would like to thank Ms. Annelissa Chin from Yong Loo Lin School of Medicine, medical library for assisting us with the search strategy.

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Lee, G.S.J., Chin, Y.H., Jiang, A.A. et al. Teaching Medical Research to Medical Students: a Systematic Review. Med.Sci.Educ. 31 , 945–962 (2021). https://doi.org/10.1007/s40670-020-01183-w

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How to Write and Publish Clinical Research in Medical School

From working hard on the USMLE® exams to holding leadership positions in a specialty’s academic society, there are many ways medical students can work towards matching into the residency of their choice. One such activity that looks great on residency applications is finding clinical research opportunities in medical school to write and publish papers. No one knows this better than Dr. Eve Bowers. 

An Otolaryngology resident at the University of Miami/Jackson Memorial Hospital, Eve became an expert in writing, submitting, and publishing manuscripts during her final years in medical school. Check out Eve’s blog post below to get valuable insights on how to get published in medical school. 

As medical students, we’re told that research is important and that publications are “good”, and even “necessary to match ” into residency, but we often aren’t given the tools we need to turn ideas into manuscripts. This is especially true given our rigorous schedules. 

When I looked through my CV, I saw I had a few abstracts and presentations, but no manuscripts. I wanted to write, but publishing seemed like just checking another resume box. On top of that, I didn’t know where to begin. 

My writing journey started with a case report I nervously picked up during my surgery clerkship . Then, over ten months of typing, editing, and sending unanswered emails, I went from writing 0 to ten manuscripts. The process was sometimes painful but mostly gratifying (yes, research can be gratifying), and you can do it, too.

To make finding, starting, and publishing high-quality research articles a little bit easier and a lot more enjoyable, check out my five tips for publishing clinical research in medical school.

1. Build your network to find publication opportunities in medical school

When looking for projects, finding great mentors is often more useful than finding the perfect project. This is especially true when starting out. Use your time on clerkships to identify attending and resident mentors who you trust to support your budding author ambitions.

At this stage, residents especially are your friends . When you demonstrate follow-through and receptiveness to feedback, you will be given more research opportunities. Don’t be shy about asking mentors for tasks if you can juggle multiple projects, but don’t bite off more than you can chew. It’s important to communicate honestly and be transparent about the amount of time you have.

2. Kickstarting your research during medical school: start small 

If you have no research experience, start with a case report. Volunteer to write an article about an interesting case you saw in the operating room or clinic. It’s much easier and more rewarding to write about patients you have experience with, and case reports are a great way to demonstrate your writing ability to more senior authors.

Pro tip : Try to figure out as much as you can independently by using published reports as blueprints before asking for help. Nevertheless, don’t be afraid to seek guidance when you need it! If you approach a mentor with a problem, come prepared with 2-3 realistic solutions or examples of how you tried to figure it out on your own.

3. Know the criteria for writing a clinical research paper 

Before you begin, ask your mentor where they would like to submit the completed work. Each journal has specific standards, styles, and submission criteria. For guidance, look to papers previously published in that journal. 

As far as annotations and citations are concerned, download and learn how to use Endnote or Zotero right now! You’ll save days of work formatting your references.

Additionally, consider creating folders and spreadsheets to keep track of projects. Set goals and timelines for yourself from the beginning, and block off dedicated time to conduct a literature review, analyze data, and write.

Pro tip : If you are the first author and overseeing a large team, improve communication and efficiency by making everyone’s roles and expectations very clear to the group via email.

4. Follow up with your mentor

Sometimes you’ll send your mentor a draft, but she won’t get back to you with edits and feedback in a reasonable timeframe. Surprisingly, many projects do not get past this point because of insufficient persistence. Here’s what to do if this happens:

• Politely nudge your mentor with follow-up emails and schedule a meeting to discuss in person or via Zoom.
• Set deadlines and give specific reasons why the paper needs to be submitted. Some reasons could include, “I need this submission for my residency application ” or “this is a requirement for my school.”
• Ask your co-author resident and/or fellow to advocate for edits and submission.

Whatever happens, don’t give up at this point. You’ve put in the work, and persistence makes or breaks a successful student-author.

5. Write about the medical topics that you love

Writing is fun when you focus on subjects you’re really passionate about. You also don’t have to stay within your institution: feel free to branch out if you come across an interesting research opportunity at a different program. A little cold email can go a long way!

If your goal is quantity, you can increase output by asking around about “productive” research mentors and sticking to topics related to clinical practice or medical education. However, my advice is to never let relatively quick publication opportunities compromise the quality of your work. Remember — every paper you write gets easier and more enjoyable, and your work will be truly important to advancing the field you care about. Good luck!

About the Author : Eve is an Otolaryngology Resident at the University of Miami/Jackson Memorial Hospital. She attended medical school at the University of Pittsburgh School of Medicine and undergrad at the University of Pennsylvania. She is passionate about medical education, mentorship, and increasing minority and female leadership in surgical fields. For more tips and tricks, follow her on Twitter and Instagram !

For more information on residency applications, check out the AMBOSS Residency Applications Clerkship Survival Guide. 

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Top 10 Tips: Getting into Research as a Medical Student

Introducing our new series: Top 10 Tips – a simple guide to help you achieve your goals!

In this blog post, Jessica Xie (final year UCL medical student) shares advice on getting into research as a medical student.

Disclaimers: 

• Research is not a mandatory for career progression, nor is it required to demonstrate your interest in medicine. 
• You can dip into and out of research throughout your medical career. Do not feel that you must continue to take on new projects once you have started; saying “no, thank you” to project opportunities will allow you to focus your energy and time on things in life that you are more passionate about for a more rewarding experience.
• Do not take on more work than you are capable of managing. Studying medicine is already a full-time job! It’s physically and mentally draining. Any research that you get involved with is an extracurricular interest.

I decided to write this post because, as a pre-clinical medical student, I thought that research only involved wet lab work (i.e pipetting substances into test tubes). However, upon undertaking an intercalated Bachelor of Science (iBSc) in Primary Health Care, I discovered that there are so many different types of research! And academic medicine became a whole lot more exciting…

Here are my Top 10 Tips on what to do if you’re a little unsure about what research is and how to get into it:

TIP 1: DO YOUR RESEARCH (before getting into research)

There are three questions that I think you should ask yourself:

• What are my research interests?

Examples include a clinical specialty, medical education, public health, global health, technology… the list is endless. Not sure? That’s okay too! The great thing about research is that it allows deeper exploration of an area of Medicine (or an entirely different field) to allow you to see if it interests you.

2.  What type of research project do I want to do?

Research evaluates practice or compares alternative practices to contribute to, lend further support to or fill in a gap in the existing literature.

There are many different types of research – something that I didn’t fully grasp until my iBSc year. There is primary research, which involves data collection, and secondary research, which involves using existing data to conduct further research or draw comparisons between the data (e.g. a meta-analysis of randomised control trials). Studies are either observational (non-interventional) (e.g. case-control, cross-sectional) or interventional (e.g. randomised control trial).

An audit is a way of finding out if current practice is best practice and follows guidelines. It identifies areas of clinical practice could be improved.

Another important thing to consider is: how much time do I have? Developing the skills required to lead a project from writing the study protocol to submitting a manuscript for publication can take months or even years. Whereas, contributing to a pre-planned or existing project by collecting or analysing data is less time-consuming. I’ll explain how you can find such projects below.

3.  What do I want to gain from this experience?

Do you want to gain a specific skill? Mentorship? An overview of academic publishing? Or perhaps to build a research network?

After conducting a qualitative interview study for my iBSc project, I applied for an internship because I wanted to gain quantitative research skills. I ended up leading a cross-sectional questionnaire study that combined my two research interests: medical education and nutrition. I sought mentorship from an experienced statistician, who taught me how to use SPSS statistics to analyse and present the data.

Aside from specific research skills, don’t forget that you will develop valuable transferable skills along the way, including time-management, organisation, communication and academic writing! 

TIP 2: BE PROACTIVE

Clinicians and lecturers are often very happy for medical students to contribute to their research projects. After a particularly interesting lecture/ tutorial, ward round or clinic, ask the tutor or doctors if they have any projects that you could help them with! 

TIP 3: NETWORKING = MAKING YOUR OWN LUCK

Sometimes the key to getting to places is not what you know, but who you know. We can learn a lot from talking to peers and senior colleagues. Attending hospital grand rounds and conferences are a great way to meet people who share common interests with you but different experiences. I once attended a conference in Manchester where I didn’t know anybody. I befriended a GP, who then gave me tips on how to improve my poster presentation. He shared with me his experience of the National institute of Health Research (NIHR) Integrated Academic Training Pathway and motivated me to continue contributing to medical education alongside my studies.

TIP 4: UTILISE SOCIAL MEDIA

Research opportunities, talks and workshops are advertised on social media in abundance. Here are some examples:

Search “medical student research” or “medsoc research” into Facebook and lots of groups and pages will pop up, including UCL MedSoc Research and Academic Medicine (there is a  Research Mentoring Scheme Mentee Scheme), NSAMR – National Student Association of Medical Research and International Opportunities for Medical Students .

Search #MedTwitter and #AcademicTwitter to keep up to date with ground-breaking research. The memes are pretty good too.

Opportunities are harder to come by on LinkedIn, since fewer medical professionals use this platform. However, you can look at peoples’ resumes as a source of inspiration. This is useful to understand the experiences that they have had in order to get to where they are today. You could always reach out to people and companies/ organisations for more information and advice.

TIP 5: JOIN A PRE-PLANNED RESEARCH PROJECT

Researchers advertise research opportunities on websites and via societies and organisations such as https://www.remarxs.com and http://acamedics.org/Default.aspx . 

TIP 6: JOIN A RESEARCH COLLABORATIVE

Research collaboratives are multiprofessional groups that work towards a common research goal. These projects can result in publications and conference presentations. However, more importantly, this is a chance to establish excellent working relationships with like-minded individuals.

Watch out for opportunities posted on Student Training and Research Collaborative .

Interested in academic surgery? Consider joining StarSurg , BURST Urology , Project Cutting Edge or Academic Surgical Collaborative .

Got a thing for global health? Consider joining Polygeia . 

TIP 7: THE iBSc YEAR: A STEPPING STONE INTO RESEARCH

At UCL you will complete an iBSc in third year. This is often students’ first taste of being involved in research and practicing academic writing – it was for me. The first-ever project that I was involved in was coding data for a systematic review. One of the Clinical Teaching Fellows ended the tutorial by asking if any students would be interested in helping with a research project. I didn’t really know much about research at that point and was curious to learn, so I offered to help. Although no outputs were generated from that project, I gained an understanding of how to conduct a systematic review, why the work that I was contributing to was important, and I learnt a thing or two about neonatal conditions. 

TIP 8: VENTURE INTO ACADEMIC PUBLISHING

One of the best ways to get a flavour of research is to become involved in academic publishing. There are several ways in which you could do this:

Become a peer reviewer. This role involves reading manuscripts (papers) that have been submitted to journals and providing feedback and constructive criticism. Most journals will provide you with training or a guide to follow when you write your review. This will help you develop skills in critical appraisal and how to write an academic paper or poster. Here are a few journals which you can apply to:

• https://thebsdj.cardiffuniversitypress.org
• Journal of the National Student Association of Medical Researchjournal.nsamr.ac.uk
• https://cambridgemedicine.org/about  
• https://www.bmj.com/about-bmj/resources-reviewers  

Join a journal editorial board/ committee. This is a great opportunity to gain insight into how a medical journal is run and learn how to get published. The roles available depend on the journal, from Editor-in-Chief to finance and operations and marketing. I am currently undertaking a Social Media Fellowship at BJGP Open, and I came across the opportunity on Twitter! Here are a few examples of positions to apply for:

• Journal of the National Student Association of Medical Researchjournal.nsamr.ac.uk – various positions in journalism, education and website management
• https://nsamr.ac.uk – apply for a position on the executive committee or as a local ambassador
• Student BMJ Clegg Scholarship
• BJGP Open Fellowships

TIP 9: GAIN EXPERIENCE IN QUALITY IMPROVEMENT

UCL Be the Change is a student-led initiative that allows students to lead and contribute to bespoke QIPs. You will develop these skills further when you conduct QIPs as part of your year 6 GP placement and as a foundation year doctor.

TIP 10: CONSIDER BECOMING A STUDENT REPRESENTATIVE

You’ll gain insight into undergraduate medical education as your role will involve gathering students’ feedback on teaching, identifying areas of curriculum that could be improved and working with the faculty and other student representatives to come up with solutions. 

It may not seem like there are any research opportunities up for grabs, but that’s where lateral thinking comes into play: the discussions that you have with your peers and staff could be a source of inspiration for a potential medical education research project. For example, I identified that, although we have lectures in nutrition science and public health nutrition, there was limited clinically-relevant nutrition teaching on the curriculum. I then conducted a learning needs assessment and contributed to developing the novel Nutrition in General Practice Day course in year 5.

Thanks for reaching the end of this post! I hope my Top 10 Tips are useful. Remember, research experience isn’t essential to become a great doctor, but rather an opportunity to explore a topic of interest further.

One thought on “Top 10 Tips: Getting into Research as a Medical Student”

This article was extremely helpful! Alothough, I’m only a junior in high school I have a few questions. First, is there anyway to prepare myself mentally for this challenging road to becoming a doctor? check our PACIFIC best medical college in Rajasthan

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Conducting research as a medical student: a need for change

• José Rodrigues Gomes Fourth-year medical student at the School of Medicine and Biomedical Sciences Abel Salazar, University of Porto. https://orcid.org/0000-0001-9973-6752

This article is a short opinion piece addressing the personal and professional importance of performing research, while also highlighting some of the difficulties we might face while doing so. With this said, a historical perspective on research conducted by medical students is given, which exemplifies the significance of this component in students' lives and future careers. Alongside this, the statistics also exemplify the student's desire to do more research and how universities have failed to meet students’ expectations. Finally, some examples of small but immediate measures are offered that can help reform medical curricula through new mentorship regimes, better communication, more financial support, and better overall opportunities that will be key in motivating more students to conduct research.

Bergmann C, Muth T, Loerbroks A. Medical students' perceptions of stress due to academic studies and its interrelationships with other domains of life: a qualitative study. Med Educ Online. 2019;24(1):1603526-1603526. doi:10.1080/10872981.2019.1603526

Bonilla-Vélez, J., Small, M., Urrutia, R., & Lomberk, G. (2017). The enduring value of research in medical education. International Journal of Medical Students, 5(1), 3744. https://doi.org/10.5195/ijms.2017.168

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

Frishman WH. Student research projects and theses: should they be a requirement for medical school graduation? Heart Dis. May-Jun 2001;3(3):140-4. doi:10.1097/00132580- 200105000-00002

Solomon SS, Tom SC, Pichert J, Wasserman D, Powers AC. Impact of medical student research in the development of physician-scientists. J Investig Med. May 2003;51(3):149-56. doi:10.1136/jim-51-03-17

View of medical students’ attitudes and influential factors towards conducting medical research: International Journal of Medical Students. View of Medical Students’ Attitudes and Influential Factors Towards Conducting Medical Research | International Journal of Medical Students. (2023).

Richardson J, Woolf K, Potts HWW, Bark P, Gill D (2009). What influences medical students' choice of Student Selected Component? The relationship between sex, personality, motivation and SSC choice in first year medical students. Medical Teacher, 31(9), e418-24

Agha, R., Fowler, A., Whitehurst, K., Rajmohan, S., Gundogan, B. and Koshy, K., 2017. Why apply for an intercalated research degree?

Ringsted C, Hodges B, Scherpbier A (2011). “The research compass”: An introduction to research in medical education: AMEE Guide No.56. Medical Teacher, doi 33: 695–709

Griffin MF, Hindocha S. Publication practices of medical students at British medical schools: Experience, attitudes and barriers to publish. Medical Teacher. 2011/01/01 2011;33(1):e1-e8. doi:10.3109/0142159X.2011.530320

Reinders JJ, Kropmans TJ, Cohen-Schotanus J. Extracurricular research experience of medical students and their scientific output after graduation. Med Educ. Feb 2005;39(2):237. doi:10.1111/j.1365-2929.2004.02078.x

Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. Dec 4 2010;376(9756):1923-58. doi:10.1016/s0140-6736(10)61854-5

Zheng DX. The Need for Horizontal Mentorship Networks to Facilitate Medical Students’ Engagement in Research. Academic Medicine. 2022;97(2):167-169. doi:10.1097/acm.0000000000004493

Schexnayder S, Starring H, Fury M, Mora A, Leonardi C, Dasa V. The formation of a medical student research committee and its impact on involvement in departmental research. Med Educ Online. 2018/01/01 2018;23(1):1424449. doi:10.1080/10872981.2018.1424449

Burgoyne LN, O'Flynn S, Boylan GB. Undergraduate medical research: the student perspective. Med Educ Online. 2010/01/01 2010;15(1):5212. doi:10.3402/meo.v15i0.5212

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Dear physician-scientists,

We're thrilled to share with you the latest issue of the  International Journal of Medical Students (IJMS) , a vibrant tapestry weaving together diverse and critical themes in the world of medicine and health education.

77 interesting medical research topics for 2024

Last updated

25 November 2023

Reviewed by

Brittany Ferri, PhD, OTR/L

Medical research is the gateway to improved patient care and expanding our available treatment options. However, finding a relevant and compelling research topic can be challenging.

Use this article as a jumping-off point to select an interesting medical research topic for your next paper or clinical study.

• How to choose a medical research topic

When choosing a research topic , it’s essential to consider a couple of things. What topics interest you? What unanswered questions do you want to address? 

During the decision-making and brainstorming process, here are a few helpful tips to help you pick the right medical research topic:

Focus on a particular field of study

The best medical research is specific to a particular area. Generalized studies are often too broad to produce meaningful results, so we advise picking a specific niche early in the process. 

Maybe a certain topic interests you, or your industry knowledge reveals areas of need.

Look into commonly researched topics

Once you’ve chosen your research field, do some preliminary research. What have other academics done in their papers and projects? 

From this list, you can focus on specific topics that interest you without accidentally creating a copycat project. This groundwork will also help you uncover any literature gaps—those may be beneficial areas for research.

Get curious and ask questions

Now you can get curious. Ask questions that start with why, how, or what. These questions are the starting point of your project design and will act as your guiding light throughout the process. 

For example: 

What impact does pollution have on children’s lung function in inner-city neighborhoods? 

Why is pollution-based asthma on the rise? 

How can we address pollution-induced asthma in young children? 

• 77 medical research topics worth exploring in 2023

Need some research inspiration for your upcoming paper or clinical study? We’ve compiled a list of 77 topical and in-demand medical research ideas. Let’s take a look. 

• Exciting new medical research topics

If you want to study cutting-edge topics, here are some exciting options:

COVID-19 and long COVID symptoms

Since 2020, COVID-19 has been a hot-button topic in medicine, along with the long-term symptoms in those with a history of COVID-19. 

Examples of COVID-19-related research topics worth exploring include:

The long-term impact of COVID-19 on cardiac and respiratory health

COVID-19 vaccination rates

The evolution of COVID-19 symptoms over time

New variants and strains of the COVID-19 virus

Changes in social behavior and public health regulations amid COVID-19

Vaccinations

Finding ways to cure or reduce the disease burden of chronic infectious diseases is a crucial research area. Vaccination is a powerful option and a great topic to research. 

Examples of vaccination-related research topics include:

mRNA vaccines for viral infections

Biomaterial vaccination capabilities

Vaccination rates based on location, ethnicity, or age

Public opinion about vaccination safety 

Artificial tissues fabrication

With the need for donor organs increasing, finding ways to fabricate artificial bioactive tissues (and possibly organs) is a popular research area. 

Examples of artificial tissue-related research topics you can study include:

The viability of artificially printed tissues

Tissue substrate and building block material studies

The ethics and efficacy of artificial tissue creation

• Medical research topics for medical students

For many medical students, research is a big driver for entering healthcare. If you’re a medical student looking for a research topic, here are some great ideas to work from:

Sleep disorders

Poor sleep quality is a growing problem, and it can significantly impact a person’s overall health. 

Examples of sleep disorder-related research topics include:

How stress affects sleep quality

The prevalence and impact of insomnia on patients with mental health conditions

Possible triggers for sleep disorder development

The impact of poor sleep quality on psychological and physical health

How melatonin supplements impact sleep quality

Alzheimer’s and dementia 

Cognitive conditions like dementia and Alzheimer’s disease are on the rise worldwide. They currently have no cure. As a result, research about these topics is in high demand. 

Examples of dementia-related research topics you could explore include:

The prevalence of Alzheimer’s disease in a chosen population

Early onset symptoms of dementia

Possible triggers or causes of cognitive decline with age

Treatment options for dementia-like conditions

The mental and physical burden of caregiving for patients with dementia

• Lifestyle habits and public health

Modern lifestyles have profoundly impacted the average person’s daily habits, and plenty of interesting topics explore its effects. 

Examples of lifestyle and public health-related research topics include:

The nutritional intake of college students

The impact of chronic work stress on overall health

The rise of upper back and neck pain from laptop use

Prevalence and cause of repetitive strain injuries (RSI)

• Controversial medical research paper topics

Medical research is a hotbed of controversial topics, content, and areas of study. 

If you want to explore a more niche (and attention-grabbing) concept, here are some controversial medical research topics worth looking into:

The benefits and risks of medical cannabis

Depending on where you live, the legalization and use of cannabis for medical conditions is controversial for the general public and healthcare providers.

Examples of medical cannabis-related research topics that might grab your attention include:

The legalization process of medical cannabis

The impact of cannabis use on developmental milestones in youth users

Cannabis and mental health diagnoses

CBD’s impact on chronic pain

Prevalence of cannabis use in young people

The impact of maternal cannabis use on fetal development 

Understanding how THC impacts cognitive function

Human genetics

The Human Genome Project identified, mapped, and sequenced all human DNA genes. Its completion in 2003 opened up a world of exciting and controversial studies in human genetics.

Examples of human genetics-related research topics worth delving into include:

Medical genetics and the incidence of genetic-based health disorders

Behavioral genetics differences between identical twins

Genetic risk factors for neurodegenerative disorders

Machine learning technologies for genetic research

Sexual health studies

Human sexuality and sexual health are important (yet often stigmatized) medical topics that need new research and analysis.

As a diverse field ranging from sexual orientation studies to sexual pathophysiology, examples of sexual health-related research topics include:

The incidence of sexually transmitted infections within a chosen population

Mental health conditions within the LGBTQIA+ community

The impact of untreated sexually transmitted infections

Access to safe sex resources (condoms, dental dams, etc.) in rural areas

• Health and wellness research topics

Human wellness and health are trendy topics in modern medicine as more people are interested in finding natural ways to live healthier lifestyles. 

If this field of study interests you, here are some big topics in the wellness space:

Gluten sensitivity

Gluten allergies and intolerances have risen over the past few decades. If you’re interested in exploring this topic, your options range in severity from mild gastrointestinal symptoms to full-blown anaphylaxis. 

Some examples of gluten sensitivity-related research topics include:

The pathophysiology and incidence of Celiac disease

Early onset symptoms of gluten intolerance

The prevalence of gluten allergies within a set population

Gluten allergies and the incidence of other gastrointestinal health conditions

Pollution and lung health

Living in large urban cities means regular exposure to high levels of pollutants. 

As more people become interested in protecting their lung health, examples of impactful lung health and pollution-related research topics include:

The extent of pollution in densely packed urban areas

The prevalence of pollution-based asthma in a set population

Lung capacity and function in young people

The benefits and risks of steroid therapy for asthma

Pollution risks based on geographical location

Plant-based diets

Plant-based diets like vegan and paleo diets are emerging trends in healthcare due to their limited supporting research. 

If you’re interested in learning more about the potential benefits or risks of holistic, diet-based medicine, examples of plant-based diet research topics to explore include:

Vegan and plant-based diets as part of disease management

Potential risks and benefits of specific plant-based diets

Plant-based diets and their impact on body mass index

The effect of diet and lifestyle on chronic disease management

Health supplements

Supplements are a multi-billion dollar industry. Many health-conscious people take supplements, including vitamins, minerals, herbal medicine, and more. 

Examples of health supplement-related research topics worth investigating include:

Omega-3 fish oil safety and efficacy for cardiac patients

The benefits and risks of regular vitamin D supplementation

Health supplementation regulation and product quality

The impact of social influencer marketing on consumer supplement practices

Analyzing added ingredients in protein powders

• Healthcare research topics

Working within the healthcare industry means you have insider knowledge and opportunity. Maybe you’d like to research the overall system, administration, and inherent biases that disrupt access to quality care. 

While these topics are essential to explore, it is important to note that these studies usually require approval and oversight from an Institutional Review Board (IRB). This ensures the study is ethical and does not harm any subjects. 

For this reason, the IRB sets protocols that require additional planning, so consider this when mapping out your study’s timeline. 

Here are some examples of trending healthcare research areas worth pursuing:

The pros and cons of electronic health records

The rise of electronic healthcare charting and records has forever changed how medical professionals and patients interact with their health data. 

Examples of electronic health record-related research topics include:

The number of medication errors reported during a software switch

Nurse sentiment analysis of electronic charting practices

Ethical and legal studies into encrypting and storing personal health data

Inequities within healthcare access

Many barriers inhibit people from accessing the quality medical care they need. These issues result in health disparities and injustices. 

Examples of research topics about health inequities include:

The impact of social determinants of health in a set population

Early and late-stage cancer stage diagnosis in urban vs. rural populations

Affordability of life-saving medications

Health insurance limitations and their impact on overall health

Diagnostic and treatment rates across ethnicities

People who belong to an ethnic minority are more likely to experience barriers and restrictions when trying to receive quality medical care. This is due to systemic healthcare racism and bias. 

As a result, diagnostic and treatment rates in minority populations are a hot-button field of research. Examples of ethnicity-based research topics include:

Cancer biopsy rates in BIPOC women

The prevalence of diabetes in Indigenous communities

Access inequalities in women’s health preventative screenings

The prevalence of undiagnosed hypertension in Black populations

• Pharmaceutical research topics

Large pharmaceutical companies are incredibly interested in investing in research to learn more about potential cures and treatments for diseases. 

If you’re interested in building a career in pharmaceutical research, here are a few examples of in-demand research topics:

Cancer treatment options

Clinical research is in high demand as pharmaceutical companies explore novel cancer treatment options outside of chemotherapy and radiation. 

Examples of cancer treatment-related research topics include:

Stem cell therapy for cancer

Oncogenic gene dysregulation and its impact on disease

Cancer-causing viral agents and their risks

Treatment efficacy based on early vs. late-stage cancer diagnosis

Cancer vaccines and targeted therapies

Immunotherapy for cancer

Pain medication alternatives

Historically, opioid medications were the primary treatment for short- and long-term pain. But, with the opioid epidemic getting worse, the need for alternative pain medications has never been more urgent. 

Examples of pain medication-related research topics include:

Opioid withdrawal symptoms and risks

Early signs of pain medication misuse

Anti-inflammatory medications for pain control

• Identify trends in your medical research with Dovetail

Are you interested in contributing life-changing research? Today’s medical research is part of the future of clinical patient care. 

As your go-to resource for speedy and accurate data analysis , we are proud to partner with healthcare researchers to innovate and improve the future of healthcare.

Should you be using a customer insights hub?

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• v.10(3); 2019 Jul

Medical students’ challenges and suggestions regarding research training: a synthesis of comments from a cross- sectional survey

John j. riva.

1 Department of Family Medicine, McMaster University, Ontario, Canada

2 Department of Health Research Methods, Evidence & Impact, McMaster University, Ontario, Canada

Radwa Elsharawi

3 Wayne State School of Medicine, Michigan, USA

Julian Daza

4 Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada

Augustin Toma

Robert whyte.

5 Department of Anesthesia, McMaster University, Ontario, Canada

Gina Agarwal

Jason w. busse.

6 The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Ontario, Canada

7 The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Ontario, Canada

We previously reported on a cross-sectional study of students from the Michael G. DeGroote School of Medicine at McMaster University that found most respondents wanted more opportunities to participate in research. Students provided additional comments that we synthesized to enrich the findings of our quantitative analysis.

From our previously administered 13-item, online questionnaire, run across three campuses in Ontario, Canada, 498 of 618 medical students completed our survey and 360 (72%) provided optional written comments, which we synthesized using thematic analysis in this current study.

Major themes that emerged were: (1) Active student participation to identify research opportunities and interested mentors are needed; (2) Types of research involvement; (3) Uncertainty whether research training translates into useable skills; (4) Desire for a formalized research curriculum and centralization of research opportunities across campuses.

Programs should stress to interested students the importance of actively looking for research opportunities and consider both large and small-group educational sessions.

Introduction

Medical students often witness curious clinical results, which may prompt some to pursue research to formally explore their experiences. This opportunity to advance knowledge within the greater healthcare system is compelling. Exposure to research experiences during training may improve analytical reasoning, communication skills, and application of emerging knowledge to patient care. 1 While many areas of medical curricula advance, research education and participation remains less formalized and variable across programs. 2 In prior studies, medical students have endorsed both the motivation and positive experiences with the formation of their research abilities during their training and highlighted competing demands on their time and limited opportunities as barriers. 3 , 4

We previously surveyed all students enrolled in the Michael G. DeGroote School of Medicine, across three distributed campuses, at McMaster University. The aim of the original study was to examine student research interest and participation as well as self- rated research ability among medical students. Most (445 of 498; 89%) respondents had had prior research experiences. While some (159 of 498; 32%) were currently participating in research, most (383 of 498; 86%) wanted more opportunities. In our adjusted logistic regression model, higher rating of supervisors’ research understanding was associated with higher student interest in research (OR=2.1; 95%CI: 1.3-3.4). Also, in our adjusted linear model prior student research work (e.g., thesis) was associated with higher self-rated research abilities. Our survey included an option to provide written comments. We reviewed and synthesized these comments to supplement our previously reported quantitative findings for the purpose of describing the challenges medical students face in participating in research training, as well as their suggestions for how such programs may be improved.

The methods for survey development, administration, and quantitative analyses have been reported previously. 5 In brief, stakeholder consultations and literature informed the development of a 13-item questionnaire that was administered online in 2014, with two follow-up reminders, across three campuses in Hamilton, Niagara, and Kitchener-Waterloo, Ontario, Canada. The current analysis was restricted to written comments provided in four survey questions (see Appendix A ). We tested for responder bias by looking for differences in the distributions between responders and non-responders by year in the program and campus using Pearson’s Chi-Square test (χ 2 ).

For our thematic analysis, four reviewers developed a preliminary coding system to categorize themes and sub-themes after a discussion around a sample of 10 surveys, using a previously established approach. 6 Three teams of reviewers then applied this system, independently and in duplicate, to written comments in other surveys until coding became stable, as evidenced by no new codes and disagreement among reviewers being minimal. Teams of reviewers then applied the final coding strategy to all written comments, with each team coding 120 surveys. Each respondent that provided written comments could contribute to more than one theme or sub-theme; however, each theme or sub-theme was only coded once in a single survey to address the issue of clustering.

There was an overall response rate of 81% to our survey (498 of 618 students), and 360 respondents provided written comment questions to at least one of the four optional questions, for a total of 967 written comments. There was no difference in the distribution of responders and non-responders to written questions by campus (χ 2 = 4.22; p=0.121) or by year in the program (χ 2 = 2.25; p=0.522) (see Appendix B ). Our coding revealed 4 distinct themes and 28 sub-themes (see Appendix A ):

Theme I. Active student participation and mentorship opportunities are needed (n=265)

Students felt that they needed to actively seek out opportunities to participate in research through talking to faculty or staff, searching the Internet, or joining interest groups. However, they also felt that some researchers were unwilling to take on students with limited research experience. Some students felt the best strategy was to join existing studies and research teams, while others felt it might be easier to initiate their own project. Others were unsure how to approach the search for opportunities and felt that availability of protected time and training in research methodology would be helpful.

Theme II. Type of research involvement (n=230)

A number of students (77 of 230; 33%) reported no engagement in research at all. Competing demands may limit participation in research. While not specifically asked, a few students (28 of 230; 12%) additionally reported on the types of research methods used in their projects. Half of the students (14 of 28) identified completing either case reports or systematic reviews while the remaining described involvement in observational studies, randomized control trials, quality improvement, or qualitative research.

Theme III. Uncertainty whether research training translates into useable skills (n=267)

Many 2 nd and 3 rd year students reported exposure to lectures on clinical epidemiology in large group sessions (65 of 267; 24%), and opportunities to apply this learning by critically appraising research studies in small-group sessions (90 of 267; 34%). Students also recognized the structure in place with respect to education on the use of the library, evidence-based medicine, epidemiology, and scholarship competencies. Although, the perceived practicality of this education and available time to focus on research was unclear to some students; moreover, some questioned whether they would be able to incorporate these skills into clinical practice.

Theme IV. Desire for a formalized research curriculum and centralization of opportunities (n=205)

Respondents acknowledged that not all medical students were interested in research training, but a number (71 of 205; 35%) felt that increased formalization of research training in their curriculum would be helpful. Specific strategies advanced included formalized testing, keeping a record of previous research activities, and a mandatory formal research project. Others thought that significant curriculum changes, such as offering a summer break or an academic credit for research completed, might improve engagement in research activities by students. Additionally, there was practical direction by some students (49 of 205; 24%) to raise awareness, for example, through the creation of an online portal to facilitate linking interested students with faculty researchers. Lastly, there was also endorsement for an online repository of materials relevant to research training.

Written comments by McMaster medical students highlighted challenges associated with securing research-training opportunities, particularly if they lacked research skills. As a result, some interested students had been unsuccessful in linking up with a research mentor. There is a need to address barriers to medical students identifying research mentors, as successful mentorship is associated with personal development, research productivity, as well as publication and grant success. 7 - 9

Other students questioned whether the skills they were acquiring regarding research methodology and critical appraisal of the literature would be practical to apply in clinical practice, which aligns with previous literature suggesting that students perceive a separation between evidence-based medicine and the realities of clinical practice. 4

Some students suggested greater formalization of research training, which differs from a previous review that suggested curriculum formalization is no different than electives from the perspective of student satisfaction. 1 Other reviews support greater formalization of research education into medical curricula. Specifically, using research education as a basis for evidence-based medicine, increasing opportunities for students to participate in research, and formalized incorporation of research methodology education into curriculum were found to increase medical students’ participation in research. 10 - 12 A sub-theme in our sample that warrants further research is the concept of offering academic credit for research.

We found that students support an online repository to centralize research opportunities. There is increasing inclusion of Internet and telephone technologies in distributed medical education, such as large real-time video-conference displays and classroom interactions between distributed campuses. 13 , 14 An increased and applied use of technologies may be important with respect to student engagement around research education and opportunities and recent changes to the Michael G. DeGroote school of medicine curriculum include new online materials summarizing research opportunities for students. Other recent strategies to encourage student research are involvement of students in research-related committees (e.g., training development, journal interest group) and formal review of student research projects. 5 Further research is needed to evaluate strategies aimed at reducing barriers to student’s participation in research.

Strengths and limitations

Strengths of our study include coding all written comments independently and in duplicate with one active medical student included in each pair to maintain relevancy with the current program. Our study also has limitations. We coded all unique themes and sub-themes from each survey, which means that some respondents contributed more content to our analysis than others. Approximately 40% of respondents did not provide written comments, and a higher number of 1st year students answered the survey relative to later years, which suggests our findings may be affected by selection bias. For example, 1 st year students may be less familiar with the research curriculum and opportunities. Lastly, the generalizability of our findings to other medical programs, particularly without distributed campuses and four-year programs, is uncertain.

Themes that emerged from this study provide areas of opportunity for medical programs to engage with students, ideally through technologies and mentorship, to improve their research education and opportunities. Programs should stress to interested students the need to be actively looking for research opportunities and consider students’ desire for more formalized large and small-group educational sessions.

Summary of Categories for Themes and Sub-Themes Ranked by Frequency & Representative Quotes

How would you go about getting more involved in research during the MD program if you were interested?

Representative Quote:

I have no background in research so I am unsure of the best ways to go about getting involved, but I have been told that the best way to go about this is to contact a physician or researcher who is researching a field that you are interested in and ask them if they are willing to take medical students. This has so far been unsuccessful, and I feel that my lack of prior experience is the major problem. [1 st year student]

Please list the topics of any research you currently are undertaking:

It's difficult without summers as many PI require dedicated time in blocks. I'm not entirely sure how I can go about this. Maybe I can get lucky throughout my MD training by coming across an opportunity where I can get involved in a project without compromising too much time away from MD training. [1 st year student]

What particular classes/units in the MD program have provided you education on research methods concepts and translating research in practice?

Representative Quotes:

During Emergency Medicine Core rotation and Medical Selective, I was asked to critically appraise an article, then present. There were several presentations prior to clerkship, during which epidemiologists presented upon the concepts of clinical epidemiology. However, those sessions were not reinforced well and served more to provide exposure than to develop skills. [3 rd year student]

The longitudinal epidemiology sessions have provided the sole basis for structured research training in the context of the MD program. [Problem-based learning] provides a framework to develop a data-gathering and analytical skill set, but there is a paucity of readily-available opportunities to apply scientific principles and research methods to clinically relevant questions. [2 nd year student]

Please share with us any thoughts you had on ways to improve the MD program in providing education on research and facilitating research opportunities:

Formalize it more. Optional videos and self-tests do not seem sufficient to me, especially given the diverse non-science background of many Mac Med students. Interpreting research correctly is one of the most important skills we will need to have as clinicians. [3 rd year student]

Having a centralized database, website, or Medportal webpage with available research opportunities, or a compendium on researchers willing to take on an MD student as a research assistant. [1 st year student]

Summary of Responders and Non-Responders by Year in Program and Campus *

What is your current year in the MD program?

What is your home base campus?

Conflicts of interest: The authors have no conflicts of interest to declare.

Funding: JJR is supported by a PhD training award from the NCMIC Foundation ( www.ncmicfoundation.org ); the funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Ethics: Our study was granted a waiver of formal approval by the Hamilton Integrated Research Ethics Board on September 2 nd , 2014 based on low risk.

• Open access
• Published: 11 May 2024

Does a perceptual gap lead to actions against digital misinformation? A third-person effect study among medical students

• Zongya Li   ORCID: orcid.org/0000-0002-4479-5971 1 &
• Jun Yan   ORCID: orcid.org/0000-0002-9539-8466 1  

BMC Public Health volume  24 , Article number:  1291 ( 2024 ) Cite this article

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We are making progress in the fight against health-related misinformation, but mass participation and active engagement are far from adequate. Focusing on pre-professional medical students with above-average medical knowledge, our study examined whether and how third-person perceptions (TPP), which hypothesize that people tend to perceive media messages as having a greater effect on others than on themselves, would motivate their actions against misinformation.

We collected the cross-sectional data through a self-administered paper-and-pencil survey of 1,500 medical students in China during April 2022.

Structural equation modeling (SEM) analysis, showed that TPP was negatively associated with medical students’ actions against digital misinformation, including rebuttal of misinformation and promotion of corrective information. However, self-efficacy and collectivism served as positive predictors of both actions. Additionally, we found professional identification failed to play a significant role in influencing TPP, while digital misinformation self-efficacy was found to broaden the third-person perceptual gap and collectivism tended to reduce the perceptual bias significantly.

Conclusions

Our study contributes both to theory and practice. It extends the third-person effect theory by moving beyond the examination of restrictive actions and toward the exploration of corrective and promotional actions in the context of misinformation., It also lends a new perspective to the current efforts to counter digital misinformation; involving pre-professionals (in this case, medical students) in the fight.

Peer Review reports

Introduction

The widespread persistence of misinformation in the social media environment calls for effective strategies to mitigate the threat to our society [ 1 ]. Misinformation has received substantial scholarly attention in recent years [ 2 ], and solution-oriented explorations have long been a focus but the subject remains underexplored [ 3 ].

Health professionals, particularly physicians and nurses, are highly expected to play a role in the fight against misinformation as they serve as the most trusted information sources regarding medical topics [ 4 ]. However, some barriers, such as limitations regarding time and digital skills, greatly hinder their efforts to tackle misinformation on social media [ 5 ].

Medical students (i.e., college students majoring in health/medical science), in contrast to medical faculty, have a greater potential to become the major force in dealing with digital misinformation as they are not only equipped with basic medical knowledge but generally possess greater social media skills than the former generation [ 6 ]. Few studies, to our knowledge, have tried to explore the potential of these pre-professionals in tackling misinformation. Our research thus fills the gap by specifically exploring how these pre-professionals can be motivated to fight against digital health-related misinformation.

The third-person perception (TPP), which states that people tend to perceive media messages as having a greater effect on others than on themselves [ 7 ], has been found to play an important role in influencing individuals’ coping strategies related to misinformation. But empirical exploration from this line of studies has yielded contradictory results. Some studies revealed that individuals who perceived a greater negative influence of misinformation on others than on themselves were more likely to take corrective actions to debunk misinformation [ 8 ]. In contrast, some research found that stronger TPP reduced individuals’ willingness to engage in misinformation correction [ 9 , 10 ]. Such conflicting findings impel us to examine the association between the third-person perception and medical students’ corrective actions in response to misinformation, thus attempting to unveil the underlying mechanisms that promote or inhibit these pre-professionals’ engagement with misinformation.

Researchers have also identified several perceptual factors that motivate individuals’ actions against misinformation, especially efficacy-related concepts (e.g., self-efficacy and health literacy) and normative variables (e.g., subjective norms and perceived responsibility) [ 3 , 8 , 9 ]. However, most studies devote attention to the general population; little is known about whether and how these factors affect medical students’ intentions to deal with misinformation. We recruited Chinese medical students in order to study a social group that is mutually influenced by cultural norms (collectivism in Chinese society) and professional norms. Meanwhile, systematic education and training equip medical students with abundant clinical knowledge and good levels of eHealth literacy [ 5 ], which enable them to have potential efficacy in tackling misinformation. Our study thus aims to examine how medical students’ self-efficacy, cultural norms (i.e., collectivism) and professional norms (i.e., professional identification) impact their actions against misinformation.

Previous research has found self-efficacy to be a reliable moderator of optimistic bias, the tendency for individuals to consider themselves as less likely to experience negative events but more likely to experience positive events as compared to others [ 11 , 12 , 13 ]. As TPP is thought to be a product of optimistic bias, accordingly, self-efficacy should have the potential to influence the magnitude of third-person perception [ 14 , 15 ]. Meanwhile, scholars also suggest that the magnitude of TPP is influenced by social distance corollary [ 16 , 17 ]. Simply put, individuals tend to perceive those who are more socially distant from them to be more susceptible to the influence of undesirable media than those who are socially proximal [ 18 , 19 , 20 ]. From a social identity perspective, collectivism and professional identification might moderate the relative distance between oneself and others while the directions of such effects differ [ 21 , 22 ]. For example, collectivists tend to perceive a smaller social distance between self and others as “they are less likely to view themselves as distinct or unique from others” [ 23 ]. In contrast, individuals who are highly identified with their professional community (i.e., medical community) are more likely to perceive a larger social distance between in-group members (including themselves) and out-group members [ 24 ]. In this way, collectivism and professional identification might exert different effects on TPP. On this basis, this study aims to examine whether and how medical students’ perceptions of professional identity, self-efficacy and collectivism influence the magnitude of TPP and in turn influence their actions against misinformation.

Our study builds a model that reflects the theoretical linkages among self-efficacy, collectivism, professional identity, TPP, and actions against misinformation. The model, which clarifies the key antecedents of TPP and examines the mediating role of TPP, contribute to the third-person effect literature and offer practical contributions to countering digital misinformation.

Context of the study

As pre-professionals equipped with specialized knowledge and skills, medical students have been involved in efforts in health communication and promotion during the pandemic. For instance, thousands of medical students have participated in various volunteering activities in the fight against COVID-19, such as case data visualization [ 25 ], psychological counseling [ 26 ], and providing online consultations [ 27 ]. Due to the shortage of medical personnel and the burden of work, some medical schools also encouraged their students to participate in health care assistance in hospitals during the pandemic [ 28 , 29 ].

The flood of COVID-19 related misinformation has posed an additional threat to and burden on public health. We have an opportunity to address this issue and respond to the general public’s call for guidance from the medical community about COVID-19 by engaging medical students as a main force in the fight against coronavirus related misinformation.

Literature review

The third-person effect in the misinformation context.

Originally proposed by Davison [ 7 ], the third-person effect hypothesizes that people tend to perceive a greater effect of mass media on others than on themselves. Specifically, the TPE consists of two key components: the perceptual and the behavioral [ 16 ]. The perceptual component centers on the perceptual gap where individuals tend to perceive that others are more influenced by media messages than themselves. The behavioral component refers to the behavioral outcomes of the self-other perceptual gap in which people act in accordance with such perceptual asymmetry.

According to Perloff [ 30 ], the TPE is contingent upon situations. For instance, one general finding suggests that when media messages are considered socially undesirable, nonbeneficial, or involving risks, the TPE will get amplified [ 16 ]. Misinformation characterized as inaccurate, misleading, and even false, is regarded as undesirable in nature [ 31 ]. Based on this line of reasoning, we anticipate that people will tend to perceive that others would be more influenced by misinformation than themselves.

Recent studies also provide empirical evidence of the TPE in the context of misinformation [ 32 ]. For instance, an online survey of 511 Chinese respondents conducted by Liu and Huang [ 33 ] revealed that individuals would perceive others to be more vulnerable to the negative influence of COVID-19 digital disinformation. An examination of the TPE within a pre-professional group – the medical students–will allow our study to examine the TPE scholarship in a particular population in the context of tackling misinformation.

Why TPE occurs among medical students: a social identity perspective

Of the works that have provided explanations for the TPE, the well-known ones include self-enhancement [ 34 ], attributional bias [ 35 ], self-categorization theory [ 36 ], and the exposure hypothesis [ 19 ]. In this study, we argue for a social identity perspective as being an important explanation for third-person effects of misinformation among medical students [ 36 , 37 ].

The social identity explanation suggests that people define themselves in terms of their group memberships and seek to maintain a positive self-image through favoring the members of their own groups over members of an outgroup, which is also known as downward comparison [ 38 , 39 ]. In intergroup settings, the tendency to evaluate their ingroups more positively than the outgroups will lead to an ingroup bias [ 40 ]. Such an ingroup bias is typically described as a trigger for the third-person effect as individuals consider themselves and their group members superior and less vulnerable to undesirable media messages than are others and outgroup members [ 20 ].

In the context of our study, medical students highly identified with the medical community tend to maintain a positive social identity through an intergroup comparison that favors the ingroup and derogates the outgroup (i.e., the general public). It is likely that medical students consider themselves belonging to the medical community and thus are more knowledgeable and smarter than the general public in health-related topics, leading them to perceive the general public as more vulnerable to health-related misinformation than themselves. Accordingly, we propose the following hypothesis:

H1: As medical students’ identification with the medical community increases, the TPP concerning digital misinformation will become larger.

What influences the magnitude of TPP

Previous studies have demonstrated that the magnitude of the third-person perception is influenced by a host of factors including efficacy beliefs [ 3 ] and cultural differences in self-construal [ 22 , 23 ]. Self-construal is defined as “a constellation of thoughts, feelings, and actions concerning the relationship of the self to others, and the self as distinct from others” [ 41 ]. Markus and Kitayama (1991) identified two dimensions of self-construal: Independent and interdependent. Generally, collectivists hold an interdependent view of the self that emphasizes harmony, relatedness, and places importance on belonging, whereas individualists tend to have an independent view of the self and thus view themselves as distinct and unique from others [ 42 ]. Accordingly, cultural values such as collectivism-individualism should also play a role in shaping third-person perception due to the adjustment that people make of the self-other social identity distance [ 22 ].

Set in a Chinese context aiming to explore the potential of individual-level approaches to deal with misinformation, this study examines whether collectivism (the prevailing cultural value in China) and self-efficacy (an important determinant of ones’ behavioral intentions) would affect the magnitude of TPP concerning misinformation and how such impact in turn would influence their actions against misinformation.

The impact of self-efficacy on TPP

Bandura [ 43 ] refers to self-efficacy as one’s perceived capability to perform a desired action required to overcome barriers or manage challenging situations. He also suggests understanding self-efficacy as “a differentiated set of self-beliefs linked to distinct realms of functioning” [ 44 ]. That is to say, self-efficacy should be specifically conceptualized and operationalized in accordance with specific contexts, activities, and tasks [ 45 ]. In the context of digital misinformation, this study defines self-efficacy as one’s belief in his/her abilities to identify and verify misinformation within an affordance-bounded social media environment [ 3 ].

Previous studies have found self-efficacy to be a reliable moderator of biased optimism, which indicates that the more efficacious individuals consider themselves, the greater biased optimism will be invoked [ 12 , 23 , 46 ]. Even if self-efficacy deals only with one’s assessment of self in performing a task, it can still create the other-self perceptual gap; individuals who perceive a higher self-efficacy tend to believe that they are more capable of controlling a stressful or challenging situation [ 12 , 14 ]. As such, they are likely to consider themselves less vulnerable to negative events than are others [ 23 ]. That is, individuals with higher levels of self-efficacy tend to underestimate the impact of harmful messages on themselves, thereby widening the other-self perceptual gap.

In the context of fake news, which is closely related to misinformation, scholars have confirmed that fake news efficacy (i.e., a belief in one’s capability to evaluate fake news [ 3 ]) may lead to a larger third-person perception. Based upon previous research evidence, we thus propose the following hypothesis:

H2: As medical students’ digital misinformation self-efficacy increases, the TPP concerning digital misinformation will become larger.

The influence of collectivism on TPP

Originally conceptualized as a societal-level construct [ 47 ], collectivism reflects a culture that highlights the importance of collective goals over individual goals, defines the self in relation to the group, and places great emphasis on conformity, harmony and interdependence [ 48 ]. Some scholars propose to also examine cultural values at the individual level as culture is embedded within every individual and could vary significantly among individuals, further exerting effects on their perceptions, attitudes, and behaviors [ 49 ]. Corresponding to the construct at the macro-cultural level, micro-psychometric collectivism which reflects personality tendencies is characterized by an interdependent view of the self, a strong sense of other-orientation, and a great concern for the public good [ 50 ].

A few prior studies have indicated that collectivism might influence the magnitude of TPP. For instance, Lee and Tamborini [ 23 ] found that collectivism had a significant negative effect on the magnitude of TPP concerning Internet pornography. Such an impact can be understood in terms of biased optimism and social distance. Collectivists tend to view themselves as an integral part of a greater social whole and consider themselves less differentiated from others [ 51 ]. Collectivism thus would mitigate the third-person perception due to a smaller perceived social distance between individuals and other social members and a lower level of comparative optimism [ 22 , 23 ]. Based on this line of reasoning, we thus propose the following hypothesis:

H3: As medical students’ collectivism increases, the TPP concerning digital misinformation will become smaller.

Behavioral consequences of TPE in the misinformation context

The behavioral consequences trigged by TPE have been classified into three categories: restrictive actions refer to support for censorship or regulation of socially undesirable content such as pornography or violence on television [ 52 ]; corrective action is a specific type of behavior where people seek to voice their own opinions and correct the perceived harmful or ambiguous messages [ 53 ]; promotional actions target at media content with desirable influence, such as advocating for public service announcements [ 24 ]. In a word, restriction, correction and promotion are potential behavioral outcomes of TPE concerning messages with varying valence of social desirability [ 16 ].

Restrictive action as an outcome of third-person perceptual bias (i.e., the perceptual component of TPE positing that people tend to perceive media messages to have a greater impact on others than on themselves) has received substantial scholarly attention in past decades; scholars thus suggest that TPE scholarship to go beyond this tradition and move toward the exploration of corrective and promotional behaviors [ 16 , 24 ]. Moreover, individual-level corrective and promotional actions deserve more investigation specifically in the context of countering misinformation, as efforts from networked citizens have been documented as an important supplement beyond institutional regulations (e.g., drafting policy initiatives to counter misinformation) and platform-based measures (e.g., improving platform algorithms for detecting misinformation) [ 8 ].

In this study, corrective action specifically refers to individuals’ reactive behaviors that seek to rectify misinformation; these include such actions as debunking online misinformation by commenting, flagging, or reporting it [ 3 , 54 ]. Promotional action involves advancing correct information online, including in response to misinformation that has already been disseminated to the public [ 55 ].

The impact of TPP on corrective and promotional actions

Either paternalism theory [ 56 ] or the protective motivation theory [ 57 ] can act as an explanatory framework for behavioral outcomes triggered by third-person perception. According to these theories, people act upon TPP as they think themselves to know better and feel obligated to protect those who are more vulnerable to negative media influence [ 58 ]. That is, corrective and promotional actions as behavioral consequences of TPP might be driven by a protective concern for others and a positive sense of themselves.

To date, several empirical studies across contexts have examined the link between TPP and corrective actions. Koo et al. [ 8 ], for instance, found TPP was not only positively related to respondents’ willingness to correct misinformation propagated by others, but also was positively associated with their self-correction. Other studies suggest that TPP motivates individuals to engage in both online and offline corrective political participation [ 59 ], give a thumbs down to a biased story [ 60 ], and implement corrective behaviors concerning “problematic” TV reality shows [ 16 ]. Based on previous research evidence, we thus propose the following hypothesis:

H4: Medical students with higher degrees of TPP will report greater intentions to correct digital misinformation.

Compared to correction, promotional behavior has received less attention in the TPE research. Promotion commonly occurs in a situation where harmful messages have already been disseminated to the public and others appear to have been influenced by these messages, and it serves as a remedial action to amplify messages with positive influence which may in turn mitigate the detrimental effects of harmful messages [ 16 ].

Within this line of studies, however, empirical studies provide mixed findings. Wei and Golan [ 24 ] found a positive association between TPP of desirable political ads and promotional social media activism such as posting or linking the ad on their social media accounts. Sun et al. [ 16 ] found a negative association between TPP regarding clarity and community-connection public service announcements (PSAs) and promotion behaviors such as advocating for airing more PSAs in TV shows.

As promotional action is still underexplored in the TPE research, and existing evidence for the link between TPP and promotion is indeed mixed, we thus propose an exploratory research question:

RQ1: What is the relationship between TPP and medical students’ intentions to promote corrective information?

The impact of self-efficacy and collectivism on actions against misinformation

According to social cognitive theory, people with higher levels of self-efficacy tend to believe they are competent and capable and are more likely to execute specific actions [ 43 ]. Within the context of digital misinformation, individuals might become more willing to engage in misinformation correction if they have enough knowledge and confidence to evaluate information, and possess sufficient skills to verify information through digital tools and services [ 61 ].

Accordingly, we assumed medical students with higher levels of digital misinformation self-efficacy would be likely to become more active in the fight against misinformation.

H5: Medical students with higher levels of digital misinformation self-efficacy will report greater intentions to (a) correct misinformation and (b) promote corrective information on social media.

Social actions of collectivists are strongly guided by prevailing social norms, collective responsibilities, and common interest, goals, and obligations [ 48 ]. Hence, highly collectivistic individuals are more likely to self-sacrifice for group interests and are more oriented toward pro-social behaviors, such as adopting pro-environmental behaviors [ 62 ], sharing knowledge [ 23 ], and providing help for people in need [ 63 ].

Fighting against misinformation is also considered to comprise altruism, especially self-engaged corrective and promotional actions, as such actions are costly to the actor (i.e., taking up time and energy) but could benefit the general public [ 61 ]. Accordingly, we assume collectivism might play a role in prompting people to engage in reactive behaviors against misinformation.

It is also noted that collectivist values are deeply rooted in Chinese society and were especially strongly advocated during the outbreak of COVID-19 with an attempt to motivate prosocial behaviors [ 63 ]. Accordingly, we expected that the more the medical students were oriented toward collectivist values, the more likely they would feel personally obliged and normatively motivated to engage in misinformation correction. However, as empirical evidence was quite limited, we proposed exploratory research questions:

RQ2: Will medical students with higher levels of collectivism report greater intentions to (a) correct misinformation and (b) promote corrective information on social media?

The theoretical model

To integrate both the antecedents and consequences of TPP, we proposed a theoretical model (as shown in Fig. 1 ) to examine how professional identification, self-efficacy and collectivism would influence the magnitude of TPP, and how such impact would in turn influence medical students’ intentions to correct digital misinformation and promote corrective information. Thus, RQ3 was proposed:

RQ3: Will the TPP mediate the impact of self-efficacy and collectivism on medical students’ intentions to (a) correct misinformation, and (b) promote corrective information on social media? Fig. 1 The proposed theoretical model. DMSE = Digital Misinformation Self-efficacy; PIMC = Professional Identification with Medical Community; ICDM = Intention to Correct Digital Misinformation; IPCI = Intention to Promote Corrective Information Full size image

To examine the proposed hypotheses, this study utilized cross-sectional survey data from medical students in Tongji Medical College (TJMC) of China. TJMC is one of the birthplaces of Chinese modern medical education and among the first universities and colleges that offer eight-year curricula on clinical medicine. Further, TJMC is located in Wuhan, the epicenter of the initial COVID-19 outbreaks, thus its students might find the pandemic especially relevant – and threatening – to them.

The survey instrument was pilot tested using a convenience sample of 58 respondents, leading to minor refinements to a few items. Upon approval from the university’s Institutional Research Board (IRB), the formal investigation was launched in TJMC during April 2022. Given the challenges of reaching the whole target population and acquiring an appropriate sampling frame, this study employed purposive and convenience sampling.

We first contacted four school counselors as survey administrators through email with a letter explaining the objective of the study and requesting cooperation. All survey administrators were trained by the principal investigator to help with the data collection in four majors (i.e., basic medicine, clinical medicine, nursing, and public health). Paper-and-pencil questionnaires were distributed to students on regular weekly departmental meetings of each major as students in all grades (including undergraduates, master students, and doctoral students) were required to attend the meeting. The projected time of completion of the survey was approximately 10–15 min. The survey administrators indicated to students that participation was voluntary, their responses would remain confidential and secure, and the data would be used only for academic purposes. Though a total of 1,500 participants took the survey, 17 responses were excluded from the analysis as they failed the attention filters. Ultimately, a total of 1,483 surveys were deemed valid for analysis.

Of the 1,483 respondents, 624 (42.10%) were men and 855 (57.70%) were women, and four did not identify gender. The average age of the sample was 22.00 ( SD  = 2.54, ranging from 17 to 40). Regarding the distribution of respondents’ majors, 387 (26.10%) were in basic medicine, 390 (26.30%) in clinical medicine, 307 (20.70%) in nursing, and 399 (26.90%) in public health. In terms of university class, 1,041 (70.40%) were undergraduates, 291 (19.70%) were working on their master degrees, 146 (9.90%) were doctoral students, and five did not identify their class data.

Measurement of key variables

Perceived effects of digital misinformation on oneself and on others.

Three modified items adapted from previous research [ 33 , 64 ] were employed to measure perceived effects of digital misinformation on oneself. Respondents were asked to indicate to what extent they agreed with the following: (1) I am frequently concerned that the information about COVID-19 I read on social media might be false; (2) Misinformation on social media might misguide my understanding of the coronavirus; (3) Misinformation on social media might influence my decisions regarding COVID-19. The response categories used a 7-point scale, where 1 meant “strongly disagree” and 7 meant “strongly agree.” The measure of perceived effects of digital misinformation on others consisted of four parallel items with the same statement except replacing “I” and “my” with “the general others” and “their”. The three “self” items were averaged to create a measure of “perceived effects on oneself” ( M  = 3.98, SD  = 1.49, α  = 0.87). The three “others” items were also added and averaged to form an index of “perceived effects on others” ( M  = 4.62, SD  = 1.32, α  = 0.87).

The perceived self-other disparity (TPP)

TPP was derived by subtracting perceived effects on oneself from perceived effects on others.

Professional identification with medical community

Professional identification was measured using a three item, 7-point Likert-type scale (1 =  strongly disagree , 7 =  strongly agree ) adapted from previous studies [ 65 , 66 ] by asking respondents to indicate to what extent they agreed with the following statements: (1) I would be proud to be a medical staff member in the future; (2) I am committed to my major; and (3) I will be in an occupation that matches my current major. The three items were thus averaged to create a composite measure of professional identification ( M  = 5.34, SD  = 1.37, α  = 0.88).

Digital misinformation self-efficacy

Modified from previous studies [ 3 ], self-efficacy was measured with three items. Respondents were asked to indicate on a 7-point Linkert scale from 1 (strongly disagree) to 7 (strongly agree) their agreement with the following: (1) I think I can identify misinformation relating to COVID-19 on social media by myself; (2) I know how to verify misinformation regarding COVID-19 by using digital tools such as Tencent Jiaozhen Footnote 1 and Piyao.org.cn Footnote 2 ; (3) I am confident in my ability to identify digital misinformation relating to COVID-19. A composite measure of self-efficacy was constructed by averaging the three items ( M  = 4.38, SD  = 1.14, α  = 0.77).

• Collectivism

Collectivism was measured using four items adapted from previous research [ 67 ], in which respondents were asked to indicate their agreement with the following statements on a 7-point scale, from 1 (strongly disagree) to 7 (strongly agree): (1) Individuals should sacrifice self-interest for the group; (2) Group welfare is more important than individual rewards; (3) Group success is more important than individual success; and (4) Group loyalty should be encouraged even if individual goals suffer. Therefore, the average of the four items was used to create a composite index of collectivism ( M  = 4.47, SD  = 1.30, α  = 0.89).

Intention to correct digital misinformation

We used three items adapted from past research [ 68 ] to measure respondents’ intention to correct misinformation on social media. All items were scored on a 7-point scale from 1 (very unlikely) to 7 (very likely): (1) I will post a comment saying that the information is wrong; (2) I will message the person who posts the misinformation to tell him/her the post is wrong; (3) I will track the progress of social media platforms in dealing with the wrong post (i.e., whether it’s deleted or corrected). A composite measure of “intention to correct digital misinformation” was constructed by adding the three items and dividing by three ( M  = 3.39, SD  = 1.43, α  = 0.81).

Intention to promote corrective information

On a 7-point scale ranging from 1 (very unlikely) to 7 (very likely), respondents were asked to indicate their intentions to (1) Retweet the corrective information about coronavirus on my social media account; (2) Share the corrective information about coronavirus with others through Social Networking Services. The two items were averaged to create a composite measure of “intention to promote corrective information” ( M  = 4.60, SD  = 1.68, r  = 0.77).

Control variables

We included gender, age, class (1 = undergraduate degree; 2 = master degree; 3 = doctoral degree), and clinical internship (0 = none; 1 = less than 0.5 year; 2 = 0.5 to 1.5 years; 3 = 1.5 to 3 years; 4 = more than 3 years) as control variables in the analyses. Additionally, coronavirus-related information exposure (i.e., how frequently they were exposed to information about COVID-19 on Weibo, WeChat, and QQ) and misinformation exposure on social media (i.e., how frequently they were exposed to misinformation about COVID-19 on Weibo, WeChat, and QQ) were also assessed as control variables because previous studies [ 69 , 70 ] had found them relevant to misinformation-related behaviors. Descriptive statistics and bivariate correlations between main variables were shown in Table 1 .

Statistical analysis

We ran confirmatory factor analysis (CFA) in Mplus (version 7.4, Muthén & Muthén, 1998) to ensure the construct validity of the scales. To examine the associations between variables and tested our hypotheses, we performed structural equation modeling (SEM). Mplus was chosen over other SEM statistical package mainly because the current data set included some missing data, and the Mplus has its strength in handling missing data using full-information maximum likelihood imputation, which enabled us to include all available data [ 71 , 72 ]. Meanwhile, Mplus also shows great flexibility in modelling when simultaneously handling continuous, categorical, observed, and latent variables in a variety of models. Further, Mplus provides a variety of useful information in a concise manner [ 73 ].

Table 2 shows the model fit information for the measurement and structural models. Five latent variables were specified in the measurement model. To test the measurement model, we examined the values of Cronbach’s alpha, composite reliability (CR), and average variance extracted (AVE) (Table 1 ). Cronbach’s alpha values ranged from 0.77 to 0.89. The CRs, which ranged from 0.78 to 0.91, exceeded the level of 0.70 recommended by Fornell (1982) and thus confirmed the internal consistency. The AVE estimates, which ranged from 0.54 to 0.78, exceeded the 0.50 lower limit recommended by Fornell and Larcker (1981), and thus supported convergent validity. All the square roots of AVE were greater than the off-diagonal correlations in the corresponding rows and columns [ 74 ]. Therefore, discriminant validity was assured. In a word, our measurement model showed sufficient convergence and discriminant validity.

Five model fit indices–the relative chi-square ratio (χ 2 / df ), the comparative fit index (CFI), the Tucker–Lewis index (TLI), the root mean square error of approximation (RMSEA), and the standardized root-mean-square residual (SRMR) were used to assess the model. Specifically, the normed chi-square between 1 and 5 is acceptable [ 75 ]. TLI and CFI over 0.95 are considered acceptable, SRMR value less than 0.08 and RMSEA value less than 0.06 indicate good fit [ 76 ]. Based on these criteria, the model was found to have an acceptable fit to the data.

Figure 2 presents the results of our hypothesized model. H1 was rejected as professional identification failed to predict TPP ( β  = 0.06, p  > 0.05). Self-efficacy was positively associated with TPP ( β  = 0.14, p  < 0.001) while collectivism was negatively related to TPP ( β  = -0.10, p  < 0.01), lending support to H2 and H3.

Note. N  = 1,483. The coefficients of relationships between latent variables are standardized beta coefficients. Significant paths are indicated by solid line; non-significant paths are indicated by dotted lines. * p  < .05, ** p  < .01; *** p  < .001. DMSE = Digital Misinformation Self-efficacy; PIMC = Professional Identification with Medical Community; ICDM = Intention to Correct Digital Misinformation; IPCI = Intention to Promote Corrective Information

H4 posited that medical students with higher degrees of TPP would report greater intentions to correct digital misinformation. However, we found a negative association between TPP and intentions to correct misinformation ( β  = -0.12, p  < 0.001). H4 was thus rejected. Regarding RQ1, results revealed that TPP was negatively associated with intentions to promote corrective information ( β  = -0.08, p  < 0.05).

Further, our results supported H5 as we found that self-efficacy had a significant positive relationship with corrective intentions ( β  = 0.18, p  < 0.001) and promotional intentions ( β  = 0.32, p  < 0.001). Collectivism was also positively associated with intentions to correct misinformation ( β  = 0.14, p  < 0.001) and promote corrective information ( β  = 0.20, p  < 0.001), which answered RQ2.

Regarding RQ3 (see Table 3 ), TPP significantly mediated the relationship between self-efficacy and intentions to correct misinformation ( β  = -0.016), as well as the relationship between self-efficacy and intentions to promote corrective information ( β  = -0.011). However, TPP failed to mediate either the association between collectivism and corrective intentions ( β  = 0.011, ns ) or the association between collectivism and promotional intentions ( β  = 0.007, ns ).

Recent research has highlighted the role of health professionals and scientists in the fight against misinformation as they are considered knowledgeable, ethical, and reliable [ 5 , 77 ]. This study moved a step further by exploring the great potential of pre-professional medical students to tackle digital misinformation. Drawing on TPE theory, we investigated how medical students perceived the impact of digital misinformation, the influence of professional identification, self-efficacy and collectivism on these perceptions, and how these perceptions would in turn affect their actions against digital misinformation.

In line with prior studies [ 3 , 63 ], this research revealed that self-efficacy and collectivism played a significant role in influencing the magnitude of third-person perception, while professional identification had no significant impact on TPP. As shown in Table 1 , professional identification was positively associated with perceived effects of misinformation on oneself ( r  = 0.14, p  < 0.001) and on others ( r  = 0.20, p  < 0.001) simultaneously, which might result in a diminished TPP. What explains a shared or joint influence of professional identification on self and others? A potential explanation is that even medical staff had poor knowledge about the novel coronavirus during the initial outbreak [ 78 ]. Accordingly, identification with the medical community was insufficient to create an optimistic bias concerning identifying misinformation about COVID-19.

Our findings indicated that TPP was negatively associated with medical students’ intentions to correct misinformation and promote corrective information, which contradicted our hypotheses but was consistent with some previous TPP research conducted in the context of perceived risk [ 10 , 79 , 80 , 81 ]. For instance, Stavrositu and Kim (2014) found that increased TPP regarding cancer risk was negatively associated with behavioral intentions to engage in further cancer information search/exchange, as well as to adopt preventive lifestyle changes. Similarly, Wei et al. (2008) found concerning avian flu news that TPP negatively predicted the likelihood of engaging in actions such as seeking relevant information and getting vaccinated. In contrast, the perceived effects of avian flu news on oneself emerged as a positive predictor of intentions to take protective behavior.

Our study shows a similar pattern as perceived effects of misinformation on oneself were positively associated with intentions to correct misinformation ( r  = 0.06, p  < 0.05) and promote corrective information ( r  = 0.10, p  < 0.001, See Table 1 ). While the reasons for the behavioral patterns are rather elusive, such findings are indicative of human nature. When people perceive misinformation-related risk to be highly personally relevant, they do not take chances. However, when they perceive others to be more vulnerable than themselves, a set of sociopsychological dynamics such as self-defense mechanism, positive illusion, optimistic bias, and social comparison provide a restraint on people’s intention to engage in corrective and promotional actions against misinformation [ 81 ].

In addition to the indirect effects via TPP, our study also revealed that self-efficacy and collectivism serve as direct and powerful drivers of corrective and promotive actions. Consistent with previous literature [ 61 , 68 ], individuals will be more willing to engage in social corrections of misinformation if they possess enough knowledge, skills, abilities, and resources to identify misinformation, as correcting misinformation is difficult and their effort would not necessarily yield positive outcomes. Collectivists are also more likely to engage in misinformation correction as they are concerned for the public good and social benefits, aiming to protect vulnerable people from being misguided by misinformation [ 82 ].

This study offers some theoretical advancements. First, our study extends the TPE theory by moving beyond the examination of restrictive actions and toward the exploration of corrective and promotional actions in the context of misinformation. This exploratory investigation suggests that self-other asymmetry biased perception concerning misinformation did influence individuals’ actions against misinformation, but in an unexpected direction. The results also suggest that using TPP alone to predict behavioral outcomes was deficient as it only “focuses on differences between ‘self’ and ‘other’ while ignoring situations in which the ‘self’ and ‘other’ are jointly influenced” [ 83 ]. Future research, therefore, could provide a more sophisticated understanding of third-person effects on behavior by comparing the difference of perceived effects on oneself, perceived effects on others, and the third-person perception in the pattern and strength of the effects on behavioral outcomes.

Moreover, institutionalized corrective solutions such as government and platform regulation are non-exhaustive [ 84 , 85 ]; it thus becomes critical to tap the great potential of the crowd to engage in the fight against misinformation [ 8 ] while so far, research on the motivations underlying users’ active countering of misinformation has been scarce. The current paper helps bridge this gap by exploring the role of self-efficacy and collectivism in predicting medical students’ intentions to correct misinformation and promote corrective information. We found a parallel impact of the self-ability-related factor and the collective-responsibility-related factor on intentions to correct misinformation and promote corrective information. That is, in a collectivist society like China, cultivating a sense of collective responsibility and obligation in tackling misinformation (i.e., a persuasive story told with an emphasis on collective interests of social corrections of misinformation), in parallel with systematic medical education and digital literacy training (particularly, handling various fact-checking tools, acquiring Internet skills for information seeking and verification) would be effective methods to encourage medical students to engage in active countering behaviors against misinformation. Moreover, such an effective means of encouraging social corrections of misinformation might also be applied to the general public.

In practical terms, this study lends new perspectives to the current efforts in dealing with digital misinformation by involving pre-professionals (in this case, medical students) into the fight against misinformation. As digital natives, medical students usually spend more time online, have developed sophisticated digital competencies and are equipped with basic medical knowledge, thus possessing great potential in tackling digital misinformation. This study further sheds light on how to motivate medical students to become active in thwarting digital misinformation, which can help guide strategies to enlist pre-professionals to reduce the spread and threat of misinformation. For example, collectivism education in parallel with digital literacy training would help increase medical students’ sense of responsibility for and confidence in tackling misinformation, thus encouraging them to engage in active countering behaviors.

This study also has its limitations. First, the cross-sectional survey study did not allow us to justify causal claims. Granted, the proposed direction of causality in this study is in line with extant theorizing, but there is still a possibility of reverse causal relationships. To establish causality, experimental research or longitudinal studies would be more appropriate. Our second limitation lies in the generalizability of our findings. With the focus set on medical students in Chinese society, one should be cautious in generalizing the findings to other populations and cultures. For example, the effects of collectivism on actions against misinformation might differ in Eastern and Western cultures. Further studies would benefit from replication in diverse contexts and with diverse populations to increase the overall generalizability of our findings.

Drawing on TPE theory, our study revealed that TPP failed to motivate medical students to correct misinformation and promote corrective information. However, self-efficacy and collectivism were found to serve as direct and powerful drivers of corrective and promotive actions. Accordingly, in a collectivist society such as China’s, cultivating a sense of collective responsibility in tackling misinformation, in parallel with efficient personal efficacy interventions, would be effective methods to encourage medical students, even the general public, to actively engage in countering behaviors against misinformation.

Availability of data and materials

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

Tencent Jiaozhen Fact-Checking Platform which comprises the Tencent information verification tool allow users to check information authenticity through keyword searching. The tool is updated on a daily basis and adopts a human-machine collaboration approach to discovering, verifying, and refuting rumors and false information. For refuting rumors, Tencent Jiaozhen publishes verified content on the homepage of Tencent's rumor-refuting platform, and uses algorithms to accurately push this content to users exposed to the relevant rumors through the WeChat dispelling assistant.

Piyao.org.cn is hosted by the Internet Illegal Information Reporting Center under the Office of the Central Cyberspace Affairs Commission and operated by Xinhuanet.com. The platform is a website that collects statements from Twitter-like services, news portals and China's biggest search engine, Baidu, to refute online rumors and expose the scams of phishing websites. It has integrated over 40 local rumor-refuting platforms and uses artificial intelligence to identify rumors.

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Acknowledgements

We thank all participants and staff working for the project.

This work was supported by Humanities and Social Sciences Youth Foundation of the Ministry of Education of China (Grant No. 21YJC860012).

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Li, Z., Yan, J. Does a perceptual gap lead to actions against digital misinformation? A third-person effect study among medical students. BMC Public Health 24 , 1291 (2024). https://doi.org/10.1186/s12889-024-18763-9

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DOI : https://doi.org/10.1186/s12889-024-18763-9

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Coming out of the ashes we rise: Experiences of culturally and linguistically diverse international nursing students at two Australian universities during the Covid-19 pandemic

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Background and aim: Research on international students conducted during the COVID-19 pandemic has persistently highlighted the vulnerabilities and challenges that they experienced when staying in the host country to continue with their studies. The findings from such research can inevitably create a negative image of international students and their ability to respond to challenges during unprecedented times. Therefore, this paper took a different stance and reported on a qualitative study that explored culturally and linguistically diverse (CaLD) international nursing students who overcame the challenges brought about by the pandemic to continue with their studies in Australia. Method: A descriptive qualitative research design guided by the processes of constructivist grounded theory was selected to ascertain insights from participants' experiences of studying abroad in Australia during the COVID-19 pandemic. Results: Three themes emerged from the collected data that described the participants' lived experiences, and they were: 1) Viewing international education as the pursuit of a better life, 2) Focusing on personal growth, and 3) Coming out of the ashes we rise. Discussion: The findings highlight the importance of recognising the investments and sacrifices that CaLD international students and their families make in pursuit of international tertiary education. The findings also underscore the importance of acknowledging the qualities that CaLD international students have to achieve self-growth and ultimately self-efficacy as they stay in the host country during a pandemic. Conclusion: Future research should focus on identifying strategies that are useful for CaLD international nursing students to experience personal growth and ultimately self-efficacy and continue with their studies in the host country during times of uncertainty such as a pandemic.

Competing Interest Statement

The authors have declared no competing interest.

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This study did not receive any funding

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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Ethical approval was obtained from Curtin University Human Research Ethics Office (HRE2022-0238) and The University of Southern Queensland Ethical Review Committee (H22REA114).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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What Premed Students Should Know About Emerging Fields of Medical Research

Aspiring physician-scientists should bone up on areas such as gene editing, nanotechnology and regenerative medicine.

Premeds and Emerging Medical Research

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If you find a field that interests you, don't hesitate to join a like-minded laboratory while training.

Premedical students aspiring to become physician-scientists will be tasked with navigating emerging fields in research and translating exciting discoveries into the clinical realm. Understanding the latest trends and breakthroughs in biomedical science is paramount for those hoping to bridge the gap between such cutting-edge research and clinical practice – a career goal for many aspiring physician-scientists.

What are these emerging fields, what should aspiring physician-scientists – including those applying to combined M.D.-Ph.D. programs – know about getting involved in these fields, and are there any pitfalls? 

This is an extraordinarily exciting time in scientific research, with recent breakthroughs in diverse fields such as gene editing, immunotherapies, nanotechnology, precision medicine, machine learning and regenerative medicine. Highlights run the gamut of the biomedical spectrum, including evolutionary genomics, novel neurotechnology, advances in cardiovascular imaging, cell-based therapies and therapeutic manipulation of the microbiome, to name a few.

Aspiring physician-scientists will undoubtedly be tempted to ride this wave of exciting discoveries and join laboratories moving the needle in these fields, many of which are still in their infancy. 

Premed students should be aware of these emerging fields, as these advances are expected to contribute increasingly to health care throughout the coming decades and will undoubtedly remain important for the duration of a lengthy career in medicine .

These fields are likely to hold long-term career opportunities for students interested in biomedical research. They also represent opportunities to contribute to innovation, be involved in groundbreaking discoveries and help shape the future of science and medicine.

Many emerging fields are exciting in part due to new or newly appreciated applications to clinical practice, with direct implications for patient care . By understanding these emerging fields, premed students will remain informed and up to date regarding novel treatment paradigms, new diagnostic tools and different preventive strategies that could benefit their future patients. 

Students’ research interests often evolve during undergraduate, graduate and postgraduate education. Many fascinating fields of biomedical science are neither new nor well known, and they deserve serious consideration. You will have multiple opportunities to change fields should your interests diverge at any point, so you should not feel locked in to the discipline of your first research experience.

However, if you do have a genuine intellectual interest in a popular scientific field at an early phase of training, don’t hesitate to join such a like-minded laboratory. 

Finding a Laboratory in Emerging Research Fields

If you are a premed student interested in an exciting field like cancer immunotherapy, genomics, AI-enabled precision medicine , etc., you may struggle to understand which laboratories would be appropriate and rewarding to join and a good fit for your career goals.

To start, assess the research landscape at your home institution through departmental web pages and note which faculty in your field of interest are involved in active research projects. Get in touch with a few faculty members and discuss the possibility of joining their laboratory.

As you learn about their research projects, you can also ask if they know of other labs in the same field that may also be of interest. Often, research faculty themselves are the best resource for understanding the current research landscape of the university, as departmental web pages and related resources can be out of date. 

Departmental administrators or undergraduate research coordinators may also be quite helpful in finding a lab in a specific area that would be a good fit for an undergraduate student. If you read a lay press article – especially from a local publication – about an area of exciting, “hot” science, pay attention to which studies and researchers they reference or quote. These investigators are often leading voices in the field. 

Use PubMed to find the latest work in a field or by a specific investigator. Explore the "trending articles" section to see which articles have had recent activity – a sign of a field gaining broad interest. If you find investigators doing work that is particularly interesting to you, use the "saved searches" function to get updates about their work directly in your email inbox. 

Appreciate that emerging fields are often a result of novel collaboration across disparate disciplines such as distinct subfields in biology and medicine, biomedical engineering or computer science .

Application of a known technology to a new field can also yield exciting advancements. A recent example is cryo-EM-mediated determination of complex structures, such as ligand-bound receptors, which could not previously be accurately determined.

Look for labs that are working in an interdisciplinary manner to tackle an important question in medicine or biology, and you are likely to find stimulating research in an important emerging field. 

Pitfalls to Avoid

Avoid presuming that only well-known fields with significant popularity and press attention are the only interesting domains of scientific research. The biggest discoveries often come from unpredictable places, and their genesis can be traced to less well-known fields.

Recent high-profile examples include prokaryotic genomics that spawned CRISPR/Cas9-based gene editing, and nucleoside modifications that advanced mRNA vaccines. This is characteristic of biomedical research and should lead you to explore various fields and meet with a variety of investigators to find the field, research and lab that most interest you. 

A few exceedingly popular fields – such as microbiome research, cancer immunotherapy , etc. – run the risk of becoming oversaturated, with many excellent investigators trying to solve similar problems. These fields can thus become quite competitive, with several associated challenges.

If you do join a competitive field, look for opportunities to do novel work that can separate your project from the rest of the crowd. A good strategy when selecting a laboratory is to assess which researchers are pushing the boundaries in these fields and are looking to incorporate interdisciplinary approaches, as they are more likely to be working in their own lane, away from other investigators. Use the same approach when selecting a project within your lab.

Medical School Application Mistakes

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About Medical School Admissions Doctor

Need a guide through the murky medical school admissions process? Medical School Admissions Doctor offers a roundup of expert and student voices in the field to guide prospective students in their pursuit of a medical education. The blog is currently authored by Dr. Ali Loftizadeh, Dr. Azadeh Salek and Zach Grimmett at Admissions Helpers , a provider of medical school application services; Dr. Renee Marinelli at MedSchoolCoach , a premed and med school admissions consultancy; Dr. Rachel Rizal, co-founder and CEO of the Cracking Med School Admissions consultancy; Dr. Cassie Kosarec at Varsity Tutors , an advertiser with U.S. News & World Report; Dr. Kathleen Franco, a med school emeritus professor and psychiatrist; and Liana Meffert, a fourth-year medical student at the University of Iowa's Carver College of Medicine and a writer for Admissions Helpers. Got a question? Email [email protected] .

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Medical residents are starting to avoid states with abortion bans, data shows

Julie Rovner

Rachana Pradhan

The Match Day ceremony at the University of California, Irvine, on March 15. Match Day is the day when medical students seeking residency and fellowship training positions find out their options. Increasingly, medical students are choosing to go to states that don't restrict abortion. Jeff Gritchen/MediaNews Group via Getty Images hide caption

The Match Day ceremony at the University of California, Irvine, on March 15. Match Day is the day when medical students seeking residency and fellowship training positions find out their options. Increasingly, medical students are choosing to go to states that don't restrict abortion.

Isabella Rosario Blum was wrapping up medical school and considering residency programs to become a family practice physician when she got some frank advice: If she wanted to be trained to provide abortions, she shouldn't stay in Arizona.

Blum turned to programs mostly in states where abortion access — and, by extension, abortion training — is likely to remain protected, like California, Colorado and New Mexico. Arizona has enacted a law banning most abortions after 15 weeks.

"I would really like to have all the training possible," she said, "so of course that would have still been a limitation."

In June, she will start her residency at Swedish Cherry Hill hospital in Seattle.

According to new statistics from the Association of American Medical Colleges (AAMC), for the second year in a row, students graduating from U.S. medical schools this year were less likely to apply for residency positions in states with abortion bans and other significant abortion restrictions.

Since the Supreme Court in 2022 overturned the constitutional right to an abortion, state fights over abortion access have created plenty of uncertainty for pregnant patients and their doctors. But that uncertainty has also bled into the world of medical education, forcing some new doctors to factor state abortion laws into their decisions about where to begin their careers.

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How florida and arizona supreme court rulings change the abortion access map.

Fourteen states, primarily in the Midwest and South, have banned nearly all abortions. The new analysis by the AAMC — exclusively reviewed by KFF Health News before its public release — found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2% between 2024 and 2023, compared with a 0.6% drop in states where abortion remains legal.

Notably, the AAMC's findings illuminate the broader problems that abortion bans can create for a state's medical community, particularly in an era of provider shortages: The organization tracked a larger decrease in interest in residencies in states with abortion restrictions not only among those in specialties most likely to treat pregnant patients, like OB-GYNs and emergency room doctors, but also among aspiring doctors in other specialties.

"It should be concerning for states with severe restrictions on reproductive rights that so many new physicians — across specialties — are choosing to apply to other states for training instead," wrote Atul Grover, executive director of the AAMC's Research and Action Institute.

The AAMC analysis found that the number of applicants to OB-GYN residency programs in abortion-ban states dropped by 6.7%, compared with a 0.4% increase in states where abortion remains legal. For internal medicine, the drop observed in abortion-ban states was over five times as much as in states where abortion is legal.

'Geographic misalignment'

In its analysis, the AAMC said that an ongoing decline in interest in abortion-ban states among new doctors ultimately "may negatively affect access to care in those states."

Dr. Jack Resneck Jr., immediate past president of the American Medical Association, said the data demonstrates yet another consequence of the post- Roe v. Wade era.

The AAMC analysis notes that even in states with abortion bans, residency programs are filling their positions — mostly because there are more graduating medical students in the U.S. and abroad than there are residency slots.

Still, Resneck said, "we're extraordinarily worried." For example, physicians without adequate abortion training may not be able to manage miscarriages, ectopic pregnancies or potential complications, such as infection or hemorrhaging, that could stem from pregnancy loss.

Those who work with students and residents say their observations support the AAMC's findings. "People don't want to go to a place where evidence-based practice and human rights in general are curtailed," said Beverly Gray, an associate professor of obstetrics and gynecology at Duke University School of Medicine.

Abortion in North Carolina is banned in nearly all cases after 12 weeks. Women who experience unexpected complications or discover their baby has potentially fatal birth anomalies later in pregnancy may not be able to receive care there.

Gray said she worries that even though Duke is a highly sought training destination for medical residents, the abortion ban "impacts whether we have the best and brightest coming to North Carolina."

Rohini Kousalya Siva will start her obstetrics and gynecology residency at MedStar Washington Hospital Center in Washington, D.C., this year. She said she did not consider programs in states that have banned or severely restricted abortion, applying instead to programs in Maryland, New Hampshire, New York and Washington, D.C.

"We're physicians," said Kousalya Siva, who attended medical school in Virginia and was previously president of the American Medical Student Association. "We're supposed to be giving the best evidence-based care to our patients, and we can't do that if we haven't been given abortion training."

Another consideration: Most graduating medical students are in their 20s, "the age when people are starting to think about putting down roots and starting families," said Gray, who added that she is noticing many more students ask about politics during their residency interviews.

And because most young doctors make their careers in the state where they do their residencies, "people don't feel safe potentially having their own pregnancies [while] living in those states" with severe restrictions, said Debra Stulberg, chair of the Department of Family Medicine at the University of Chicago.

Stulberg and others worry that this self-selection away from states with abortion restrictions will exacerbate the shortages of physicians in rural and underserved areas.

"The geographic misalignment between where the needs are and where people are choosing to go is really problematic," she said. "We don't need people further concentrating in urban areas where there's already good access."

From Tennessee to California

After attending medical school in Tennessee, which has adopted one of the most sweeping abortion bans in the U.S., Hannah Light-Olson will start her OB-GYN residency at the University of California San Francisco this summer.

It was not an easy decision, she said. "I feel some guilt and sadness leaving a situation where I feel like I could be of some help," she said. "I feel deeply indebted to the program that trained me and to the patients of Tennessee."

Light-Olson said some of her fellow students applied to programs in abortion-ban states "because they think we need pro-choice providers in restrictive states now more than ever." In fact, she said, she also applied to programs in abortion-ban states when she was confident the program had a way to provide abortion training.

"I felt like there was no perfect 100% guarantee. We've seen how fast things can change," she said. "I don't feel particularly confident that California and New York aren't going to be under threat too."

As a condition of a scholarship she received for medical school, Blum said, she will have to return to Arizona to practice, and it is unclear what abortion access will look like then. But she is worried about long-term impacts.

"Residents, if they can't get the training in the state, then they're probably less likely to settle down and work in the state as well," she said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling and journalism.

• rural health
• medical residency
• abortion bans
• medical provider shortage

• Open access
• Published: 10 May 2024

Novice providers’ success in performing lumbar puncture: a randomized controlled phantom study between a conventional spinal needle and a novel bioimpedance needle

• Helmiina Lilja 1   na1 ,
• Maria Talvisara 1   na1 ,
• Vesa Eskola 2 , 3 ,
• Paula Heikkilä 2 , 3 ,
• Harri Sievänen 4 &
• Sauli Palmu 2 , 3  

BMC Medical Education volume  24 , Article number:  520 ( 2024 ) Cite this article

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Metrics details

Lumbar puncture (LP) is an important yet difficult skill in medical practice. In recent years, the number of LPs in clinical practice has steadily decreased, which reduces residents’ clinical exposure and may compromise their skills and attitude towards LP. Our study aims to assess whether the novel bioimpedance needle is of assistance to a novice provider and thus compensates for this emerging knowledge gap.

This randomized controlled study, employing a partly blinded design, involved 60 s- and third-year medical students with no prior LP experience. The students were randomly assigned to two groups consisting of 30 students each. They performed LP on an anatomical lumbar model either with the conventional spinal needle or the bioimpedance needle. Success in LP was analysed using the independent samples proportion procedure. Additionally, the usability of the needles was evaluated with pertinent questions.

With the conventional spinal needle, 40% succeeded in performing the LP procedure, whereas with the bioimpedance needle, 90% were successful ( p  < 0.001). The procedures were successful at the first attempt in 5 (16.7%) and 15 (50%) cases ( p  = 0.006), respectively. Providers found the bioimpedance needle more useful and felt more confident using it.

Conclusions

The bioimpedance needle was beneficial in training medical students since it significantly facilitated the novice provider in performing LP on a lumbar phantom. Further research is needed to show whether the observed findings translate into clinical skills and benefits in hospital settings.

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Lumbar puncture (LP) is one of the essential skills of physicians in medical practice, especially in the fields of neurology, neurosurgery, emergency medicine and pediatrics. It is one of the procedures that medical students practice in their training. LP is an important clinical procedure for diagnosing neurological infections and inflammatory diseases and excluding subarachnoid hemorrhage [ 1 ]. LP can also be used for examining the spread of cancer cells to the central nervous system in diagnosing acute lymphoblastic leukemia (ALL) and for delivering intrathecal administration of chemotherapy in patients with ALL [ 2 ]. In recent years, the number of LPs in clinical practice has steadily decreased [ 3 , 4 ]. Over the past decade, a 37% decrease in LPs was observed across US children’s hospitals [ 3 ]. Similar trends have also been observed in emergency medicine [ 4 ]. Stricter criteria in practice guidelines, changes in patient demographics, and development in medical imaging have likely contributed to this decrease. This trend presumably reduces residents’ clinical exposure and may compromise their skills and attitude towards LP.

When performed by an experienced physician, LP is a relatively safe procedure, albeit not always straightforward or free from complications [ 4 ]. The spinal needle used in LP is thin and flexible, making its insertion into the spinal canal without seeing the location of the needle tip or destination challenging. The physician performing the procedure must master the specific lumbar anatomy to avoid complications [ 5 ]. The LP technique is not the only thing that matters, but patients’ size and comfort also affect the success of the procedure [ 6 ]. Hence, a practitioner lacking adequate experience in LP should be appropriately supervised when performing the procedure [ 4 ]. Nevertheless, there are situations in which such supervision is not possible.

Little experience in performing LPs may require more attempts to obtain cerebrospinal fluid (CSF) samples [ 7 ]. Because of several attempts, blood can be introduced to CSF and result in a traumatic LP. Success at the first attempt is associated with a lower incidence of traumatic LPs [ 2 , 8 , 9 , 10 , 11 , 12 ]. A bloody CSF sample complicates the diagnostics [ 8 ]. It has also been shown that a high number of attempts increases the incidence of postdural puncture headache (PDPH), the most common complication of LP, in addition to other adverse effects [ 9 ].

Considering the possible complications and difficulties of performing LP, a concern arises regarding whether inexperienced physicians can perform LP with adequate confidence and safety. The use of a novel bioimpedance-based spinal needle system could offer a solution. This needle provides real-time feedback from the needle tip when penetrating the lumbar tissues and informs the physician when the needle tip reaches CSF with an audio-visual alarm. This information may make performing the LP procedure smoother, thus decreasing the incidence of the most common complications [ 13 ]. A bioimpedance-based spinal needle system has been recently found clinically feasible in LPs among adults, adolescents, and children, including neonates [ 2 , 14 , 15 ].

The current phantom study aimed to assess whether the novel needle technology can compensate for the lack of experience when a medical student performs LP for the first time. In particular, we compared the performance of the bioimpedance spinal needle and conventional spinal needle in terms of the overall success rate of the LP procedure, success rate at the first attempt, duration of the procedure, and number of stylet removals. We hypothesized that novice users would find the bioimpedance needle more useful in performing LPs than a conventional spinal needle. If so proven, the use of this novel device can contribute to training medical students in this important skill and facilitate situations when an inexperienced physician needs to perform LP without the supervision and guidance of an experienced physician [ 4 ].

We planned to recruit 60 medical students from Tampere University in this randomized controlled trial. Students who were studying medicine for their third year or less were considered eligible for the study. At this stage of studies, they were expected to have no clinical experience and be thus naïve in performing an LP. All students had the same baseline knowledge regarding lumbar spine anatomy.

The participants were recruited by sending an invitation e-mail to all potentially eligible medical students. The email provided information about the study. Of the 177 students who responded to the invitation, 60 students were included on a first-come-first-serve basis. The participants were rewarded with a 10€ voucher to the university campus cafeteria.

Randomization lists in blocks of six were generated for two groups (A and B) before recruitment by an independent person who was not involved in recruitment or data collection. Participants assigned to group A used a conventional spinal needle (90 mm long 22G Quincke-type needle), and those to group B used the bioimpedance needle system (IQ-Tip system with a 90 mm long IQ-Tip needle, Injeq Plc, Tampere, Finland).

The study LPs were performed on an adult-size anatomical lumbar phantom (Blue Phantom BPLP2201, CAE Healthcare, FL, USA) intended for medical training and practising. The phantom is made of a tissue-simulating elastomer material that looks and feels like human soft tissue. Skeletal structures made of hard material and a plastic tube mimicking the spinal canal are embedded in the phantom. The saline inside the tube mimics CSF and is under hydrostatic pressure. The phantom offers a relatively realistic feel in palpating the lumbar anatomy and getting haptic feedback from the advancing needle.

The study LPs were performed in February 2023 in ten different sessions, with 6 participants in each session. Two separate rooms were used to conduct the study. The participants were first admitted to a waiting room and then separately to another room where each student performed the study LP with the assigned spinal needle under supervision (HL and MT). By having these two rooms, we ensured that no information was exchanged after or during the procedure.

Before the study LPs, the participants were shown an instructional video on how to perform an LP from the widely used Finnish medical database Terveysportti [ 16 ] and a video on the operation of the bioimpedance needle [ 13 ]. The first video (duration 3 min) describes the indications, contraindications and a step-by-step instruction on how the procedure is performed. The latter is a 25- second animation showing how the bioimpedance system operates and guides the procedure. In addition, the supervisor gave each participant the following instructions before starting the study LP: When you think you have reached the subarachnoid space, remove the stylet from the needle. If you are in the correct place, the fluid will start flowing from the needle. You may redirect the needle as many times as you wish, but you are only allowed to remove the needle and do a new attempt five times. Please wait a while when you have removed the stylet because it may take a while before the fluid starts dropping. These instructions were given to all participants irrespective of the study group to standardize the information in all sessions.

After watching the videos and listening to the instructions, the participants became aware of their assigned study group. Participants were allowed five attempts, while redirections of the needle and stylet removals could be performed as many times as needed. We measured the duration of the LP procedure and collected data on the number of stylet removals, the number of attempts, and whether the LP was successful.

The duration of the procedure was defined from the point when the needle penetrated the phantom surface to either when the first drop of fluid fell from the needle, or the participant wanted to stop or had used all five attempts. There was no maximum time for completing the LP procedure. The procedure was defined as successful if the participant succeeded in obtaining a drop of fluid from the needle.

In addition, seven relevant statements to this study were chosen from the System Usability Scale (SUS) [ 17 ], which is an industry standard for evaluating the usability of various devices and systems. The seven statements, slightly modified from the original statements, are shown in Table  1 . After performing the study LP and irrespective of their success, all participants were asked to respond to the statements using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree).

Statistical analysis

For the estimation of statistical power, we assumed that the overall success rate would be 60% with the conventional needle (group A) and 90% with the bioimpedance needle (group B). Then, the sample size of 60 participants divided randomly into two equal-sized groups would be sufficient to detect a between-group at a significance level of p  < 0.05 and with 80% statistical power if such a difference truly exists.

Overall success in performing the lumbar puncture and success at the first attempt in the groups were analysed by the independent samples proportion procedure. The median number of attempts and stylet removals in the successful procedures were compared by independent samples Mann‒Whitney U test. Responses to the seven usability statements were compared by this test as well.

Statistical analyses were performed with IBM SPSS Statistics for Windows, version 29.0 (IBM Corp., Armonk, NY, USA). A p value less than 0.05 was considered statistically significant.

Sixty medical students were randomly assigned into two groups, 30 performing the LP procedure on the lumbar phantom using a conventional spinal needle and 30 using the bioimpedance needle. None of the participants had previous experience in performing an LP.

With the conventional spinal needle (group A), 12 out of 30 participants (40%) succeeded in performing the LP procedure, whereas with the bioimpedance needle (group B), 27 out of 30 participants (90%) were successful ( p  < 0.001). The procedures were successful at the first attempt in 5 (16.7%) and 15 (50%) cases ( p  = 0.006), respectively.

Figure  1 illustrates the number of attempts and stylet removals in the study groups. Regarding the success of the procedure at any attempt, the median number of attempts was 2 (range 1–5) for the conventional needle and 1 [ 1 , 2 , 3 , 4 , 5 ] for the bioimpedance needle ( p  = 0.56).

In the successful procedures, the median number of stylet removals was 4 [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] and 1 (1–33) ( p  = 0.001), respectively. The mean duration of a successful procedure was 3:51 (SD 3:43) with the conventional needle and 1:59 (2:25) with the bioimpedance needle ( p  = 0.068).

The responses to the seven usability statements are illustrated in Fig.  2 . Regarding the statements on regular use, ease of use, need for support from an experienced user, learning to use, and cumbersomeness, the responses differed significantly between groups, consistently favouring the bioimpedance needle ( p  < 0.001). Regarding the feeling of confidence in use, the responses significantly favoured the bioimpedance needle ( p  = 0.012). Likewise, the responses significantly favoured the bioimpedance needle to less need to learn many things before its use.

Distributions of the number of attempts in successful LP procedures (left panel) with the conventional spinal needle (group A, yellow bars) and with the bioimpedance needle (group B, blue bars). Respective distributions of the number of stylet removals (right panel) in groups A and B

After performing the LP, the provider answered seven statements about the usability of the needle in question on a scale of 1 (strongly disagree) to 5 (strongly agree). Distributions of responses to every seven usability statements in group A (conventional spinal needle, yellow bars) and in group B (bioimpedance needle, blue bars) using the System Usability Scale (SUS)

The decline in the number of LPs during the last decade [ 3 , 4 ] likely weakening the practical knowledge and skills of novice physicians served as the rationale for the current study. Using a solid randomized controlled study design, we assessed whether bioimpedance-based tissue detection technology could help an inexperienced provider perform LP. Our study was conducted among early-stage medical students who had no previous experience with LPs. Following our hypothesis, we found that the use of a bioimpedance needle in simulated phantom LPs was useful to novice providers. The bioimpedance needle decreased not only the number of attempts to achieve a successful LP but also its time, in addition to the significantly lower number of stylet removals during the procedure. Furthermore, the usability of the bioimpedance needle was found to be significantly better than that of the spinal needle used currently in clinical practice.

The users of the bioimpedance needle found the novel device easy and intuitive to learn and use while feeling more confident in performing LP compared to those using the conventional needle. They also expressed their interest in using the bioimpedance needle regularly. It is recalled that the present providers were all novices without earlier experience in LP, and therefore, the observed between-group differences in performance could have been smaller with more experienced providers.

Of common bedside procedures in clinical practice, LP was recently found to be associated with the lowest baseline levels of experience and confidence among 4 th− to 6th -year medical students. However, a single seminar with standardized simulation training brought more confidence to the LP procedure among these students [ 18 ]. Other recent studies have also shown that simulation-based education can improve procedural competence and skills in performing LP [ 19 , 20 , 21 , 22 ]. In these studies, the participants had more experience than in our study, but the benefits of simulation-based learning were significant. A recent study assessing a mixed reality simulator found this approach helpful in learning of LP among residents, faculty, interns, and medical students, approximately 60% having no previous experience in LP [ 23 ]. After mixed reality training, the success rate of LP increased while the time of the procedure decreased [ 23 ], which is in line with our findings. Virtual reality-based training in LP learning has also been studied, and it might have beneficial results in the provider’s skills and confidence [ 24 , 25 ]. All these findings speak for the utility of various simulation approaches in adopting essential (new) clinical skills for LP at different stages of medical studies and careers.

Lumbar puncture is commonly considered a difficult and possibly frightening procedure to perform. In addition to the physician’s experience and skills, there are other factors that affect the success of LP, including patient size, spinal deformities, lumbar anatomy, cooperation and comfort [ 6 ]. Occasionally, a physician may have to insert the needle more than once to succeed in LP. However, repeated attempts are associated with several complications, such as PDPH and traumatic LP [ 7 , 10 , 11 , 12 , 26 , 27 , 28 ]. In our study, the median number of attempts was two for the conventional spinal needle and one for the bioimpedance needle. The low number of attempts may have also contributed to the low incidence of traumatic LP and PDPH observed in pediatric patients with leukemia, whose intrathecal therapy was administered using the bioimpedance needle [ 15 ]. Since the basic use of a bioimpedance needle is virtually similar to that of a conventional spinal needle with no need for additional devices (e.g., ultrasound imaging), it may offer a notable option for effective teaching of LP among medical students. Its real-time CSF detection ability is likely to consolidate the learning experience and increase confidence in one’s skills.

In this study, we found a significantly higher success rate and confidence in procedural skills of medical students associated with using the bioimpedance needle compared to the conventional spinal needle. Should these benefits translate into the real clinical world and manifest as a lower incidence of failed LP procedures and procedure-related complications, a higher incidence of high-quality CSF samples, a lower need for repeated procedures, a lower need for experienced and more expensive physicians to supervise, perform, or complete the LP procedure, substantial savings in the total costs of the lumbar puncture procedure are possible despite the initially higher unit cost of the bioimpedance needle system compared to conventional spinal needles. Further clinical studies on the benefits of the bioimpedance needle system in clinical LP procedures are needed to confirm these speculations.

The major strengths of the present study are the randomized controlled, partly blinded design and adequate sample size. The random assignment of participants to study groups and data analysis were performed by an independent person who was not involved in recruitment or data collection. The participants received the same instructions and information before performing their assigned LP procedure and were asked not to study LP in advance to keep the participants as naïve in performing LP as possible. Obviously, we could not control for this and have full certainty about the prior information on retrieval of the participants. However, the participants were not told before the study session which type of spinal needle they would use in their assigned LP.

During the LP sessions, there were a few technical issues concerning the lumbar phantom and bioimpedance needle. First, since the pressure inside the phantom spinal canal (plastic tube) affects the fluid flow through the needle, we attempted to keep the height of the hydrostatic saline column constant by adding new saline as needed, but slight variation in pressure may have occurred, and concerned all study LP procedures. Second, when the plastic tube and surrounding phantom material are pierced multiple times in succession, it is possible that the leakage of saline moistens the rubbery material and increases markedly its electrical conductivity despite the self-healing property of the material. Had this happened, consequent false detections may have led to unnecessary removals of the stylet in the LP procedures performed with the bioimpedance needle system. Therefore, as a precaution, the maximum number of participants at each session was limited to six to mitigate the risk of moistening of material. Third, in two cases, the bioimpedance needle system did not detect saline, although the needle tip was in the correct place, confirmed by saline flow after stylet removal. This rate of missed detections in line with clinical experience [ 2 , 15 ] and may be due to elastomer remnants stuck at the needle tip compromising the bioimpedance measurement and saline detection. However, despite the failed functionality, the mechanical performance of the bioimpedance needle as a spinel needle is maintained and LP could be performed as usual. Regarding the credibility of the present findings, the bioimpedance needle did not get any undue benefit from these technical issues compared to the conventional spinal needle.

Given that the participants were clinically inexperienced early-stage medical students, the study was conducted using an anatomical lumbar phantom, not on actual patients. Obviously, the haptic feedback from the phantom and anatomic variation in the lumbar region do not fully correspond to a real patient. On the other hand, the use of phantom takes off the pressure from a novice provider and possibly eases the procedure, not having to take thought on a patient’s comfort, anatomy, and condition. Although the LP procedure was performed for the first time without the guidance of an experienced physician, the users of the bioimpedance needle felt more confident and performed significantly better than those with the conventional spinal needle. If used for teaching purposes, the bioimpedance needle and the anatomical lumbar phantom could offer a positive experience of the LP procedure and raise confidence in one’s own skills before the first real patient encounter. Whether the present promising results of a phantom study would translate into improved performance in actual clinical work calls for further investigation.

Lumbar puncture is a widely used but demanding procedure needed for the diagnosis and treatment of several diseases. It is relatively safe when performed correctly, but due to the decreasing trend of performed LP procedures, a concern has arisen concerning novice physicians’ expertise in LP. The bioimpedance needle could offer a solution to this problem and facilitate practical training of LP among early-stage medical students. The present randomized controlled phantom study showed that providers with no previous experience in LP perceived the bioimpedance needle as more useful, became confident, and achieved significantly higher success rates both overall and at the first attempt with fewer stylet removals compared to those using a conventional spinal needle. Further research is needed to show whether the observed findings translate into clinical skills and benefits in hospital settings.

Data availability

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

Abbreviations

Acute lymphoblastic leukemia

Cerebrospinal fluid

• Lumbar puncture

Postdural puncture headache

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Helmiina Lilja and Maria Talvisara contributed equally to this work.

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Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland

Helmiina Lilja & Maria Talvisara

Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland

Vesa Eskola, Paula Heikkilä & Sauli Palmu

Tampere University Hospital, Elämänaukio 2, Tampere, 33520, Finland

Injeq Plc, Biokatu 8, Tampere, Tampere, 33520, Finland

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H.L. and M.T.: data collection, data analysis, drafting the manuscript, editing the manuscript. V.E. and P.H.: planning the study, editing the manuscript. H.S. and S.P.: conceptualizing and planning the study, data analysis, editing the manuscript.

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Correspondence to Sauli Palmu .

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Lilja, H., Talvisara, M., Eskola, V. et al. Novice providers’ success in performing lumbar puncture: a randomized controlled phantom study between a conventional spinal needle and a novel bioimpedance needle. BMC Med Educ 24 , 520 (2024). https://doi.org/10.1186/s12909-024-05505-z

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Received : 06 October 2023

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Published : 10 May 2024

DOI : https://doi.org/10.1186/s12909-024-05505-z

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