Barriers and Challenges to Effective Medical Research Among Nigerian Medical Students: A Cross-Sectional Study

doi:10.21203/rs.3.rs-2635592/v1

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Barriers and Challenges to Effective Medical Research Among Nigerian Medical Students: A Cross-Sectional Study

https://doi.org/10.21203/rs.3.rs-2635592/v1

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Objectives: Research is an essential part of improving health care which plays an integral role in medicine and clinical practice. The study aimed to assess the barriers to research by medical students of the different universities in Nigeria and find adequate strategies for managing them.

Methods: This was a cross-sectional study using a cultured online questionnaire adopted from a previous study containing 29 items on institutional barriers, environmental barriers, academic barriers, individual barriers, practical barriers, and barriers due to research standards and outcomes. The data were analysed using descriptive statistics, analysis of variance (ANOVA), and the independent-samples t-test. Where the p value was set at 0.05.

Results: our study included 421 medical students from 37 different private and public medical schools in Nigeria. Medical students hold a neutral stance towards institutional and personal barriers to clinical research with scores of 2.98±0.41 and 2.69±0.93 respectively. However, they recognize environmental, academic, and practical barriers as significant hindrances to research with mean scores of 3.57±0.31, 3.08±0.48, and 3.51 +_ 0.37 respectively. The majority of barriers towards research among medical students appeared to be time, the bulkiness of academic tasks, inadequate equipment for carrying out research, inadequate payments for research-related activities, expensive nature of research-related services, and lack of proper scientific and research atmosphere in the University.

Conclusion: The most significant barriers to medical student research are environmental, followed by practical, academic, and institutional. Improving the situation requires a joint effort from medical students, medical institution management, and government support in promoting education and research.

Medical students

Barriers

Challenges

Research

Undergraduate

Nigeria

Research is an organized process that uses scientific methods in order to achieve new knowledge, invention, or science [1]. It is an essential part of improving health care and plays an integral role in medicine and clinical practice [2]. Development in healthcare and medicine, including diagnosis, treatment, prevention, and disease surveillance, relies strongly on the quantity of research [3]. Medical students are viewed as potential researchers and due to this fact, research training is important during their undergraduate years. It has been documented that being involved in research as a student influences the students’ attitude toward medical science positively [2]

Engagement of medical students in research has been seen to improve their knowledge and research capacity [2, 4, 5]. It has been reported that getting involved in research early tends to encourage continuity of research in the later part of the medical profession [6, 7]. Early research education helps students cultivate critical appraisal skills [7] and inspires them to pursue clinical research careers [8].

The chances of medical students being accepted into competitive postgraduate training programs are increased with subsequent publications and research experience [4]. Furthermore, the skill of accessing the literature brings about an experience in writing and practice in relating data within the scientific field as well as provides lessons on teamwork [9]

PubMed indexed papers authored by medical students were analysed, and it revealed that the United States of America tops the list with 68%, followed by Europe with 19%, Asia with 13%, and Africa with zero percent [10]. Studies have shown that African Medical students are motivated to carry out research but are withheld by certain barriers [11].

These barriers include lack of funding and an extensive curriculum, little practical impact on the society, lack of sources of literature and facilities, the generalized negative attitude shown by their supervisors to younger researchers, and lack of guidance and encouragement from mentors about research [12–17]. To the best of our knowledge, studies identifying the barriers to effective research among medical students in Nigeria have not been extensively reported in any formal literature

This study aims to assess the barriers to research by medical students in the different medical schools in the 36 states of Nigeria and identify the adequate strategies for managing medical student research. The results from this study will help in ensuring a more conducive and appropriate research environment for medical students in Nigeria as well as initiating policies as regards to effective curriculum planning of medical education in Nigeria.

Study design

A cross-sectional study was carried out using a self-administered structured online survey tool through the “Google Forms” platform following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Study population

This study was carried out among medical students from first year to final year in all the fully accredited medical schools across the six geo-political zones in Nigeria. With a large and diverse population of over 206 million people, 250 ethnic groups, and about 450 languages in 36 states [18], modern Nigeria is divided into six geopolitical zones based on similar ethnic groups, geographical location, and common political history [19].

The Southern region of Nigeria has higher levels of educational attainment and reduced levels of educational inequality with all its geopolitical zones with educational attainment levels greater than the national average of 5.08.[20] This is reflected in the distribution of medical schools in the country; of the 37 fully accredited medical schools in the country, 27 are in the Southern region as follows: nine in the south-south zone, seven in the south-east zone, ten in the south-west zone [21].

Although there are over 250 ethnic groups in Nigeria, there are traditionally three major groups: Yoruba, Hausa and Igbo. There are about 60,000 medical students in schools across the country [21]. Medicine is studied for 6 years in most Nigerian schools. The regular six-year Bachelor of Medicine and Bachelor of Surgery (MBBS) program in Nigeria consists of 12 months in preliminary basic sciences, 18 months in the Basic Medical Sciences preclinical program (including courses in human anatomy, medical biochemistry, and human physiology), and the remaining 42 months in the teaching hospital as a clinical study [22].

Eligibility criteria

The inclusion criteria were all individuals who agreed to participate in the study, who were medical students in Nigerian medical schools studying medicine and surgery across the 37 fully-accredited medical schools in the country. These included students in the premedical class (100 level), the preclinical classes (200–300 levels), and the clinical classes (400–600 levels). There were no restrictions on gender, nationality, occupation, or socio-economic level of the participants. The exclusion criteria were non-medical students, or medical students outside Nigeria, and those who refused to take part in the study. Moreover, Students on transfer or exchange programs from other outside Nigeria medical institutions were excluded.

Sampling

All participants fulfilling the inclusion criteria were invited to participate. The population of eligible students was around 60,000. The sample size using the normal approximation to the hypergeometric formula showed that with z = confidence level at 95% confidence level, which is 1.96, p = 0.5, and q = 0.5, 382 students were needed for the study [23]. However, we recruited approximately 421 medical students- extra by 10% of our sample size- taking in consideration the possibilities of participants drop out or incomplete responses or missing values. Snowball sampling was used to select the study participants.

Data collection

An online link of the web-based questionnaire was developed using “Google Forms” obtaining information about barriers faced in conducting clinical research by medical students in 37 Nigerian Medical Schools (30 Public and 7 Private) during the period from August and September 2021.Our survey was approved by the ethical committee of faculty of Medicine, University of Calabar, Nigeria. The survey was distributed through social media platforms, including WhatsApp and Telegram. On the first screen, a Plain Language Information Statement (PLIS) and Consent Form were placed. Only the participants providing consent to participate in the study can move to the next section containing the screening questionnaire to confirm the age is consistent with the predefined criteria. Upon confirmation, the participants were moved to the succeeding sections containing the self-administered questionnaire. The questionnaire contained 29 questions divided into 3 sections. Data on respondent's socio-demographic characteristics, institutional barriers, environmental barriers, academic barriers, individual barriers, practical barriers, and barriers due to research standards and outcomes were collected. Our questionnaire was culturally adapted from a previous study carried out by Mokhtavi et al [24] with the authors' permission, where the questionnaire was pretested and validated among medical students and hence didn’t require any validation, reliability, internal consistency testing.

The google form was set in such a way that it accepts only one response per person in order to ensure the correctness and accuracy of the data collected and avoid response duplication.

Statistical analysis

Responses were retrieved from the google forms in the form of Microsoft Excel. Afterward, the data were analysed using IBM SPSS for Windows version 25 statistical software (S.P.S.S. Inc., Chicago, IL, U.S.A.). Categorical data were reported as frequency/percentage and continuous data as mean/standard deviation. Continuous data were explored for normality by checking the distribution of data and using tests of normality (Kolmogorov–Smirnov and Shapiro–Wilk tests). Between-group comparisons were analysed by one-way ANOVA. Independent sample t-test was used to compare the means in between groups. Associations between different parameters were analysed through Chi-Square test, and we allotted strongly disagree 1 point, disagree 2 points, neutral 3 points, agree 4 points, and strongly agree 5 points. The p value was set at 0.05.

Sociodemographic Characteristics

A total of 421 medical students aged 22.62 ± 3.38 years consisting of 247 males (56.7%) and 174 females (41.3%) completed the online questionnaire with an overall response rate of 100%. The proportion of the response rates for the different levels of study from 100L to 600L were 8.3%, 12.1%, 11.9%, 25.4%. 24.2% and 18.1% respectively. Table 1 shows their socio-demographic characteristics of study participants and Figs. 1, 2 and 3 shows their socio-demographic characteristics in charts.

Table 1

; Socio – Demographic Characteristics of the Study Participants
CHARACTERISTICS	FREQUENCY	PERCENTAGE
Age
15–19	55	13.06
20–24	241	57.24
25–29	102	24.23
> 29	23	5.46
Sex
Male	247	58.7
Female	174	41.3
Marital Status
Married	10	2.4
Separated	1	0.2
Single	409	97.1
Widowed	1	0a.2
Level of study
1st Year	35	8.3
2nd Year	51	12.1
3rd Year	50	11.9
4th Year	107	25.4
5th Year	102	24.2
6th Year	76	18.1
INSTITUTIONS
Abia State University, Uturu, Abia State	7	1.7
Afe Babalola University Ado-Ekiti, Ekiti State	4	1.0
Ahmadu Bello University Zaria, Kaduna State	25	5.9
Ambrose Alli University, Ekpoma, Edo State	1	.2
Anambra State University, Uli, Anambra State	2	.5
Babcock University Ilisham-Remo, Ogun State	6	1.4
Bayero University Kano, Kano State	5	1.2
Benue State University, Makurdi, Benue State	8	1.9
Bingham University Karu, Nasarawa State	27	6.4
Bowen University, Iwo, Osun State	14	3.3
Delta State University, Abraka, Delta State	2	0.5
Ebonyi State University Abakaliki, Ebonyi State	2	0.5
Ekiti State University, Ado-Ekiti, Ekiti State	6	1.4
Enugu State University of Science and Technology, Enugu, Enugu State	18	4.3
Gombe State University, Gombe State	3	0.7
Igbinedion University, Okada, Edo State	2	0.5
Imo State University, Owerri, Imo State	1	0.2
Kaduna State University, Kaduna State.	17	4.0
Ladoke Akintola University of Technology, Ogbomoso, Osun State	1	0.2
Lagos State University Ikeja, Lagos State	6	1.4
Madonna University Elele, Rivers State	1	0.2
Nnamdi Azikiwe University Nnewi, Anambra State	25	5.9
Obafemi Awolowo University Ile-Ife, Osun State	15	3.6
Olabisi Onabanjo University Ago Iwoye, Ogun State	6	1.4
University of Abuja, Abuja	11	2.6
University of Benin, Benin-City, Edo State	25	5.9
University of Calabar, Calabar, Cross River State	40	9.5
University of Ibadan, Oyo State	15	3.6
University of Ilorin, Kwara State	18	4.3
University of Jos, Plateau State	11	2.6
University of Lagos, Idi-Araba, Lagos State	15	3.6
University of Maiduguri, Borno State	23	5.5
University of Nigeria, Enugu Campus, Enugu State	21	5.0
University of Port-Harcourt, Rivers State	14	3.3
University of Uyo, Akwa Ibom	7	1.7
Universiy of medical sciences, Ondo State	9	2.1
Usmanu Danfodio University Sokoto, Sokoto State	8	1.9

Research Experience

A total of 200 (47.5%) of respondents reported having previous experience in research, 39.5% had participated in research workshops, 38.7% had carried out research projects, and 25.7% were currently working on research projects. Table 2 shows the research experience of the respondents. Exposure to research was found to be directly associated with level of study, the higher the level of medicine study, the more exposure medical student has to clinical research (p = 0.05); moreover, males were associated with more previous experience in clinical research (p = 0.05) as out of 200 medical students who have experiences in clinical research, we had 127 (63.5%) males compared to 73 (36%) females. With those in their final year being more exposed than other levels. There was no significant association with gender. Table 2 shows the research experiences of the study participants.

Table 2

; Research Experiences of the Study Participants
CHARACTERISTIC	FREQUENCY	PERCENTAGE
Have you had any previous experience in research
Yes	200	47.5
No	221	52.5
Have you participated in any research workshops
Yes	151	35.9
No	270	64.1
Have you carried out any research projects in the past
Yes	163	38.7
No	258	61.3
Are you currently working on any research projects
Yes	108	25.7
No	313	74.3

Barriers to Research

Barriers were examined by the responses to 29 items in Table 3. Based on the answers, Institutional and individual barriers have a mean score of 2.98\(\pm\)0.41 and 2.69\(\pm\)0.93, respectively which indicate that medical students are neutral toward institutions and themselves being barriers toward clinical research, yet environmental, academic, and practical barriers have mean of 3.57\(\pm\)0.31, 3.08\(\pm\)0.48, and 3.51 +_ 0.37, respectively which indicate that medical students agree that environment, academia, and practical aspects are real barriers toward research. Table 3 shows the frequency and mean scores of the barriers to student research from the perspective of medical students.

Table 3

; The Frequency and Mean scores of the Barriers to Student Research from the Perspective of Medical Students
Characteristics	Response
Characteristics	SA (5)	A (4)	NI (3)	D (2)	SD (1)	Mean likert	Mean score
INSTITUTION
The staffs of the research administration in our university have inappropriate conducts	29(6.9)	58(13.8)	189(44.9)	80(19.0)	65(15.4)	2.78	2.98 ± 0.41
Research administration experts in our university have no effective supervision	59(14.0)	85(20.2)	136(32.3)	99(23.5)	42(10.0)	3.05
Hospital and university authorities do not collaborate with students in data collection	53(12.6)	118(28.0)	103(24.5)	111(26.4)	36(8.6)	3.10
Authorities do not trust students in research related affairs	52(12.4)	100(23.8)	140(33.3)	100(23.8)	29(6.9)	3.11
Students research related activities do not contribute to student’s assessment	60(14.3)	68(16.2)	95(22.6)	112(26.6)	86(20.4)	2.77
Research related activities have no effect on student’s career prospect	22(5.2)	42(10.0)	71(16.9)	143(34.0)	143(34.0)	2.19
There are strict regulations on doing student research projects	51(12.1)	93(22.1)	170(40.4)	84(20.0)	23(5.5)	3.15
Authorities do not allow the use of research results in practice	42(10.0)	76(18.1)	177(42.0)	85(20.2)	41(9.7)	2.98
Payments for research related activities are inadequate	129(30.6)	113(26.8)	121(28.7)	47(11.2)	11(2.6)	3.72
ENVIRONMENT
There is no proper scientific and research atmosphere in the university	154(36.6)	117(27.8)	59(14.0)	64(15.2)	27(6.4)	3.73	3.57 ± 0.31
Research related affairs and services such as typing and printing are too expensive	126(29.9)	154(36.6)	77(18.3)	48(11.4)	16(3.8)	3.77
there are few competent researchers in my university to help students in research	71(16.9)	102(24.2)	127(30.2)	88(20.9)	33(7.8)	3.21
ACADEMIC
I do not have adequate knowledge for doing research	86(20.4)	136(32.3)	70(16.6)	96(22.8)	33(7.8)	3.35	3.08 ± 0.48
I do not have adequate knowledge for statistics	70(16.6)	143(34.0)	66(15.7)	107(25.4)	35(8.3)	3.25
There are no scientific writing research methodology and biostatistics workshops for students	90(21.4)	113(26.8)	104(24.7)	79(18.8)	35(8.3)	3.34
I do not have adequate skills in the area of computer internet	22(5.2)	83(19.7)	40(9.5)	156(37.1)	120(28.5)	2.36
RESULT STANDARD AND OUTCOME
Research results are not clear and understandable	20(4.8)	62(14.7)	126(29.9)	154(36.6)	59(14.0)	2.60	2.80 ± 0.28
Understanding and interpreting statistical results are difficult	29(6.9)	121(28.7)	128(30.4)	106(25.2)	37(8.8)	3.00
PRACTICAL
The process of doing research is complex	77(18.3)	166(39.4)	98(23.3)	61(14.5)	19(4.5)	3.52	3.51 ± 0.37
Study results are not collected and presented in a certain place	61(14.5)	111(26.4)	165(39.2)	66(15.7)	18(4.3)	3.31
The steps in doing research not clear	47(11.2)	104(24.7)	114(27.1)	122(29.0)	34(8.1)	3.02
There are inadequate facilities and equipment for doing research	130(30.9)	135(32.1)	81(19.2)	58(13.8)	17(4.0)	3.72
Research related affairs are time consuming	141(33.5)	179(42.5)	65(15.4)	29(6.9)	7(1.7)	3.99
INDIVIDUAL
I do not have adequate time for doing research	96(22.8)	172(40.9)	70(16.6)	68(16.2)	15(3.6)	3.63	2.69 ± 0.93
I am not interested in research	13(3.1)	33(7.8)	54(12.8)	122(29.0)	199(47.3)	1.90
My academic task does not give me enough time to engage in research	117(27.8)	178(42.3)	52(12.4)	52(12.4)	22(5.2)	3.75
House hold responsibilities do not give me enough time to engage	36(8.6)	82(19.5)	83(19.7)	137(32.5)	83(19.7)	2.65
Social responsibilities and employment do not give me enough time	47(11.2)	100(23.8)	75(17.8)	134(31.8)	65(15.4)	2.83
I think researches are not useful	5(1.2)	12(2.9)	23(5.5)	63(15.0)	318(75.5)	1.39

Medical students in Nigeria face numerous barriers when it comes to participation in research. This study is the first original article in Nigeria that looks at barriers to research among medical students in different medical schools in the whole country. The study was carried out mainly to assess the perceived barriers of these students to participate in research. The barriers to research by medical undergraduates in Nigeria were analysed in different domains.

From our study, the male participants (58.7%) were more compared to previous studies [1, 23, 24, 25], this could be attributed to the preponderance of males within the medical school [26].

However, the most important barriers were in environmental, practical, and academic domains. These barriers reported by us are slightly similar to those reported in a previous study, although the slight differences may have resulted from differences in the settings and samples of studies [1, 23, 24, 25, 27, 28]. Furthermore, our findings indicated that one of the main hindrances to medical student research was the time-consuming process of doing research. This is in agreement with the study by Awofose et al, 2020, where out of 343 medical students, 96.5% attested to lack of time as a hindrance to doing quality research [29]. Other studies have also reported that the bulk of the medical students' curriculum and lack of time are two important barriers to students' research [30, 31, 32].

Medical students in the universities usually spend a more significant part of their time attending classes and clinical settings to fulfil their apprenticeships which causes their lack of time and decreases their motivation to partake in research activities, especially when these medical students have no prior research experience [29, 32, 33]. Moreso, since a greater percentage of medical students are addicted to the internet for games and entertainment, research training is important to prevent wasting time [34, 35]. We also found out that another significant barrier to carrying out adequate research by Nigerian medical students was the lack of well-equipped facilities. Similar barriers have been reported in developing and developed countries [24, 25, 26, 36, 37, 38]. If students have access to well-equipped laboratories within their schools, they might be able to do good research studies with proper and adequate information made available from these laboratories or facilities.

Our result findings showed that institutional barriers were the fourth most crucial barrier to effective medical student research. Previous studies cited institutional barriers as the most important and main barrier to research [38, 39, 40]. Inadequate payment for research-related activities was the significant institutional barrier that reduces medical students' motivation to engage in research activities. studies also reported this [23, 25, 38, 41]. Strict regulations on carrying out student research projects, authorities not trusting students in research-related affairs, and non-collaboration with students between hospital and university authorities in data collection also played roles under the institutional barrier in hindering medical students from carrying out adequate research this is in consonance with other studies [24, 25, 26].

The highest-scored barrier to the medical student research subscale was environmental barriers. We found out that research-related affairs such as typing and printing are too expensive and that these universities do not have a proper scientific and research atmosphere, which is in line with the findings of previous studies [42, 29]. El Achi et al. reported interest among students toward medical clinical research, yet without solid organizational support [43]; moreover, both Sobczuk et al. and Kumar et al. reported that not only organizational support, but also lack of time, resources, and mentorship are listed as barriers as well. [23, 25, 38, 39, 44, 45]. Individual barriers were the lowest scored barriers to the medical student research subscale, suggesting medical undergraduates' readiness to participate in research activities. The most important individual factor was the lack of time due to the academic task of the students. The study conducted in Lagos, Nigeria, still reported that educational tasks require students to prioritize research activity less seriously [29].

Strengths and limitations

This is the first study that spanned across accredited medical schools in Nigeria as the time of study and thus can be generalized to the entire medical students’ community in the country. Furthermore, the online tool used to collect data was set in such a way that it does not undermine the accuracy of the data generated hence maintaining its correctness. Also, the study tool is validated and reliable as it was adopted from previous study.

There were certain limitations to this study that needed to be noted. This study was a cross-sectional study, and as such, we could not analyse a concrete cause-effect relationship. Medical students who decided not to fill the questionnaires were not assessed whether there was any particular difference between them and those who took part in the survey. Independent verification of the data in this study could not be done since it was a self-report survey.

The barriers to medical student research in the order of importance are; environmental, practical, academic, and then institutional barriers. Moreover, the lack of proper scientific and research atmosphere with the expensive research-related affairs and services were among the list, besides the time-consuming nature of research-related activities. Although these barriers are widely spread worldwide among medical students, Nigerian medical students are affected the most due to low economic status of the country and lack of organizational support. Meanwhile, Nigerian medical students have shown great interest in improving their research conduct given the barriers are removed. Improving these barriers requires the roles of both the medical students, the medical institutions’ management and the government’s support in encouraging education and research amongst its medical students.

Conflict of interest: All authors declared no conflict of interest.

Funding resources: None

Consent for publication: all authors reviewed and agreed on the final version of the manuscript

Ethics Approval Statement: Ethical approval was requested by the Health and Ethics committee of the University of Calabar Teaching Hospital, Nigeria, however, the study was deemed not to require ethical approval as all responses were anonymized and informed consent was given by student prior to completing the study in line with Declaration of Helsinki.

Availability of data and materials: all data are available and attached

-None of the article contents are under consideration for publication in any other journal or have been published in any journal.

-No portion of the text has been copied from other material in the literature (unless in quotation marks, with citation).

-I am aware that it is the authors responsibility to obtain permission for any figures or tables reproduced from any prior publications, and to cover fully any costs involved. Such permission must be obtained prior to final acceptance.

Authors' contributions: VBE and MME contributed to the conception and design of the study. FC and AKA analysed the data. AKA, OPU, VBE, and MAT drafted the manuscript. MUE supervised the study process. DJ and OPU reviewed the manuscript critically for important intellectual content and approved for the manuscript to be published. All authors have participated in the work and have reviewed and agree with the content of the article.

Acknowledgment: We would like to thank the Koustav Biswas from JIPMER, Puducherry, India for his supervision in the writing process which contributed greatly to this study

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No competing interests reported.

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Barriers and Challenges to Effective Medical Research Among Nigerian Medical Students: A Cross-Sectional Study

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Research Experience

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