SKIN July RLET 1189 Proof returned SKIN July 2021 Volume 5 Issue 4 Copyright 2021 The National Society for Cutaneous Medicine 388 RESEARCH LETTER Assessing Comfort in Conducting Research Among Medical Students Interested in Dermatology Carmen Carlos, BA1, Christen Brown, MS1, Erika Elliott, MD1, Andrea Murina, MD1 1Tulane University School of Medicine, Department of Dermatology, New Orleans, LA USA Conducting research in medical school can foster a commitment to lifelong learning. Formal research instruction includes activities such as Self-Directed Learning (SDL) and Problem-Based Learning (PBL), as well as sessions in Evidence Based Medicine (EBM).1,2 However, skills gained from isolated activities such as these may be limited. Though research during medical school has increasingly become an expectation, high numbers of research projects may not indicate competence in all research-related skills. The assessment of research activity is frequently based on project outcomes rather than evaluation of the skills required for successful completion of research projects.3- 5 Frameworks have been developed that define the skills deemed essential for medical research,6 but many do not provide an assessment tool.7,8 The literature lacks a clear conceptual framework9 to assess ABSTRACT Introduction: Participation in research has become increasingly popular amongst US medical students hoping to match into dermatology residency. While medical students have increasingly high research output by the time of graduation, the preparedness of medical students for independent research is unknown. Methods: An anonymous survey was distributed to 137 dermatology interest groups across the country. The survey contained 21 multiple choice and free text questions that assessed students’ research experiences and self-assessed competency in key research components. Fifty-seven students participated. Results: Students were most comfortable with creating posters for presenting research, writing an abstract and reviewing charts to gather pertinent data for research projects. Students reported a below-average comfort level with data analysis. Medical students who participated in more than eight research experiences and those who perform epidemiological research or commentaries have greater confidence in their ability to conduct research. Conclusion: Experience in research is associated with the ability to conduct research independently, but there is significant variance in the comfortability to perform essential research-related tasks. INTRODUCTION SKIN July 2021 Volume 5 Issue 4 Copyright 2021 The National Society for Cutaneous Medicine 389 medical student clinical or translational research skills and attitudes toward performing defined research tasks. While objective self-assessment is inherently imperfect, it has been established that objective competence requires a degree of subjective awareness of one’s personal performance and judgement.10 Epstein et al proposes a framework that emphasizes integrating external and internal data to assess performance on future learning and self-assessment of skill.11 This study integrates medical student self-assessment of comfortability with externally defined requisite standards of research. Our analysis seeks to discover if the current method of undergraduate medical research results in a high degree of self-assessed competence with research skills. An anonymous survey approved by the Tulane Institutional Review Board was distributed to 137 Dermatology Interest Group (DIG) presidents at Dermatology Interest Group Association (DIGA) affiliated medical schools to be distributed to their members via email listservs. The survey contained 21 questions and consisted of multiple choice and fill-in-the-blank questions that assessed students’ background and research experience. The survey utilized a Likert scale to assess students’ comfortability with conducting research. 57 responses were received. Responses included students of all years of medical school and 96.4% had participated in research during medical school. First year students represented 30.4% of all survey responses. A majority of students had research experiences outside of the standard medical curriculum with 85.4% of respondents indicating that they were involved in research during undergraduate education and 62.5% participating in research years before attending medical school. 79% of respondents reported having a research mentor in medical school. Twenty- nine percent of students reported participating in dermatology-specific research during medical school. The number and types of research projects varied among respondents. (Tables 1 and 2) Table 1. Number of research projects students participated in during medical school. Number of research projects (%) student participation N=45 1-3 N=21 (46.6) 4-7 N=12 (26.7) 8+ N=12 (26.7) Table 2. Student participation in various categories of research. Research project category (%) student participation N=127 Case report/case series N=27 (21.3) Review article N=17 (13.4) Commentary/editorial N=8 (6.3) Basic science research study N=13 (10.2) Clinical medicine research study N=29 (22.8) Educational research study N=16 (12.6) Epidemiological research study N=12 (9.5) Other N=5 (3.9) Comfort levels with different research skills varied when measured on a Likert scale. Students reported the highest average METHODS RESULTS SKIN July 2021 Volume 5 Issue 4 Copyright 2021 The National Society for Cutaneous Medicine 390 Figure 1: Graphical representation of students’ responses on a Likert scale of 1-5 comfort with creating posters for presenting research (4.22 mean, 0.80 variance). Respondents reported considerable comfort with writing an abstract (4.11 mean, 0.85 variance), reviewing charts to gather pertinent data for research projects (4.11 mean, 1.08 variance), and developing a scientific question (4.02 mean, 0.91 variance). Students reported the lowest average comfort with analysis of collected data (2.91 mean, 1.68 variance). The most variance in responses was found in comfortability with writing a manuscript for publication (3.53 mean, 1.85 variance) and conducting literature reviews (3.62 mean, 1.75 variance). Students were confident in their abilities to conduct research during residency (4.20 mean) with 51.1% of respondents “completely comfortable” in their abilities. A chi square test revealed a significant association between the number of research projects that students participated in and their comfortability with writing an IRB protocol, writing a manuscript for publication, and conducting scholarly activity as part of residency in the future (p= <.05). Post hoc comparisons revealed that those who participated in >8 research projects were more confident in their ability to conduct research as part of residency than those who had participated in 1-3 projects or 4-7 projects (p=0.02). Differences in quality of research yielded varied confidence in ability to conduct research in residency. Conducting epidemiological research and writing a commentary/editorial showed a significant association (p=0.02 and 0.04, respectively). Writing case reports or review articles showed no association with confidence of conducting research during residency (p= 0.14 and 0.23, respectively). Notably, there was an association between year in medical school and comfortability with giving oral presentations and chart review (both p= 0.01). There was no association between 0.8 0.85 1.08 0.91 1.68 1.85 1.75 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 creating posters writing an abstract reviewing charts scientific question analysis of data writing a manuscript literature review Li ke rt s ca le 1 -5 MEDICAL STUDENTS' SELF ASSESSED RESEARCH SKILLS Mean comfort level Variance SKIN July 2021 Volume 5 Issue 4 Copyright 2021 The National Society for Cutaneous Medicine 391 completing a research year and any measure of comfort (p= >.05). Participation in research is popular among US medical students hoping to match into dermatology residency. Students interested in the field recognize the high importance that residency programs place on research participation and publications. The average number of abstracts, presentations, and publications among US seniors who matched into dermatology in 2020 is nineteen.12 However, our survey revealed that students interested in dermatology as a career do not report consistent levels of comfort regarding ability to conduct various forms of research. Although self-directed learning is considered a standard for medical school accreditation, independent research is not a requirement.2 Instituting research as a standard for accreditation would encourage medical schools to teach the fundamentals of research. There may be potential time and cost restraints associated with implementing formal curriculum interventions. An alternative approach which has been already widely implemented among medical students—mentorship—has been previously associated with increased research productivity, while lack of mentorship has been associated with loss of interest in an academic career.13 While mentorship is highly utilized among our study population, mentorship alone has not closed the gaps uncovered by our study. Overall, participation in a larger quantity of research projects yields greater comfortability with writing an IRB protocol and writing a manuscript for publication. Additionally, case reports have been inversely associated with research productivity during residency, a finding that may be supported by our finding that students who performed case reports had less confidence in research skills.14 Future research comparing dermatology applicant comfortability with research compared to that of other similarly competitive specialties could help to establish the pervasiveness of research knowledge gaps and subsequently develop strategies – across specialty and institution – to close those gaps. Providing the framework in which medical students can participate in the pre-clinical years of medical school may help build the necessary skills to perform higher quality research in dermatology. The study is limited by use of a non-validated study low response rate and recall bias. Because we collected responses from all years of medical school, reported comfort levels may vary based on student-year and curriculum. Overall response rate is unknown due to dissemination via listserv. It is possible that students not applying to dermatology were included in the survey. Self-selection bias likely occurred and could be associated with respondents completing more or less research than the average dermatology applicant. The results are not generalizable to all medical students. Among medical students interested in specializing in dermatology, there are notable discrepancies, as well as some concerning gaps, within students’ research skills. Research-focused interventions, such as research participation requirements and/or online educational modules, may be the key to enhancing medical students’ research skills. Future studies could examine whether these gaps discourage or encourage participation in research during residency. It DISCUSSION CONCLUSION SKIN July 2021 Volume 5 Issue 4 Copyright 2021 The National Society for Cutaneous Medicine 392 is yet to be determined whether high scholarly productivity during medical school is associated with high productivity during residency training. Conflict of Interest Disclosures: None Funding: None Corresponding Author: Andrea Murina, MD, FAAD Tulane University School of Medicine 1430 Tulane Ave., #8036 New Orleans, LA 70112 Email: amurina@tulane.edu References: 1. “Functions and Structure of a Medical School.” LCME, Association of American Medical Colleges and American Medical Association. lcme.org/publications/. Published March 2020. Accessed July 2020. 2. Laidlaw A, Aiton J, Struthers J, Guild S. Developing research skills in medical students: AMEE Guide No. 69. Med Teach. 2012;34(9):754-771. 3. Kanna B, Deng C, Erickson SN, Valerio JA, Dimitrov V, Soni A. The research rotation: Competency-based structured and novel approach to research training of internal medicine residents. BMC Med Educ. 2006;6. 4. Ianni PA, Samuels EM, Eakin BL, Perorazio TE, Ellingrod VL. Assessments of Research Competencies for Clinical Investigators: A Systematic Review. Eval Health Prof. December 23, 2019:016327871989639. 5. Adkison LR, Glaros AG. Assessing Research Competency in a Medical School Environment. Med Sci Educ. 2012;22(3):139- 142. 6. Sonstein SA, Li R, Jones CT, Silva H, Daemen E. Moving from Compliance to Competency: A Harmonized Core Competency Framework for the Clinical Research Professional. 7. Yoon HB, Park DJ, Shin J-S, Ahn C. Developing a core competency model for translational medicine curriculum. Korean J Med Educ. 2018;30(3):243-256. 8. Dilmore TC, Moore DW, Bjork Z. Developing a Competency-Based Educational Structure within Clinical and Translational Science. Clin Transl Sci. 2013;6(2):98-102. 9. Bordage G. Conceptual frameworks to illuminate and magnify. Med Educ. 2009;43(4):312-319. 10. Kruger J, Dunning D. Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self- assessments. J Pers Soc Psychol. 1999;77(6):1121-1134. 11. Epstein RM, Siegel DJ, Silberman J. Self- monitoring in clinical practice: A challenge for medical educators. J Contin Educ Health Prof. 2008;28(1):5-13. 12. Characteristics of U.S. MD Seniors Who Matched to Their Preferred Specialty in the 2020 Main Residency Match (Vol. 2, p. 36). Washington, D.C. 2020. National Resident Matching Program. 13. Reck SJ, Stratman EJ, Vogel C, Mukesh BN. Assessment of residents’ loss of interest in academic careers and identification of correctable factors. Arch Dermatol. 2006;142(7):855-858. 14. Stephens MR, Barbieri JS, Lipoff JB. Predicting future dermatology academic productivity from medical school publications. J Am Acad Dermatol. 2020 Aug;83(2):624- 626. doi: 10.1016/j.jaad.2019.08.076. Epub 2019 Sep 6. PMID: 31499150