Pirated academic accounts and use of Sci-hub
The use of Sci-Hub was reported in 19.2% (n= 1273) of the students surveyed, of whom 19.3% (n=243) published a manuscript during their medical training. The awareness and use of Sci-Hub may be due to the high need to access top-level scientific evidence behind a paying wall. However, medical students have reported difficulties to access Sci-Hub because it is considered an illegal service in many regions, then the web domain is often blocked (18)(19–21).
The use of Sci-Hub was associated with higher prevalence of scientific publications among medical students (PR: 1.81; CI95%: 1.50-2.20). Students feel the great need to obtain access to payed articles, leading to seek free access throughout Sci-Hub (19,21). However, even those students who do not face a paying wall, found convenient to reduce the time and simplicity of browses using Sci-Hub (23). In addition, many researchers and students identify Sci-Hub as a faster option not limited to their institution's catalog (21). This is likely homogeneous between high and low income countries worldwide (24). More than 56,000 article downloads via Sci-Hub came from different east coast cities of the United States, especially from cities where large universities have subscriptions to different editorial groups (23).
The use of pirated academic accounts was associated with higher prevalence of scientific publications (PR: 2.08; CI95%: 1.83-2.36). The institutional licenses let access to journals, books, or specialized databases such as Scopus or Web of Science. These paid services are funded by government institutions in low- or middle-income countries (LMIC), however, these are not widely distributed or have not been implemented in LMIC (24). Alternatives such as HINARI allow access to paid articles in low- and middle-income countries, and is available to the academic and research community only from certified institutions who achieved certain milestones defined by local science systems (25). All this complex context, lead users to exchange, loan or acquire access accounts or proxy links to journal catalogs of institutions by non-legal terms (23).
Courses in scientific writing
The 34.9% of students who reach a scientific publication attended a course in scientific writing skills. Attending a scientific writing skills course increased the prevalence of scientific publications in 85% (PRp=1.85, CI95%=1.59 - 2.15, p<0.001). This likely because of the great need of medical students to improve their skills to effectively communicate scientific findings, make a relevant academic reflection, and enhance the chances of acceptance into a scientific journal (26). Novel medical students in research training are eager to be trained in scientific writing skills and seek an experienced mentor to train them (28). In addition, medical students actively seek for courses of scientific writing and communication, for instance, the Brazilian DivulgaMicro initiative was a course funded by the Fundação de amparo a pesquisa do estado de São Paulo (FAPESP, by its acronym in Portuguese) to train early career researchers to translate complex scientific messages to understandable pieces of information to community members (29). After 30 days of launched, the website registered 1,026 users from different regions worldwide including Latin American, United Kingdom, Pakistan, Germany and Canada. This was one of the most visited free and open scientific communication workshops, that trained over 600 novel medical student researchers (29).
An advanced English proficiency was reported in 14.1% of the students, of whom 11.2% published a scientific manuscript during medical training. In addition, the prevalence of scientific publications increased in 51% among students with advanced English proficiency (PRp=1.51, 95%CI=1.21 - 1.87, p<0.001). Students are encouraged to understand a scientific evidence written in English (29). The TOEFL score is correlated with publishing in a medical journal (correlation coefficient: 0.63) (30). Scientific journals preferably accept articles from English natives versus non-English natives (acceptance rate 7% vs 3.6%, accordingly) (31). Likewise, Americans are 49% more likely to reach an article peer-review or acceptance in an American journal comparing to non-English natives (31). Medical students from second to sixth year who attended an English scientific writing skills training reported 53% of them perceived that they were not English proficient enough to publish a manuscript in English written journals (32).
The association between scientific publications and advanced English proficiency could be likely because of students’ desire to pursue an academic training abroad offered by institutions requiring academic excellence and a great potential. In 2016, the Peruvian Program of Educational Grants and Credits (PRONABEC, by its acronym in Spanish) jointly funded the Fulbright, FONDECYT (Fondo Nacional de Desarrollo Científico y Tecnológico), and Chevening scholarships in Peru which benefited 14, 6, and 15 Peruvian graduate applicants, accordingly (33). In this way, the scholars could be trained in outstanding foreign universities and capitalize a generation of researchers with masters and doctoral degrees who upon returning to their home countries seek to improve the science and technology system (34–36). During 2004-2012, the Fogarty International Clinical Research Fellows Program funded promising initiatives of highly competitive English-dominant students from LMIC whose scientific discoveries can address long-term global health needs (37,38). This approach has become Fogarty's hallmark: bringing great science to solve local problem of global outreach and building local research capacities (38). During 2014-2015, Fogarty has contributed substantially to the training of more than 6,100 global health leaders, 140 of whom have earned doctorates in epidemiology and 96 in public health (39).
The Fogarty International Center builds a bridge between the NIH (National Institutes of Health) and the global health research community, 85-90% of trained fellows return to LMICs and obtain research positions into academia, government agencies, and institutes (38). However, young Latin American scholars and postdoctoral researchers trained abroad find it difficult because of an unfavorable science system (25). For instance, the investment of the Peruvian administration to progress in science and research is still insufficient, it is only 0.12% of the gross domestic product compared to 0.36% in Chile, 1.3% in Brazil and 2.8% in the United States (41)(40).
Affiliated to a scientific medical student society
Our findings showed that being affiliated to a medical student scientific society increased the prevalence of scientific publication in 36% (PRp:1.36, CI95%=1.16-1.59, p<0.01). Student scientific societies, such as the Peruvian Medical Student Scientific Society (SOCIMEP, by its acronym in Spanish) tries to fill the gaps of research training and provide students the mentors, courses, and scientific opportunities to pursue a research career (9,41). Over 30 years of operations with local-level scientific societies across Peru, SOCIMEP promotes research events at a regional, national, and local level multidisciplinary university research and service camps (CUMIS, by its acronym in Spanish), the annual scientific conferences, and foundation courses in epidemiology, research design, and biostatistics (42). The enduring outreach of the SOCIMEP achieved overall societies underlie 242 published articles, of which 11% (n=67) were published in Q1 journals, under the mentorship of highly experienced national researchers (43).
However, we must understand our findings under the following statements. First, the information bias, several parameters of the questionnaire were self-reported which may cause an undifferentiated classification of the outcome, and may increase the residual confusion of confounding parameters. However, we tried to control this situation motivating the students to answer the questionnaire truthfully and did not rush their answers; in this sense, our outcome is consistent with reality. Second, selection bias, all 40 medical schools were affiliated with FELSOCEM, so our findings are useful for these schools and similar studies should be extended to understand local and regional scientific realities from different countries.