Barriers Preventing Medical Trainees from Active Participation in Research Activities

Introduction

Medical research is the systematic process of developing knowledge to improve patient care practices. Research has substantially promoted scientific output, facilitated access to research-focused jobs, and improved healthcare and quality of life.¹ Moreover, exposure to research stimulates research skills, including literature search, critical thinking, hypothesis testing, data communication, problem-solving, and results interpretation.² The future of research will depend on scientific investigation and the critical thinking skills of today’s medical trainees, who will become future leaders. Medical trainees refer to individuals who are in the process of acquiring specialized medical skills and knowledge through education and practical experience to reach the level of competence necessary for independent practice.³ This encompasses a range of roles, including medical students, interns, residents, and fellows, who are engaged in various stages of professional medical training. Earlier studies suggest that exposure to research will prepare medical students for more substantial career options by fulfilling their roles as clinicians, educators, and researchers.⁴

Over time, research has become vital to medical trainees practice and a compulsory component in most medical training.⁵ International regulatory bodies, including the Accreditation Council for Graduate Medical Education (ACGME) and the United Kingdom’s Royal College of General Practitioners, emphasize the importance of scholarly activity as an essential educational competency.^6,7

Nowadays, it has become essential for medical trainees to participate in research to improve clinical performance and keep up with the advances in modern medicine. Medical trainees are motivated and have an interest in undertaking research. Cited motivations include acquiring critical thinking skills, career progression, financial incentives, and, most importantly, personal interest.^8–10 Moreover, medical trainees acknowledge the benefits of involvement in research in improving their knowledge and sharing medical discoveries.^11,12

Nevertheless, it is uniquely challenging for medical trainees to conduct research because of the barriers inherent to residency training programs. In essence, medical trainees are often faced with personal and organizational challenges to conduct high-quality research. Such challenges include an overwhelming academic workload, personal disinterest, poor research training, unavailability of mentorship, and, most importantly, limited time in a heavy-duty schedule.^8,9,13–15

Previous research in developed countries has shed light on these challenges. For instance, among medical residents, barriers primarily stem from personal factors such as limited time, diminished interest, and insufficient scholarly skills.^9,13,16–18 Senior medical students often cite the absence of specialized research courses and limited access to expert mentors.¹⁹ Interestingly, while first-year medical students display a favorable attitude towards science, they exhibited limited knowledge about scientific research methods.¹¹ Moreover, a survey of consultants and junior doctors in Wales revealed similar obstacles including time restrictions, administrative burdens, and lack of research knowledge.¹⁵

The situation is similar across developing nations and Gulf countries, where research among medical trainees shows a universally positive attitude towards the importance of research in medicine.^20–23 Despite this, there is a notable gap between the enthusiasm for research and actual engagement. Studies have shown that medical trainees in many medical institutions in developing countries publish few articles, a circumstance primarily attributed to systemic issues such as insufficient research training, time constraints, financial barriers, inadequate mentorship, and the lack of a structured research curriculum. Furthermore, these studies also emphasize that research has not yet become an integral part of the medical education curriculum in developing countries.

However, the silver lining remains that many are enthusiastic about future research, indicating that interventions like structured training, allocating dedicated research time, and offering incentives to boost research participation.

Studies worldwide have shown that, for many years, medical trainees’ scholarly output has declined.⁸ These alarming figures reflect a global concern rather than an isolated issue of one geographical region. As a result, it becomes essential to focus deliberate attention on this issue in the United Arab Emirates (UAE) to identify and overcome such challenges.

The United Arab Emirates, a member of the Gulf Cooperation Council, has transformed its medical education infrastructure to meet healthcare needs.²⁴ To attain sustainable improvement in health research, the development of research capacity is imperative at the individual and institutional levels. Hospitals have shifted from traditional clinical institutions to evidence-based centers.²⁵ The Accreditation Council for Graduate Medical Education-International (ACGME-I) accredited nearly all teaching hospitals and the majority of residency programs. Research training has been integral to medical school and residency training programs to achieve academic excellence and develop competent physician-scientists. Yet, medical trainees research participation and scholarly activity remain low. Several initiatives have been taken to encourage research involvement; however, many healthcare facilities still need to generate a robust research agenda. Educational leaders cannot target meaningful interventions without accurate information on barriers and facilitators to scholarly research. Therefore, the UAE needs to identify the barriers to research to effectively promote a research-oriented culture, particularly among doctors in training.

There has been increasing interest in exploring trends in resident research and scholarship across the world, yet, limited research has focused specifically on the UAE.^9,26 This study aims to determine the level of knowledge, attitude, practice, and barriers to conducting research among clinical medical trainees in the UAE. This survey is an essential first step toward understanding the contributing factors and barriers to medical trainees’ research participation. Responses are intended to help identify perceived barriers faced by medical trainees and assist medical educators and academicians in informing priorities and implementing targeted interventions to mitigate the barriers, promote research among medical trainees, and improve future research success.

Methods

A descriptive cross-sectional survey was conducted on interns, residents, and fellows at Sheikh Shakhbout Medical City (SSMC) in the emirate of Abu Dhabi. Research Ethics Committee at SSMC provided an approval for this study (SSMCREC-309). The survey was digitized using Google Forms and circulated to all medical trainees across diverse specialties at SSMC between June and November 2022.

An extensive scoping review of the literature, supplemented by consultation with medical experts, informed the design of the survey. The survey was organized into distinct sections to collect data on 1) demographic Information, including gender, training level, and specific training program, 2) previous research experience, covering aspects like past publications – both abstracts and full-length papers, 3) barriers to research, comprising questions on perceived barriers that trainees face in conducting research, 4) attitudes towards research, assessing participants’ perspectives on the importance and relevance of research to their careers and 5) awareness of technologies, gathering insights into trainees’ familiarity with emerging technologies in healthcare. Each section contained a mix of multiple-choice, Likert-scale, and open-ended questions. For instance, the barriers and attitudes sections used a 5-point Likert Scale ranging from “strongly disagree” to “strongly agree”.

Medical trainees were encouraged to express their beliefs and assured that their responses would be kept confidential. Responses were analyzed and summarized using simple descriptive statistical methods.

Results

Medical Trainees Characteristics

Fifty-seven of all one-hundred-and-eight medical trainees responded to the survey (response rate 52.7%). Of these, 64.9% were females. The training program with the highest representation was the internal medicine residency (75.4%). In addition, most medical trainees (52.6%) were in the early stages of specialty training for less than three years. Medical trainees’ demographic characteristics are summarized in Table 1. Most medical trainees acknowledged the importance of undertaking research in the medical field, yet, only a few reported any research involvement or submitted their research for publication (65%). Of these, 51% have published at least one abstract and 45.6% have published journal papers. Scholarly research was more commonly completed by medical trainees at an advanced level of training than at earlier levels and less likely for females than males.

Table 1 Demographic Characteristics of Medical Trainees (n=57)

Prior Knowledge of Research

Overall, participants’ knowledge of scientific research was good despite existing barriers. 72% of participants were familiar with the literature review, 67% were familiar with research methodology and ethics, and 40% were familiar with statistics. On the other hand, knowledge of academic writing and Institutional Research Board (IRB) initiation was dramatically low; only 2% of medical trainees were familiar with them. Results are summarized in Figure 1.

Figure 1 Prior Research Skills and Knowledge.

Barriers to Research

The results show that lack of time to conduct research (77%), lack of statistical skills (72%), the burden of other educational activities (72%), lack of research methodology training (72%), lack of rewards, incentives, or recognition associated with research work (70%) and lack of personal knowledge or research process (70%) were found to be the most significant barriers the study participants faced to conducting research. Other barriers include the unavailability of mentorship and faculty experienced in conducting research, lack of funding to support medical students/medical trainees conducting research, and lack of access to research equipment and facilities. Figure 2 summarizes the perceived barriers toward medical research as identified by medical trainees.

Figure 2 Perceived Barriers to Conducting Research.

A considerable number of medical trainees (68.4%) felt that the research opportunities are prioritized by program leadership. However, believe that their training needs to undergo a significant transformation to encourage meaningful research by medical trainees. The majority considered increasing the time available for research and allocating research mentors are the most successful interventions to improve scholarly research. Other interventions that were considered helpful include giving research opportunities to the medical trainees, offering training sessions, making research participation mandatory, and providing incentives.

Attitude to Research

The attitude toward research undertaking and interest was positive. Most medical trainees responded that research would improve their critical thinking, widen their medical knowledge, allow exploring different areas of medicine, and apply the evidence-based practice. Moreover, a majority believe that research will increase their research output, improve the chance for collaborative research work, stay in touch with up-to-date literature, and build future career opportunities. Most recognize the relevance of research to their career and training. The majority responded that they are open to trying new technologies in the healthcare industry.

When asked about how the COVID-19 pandemic changed their attitude toward research; almost half of the participants believed the pandemic had no impact on their interest toward research. Conversely, the other half believed that the pandemic has increased the chance of research and made it more accessible, mainly because of the increased collaboration between external partners. Moreover, they claimed that the pandemic has significantly increased their motivation to engage in research and utilize emerging technologies in the medical field.

Awareness of Technologies

When awareness of emerging technologies in healthcare was questioned, as summarized in Figure 3, respondents (43%) were aware of Artificial Intelligence (AI) and Telehealth technologies. However, knowledge of other technologies, like the Internet of Things, Blockchain and Cloud Computing, were rare among medical trainees. Additionally, when questioned about the impact of AI on future clinical research; the majority (77%) believe the impact will be positive, AI will make data collection and statistical analysis more accessible, minimize medical errors, increase patient safety and healthcare efficacy, provide accurate diagnoses, and lessen the burden on the medical staff.

Figure 3 Awareness of Emerging Technologies in Healthcare.

Discussion and Findings

Our study details the current research environment in a large hospital in UAE, emphasizing the barriers that medical trainees face in pursuing research. Although several global studies have explored barriers encountered by medical professionals in research,^13–15,17 the existing body of literature focusing specifically on trainees in the UAE is relatively scant.^9,26

The main finding of our study is the disparity between trainees’ positive attitude toward engaging in research activities and their tangible research output (measured by their research paper or abstract publications). Despite the robust understanding of scientific research, the knowledge did not reflect the reported attitude in their publication records: 51% published abstracts, while 46% published journal papers. This disparity between attitudes and engagement in research mirrors global trends. Predominantly, time constraints emerged as common barrier.^{9,13,16,17,27}. It is hypothesized worldwide that the structure of many medical training programs may unintentionally impose this barrier. The demanding nature of medical training, paired with exhaustive post-graduate examinations, often leaves trainees with minimal room for research. Addressing this requires a pivotal shift in medical training structures. Some disciplines, like radiology, have endorsed dedicated research durations to improve engagement,^28–31 suggesting that allocating specific periods for research could uplift research productivity.^32,33

Besides time constraints, our study resonated with other global challenges in residency programs.^{12,22,34–36} These include the burden of other educational activities, statistical skills deficits, inadequate mentorship, and lack of rewards, incentives, or recognition for research efforts. Lack of time and mentorship, trainees workload, and limited funding were particularly emphasized in studies from developing countries.^{12,22,23,36,37} Systematic adjustments in the academic ecosystem of residency programs, emphasizing research as an integral component might offer a resolution.

Our study also reported the willingness and personal interest of medical trainees to participate in research training, especially related to statistical analysis, as they believe it is key to enabling research productivity. Most agree that research would improve their critical thinking, widen their medical knowledge, allow exploring different areas of medicine, and apply evidence-based practice. A growing body of evidence suggests that research activity in hospitals is associated with improved patient outcomes. Studies report that continued medical research improves health and care for future generations. Thus, there is a need to build a culture that reinforces the relationship between quality of care and research.

Strategically, integrating research curricula and introducing specialized training can be transformational, as validated by published results from other surveys of trainees. Merani et al (2014) demonstrated that research training positively affects research outcomes.³⁷ Moreover, a positive association between research training in medical schools and more publications has been found.^38,39 Numerous studies have consistently determined that effective research training is a significant determinant of the success of scholarly research.⁴⁰ As such, it is interesting to note that implementing a research training program to optimize medical trainees’ research skills will positively impact research productivity⁴⁰. Hence stressing that research training and exposure should take place early in residency and even during undergraduate education. It is also imperative to dedicate more protected time to research training with focused skills in research methodology and statistics.⁴¹

Notably, more than half of the medical trainees (70%) believe that lack of rewards and incentives is strongly linked to research output. Several studies have documented increased research productivity with the implementation of reward systems.⁴² Such a system is a feasible method of encouraging medical trainees to collaborate and increase their exposure to research.

Furthermore, this study provides valuable information on promoting a research environment among medical trainees from various specialties in the UAE. Establishing an academic environment that promotes research and acknowledges personal interests is the most efficient strategy for motivating medical trainees to engage in research.⁴³ While personal disinterest in research is a recognized barrier worldwide, it was relatively minor in our context. Only 28% of trainees exhibited research disinterest, aligning with most surveys mentioned in the literature.^13,14,44,45

Medical trainees may have an appetite for research. However, they need more time or statistical skills to practice research or are unaware of the available opportunities. According to (72%) of medical trainees, lack of methodology training is a significant barrier. Without research training, medical trainees find it challenging to develop meaningful research questions, identify metrics, collect data, submit successful Institutional Research Ethics Board applications, conduct accurate statistical analysis, and publish their research in journals. An example of a successful research training program in the United States revealed that a specialized 2-week research training course has led to each trainee completing, on average, four papers, posters, abstracts, and presentations by the end of their residency.⁴⁶

Further, most medical trainees expressed their desire for more accessible faculty mentorship. There is no doubt that good mentorship results in more extraordinary research achievements. Mentors help encourage medical trainees’ interest, inspire intellectual curiosity, and significantly impact their future academic and career choices.¹³

The framework presented in Figure 4 summarizes the potential barriers medical trainees face when undertaking research, which are broadly consistent with global observations.^13–15,21 The challenges are categorized into internal, organizational, and external challenges. Internally, targeted educational initiatives such as specialized training workshops can address skill gaps. Organizational strategies like formal mentorship programs and the allocation of protected research time are vital in overcoming mentorship scarcity and time constraints.^{9,13,20,21,27} These strategies are reflective of successful worldwide practices.^28–33 Externally, establishing research forums can foster collaborative environments, while streamlining administrative processes may reduce barriers to entry, facilitating smoother transitions into research for trainees. Thus, while this framework is contextualized within our institution, its principles are applicable to other residency programs aiming to enhance research exposure among medical trainees. We would advise program leaders to adopt a collaborative approach, engaging trainees in identifying research barriers and tailoring interventions to promote research activities within their respective program structures.

Figure 4 Research Barriers and Solutions Framework.

Limitations and Future Research

Our study, conducted at a single hospital in the UAE, involved a relatively small sample size (n=57). While this sample is reflective of the scale of many residency programs in the UAE, its scope limits the broader generalizability of our findings. To truly comprehend the barriers to research participation among medical trainees, future studies would benefit from a broader sample, incorporating multiple hospitals and addressing other potentially influential factors cultural influences and the diverse personalities of medical trainees. Notably, the voluntary nature of our survey, combined with its decent response rate (52.7%), might suggest a bias toward those with a more positive research attitude. In the context of the UAE, this research represents an initial attempt to identify and address the barriers medical trainees face in engaging with research activities. We emphasize the need for ongoing research in this area to provide a more robust foundation for interventions to improve scholarly research among medical trainees. While the challenges and unmet needs identified are specific to a UAE hospital context, they echo broader themes prevalent in medical training programs globally. Therefore, our findings, while regionally specific, may offer valuable insights into universal educational challenges. Our results herein provide a framework to identify potential barriers and proposed interventions for institutions seeking to increase research output.

Conclusion

The future of the medical field relies significantly on the current cohort of medical trainees and their active involvement in ongoing research endeavors. The findings revealed that only a small percentage of medical trainees successfully complete research projects for publication, primarily due to the considerable constraint of insufficient time dedicated to research activities. Additionally, barriers such as inadequate statistical skills, the heavy workload of other educational commitments, lack of adequate training in research methodology, absence of rewards, incentives, or recognition, and a lack of personal understanding of the research process were identified as significant hurdles for medical trainees engaging in research.

To address these primary obstacles, successful interventions have been identified, including the dedication of specific time slots for research, the provision of research mentors, and the facilitation of training sessions. These interventions have demonstrated efficacy in fostering a culture encouraging to fruitful research and have the potential to significantly increase research productivity among medical trainees.