Research waste is still a scandal—especially in medical students
We thank Paul Glasziou and Iain Chalmers for their informative essay, “Research waste is still a scandal” (1).
As medical students in the UK we already feel pushed to complete research. No group is more susceptible to designing, conducting and reporting poor quality research than medical students who have not had time to develop the essential skills needed to conduct meaningful research. A 2016 study of medical students in the USA found that only 23% of students pursued research for academic interest, with the largest group of students (32%) pursuing research to increase the competitiveness of their postgraduate job application (2). Some of the same ulterior motivators that encourage wasteful research in the USA also exist in the UK.
We feel it is necessary to complete research to remain competitive for future job applications as do many of our peers – similar to the study in the USA. The UK correctly focusses on “putting patients first” but houses systematic motivators to pursue research for reasons ulterior to those of improving patient care. For example, the UK uses standardised scoring systems to recruit junior doctors immediately after leaving medical school where authorship on up to two publications is rewarded by more points (3). These motivators often favour quantity over quality and exist in core training, speciality training and at consultancy (4). To highlight the pressure students’ face to publish research it is joked that, “soon you will have to be a published author to even get into medical school”.
Bernard M Y Cheung, editor of the BMJ Postgraduate Medical Journal, recently addressed the question of, “is [medical student research] necessary and beneficial?” (5). He highlights that is it not unusual for students to finish university having completed a research project. Observations like this increase the pressure we burden ourselves with to conduct research outside of our taught curriculum despite knowing the impact the project has will be small.
The challenge remains of how to encourage students and junior colleagues to engage with meaningful research, whilst not pursing a culture of quantity over quality. We have two suggestions to address this.
Firstly, we suggest a greater reward being placed on participation in well-designed and well-conducted research even if this is a small role in a large project that does not result in authorship. This will reduce the “85% of wasted effort in medical research” that Glasziou and Chalmers highlighted (1) by removing some of the burden on junior colleagues to pursue low impact research in order to have authorship on the publication. The teamwork involved in this will foster an environment where inexperienced members can develop advanced research skills without having to publish potentially wasteful research themselves. Unfortunately, collaborative research networks such as the Student Audit and Research in Surgery Collaborative (STARsurg) (6) do not reward participants with a PubMed ID and therefore students are not rewarded with UK Foundation Programme points for participating. We feel greater rewards should be given to those involved in these collaborative networks as they begin to teach students the important skills required conduct meaningful research.
This leads on to our second suggestion. Greater rewards must be given to those who demonstrate advanced knowledge and understanding of research methodology and critical appraisal. Whether you are an academic, clinician or manager, it is essential that you are able to recognise the quality of research you are reviewing and use the results produced accordingly. These skills are often assessed within academic foundation programme applications, yet not routinely assessed in normal UK Foundation Programme applications (7). We suggest that the current point system could be altered to include assessment of knowledge of research methodology and critical appraisal above and beyond what is expected for final exams. We feel these suggestions can begin to correct the issue of wastefulness that persists in medical research today.
We would like to hear the opinions of Paul Glasziou and Iain Chalmers on medical student research.
1. Glasziou P, Chalmers I. Research waste is still a scandal—an essay by Paul Glasziou and Iain Chalmers. BMJ. 2018;363:k4645.
2. Pathipati A, Taleghani N. Research in Medical School: A Survey Evaluating Why Medical Students Take Research Years. Cureus. 2016;8(8):e741.
3. UK Foundation Programme Office. UKFP 2019 Applicants' Handbook. London: UK Foundation Programme Office; 2018.
4. Health Education England. Person specifications [Internet]. Specialty Training. 2018 [cited 18 November 2018]. Available from: https://specialtytraining.hee.nhs.uk/Recruitment/Person-specifications
5. Cheung B. Medical student research: is it necessary and beneficial?. Postgraduate Medical Journal. 2018;94(1112):317-317.
6. STARsurg. Home [Internet]. STARsurg. 2018 [cited 19 November 2018]. Available from: https://starsurg.org/
7. UK Foundation Programme Office. Rough Guide to the Academic Foundation Programme. London: UK Foundation Programme Office; 2013. Available from: http://www.foundationprogramme.nhs.uk/sites/default/files/2018-08/Rough%...
Competing interests: No competing interests