Research and audit
Opportunities to get involved start as a medical student, say Aimun A B Jamjoom and colleagues
Gaining research experience while at medical school is becoming increasingly important. The UK General Medical Council’s guidelines
Tomorrow’s Doctors state that graduating medical students in the UK must be able to “evaluate and integrate evidence critically.” Involvement
in research can help medical students to acquire these essential skills while nurturing a deeper understanding in an area
of interest. Even if you have no intention of pursuing an academic career it is still a valuable skill (figure1).
Taking a year out during medical school to undertake an intercalated degree is the most obvious route for formal student involvement
in research. However, considering only a third of medical students intercalate research degrees in the UK, this leaves two
thirds of students with no hands-on experience of running their own research or audit project. So here are a few tips on how
to get involved at medical school.
Audit or research?—Audit is a good introduction to an academic project because these tend to be on a smaller scale and are easier to undertake
as a student.1 See “Research is concerned with discovering the right thing to do; audit with ensuring that it is done right” for the difference
between research and audit.2
Getting started—There is no right time to get started with research. Opportunities range from finding a topic of interest to meeting a dynamic
and enthusiastic doctor who encourages you to get your academic ball rolling. However, you should remember that from starting
a project to seeing an outcome can take a long time. Depending on the size of the project, how long it takes you to do your
part, and the keenness of your supervisor it may take from six months to a year or more before you have anything to show for
it. So if the chance arises it may be better to start earlier rather than later.
Ask around—Finding the right person who will offer you the opportunity to do research or audit work can be difficult, and this is where
most people struggle. The key to success requires a mixture of relentless questioning of doctors but also a little detective
work. If you hear of a friend or colleague who’s doing some work with someone try and find out their supervisor’s name and
inquire whether they have any other projects that they need help with. Doctors who are active in research tend to have more
than one project going at once.
Clarity is the key—Once you’ve found someone who is willing to let you help them it is important for you to clarify a few points.
What exactly will I be doing?—It is important to make sure that your supervisor shows you exactly what you should be doing and how. The results of a study
may depend on your work, so getting it right is vital.
How much support will I have?—It is easy for a busy doctor to leave you floundering with a mass of patients’ notes and little idea about how to go through
them properly. So ask how much he or she can help you.
What do you aim to get from this project?—The answers you will get can vary greatly. It’s a good sign if your supervisor tells you exactly what his or her intentions
are. This includes where they aim to present the study and whether they think the work could be published.
What is my contribution worth?—This is important and should be asked, however awkward it may seem. Different supervisors have different views on what medical
students’ contributions to projects are worth, therefore, it is essential to ask whether your hard work will result in your
name on a submitted manuscript to a learned journal or merely a pat on the back.
Reading around your project—Once you have found a project to work on, it is important to read about it in journals and textbooks. This helps put what
you are doing in perspective and refines your ability to critically appraise published papers, a vital skill for instilling
evidence based practice throughout your future career.
Location—If you’re doing a project that involves work in a hospital try to make sure that you are attached to that hospital for the
duration of the project or live nearby—this makes life a lot easier.
Find a partner—Having a friend or colleague involved can help a great deal. This allows work to be shared but also means that you have someone
to spur you on and keep you company.
Collaborations—If you find a good supervisor and a medical student you enjoy working with, keep with them. There is no need to stop at one
project.
Effort—The roles you get will not be extremely time consuming and do not require as much effort as people often think.
Research ethics—It is unlikely that you will have the task of applying for ethical approval as a medical student. However, consideration
of a study’s ethics is fundamental to medical research, and you must ensure that your supervisor has considered this before
undertaking his or her project. Local approval of clinical audits may also be required.
If all else fails—If you can find no one with any projects or every project you start gets nowhere, why not come up with your own idea and
approach a doctor for supervision and guidance? Questionnaire surveys are simpler projects to undertake and don’t necessarily
have to involve patients (surveys of patients require ethics or audit committee approval). You could answer a question in
medical education by distributing a questionnaire among medical students in your year.
Research can be very fulfilling but at times frustrating: do not let this deter you from getting involved with at least one
project during your medical school career. The experience will help you to understand the work involved in providing evidence
to help doctors improve patients’ lives; allow you to tackle new and exciting areas through original and critical thought;
and improve your abilities as a doctor.
Competing interests: None declared.
Provenance and peer review: Not commissioned; externally peer reviewed.
See “Should I do an intercalated BSc?” (Student BMJ 2008;15:238-9, http://student.bmj.com/issues/08/06/careers/238.php).
Aimun A B Jamjoom final year medical student University of Nottingham Medical School, Nottingham NG7 2UH
mzyyaaj@nottingham.ac.uk
Ali Nikkar-Esfahani final year medical student University of Nottingham Medical School, Nottingham NG7 2UH
J E F Fitzgerald clinical research and teaching fellow and specialty trainee, general surgery Department of Gastrointestinal Surgery and Medical Education Unit, Nottingham University Hospital, Nottingham NG7 2UH
Student BMJ 2009;17:62-63 | February
- Janmohamed F, Halpin L, Patwardhan S. Clinical audits made easy. Student BMJ 2006;14:20-2. http://student.bmj.com/issues/06/01/careers/20.php
- Smith R: Audit and research. BMJ 1992;305:905-6.
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CAREERS
Research and audit
(Aimun A B Jamjoom and colleagues, February 2009)
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Bayanne Olabi
(February 5th, 2009)
Intercalating medical student, University of Edinburgh s0680946@sms.ed.ac.uk
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Aimun A B Jamjoom and colleagues have raised an important issue: encouraging medical students to critically appraise and publish original research is an excellent opportunity to engage in academic medicine, and with the increasing emphasis on evidence-based-medicine in the NHS, these skills will soon be as important for doctors as clinical competence, effective communication and teamwork. With the International Campaign to Revitalise Academic Medicine(1) now underway, there is no better time to get involved in research and audit, especially as a student. But how else can we get our foot on the academic research ladder? Publishing letters and critically appraising current research is a good way to demonstrate those skills.
However, it seems that fewer medical students are publishing letters to the editor. After examining the letters section of the BMJ from Jan 2000 to Dec 2007, and determining the percentage of letters with medical student authorship, it was found that over this eight year period, 69 (2.1%) of the total 3247 published letters had at least one medical student author, with students from overseas contributing significantly to the letters section (26% of letters studied) and 33 (48%) of these letters were written by students alone, without coauthors in the specialty.
Worryingly, however, since 2003, the percentage of letters with medical student authorship has progressively fallen, from 3% in 2003, to 1.9% in 2005, to 1.4% in 2007. Also, when analysing the type of letter written by year, before December 2007, the last student critical appraisal was written in October 2003, whereas 18 viewpoints were published throughout this time, and students were offering an opinion on any topic or article but without critical appraisal of the work.
Perhaps we rectify this falling trend by providing students with more opportunities to carry out and appraise current research. For example, at the University of Edinburgh, all students undertake a research project in fourth year, and intercalating is optional. This year, a new student society ATRIUM (Academic TRaining In Undergraduate Medicine) has also provided students with information and resources to develop these skills, even running a "how to write letters to the editor" session, which returned excellent feedback from students. In my opinion, changing medical school curriculums to acknowledge the importance of research to clinical work is a step in the right direction.
- Tugwell P. Campaign to revitalise academic medicine kicks off. BMJ 2004;328: 597.
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CAREERS
Research and audit
(Aimun A B Jamjoom and colleagues, February 2009)
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Alison Myers
(February 23rd, 2009)
medicine, 5th year, UCL a.myers@ucl.ac.uk
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In response to Bayanne Olabi:
The worrying trend noted by Bayanne Olabi, in the lack of responses by medical students to articles seems to highlight a gap in medical education. Medical schools' seem very concerned with teahing us to critically evaluating evidence however at no stage of my medical education have i been given guidance on why i should try to publish articles and how to go about it. It would seem that even if there is no room in an already package medical curriculum then surely these skills could be offered as a special study module.
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CAREERS
Research and audit
(Aimun A B Jamjoom and colleagues, February 2009)
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Sukhpal S Gill
(February 24th, 2009)
Final Year Medical Student, School of Medicine, University of Birmingham, Birmingham B15 2TT sukhpal.gill@doctors.org.uk
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I share Alison Myers' views in that medical schools could do more to encourage students to get published.
My experience of fellow students is that some are more ambitious, confident and CV-driven than others and are probably likely to get something publishing simply because they try. Incorporating some form of medical journalism in to the core curriculum, (which tends to be taken more seriously across the board than non-assessed material) may allow those students who prefer to sit mute, to be credited for expressing thought-provoking views.
Providing options to be mentored by appropriate people through Special Study Modules (as suggested by Myers) would be very useful. Alternatively, arrangements could be made through medical schools for students to submit letters to newspapers like they do in Australia (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1117792) where the best ones are chosen for publication by the editors. The Student BMJ and BMJ are excellent media for this purpose.
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CAREERS
Research and audit
(Aimun A B Jamjoom and colleagues, February 2009)
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Vikas Dhikav & Richa Gupta
(March 4th, 2009)
Senior Research Officer, All India Institute of Medical Sciences, New Delhi-110029, INDIA vikasdhikav@hotmail.com
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We agree with the views of author1 regarding the induction of medical students in research and audit. We present the scenario of medical students interested in research in India.
1. Medical students, as we agree with Gill2 who thinks that students may be CV driven. Indeed, research projects may be needed by USMLE and few other organizations that is their incentive to take part into this. Few students however may be interested in research out of curiosity. Some of them are really very good.
2. Many medical students may be all too enthusiastic and start off well. Soon they may loose focus knowing the amount of hard work it may involve. They may not have time.
3. Many a times, students may have high expectations of their projects and failure to meet them may leave them frustrated.
We think, induction of students into research methodology is a must and following are the suggestions from our side:
a) Students should be taught a bit of research methodology and importance of research in medicine should be highlighted.
b) Research should be introduced to students not as a burden or responsibility but as an exciting option that they may like to take or test their skills with.
c) They should be given small projects to participate and their skills as editors, as planers and project workers should be sharpened. That means induction should be phasic.
d) They should be guided properly at every step starting from inception to publication. They should be made to participate.
e) Creativity among students should be encouraged. They should be encouraged to take up projects of their choices and guides should make sure that they supervise them well.
- Student BMJ 2008;15:238-9, http://student.bmj.com/issues/08/06/careers/238.php.
- Response to Aimun A B Jamjoom and colleagues, February 2009. http://student.bmj.com/issues/09/02/careers/62.php.
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CAREERS
Research and audit
(Aimun A B Jamjoom and colleagues, February 2009)
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1. Fayaz Roked; 2. Femi Oyebode
(March 8th, 2009)
1. Foundation year one trainee; 2. Professor of Psychiatry, 1. Hammersmith Hospital, London; 2. University of Birmingham fayaz.roked@imperial.nhs.uk
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Jamjoon and colleagues have identified an important issue. Most medical journals publish the findings of cutting edge research carried out in laboratories or multicentre randomised controlled trials, so how can a medical student get his name in a journal amongst leading academics and researchers? Competition for jobs in the medical profession is fierce and employers look for candidates who have accomplishments that enable them to stand out from the crowd.
As Jamjoon and colleagues suggest involvement in research and audit can lead to publications and these are an excellent way of setting the good student apart from the rest. But, there is a lack of guidance for students in medical school regarding the publication process.
Even if students are not involved in these activities, there are still many opportunities. Most journals publish review articles, opinion pieces and letters to the editor. The letters do not have to be research-based. Although they are often idiosyncratic and humorous, it is probably best to aim to make a thoughtful response to an already published paper based on reading or clinical experience. Experiences and views about life as a medical student are also a potential source of material.
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