High-standard academic medical centers worldwide are encouraging residents and faculty to engage in research. Yet, worldwide there is evidence that residents' research engagement continues to lag . Around the world, few studies have investigated residents’ perspectives and perceived barriers to conducting research projects . Saudi Arabia is a rapidly developing country in the Middle East region with plenty of resources in comparison to other Middle East countries. Over the past couple of decades, Saudi Arabia has made remarkable efforts toward improving the level of education, health services, academia, and research . Therefore, it was of interest to investigate ophthalmology residents’ research status and perspectives in Saudi Arabia. To our knowledge, this is the first national study surveying the barriers to research in ophthalmology residency in Saudi Arabia.
One of the most substantial factors that can motivate the initiation of any work is personal interest. The vast majority of the studied population amply demonstrated a passionate interest and positive attitude toward clinical research, with the majority agreeing that research enhances clinical knowledge and promotes critical thinking (Table- 3), which is consistent with the findings of Kern DC et al .
A considerable number of perceived barriers and the associated factors for efficiently conducting ophthalmic research by residents in Saudi Arabia have been identified. As illustrated in Figure 1, the burden of other educational activities (4.27) and lack of protected time allotted to research [4.11] are the top barriers toward conducting high-quality ophthalmic research. Moreover, around 77.6% of residents suggested that training programs must devote time for residents’ research (Figure 2). The limitation of time seems to be a constant barrier for conducting research across different specialties, times, and regions around the world [19, 20]. Same barrier was perceived by Canadian plastic surgery residents . Like other surgical residency programs, ophthalmology residency program demands high workloads. Ophthalmology Residents have a total commitment to their surgical training might find difficulties to integrate research in their overloaded schedule.
A considerable number of participants agreed that the difficult and lengthy process of obtaining ethical approval represents a strong barrier to conducting research (3.67). It is professionally known that any clinical research involving human data utilization, patients’ participation, or interventions to patients care must be reviewed by an ethical committee prior to initiating the project. All high-quality health care institutions have local or regional research ethics committees (REC), also known as institutional review boards (IRB). According to our data, IRB approval can be a significant obstacle in front of numerous investigators as reported in multiple studies . The steps of applying to and communicating with REC/IRB can be extremely complex and troublesome for investigators, especially in the presence of other demotivating factors such as the limitation of time and lack of funds. At the end of our questionnaire, we included an optional empty box for residents to add any further comments they had. One resident mentioned that “IRB should not complicate things” another commented by saying “too much regulation are demotivating for starting any novel idea’’.
As reported in the previous literature, investigators usually have difficulty in both steps of application and communication with IRB/REC. In a study published by Ito-Ihara T et al , the percentage of doctors at Kyoto and Seoul University Hospitals reporting difficulties in communicating with IRB/REC was 68% and 24% respectively. There is a genuine need for carefully reviewing these administrative bureaucracies that might hinder the conduction of research projects.
It is not reassuring to note that lack of mentors and senior supervisors was the fourth most cited barrier by residents (3.62). Furthermore, 81.6% of the respondents suggested that supervisors need to be more aware and committed to the projects. Undoubtedly, mentoring positively correlates with the achievement of mentee outcomes . Residency training programs should be structured in a manner that encourages mentors and senior supervisors to pass their own experience to the next generation and actively supervise residents’ research projects.
Nowadays, health institutions are acknowledging the paramount importance of mentorship programs, thereby they are formalizing the process of mentorship by assigning each junior resident with a senior supervisor formal mentoring), however, some mentees prefer to find someone they respect and trust to help them reach their objectives [Informal mentoring] . Either formal or informal mentoring can be effective. Once the partnership is underway, both mentors and mentees must sustain this relationship to produce the best out of it.
Difficulty in selecting an appropriate topic and the lack of education about the research process were two other perceived barrier that residents in our study agreed with (3.61 and 3.52 respectively). Besides adequate mentoring of residents, curricula of training programs must also include formal teaching on research methodology, fundamentals of biostatistics, and manuscript writing, as such approaches will ensure that residents are capable of producing high-quality research projects .
This is a study that targeted Saudi ophthalmology residents, the generalization of our results to the rest of the world is not possible, therefore we recommend further research that covers wider geographic areas outside Saudi Arabia.