Dr Sherin K K
ABSTRACT
Background: Prioritizing undergraduate research is emphasized to develop critical analytical skills and thinking, independent writing, future clinical practice, enhanced employability, and improved research productivity. Despite far-reaching consequences, research perception of Homeopathic undergraduate students has barely been investigated to date. Poor participation of Homeopathic undergraduates in research is reflected by a single MEDLINE indexed publication with adequate students’ contribution in the last decade. We aimed to assess their knowledge and attitude towards research and to identify barriers towards successful conduct of research.
Methods: Institutional cross-sectional survey was carried out during December-October 2023- 2024, in the five undergraduate homoeopathic colleges in Kerala , India involving 1300 participants. A semi-structured questionnaire was developed for the purpose depending on earlierstudies on medical undergraduates. 218 completed responses were analysed in the end.
Results: Study sample mostly spanned 19- 28 years of age group ,With no gender differences (almost 1:1) and no physicians in family (20.3%). Maximum complete responses were obtained from Final year students (41%) and students of Calicut Homoeopathic Medical College and Hospital (41%). In spite of willingness to participate and keeping a positive attitude toward research, current involvement, training, knowledge and awareness remain quite unsatisfactory. Lack of training was identified as the chief barrier towards research.
Conclusion: Undergraduates had a positive attitude towards homeopathic research, but need a realistic understanding of the research process. Opportunities for research skill development are underdeveloped.
Keywords: Undergraduate homoeopathic students, India, research perception.
- Athurasramam S.S. Homoeopathic Medical College, Kottayam.
- Padiar Memorial Homoeopathic Medical College, Ernakulum.
- Homoeopathic Medical College, Thiruvananthapuram.
- Homoeopathic Medical College, Calicut.
- Shree Vidyadhiraja Homoeopathic Medical College,
AIM
A survey exploring research perception of homeopathic undergraduate students in five Homeopathic Medical Colleges in Kerala, India.
OBJECTIVES
To study the knowledge and attitude towards research in undergraduate students of homoeopathic medical colleges of Kerala.
INTRODUCTION
In recent years, a paradigm shift has been noticed from experience-based to evidence-based practice in medicine and education. Research is the cornerstone of evidence-based medical practice, which translates new knowledge and technological capability into powerful tools for prevention and treatment of disease . Students and practitioners need to continually updating them to keep abreast of relevant exponentially expanding knowledge of research. Exposing students at an earlier stage in their careers to the basics of research not only improves their knowledge and attitude towards research, but also provides lessons in teamwork, helps to develop critical analytical skills, thinking and also enhance their skills in searching and evaluating literature, independent writing, future clinical practice, enhanced employability, and improved research productivity .
Homeopathic research in India like most developing countries is clearly still in its infancy. This country faces obstacles in research which are similar to other developing countries. With a few exceptions, there is little quality research in India and a large majority of work is compromised due to flawed methodology and poor research training and background of researchers. Some efforts are being made to improve training in research at post graduate level only, yet research output still remains almost non-existent. Most of the research being produced is through required papers generated by postgraduate trainees; which is a mandatory requirement for completion of their training. Inclusion of epidemiology and biostatistics even in the UG curriculum is getting minimal attention. It is therefore important to understand and highlight the attitudes and problems in conducting quality research. This may help identify barriers and further encourage research by young professionals so that future research is more In number, better in quality and greater in impact.
The Central Council for Research in Homoeopathy (CCRH), formally constituted on 30th March, 1978, was set up as an autonomous organization and registered under the Societies Registration Act XXI, 1860. CCRH is fully funded/controlled by the Ministry of AYUSH .The broad research activities of the Council include ‘Survey, collection and cultivation of medicinal plants’, ‘Drug standardization’, ‘Drug proving’, ‘Clinical verification’ and ‘Clinical research’. Other than these the Council is also affianced in fundamental & basic research; public health programmes of national importance; health meals. Till date Council has conducted 211 studies on various diseases, out of which 178 studies are concluded (139 observational studies and 39 randomized clinical trials). Currently 13 studies are ongoing.
The Central Council for Research in Homoeopathy (CCRH) has initiated the Short -Term Studentship Program in order to promote interest and aptitude for research among medical undergraduates. The main objective of this program is to provide an opportunity to undergraduate medical students to familiarize themselves with research methodology and techniques by being associated for a short duration with their seniors on ongoing research program or by undertaking independent projects. This may serve as an incentive for them to take up research as a career in the future. The Guide/ Institution must provide the student with all facilities for carrying out research. The value of the studentship will be Rs. 20000/- only and is meant to be a stipend for the student. Cost of research must be borne by Medical College/ Institution where research is carried out .This program is only for undergraduate Bachelor of Homoeopathic Medicine and Surgery(BHMS) students before they appear in their final exams and therefore, interns/ PG Students are not eligible to apply. The student must carry out the research in his/ her own medical college under the guide Who is employed in the medical college as a faculty. Only permanent full time faculty members working in any of the Department of the Medical where the student is Enrolled can act as the guide. Part time consultants/visiting faculty/ residents/ Tutors/ Pool Officers/ PG students cannot be the guide. Only one student will be allowed to work under one guide. Two or more are not permitted To work on the same topic together. Proposals submitted on the same topic by different students are liable to be rejected outright. The student may have one Guide and other Co Guides. However, CCRH will recognize only ONE main Guide for all purposes. Only Indian National students who are studying in recognized homeopathic medical Colleges of India can apply. NRI’s & Students from foreign institutes are not eligible for this program.
Kerala Development & Innovation Strategy Council, (K-DISC) is a strategic think tank and advisory body constituted by the Government of Kerala to bring out path-breaking strategic plans that reflect new directions in technology, product and process innovations, social shaping of technology and creating a healthy and conducive ecosystem for fostering innovations in the state of Kerala. Young Innovators Program (YIP) is the specially designed, flagship program under KDISC that aims to empower future innovators to innovate new products, services or solutions to meet the emerging era requirements of the state, unarticulated needs, or existing market needs of the society more effectively through an innovative challenge . YIP was launched in 2018. It is unique in that the program makes a commitment to walk with the innovator for three years. It is modelled around the National Science Foundation in- novation promotion program in the United States of America. There are three live tranches of YIP active now viz. YIP 2018- 21,YIP 2019-22 and YIP 2020-23.
This study aimed to gauge students’ awareness of research activities and perception of their research-specific skills and competencies, to determine their motivation for research, and to identify personal views about obstacles towards conduct of research. Another purpose of our study was to collect reliable data that would be helpful for drafting recommendations concerning development and improvement of their research perception.
METHODS
Setting and design: An institutional survey was carried out during December – October , 2023- 24 in the five homoeopathic medical colleges of Kerala, India, namely Athurasramam N.S.S. Homoeopathic Medical College, Kottayam, Dr. Padiar Memorial Homoeopathic Medical College, Ernakulum, Govt. Homoeopathic Medical College, Thiruvananthapuram, Govt. Homoeopathic Medical College, Calicut, Shree Vidyadhiraja Homoeopathic Medical College, Thiruvananthapuram.
Participants: Out of total ~1300 students enrolled in the (41/2+1) years Bachelor in Homeopathic Medicine and Surgery (BHMS) courses running in the five colleges under approval of AYUSH, Government of Kerala and under affiliation to Central Council of Homoeopathy, Government of India, 218 participated and answered the questionnaire. For analytical purposes, Students were divided into four academic years .
Sample size: Considering margin of error as 5%, confidence level 95%, response distribution unknown, taken as 50%, and population size of 1300 (enrolled number of students in the undergraduate courses in the five homoeopathic schools in Kerala ), target sample size became 100. However, as we obtained 218 complete and analysable responses, the confidence level was increased to almost 99%.
Questionnaire and data analysis plan: No universally accepted standardized questionnaire was available to evaluate homeopathic undergraduate students’ perception towards research. We developed a questionnaire extracting items from earlier studies by Ahmed F, et al. 2009 and Ejaz K, et al. 2011 on medical undergraduate students. The directions to fill up the questionnaire were explained verbally to all the students In detail by the research assistants. The questionnaire consisted of three sections. The first open section sought information regarding students’ institutions, academic standings, age, gender, residence and presence of physicians in family. Section two comprised of eighteen close-ended questions focusing on students’ knowledge and attitude towards homeopathic research. The last section was also close-ended and aimed to identify barriers towards research as perceived by the students.
To evaluate the feasibility of application of the questionnaire in a large population, a pilot testing was done on 10 students of Ghmc Calicut before conducting the study. It took only five minutes time to complete and all the data were collected from them. Instructions on the questionnaire promised anonymity. No participant identifiable information was required to ensure protection of privacy. Also the filled in questionnaires were concealed by putting those inside opaque envelops which were sealed at the survey site by the students themselves. All these were collected by the research assistant and were sent for data analysis. All the responses were individually extracted in a specially designed excel sheets and subjected to statistical analysis using online statistical calculator.
Statistical analysis plan: Descriptive statistics has been represented in the form of absolute values and percentages.
RESULTS
Variables: Though poor, maximum (40.8 %) of complete responses were obtained from GHMC Calicut and The lowest (13.3%) from Padiyar College . The final year students contributed the highest (40.8%) responses and the first year and third year the lowest (14.2%).Respondents spanned 18-25 years. Gender distribution was not the same among the sample analysed , more females (90.4%) participated than males (9.6%). Students chiefly belonged to urban families and 20.2% had physician in family.
DISCUSSION
The validity and reliability of the developed questionnaire has not been addressed. Instead, most enticing is the fact that homeopathic undergraduate students from five homeopathic schools in Kerala, India have positive attitudes towards homeopathic research despite poor knowledge and awareness of research methods and scientific communication. They recognized the benefits of acquiring research skills, but identified practical difficulties of participating. The most important covariates of skill levels were lack of infrastructure, current time commitment to research, and lack of formal training and mentors, as were identified. Increase in knowledge of scientific methods and critical thinking may reinforce attitudes towards science and help to embrace evidence based medicine (EBM). But overall, in contrast with the global and even Indian mainstream population- based medical research scenario , undergraduate homeopathic research in India is almost non- existent. Majority of students expressed unawareness about research. Students are not necessarily clear about what research actually constitutes. Only a minority of students are submitting articles for publication which agrees with other studies that quote 8-17.6% of medical students either had anticipated or published articles .
Working in research projects require in-depth understanding of research methodology, epidemiology, and biostatistics , which are usually not acquired during undergraduate medical training . Other potential deterrents identified were constraints in research funding and devoted time, work overload, poor pay, lack of motivation, rewards, recognition and guidance, minimal awareness, lack of facilities, inadequate faculty-student interaction, conflicts between the role of clinicians and scientists, and sometimes a scientifically uninteresting research question; findings similar to a recently concluded study. The main cause of our dismal performance in the field of research and innovation has been a medieval curriculum that focuses on didactic learning instead of a scientific and an experimental approach. This lecture-based curriculum does not stimulate students’ interests in research during medical school and therefore they are less likely to seek a research experience. Majority of the faculty lacks experience in research. Thus students are not exposed to dedicated role models and hence a vicious cycle of a nonexperimental approach towards science is set up. Economic factors also need to be considered. Student’s in developing countries make career decisions within a framework that includes income potential. Also counselling about research opportunities and research careers is non-existent at almost every homeopathic school in Kerala. These factors combined with the uncertainty of research funding make a career in research less attractive economically.
Thus, there is an urgent need to emphasize the importance of research and to undertake professional programs preparing students as well as supervisors for this task . Courses in research methodology have already been proved a helpful tool toward successful conduct of research , that can substantially increase research knowledge, skill, competence and productivity. Evolving medical science necessitates research training to be considered as an essential and fundamental component, ‘an underlying principle’, in an innovative undergraduate medical curriculum . Undergraduate research is being seen as a fundamental element of general higher education in the UK, US and elsewhere. A recent study showed that most medical students can generate scholarly work during medical school and sustain a high level of interest in research as a career option. Despite the existence of courses in medical informatics, guides and thesis regulations, many students do not understand the process of scientific writing . Some medical schools have developed student-oriented courses and program to overcome the perceived
Difficulties and improve the quality of theses and promote their publication. It is important to teach undergraduate students the full scientific publishing process, including the peer review process, the format for scientific articles and the necessary skills in word processing. Requiring students to write their these according to the guidelines of a few selected journals, improving the supervisor’s engagement in the reporting and improving students’ understanding of the peer review process would add a new dimension to the thesis process and provide additional opportunities for publication. The full digital text of the completed and reviewed thesis should be made visible and accessible in the institutions self-archive . Appreciation of research work should be made a part of institutional mind-set. In health care sciences, understanding biostatistics have important implications in modulating clinical practice as it possesses a large effect on evidence-based diagnostic and treatment applications. Similarly, in academics, sufficient knowledge of epidemiological principles is required to successfully conduct a study and correctly analyse data derived from clinical investigations. Case discussion teaching and problem-based learning (PBL) can be employed successfully rather than traditional lecture-based courses. Finally, encouraging research culture and fostering the development of inquiry and research-based learning among students is a high priority in order to develop more and better patient-oriented clinician-researchers and strengthening integrity in the academic environment and society as a whole .
Medical students’ research may help instil a culture of EBM in clinical medicine. The ‘teaching- research nexus’ should be central to medical education; however, the Dilemma of education versus research-oriented publication seems to continue to exist . The model proposed by Healey and Jerkins may be of use. Also, the Continuous Research Education and Training Exercises (CREATE) program has been proposed as a peer- and group based, interactive, analytical, customized, and accrediting program with didactic, training, mentoring, administrative, and professional support to enhance clinical research knowledge and skills among healthcare professionals, promote the generation of original research projects, increase the chances of their successful completion, and optimize the potential for their meaningful impact.
CONCLUSION
One long-term and effective strategy for promoting health research is to target medical students early in their careers. Student research can contribute to the published output of an institution. Nothing can be more motivating for a student than to get published. Currently there is very little literature that presents innovative ways of teaching public health research methods to undergraduate medical students. Above all, students need to be “sensitized” to research – that is, they should be made aware of why research is so crucial to health care. Then only it may be quite feasible to integrate medical student teaching with real-world research. This approach to integrated teaching and research should be considered further in health sciences training and continue to be evaluated and refined. Many medical graduates feel they have insufficient knowledge when it comes to basic research skills. This deficit could be due to the fact that students are often not taught these skills and do not value them in their under-graduate curriculum. A low importance attached to public health, along with little understanding of research skills is not a promising combination, especially given the growing importance of evidence-based approaches to making health sector activities more effective and cost-effective. Accessible resources, appropriate rewards, financial incentives, sufficient time allocation, promotion and tenure have already been identified as stimulators in promoting research and scholarly activity.
LIMITATIONS
Our preliminary evaluation is limited by the paucity of the existing evaluation model for assessing research perception of undergraduate homeopathic students. Another limitation of this study was that we did not look at the type of research done by the extremely limited number of study participants. Even though not a study objective, information of the quantity and quality of research would have given more information of research output and reflected on adequacy of research. Thirdly, a larger sample size would have allowed for a stronger analysis than the one performed in this study. Despite these limitations, this study was able to capture a wide sample across four academic institutions allowing for a fair representation. The study was undertaken in India-based homeopathic schools making the generalizability of the results unclear. Future studies investigating such attitudes and participation in research would be welcome from other homeopathic schools in both India and abroad. In addition, it would be of interest to assess the effectiveness of potential educational interventions such as establishing a student research group within homeopathic schools to act as a way of coordinating and promoting extracurricular research.
SUGGESTIONS
All opportunities to bring research-active staff and research-enthusiastic undergraduates together must be explored and the value of undergraduate research must be recognized by funding authorities. Many studies have addressed the benefits of financial investment in research; likewise, many benefits have been provided from researches for the welfare of community. These studies have encouraged policy makers to invest in research and innovation. Health research should be organized from a systems perspective with an emphasis on ethics and equity. An enabling environment for research requires vision, institutional support, adequate funds, appropriate training, and attractive career pathways.
Collaboration across the region needs to be strengthened. Use of health research to inform health policy, professional practices, and public behavior needs to be increased. There also need to be effective international agreements to halt the “brain drain” of academic clinicians from low-income to high-income countries, since this migration robs medical students of role models. Several medical schools are developing ‘Student Research Offices’ in order to facilitate participation in extracurricular research. Despite significant motivation for curriculum vitae, many are enthusiastic regarding extracurricular research opportunities but frustrated by the obstacles faced . Bangash MA, 2002 suggested different Recommendations for promoting undergraduate medical research that are equally applicable for homeopathic schools in India.
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Dr Sherin K K
Intern Doctor, Govt Homoeopathic Medica College, Calicut Kerala
UGO Dr Mansoor Ali Professor HOD, Department of HRC
Email :sherinmuhammedd@gmail,com
Ph: +91 7561818955
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