A Multi-centre Study from Saudi Arabia

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Original Article

Faculty Perspective on Competency-based Research Education: A Multi-centre Study from Saudi Arabia Hamza Naji, Jumana Sarraj, Ibrahim Muhsen, Shouq Kherallah, Ahmed Qannita, Akef Obeidat, Muhammad Raihan Sajid Department of Medical Education, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

Abstract Introduction: Research is becoming indispensable in today’s medical education and clinical practice. Engaging medical students in research activities and producing clinically competent and research‑oriented medical students are essential demands of today’s modern medicine. Incorporating research‑based competencies and designing research‑oriented medical curricula are challenging and need more attention, especially in developing countries. The aim of this study was to identify research competencies for medical students and the best instructional modality for their integration in the medical curricula. Methodology: A list of research competencies needed to be acquired by medical students during their undergraduate level have been proposed and classified under the following categories: general research skills, biostatistics, basic biomedical research and clinical research and epidemiology. The competencies were further reviewed by academicians of different fields. Afterwards, a questionnaire was prepared targeting researchers who have mentored undergraduate medical students in Riyadh, Saudi Arabia. Research mentors were asked to rate the importance of the competencies listed using a 5‑point Likert scale and to determine how they should be delivered into the medical curricula. Results: Results showed that Likert scale mean score ranged from 3.44 to 4.71, illustrating mentors’ agreement to the importance of the competencies listed. Around 52% and 58% of mentors choose ‘compulsory component’ in case of ‘general research skills’ and ‘biostatistics’, respectively. On the other hand, 75% and 66% of mentors choose ‘non‑compulsory component’ in case of ‘basic research’ and ‘clinical research and epidemiology’, respectively. Conclusion: Standardisation of competencies might help to better integrate research competencies in medical curricula. Keywords: Biostatistics, general research skills, research competencies, undergraduate medical education

Introduction Medical education should evolve to meet expectations and challenges of the new millennium and must also be able to produce physicians who can provide a high‑quality healthcare.[1] A long list of challenges is expected to be solved by the medical system of the 21st century which encompasses a possible cure for cancer, development of stem cells’ usage and a change of the current medical system to individualized care that takes advantage of the human genome project.[2,3] Those challenges necessitate the need to not only prepare future physicians to be clinically competent, but also to develop the skills needed to meet those gigantic expectations, including the ability to develop biomedical research.

towards science allowing medical students to add valuable input to current and future science.[1,4‑6] Despite the importance of research education, it is still an area that needs a lot of development, especially in developing countries.[4] Research education lacks coherent integration within the curriculum, despite this, medical students are involved in research activities through hands‑on experience or research electives relating to both basic science and clinical research.[3,7‑9] Defining research competencies is an important step to standardise and effectively integrate research education in curriculum. Some of these competencies have been defined by Laidlaw et al., 2009, which aimed to ensure that the current medical curricula produce graduates who are equally equipped for Address for correspondence: Dr. Muhammad Raihan Sajid, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. E‑mail: [email protected]

Incorporating research concepts and competencies can lead to the development of problem‑solving skills and critical evaluation aptitude. It can also create a positive attitude Access this article online Quick Response Code:

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DOI: 10.4103/jhs.JHS_145_16

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How to cite this article: Naji H, Sarraj J, Muhsen I, Kherallah S, Qannita A, Obeidat A, et al. Faculty perspective on competency-based research education: A multi-centre study from Saudi Arabia. J Health Spec 2017;5:129-34.

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[Downloaded free from http://www.thejhs.org on Wednesday, July 12, 2017, IP: 36.233.217.205] Naji, et al.: Research mentors’/faculty perspective on research competencies for medical students

either a clinical or a research career in future.[10,11] However, some of these competencies are generalised in nature and not very specific. The aim of this study was to primarily identify research competencies for medical students in all the four fields of general research, namely basic biomedical research, biostatistics and clinical and epidemiological research. Second, the study aimed to evaluate the importance of these competencies in the perspective of research mentors. Finally, the reviewed literature showed different ways of delivery including: specific compulsory courses that teach some basic research concepts, summer courses or elective courses.[4,7,12‑14] It is essential to identify the best instructional modality for the integration of the competencies in the medical curricula. This, in turn, will help to promote the research skills of medical students through the integration of well‑structured and well‑designed research components into their medical curricula.

Methodology Research competencies relevant to medical students were evaluated by a team of experts in quality assurance, medical curriculum design and planning, clinical research and basic research. The team also included researchers in medical education from multiple institutions, as well as medical students from a university in Riyadh, Saudi Arabia. After a review of the literature, approximately, eighty core competencies and skills were identified and finalised and furthermore distributed into one of the following categories: general research skills, biostatistics, basic biomedical sciences research and clinical research and epidemiology. The primary competencies were later on revised, with removal of overlapping concepts and merging of similar competencies. After these steps, a total of forty competencies were shortlisted. To determine the validity of these competencies and the optimal way of delivering them into the medical curriculum, a questionnaire was designed and distributed to faculty at four different institutes in Saudi Arabia. It targeted faculty who have mentored undergraduate medical students and have research experience.

Survey

This was a multi‑institutional cross‑sectional study based on a survey that mainly targeted researchers who mentor undergraduate medical students in four different institutions in Riyadh, the capital of the Kingdom of Saudi Arabia. The questionnaire was approved by the Institutional Review Board of Alfaisal University (IRB code number: 2014‑49) and the Institutional Review Board of King Fahad Medical City (IRB No.: 14‑232E). The questionnaire took about 15 min to fill and had three sections: The first section consisted of demographical questions: gender, highest degree obtained, academic levels of students he/she has mentored, years of experience and type of research he/she mainly conducts. 130

The second section included four tables which listed the final competencies, which were classified according to the predetermined research areas (general research, biostatistics, basic biomedical research and clinical research and epidemiology). Each mentor was asked to perform two tasks: the first task included rating the importance of each competency for medical students using a 5‑point Likert scale, where 1 signified complete disagreement and 5 signified complete agreement. The general research skills’ section was filled by all respondents. Mentors who were involved in basic or clinical research were then asked to fill the table of competencies pertaining to their area of expertise (basic research scientists filled the table for basic research competencies, and clinical researchers filled the table for clinical research competencies). Mentors who have worked in multiple fields were asked to fill both tables that were relevant to their working experience. In the third section, respondents were asked to provide their feedback on whether they agree that these research competencies should be taught in the medical curriculum or not; and if they agree that they should be taught, should it be achieved through mandatory courses or elective courses. After each section, an extra space was provided for open‑ended answers/comments and feedback.

Participants

The participants included research mentors who have an MD degree, are board certified or holders of a PhD in Biomedical Sciences. The mentors were academicians, basic scientists or clinical researchers. To be included within the study, the mentors must have at least trained undergraduate medical students.

Statistical analysis

The mean of the Likert scales with standard deviation was used to illustrate mentors’ agreement/disagreement to the listed competencies. All data were entered and analysed through statistical package SPSS Version 20 (Armonk, NY: IBM Corp.).

Results Participants

Seventy research mentors completed the questionnaire, of which twenty researchers had experience in the basic research field, 25 in the clinical field and 24 had experience in both fields. Table 1 shows general information about the gender, highest academic degree and years of experience of mentors, along with their educational level. The majority of the research mentors had an experience ranging between 1 and 3 years of mentoring medical students.

Research competencies

In regards to the level of importance of competencies, Tables 2 and 3 illustrate mentors agreement or disagreement according to the list of competencies pertaining to the predetermined four areas of research. For general research

Journal of Health Specialties ¦ Volume 5 ¦ Issue 3 ¦ July-September 2017


skills and biostatistics, the competencies of highest importance were ‘the basis of literature search in different databases’ and ‘understand and present data on different types of graphs and charts’, respectively. In regards to basic biomedical research and clinical and epidemiological research, the competencies of highest importance were ‘laboratory safety signs and rules’ and ‘the basics of placebo use, blinding and its different types’, respectively. Table 1: General demographics of research mentors/faculty General characteristics Gender (n=70) Male Female Field of research (n=70) Basic Clinical Both (clinical and basic) Others Educational degree (n=70) MD Board certified/fellowship MD with PhD PhD Years of experience (n=70) 1‑3 4‑6 7‑10 11‑14 ≥15

n (%) 57 (81.4) 13 (18.6) 20 (28.6) 25 (35.7) 24 (34.2) 1 (1.4) 6 (8.6) 24 (34.3) 10 (14.3) 30 (42.9) 24 (34.3) 12 (17.1) 12 (17.1) 6 (8.6) 17 (24.3)

In the open‑ended answers, comments and feedback section, the following important, additional competencies were also identified by the mentors: the issue of plagiarism, confidentiality of data and the basics of experimental design.

Mode of delivery of research competencies

The preferred mode of delivery for basic biomedical research skills was recommended to be in elective courses by nearly 40% of mentors. Around 25% of mentors recommended compulsory courses and 20% and 15% were in favour of summer electives and workshops, respectively. For clinical and epidemiological research skills, 33% and 30% recommended compulsory and elective courses, respectively, followed by summer courses 17% and workshops 20%. For general research skills and biostatistics, 52% and 59% of the mentors recommended compulsory courses as the best method to deliver research competencies.

Discussion The importance of research integration has been highlighted in many reports; for instance, the World Federation for Medical Education has listed research methodology and electives as one of its recommendations for the content of medical curriculum.[15] Moreover, the General Medical Council’s ‘Tomorrow’s Doctors’ report has listed the outcomes of undergraduate medical education including ‘The doctor as a scholar and a scientist,’ in which it expects medical curriculums to prepare students to ‘Apply scientific method and approaches to medical research’.[16]

Table 2: General research and biostatistics’ competencies Detail of competency General research The basis of literature search in different databases Understanding scientific methodology and its different steps Introduction to ethical considerations in research Writing using scientific language Reading and understanding scientific articles The definition of research, its aims and types Introduction to health and safety legislation The components of a manuscript and a grant proposal Introduction to methods of reference management Biostatistics Understand and present data on different types of graphs and charts Knowledge about the importance of statistics Statistical inference Calculating frequency measurements (e.g., mean, range and standard deviation) Using statistical programmes such as Excel and SPSS Basics of sampling and bias and the errors introduced Concept of correlation and association between variables Use and interpret different tests to compare means Normal probability distribution Probability, its types and distribution Introducing non‑parametric methods SD: Standard deviation Journal of Health Specialties ¦ Volume 5 ¦ Issue 3 ¦ July-September 2017

Mean

SD±1

4.77 4.69 4.61 4.57 4.56 4.52 4.34 4.23 4.16

0.40 0.56 0.61 0.49 0.55 0.74 0.85 0.95 0.81

4.34 4.31 4.21 4.20 4.16 4.13 4.08 4.05 4.00 3.93 3.44

0.63 0.63 0.96 0.78 0.86 0.85 0.92 0.93 0.90 0.86 1.17

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Table 3: Basic biomedical research and clinical and epidemiological research competencies Detail of competency Basic biomedical research Laboratory safety signs and rules The basic principles in chemistry such as the solubility of solutions and what materials are heat and light labile Introduction to the use of basic laboratory instruments The basics of humans’ sample use in basic research, collection, significance and ethics The basics of animal use in basic research, types, significance and ethics Introducing basic laboratory calculations (e.g., C1V1=C2V2) Introduction to the basic laboratory techniques (e.g., Western blot, PCR) Clinical and epidemiological research The basics of placebo use, blinding and its different types Different types of studies that are used in clinical and epidemiological research Major terms used and how to calculate them (e.g., incidence, prevalence and case fatality) Basics of diagnostic and screening tests and their sources of bias Epidemiology and public health (e.g., criteria for characterising the causality of association) Steps of evidence‑based medicine The importance, scope and use of epidemiology The concept of bias and confounding and their different types The important of clinical trials and its different phases Formulation of clinical questions Calculate measures of association in identifying risk factors of diseases Critical appraisal of the literature and the ability to evaluate evidence The methods of recruiting participants and its ethics SD: Standard deviation

Nationally, different educational bodies have also highlighted the significance of research in medical education. For instance, in 2011, a national competence framework ‘Saudi Meds’ was developed which constitutes of seven major domains to aid medical schools in refining their undergraduate medical curricula for better competent medical graduates. One of the domains of the Saudi Meds is research in the context of medical education, in which it is crucial to familiarise medical students with the value of medical research and the way of conducting medical research.[17] Similarly, the National Commission for Academic Assessment and Accreditation established the expected learning outcomes of undergraduate medical education in 2010. Essentially, it is anticipated that medical graduates will be capable of being up to date by searching literature to retrieve data related to their practice and to analyse simple research data.[18] Developing research skills among undergraduate medical students by integrating research into the undergraduate medical curricula will augment their critical thinking abilities, problem‑solving skills, as well as teamwork and communication skills. These characteristics are essential in a physician to provide appropriate patient care; therefore, research as part of undergraduate medical curricula will not only enhance the medical students’ research knowledge and experience, but will also help medical students to have a better postgraduate training experience. Moreover, research experience is an important criterion of acceptance of postgraduate residency and fellowship training nowadays, including Saudi Arabia. Despite this agreement on the importance of undergraduate

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Mean

SD±1

4.76 4.59 4.54 4.46 4.30 4.27 4.22

0.57 0.48 0.004 0.055 0.706 0.962 0.002

4.49 4.46 4.44 4.44 4.38 4.31 4.28 4.28 4.15 4.13 3.95 3.95 3.85

0.313 0.181 0.229 0.511 0.070 0.611 0.578 0.074 0.283 0.156 0.955 0.446 0.341

research, it is still an area that needs a lot of development, especially in developing countries.[4] Literature also shows a lack in defining competencies that should be delivered as a compulsory component of medical curriculums and those that should be left for non‑compulsory modes. Moreover, there is still a lack of consensus on how to deliver and teach research skills, despite the fact that literature suggests different examples of research courses’ design.[12‑14] Laidlaw et al., 2009, have listed seven attributes and skills that medical students should obtain. However, those attributes were general attributes and skills and not specific competencies that can help medical curricula developers to create more relevant courses.[10] The AMEE guide 69 has also identified general graduate attributes and skills perceived to be important from a research perspective for all medical, veterinary and dental students. It is important to note that these attributes were more generalised and lacked specific details.[11] We have tried to take it one step further by considering faculty/mentors’ perspective on individual competencies and skills and summarising them as core framework in this paper. After an extensive literature review and brainstorming sessions, we were able to propose and identify 9 general research skills and 11 competencies in biostatistics. In addition, 7 basic biomedical research skills and 13 clinical and epidemiological research competencies were identified. All these competencies were endorsed by the surveyed faculty and research mentors. The results of the survey showed that research mentors believe



that the competencies that were listed are important. Likert scale mean score ranged from 3.44 to 4.71. We also suggest that the competencies listed should help medical schools in defining the framework of the major outcomes that medical students are expected to know, this framework can be further enhanced and improved according to the expectations of medical students and schools. For instance, some studies have demonstrated students’ excitement towards having research training and experience.[19-21] Alamodi et al., 2014, introduced the Undergraduate Research Committee, in which the student body runs research delivery to the other students at the university.[19] Similar efforts have been highlighted by other authors, who have introduced the role of student bodies in promoting research in Latin America.[20] Furthermore, conducting research is not only beneficial to let them acquire research competencies and to develop passion towards research, but to also add to science. For instance, insulin, heparin and ether anaesthesia are some of the discoveries made by medical students.[6] In a new era of medical education, that is, competencies based, the results of this study can help curriculum developers to define and standardise research competencies needed for medical students. This approach of defining certain outcomes expected from medical curriculum has been supported by different reports.[22,23] However, it has also been criticised to lead to students’ disempowerment and inflexibility in the curriculum.[24] We believe that using those competencies as a general framework and being flexible in the depth and methods of delivery can help in achieving advanced personalised curriculum mapping.[22] The opinion of most of the mentors was that research competencies should be delivered in an integrated fashion in medical curricula. Research‑oriented courses can be compulsory or non‑compulsory and is in agreement with recommendations in the AMEE guide 69.[11] Non‑compulsory components include a variety of methods such as summer programmes, student‑selected components (or elective courses) and workshops. Those might be suitably carried out in a mentorship programme in summer, in which students can work on a project under a mentor’s supervision, which will enable them to practically learn different tools that are used in these two research areas. Zier et al., described an example of a summer programme where medical students can take part of a research project in basic, clinical, translational or public health. Students are involved in the project at its different steps and have a chance to present their work at the end of the programme.[12] Furthermore, we believe that research teaching can be substantially improved through implementing more active learning strategies into teaching research skills. Educators should not only aim to deliver the material’s objectives, but should also include prompting students to get more involved

in research and help cultivate their research skills and grow their interest in this field. Literature has shown the importance of active learning in adding to student’s other skills that lectures do not add to, such as problem‑solving, teamwork and communication skills.[25] Other innovative active learning approaches can be used to teach research. An example to that would be problem‑based learning, which can be effectively utilised to apply and deliver research‑based competencies.[26] In addition to our recommendations and competencies, few other competencies were added by mentors in the open‑ended answers/comments and feedback section; the following important, additional competencies were also identified by the mentors: plagiarism, confidentiality of data and basics of experimental design.

Limitation of the study

This study was conducted among faculty who themselves might be more inclined or biased towards seeing research as an important aspect because of the nature of their work. Thus, giving competencies a high importance average could be due to this fact. It is recommended that opinions of other stakeholders involved should be given weight as well, including students, curriculum developers and clinical physicians.

Conclusion It is crucial to illustrate that engaging medical students in scholarly research activities and producing clinically competent and research‑oriented medical workforces are essential demands, particularly in developing countries. Exposure to research during undergraduate years has been recognised as a successful mechanism in promoting interest in science research careers and generating physician–scientist professionals. Therefore, the results of this research in terms of the outlined competencies in different research fields, along with the several suggested modes of delivery according to experienced mentors, could be utilised to assist curriculum designers in order to identify and standardise research competencies for medical students to create more effective courses. Furthermore, we recommend the utilisation of these competencies in future curriculum‑mapping projects. Finally, integrating ‘general research skills’ should take place early in the medical curriculum; other more specialised research fields and competencies might take place later in the curriculum design as seen fit by the curriculum designers. Summer programmes can include student‑selected components and research workshops and should be supported by medical colleges. This will give the students the chance to experience basic and clinical research and will lead to a stronger base for postgraduate research which is now a requirement for all postgraduate programmes in Saudi Arabia.

Acknowledgements

The authors would like to acknowledge with great thanks all research mentors who took part in this study and Dr. Mohammad Al-Tannir and Mohammed Alzoghaibi should be acknowledged for their exceptional work and support throughout the study.


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Financial support and sponsorship Nil.

Conflicts of interest

There are no conflicts of interest.

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