التصورات واملمارسات البحثية خلرجيي الطب دراسة مقطعية تقارن بني خرجيي جامعة امللك عبد العزيز لعامي 2015 و 2017 اأحمد با�سكران، مي�ساء بنجري، مالك املرغوب، اإيالف الزرنوقي abstract: Objectives: This study aimed to compare changes in medical students’ research practices and perceptions of two cohorts of graduates. Methods: This cross-sectional comparative study was conducted from November 2014 to December 2017 and included the 2015 and 2017 medical graduates of King Abdulaziz University, Jeddah, Saudi Arabia. A validated self-administrated questionnaire, which included questions about participants’ age and gender, research activities, and obstacles to and motivators for research involvement was used. Results: A total of 484 graduates were included in this study (response rate: 96.8%). A significant difference was found between the 2015 and 2017 graduates who had not started any research project (48.4% versus 35%; P <0.001) and a 20% increase in the 2017 graduates’ conf- idence in their abilities to start their own projects was observed (P <0.001). Significantly more 2017 graduates were engaged in various research roles, other than 'author', compared to 2015 graduates (71.3% versus 55.4%; P <0.001). Career progression was the main motivator for both the 2015 and 2017 medical graduates to participate in research (79.5%). Reported obstacles to research included a lack of dedicated time for research and methodology training and a shortage of research project opportunities. Conclusion: This study highlights positive changes in attitudes towards and perceptions of research among medical graduates. Keywords: Medical Students; Research; Professional Practice; Attitude; Perception; Medical Education; Saudi Arabia. امللخ�ص: الهدف: هدفت هذه الدرا�سة اإىل مقارنة التغريات يف الت�سورات واملمار�سات البحثية لطالب الطب على مدار عامني. الطريقة: اأجريت درا�سة مقطعية امتدت من نوفمرب 2014 اإىل دي�سمرب 2017 و�سملت مقارنة خريجي الطب لعامي 2015 و 2017 بجامعة امللك عبد العزيز ، جدة ، اململكة العربية ال�سعودية. وللمقارنة مت ا�ستخدام ا�ستبيان تقييم ذاتي معتمد م�سبقا، والذي ت�سمن اأ�سئلة حول عمر وجن�ض امل�ساركني واأن�سطتهم البحثية ودوافعهم للم�ساركة يف البحوث بال�سافة اىل العقبات التي حتول دون تلك امل�ساركة. النتائج: �سملت هذه الدرا�سة 484 خريجا )معدل ال�ستجابة: %96.8(. مت العثور على فرق ذو دللة اح�سائية بني خريجي 2015 و 2017 من حيث ن�سبة الطلبة الذين مل يبداأوا اأي م�رسوع بحثي بعد )P >0.001؛ %35 مقابل %48.4( غري انه لوحظت زيادة بن�سبة %20 يف ثقة خريجي عام 2017 بقدراتهم على البدء بامل�ساريع البحثية اخلا�سة بهم )P >0.001(. �سارك عدد اأكرب من خريجي عام 2017 يف اأدوار بحثية خمتلفة ، بخالف دورهم كموؤلفني ، مقارنة بخريجي عام P > 0.001( 2015؛ %55.4 مقابل %71.3(. كان التدرج الوظيفي هو الدافع الرئي�سي لكل من خريجي الطب عامي 2015 و 2017 للم�ساركة يف البحوث )%79.5(. �سملت معوقات البحث التي مت ذكرها قلة الوقت املخ�س�ض للبحث وعدم توفرالتدريب الكايف على منهجية البحث ونق�ض امل�ساريع البحثية املتاحة. اخلال�صة: ت�سلط هذه الدرا�سة ال�سوء على التغريات الإيجابية يف مواقف وت�سورات خريجي الطب جتاه البحث. الكلمات املفتاحية: طلبة الطب؛ بحث؛ املمار�سة املهنية؛ موقف؛ ت�سور؛ التعليم الطبي؛ اململكة ال�سعودية. Medical Graduates’ Research Practices and Perceptions A comparative cross-sectional study between 2015 and 2017 graduates of King Abdulaziz University Ahmed M. Basakran,1 *Maysaa A. Banjari,2 Malak A. Almarghoub,3 Elaf M. Alzarnougi4 Sultan Qaboos University Med J, February 2019, Vol. 19, Iss. 1, pp. e32–37, Epub. 30 May 19 Submitted 19 Jul 18 Revisions Req. 29 Jul & 13 Sep 18; Revisions Recd. 5 Aug & 16 Oct 18 Accepted 21 Nov 18 Advances in Knowledge - Positive changes in medical graduates’ perceptions of research and practice is an indication of the importance of awareness to research involvement. - The main barriers affecting research activities were a lack of dedicated time and methodology training as well as a lack of research project availability. Application to patient care - Understanding evolving changes in perceptions and practice associated with research will help to focus efforts to ensure more research involvement among medical graduates. - Improving perceptions of research and practice among medical graduates can help them properly implement evidence-based medicine in a clinical setting. 1Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia; Departments of 2Pediatrics and 3Obstetrics & Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Internal Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia *Corresponding Author’s e-mail: maysaa.ban@live.com This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License. https://doi.org/10.18295/squmj.2019.19.01.007 clinical & basic research https://creativecommons.org/licenses/by-nd/4.0/ Ahmed M. Basakran, Maysaa A. Banjari, Malak A. Almarghoub and Elaf M. Alzarnougi Clinical and Basic Research | e33 Research is an essential component of medicine as it plays a vital role in advancing scientific knowledge.1 Clinicians are required to make decisions based on the best available evidence. This practice can only be accomplished with optimum understanding of research principles.2 In order to imp- rove medical practice and scientific knowledge, research activities should be encouraged and implemented in the undergraduate years.3 Encouraging medical students to participate in research can help them develop skills associated with communication, teamwork, time management and indep- endent learning. As students gain research experience, they in turn are motivated to pursue a career in research. Further, participating in research at an early stage in education could help students establish a positive pers- pective towards science and scientific methodologies.4–7 Understanding the attitude of undergraduate students and graduates towards research can improve research practice in the postgraduate period.8 Shahbaz et al.’s study conducted in Lahore with undergraduate university students found that 86% believed research was an essential aspect of their field of study; however, only 33% had previous research experience.9 In addition, Ibrahim et al.’s study in Egypt revealed that 69% of medical students believed that research experience would greatly help their long-term career objectives, yet only 11% had publ- ished a paper.10 Several studies have been conducted in Saudi Arabia to understand medical students’ perceptions of their research practice. A study conducted in Makkah’s Umm Al-Qura University with undergraduate students in the health colleges revealed that only 6.6% had published research-based writing.11 Another study conducted in Jeddah in 2010 with medical graduates of King Abdulaziz University found that 31% had co-authored research papers, with only 3.2% being first authors.12 At King Abdulaziz University, research is an essential part of the undergraduate curriculum. At the time of this paper’s writing, students had no graduation requirements to participate in a research project. How- ever, during their third, fourth and fifth years of medical school, the university offered lectures and assignments designed to teach undergraduates the basics of research, such as idea formation, data acquisition and analysis, manuscript writing and how to appraise research articles. The current study aimed to compare research practices and perceptions among undergraduate medical students who graduated in 2015 and 2017 from King Abdulaziz University. These two groups were chosen because of increased efforts around improving research awareness over the two years preceding this study, in part due to a new unit established to deliver free workshops emphasising the importance of research. In addition, in Jeddah in 2016, a summer school was established to encourage undergraduate students to participate in research by providing them with research opportunities. Finally, the Saudi Commission for Health Specialties (SCFHS), the organisation responsible for postgraduate studies in Saudi Arabia, announced that conducting research, authoring papers and presenting at conferences would improve a medical graduate’s likelihood of admission into postgraduate programmes. Methods This comparative cross-sectional study was conducted at King Abdulaziz University in Jeddah, Saudi Arabia, between November 2014 and December 2017. The study included 2015 and 2017 medical school graduates who had completed six years of an undergraduate medical programme and were in their internship years during the data collection phase. Both groups were approached in person or through mobile phone text messages. This population was chosen due to ease of access and because the graduates were in the process of applying to post- graduate programmes and would therefore be aware of research. This study used a validated, self-administered, online questionnaire that was originally used in a study cond- ucted in the same setting; permission was taken from the primary author to use this tool in the current study.12 The questionnaire comprised 29 questions, including questions about age, gender and grade point average (GPA). Further questions sought information about research activities, motivators to be active in research, obstacles affecting research progress and measures to improve research involvement. Graduates’ answers were classified according to a Likert scale and were rated from strongly disagree to strongly agree (1–5, respectively). Data were analysed using Statistical Package for the Social Science (SPSS), Version 16 (IBM Corp., Armonk, New York, USA) and were expressed as numbers and percentages. A chi-squared test was used to assess whether the data followed a random distribution. A P value of <0.005 was considered statistically significant. Consent was collected after the purpose of the study was thoroughly explained to the participants. Ethical approval was received for this study from the Ethical Committee of King Abdulaziz University (62261\39\d). Results A total of 500 medical graduates were contacted and 484 completed the questionnaire (response rate: 96.8%) Medical Graduates’ Research Practices and Perceptions A comparative cross-sectional study between 2015 and 2017 graduates of King Abdulaziz University e34 | SQU Medical Journal, February 2019, Volume 19, Issue 1 of which 51.4% were females. Females and those with higher GPAs were more likely to begin research during their undergraduates’ education [Table 1]. More 2015 graduates had not started a research project compared to 2017 graduates (48.4% versus 35%; P <0.001) [Table 2]. Moreover, a significant increase was seen in the number of 2017 graduates compared to 2015 graduates engaging in research in a role other than author such as data collector, etc. (71.3% versus 55.4%; P <0.001). Less 2015 graduates published papers as a first author than 2017 graduates (8.7% versus 22.67%; P <0.001). More 2017 graduates felt confident to start their own research project (62% versus 42.4%; P <0.001) and submit an article without supervision (37.3% versus 13.6%; P <0.001) than 2015 graduates [Table 2]. Table 1: Comparison of the research activities, grade point averages, genders and ages between 2015 and 2017 medical graduates from King Abdulaziz University, Jeddah, Saudi Arabia (N = 484) Characteristic n (%) P value n (%) P value 2015 graduates 2017 graduates Started research (n = 95) Did not start research (n = 89) Started research (n = 195) Did not start research (n = 105) Gender Male 31 (32.6) 54 (60.7) <0.001 86 (44.1) 64 (61) 0.005 Female 64 (67.4) 35 (39.3) 109 (55.9) 41 (39) GPA 4–5 61 (64.2) 55 (61.8) 0.085 165 (84.6) 42 (40) <0.001 3–3.99 14 (14.7) 23 (25.8) 25 (12.8) 62 (59) ≤2.99 0 (0) 0 (0) 1 (0.5) 0 (0) Undisclosed by students 20 (21.1) 11 (12.4) 4 (2.1) 1 (1) Age in years ≥24 56 (58.9) 34 (38.2) 0.005 94 (48.2) 44 (41.9) 0.296 <24 39 (41.5) 55 (61.8) 101 (51.8) 61 (58.1) GPA = grade point average. Table 2: Comparison of research activity between 2015 and 2017 medical graduates from King Abdulaziz University, Jeddah, Saudi Arabia (N = 484) Graduates’ research involvement n (%) P value 2015 graduates (n = 184) 2017 graduates (n = 300) 1. Graduates who had not yet started a research project 89 (48.4) 105 (35) <0.001 2. Graduates who had started a research project 95 (51.6) 195 (65) <0.001 3. Graduates who had started a research project but stopped 51 (27.7) 58 (19.3)* <0.001 4. Graduates who had completed a research project 44 (23.9) 145 (48.3)* <0.001 Role in research other than author† (n = 102) (n = 214) <0.001 Hypothesis creation 32 (17.4) 60 (20) Data collection 80 (43.5) 204 (68) Data analysis 33 (18) 69 (23) Manuscript writing 31 (16.8) 63 (21) Graduates who had submitted their papers for publication 31 (30.4) 111 (37) <0.001 Graduates who had published a research paper 16 (8.7) 68 (22.7) <0.001 Graduates who felt confident enough to start their own project 78 (42.4) 186 (62) <0.001 Graduates who felt confident in submitting an article without supervision 25 (13.6) 112 (37.3) <0.001 *Some participants chose both options three and four as they had participated in more than one research project. †Participants could choose more than one option. Ahmed M. Basakran, Maysaa A. Banjari, Malak A. Almarghoub and Elaf M. Alzarnougi Clinical and Basic Research | e35 Graduates identified career progression as the main motivator to participate in research (79.5%), followed by a motivation to improve academic performance (60%) and pursue research interests (33.5%). In addition, peer pressure to carry out research was significantly higher among the 2017 graduates than the 2015 graduates (18% versus 7.6%; P <0.001) [Table 3]. In terms of barriers to active research, a lack of dedicated time (73.4%) and methodology training (69.6%) were identified as major obstacles by the 2015 graduates. On the other hand, the 2017 graduates reported that the main barriers to being more active in research was a lack of dedicated research time (66.3%) and a paucity of available research projects (60%) [Table 4]. The majority (60.8%) believed that including a one- month rotation devoted to research during the internship period could be an effective approach to enhancing research activities. In addition, 60.3% agreed that a 2–3-month rotation would have the same benefit. Discussion This study aimed to compare research practice and perception among 2015 and 2017 graduates of an under- graduate medical programme in Saudi Arabia. The findings highlight the effect of increased awareness of the importance of research and a change in research- specific criteria for post-graduate programme acceptance. Two main findings emerged from this study. First, significantly more 2017 graduates were active in research compared to 2015 graduates (P <0.001). Second, the researchers noted a pronounced boost in graduates’ confidence in their ability to author and submit research independently, demonstrating a positive change in attit- udes and perceptions. In this study, 65% of the 2017 graduates indicated they had begun their own research project in comparison to 51.6% of the 2015 graduates. This finding could be explained by an increased awareness of the importance of involvement in research through the activities of student research units and the changes that occurred in the SCFHS criteria of admission into postgraduate programmes. It is worth noting that research involve- ment of both the 2015 and 2017 graduates is higher than other studies done in Sweden and Brazil.13,14 However, both of these studies were conducted on medical students, while our study was conducted on medical graduates, who had more time to be involved in research. In the current study, the confidence of the graduates to start their own projects without supervision increased significantly in 2017, possibly due to those graduates’ increased involvement in research-promoting activities (P <0.001). Past research has noted that students’ active participation in research can improve their confidence in and understanding of research, in addition to incr- easing their interest in pursuing research-based careers in the postgraduate period.15 However, graduates expr- essed concerns about not having sufficient research opportunities in their university. This finding could indicate that even though barriers were present, students found alternative solutions to increasing research involve- ment, such as eliciting support from supervisors from different universities and attending summer schools or focused workshops that provided research opportunities. This observed high level of confidence and incr- eased research practice could be a result of reporting Table 3: Factors motivating 2015 and 2017 medical grad- uates from King Abdulaziz University, Jeddah, Saudi Arabia, to actively participate in research (N = 484) Factor* n (%) P value 2015 graduates (n = 184) 2017 graduates (n = 300) Total (n = 484) Career progression 138 (75) 247 (82.3) 385 (79.5) 0.052 Improved academia 101 (54.9) 189 (63) 290 (59.9) 0.077 Personal interest 54 (29.3) 108 (36) 162 (33.5) 0.132 Supervisor encouragement 32 (17.4) 38 (12.7) 70 (14.5) 0.151 Peer pressure 14 (7.6) 54 (18) 68 (14) 0.001 No motivation 4 (2.2) 16 (5.3) 20 (4.1) 0.090 *Participants could choose more than one factor. Table 4: Factors preventing 2015 and 2017 medical grad- uates from King Abdulaziz University, Jeddah, Saudi Arabia, from being active in research (N = 484) Factors* n (%) P value 2015 graduates (n = 184) 2017 graduates (n = 300) Lack of dedicated research time 135 (73.4) 199 (66.3) 0.014 Lack of methodology training 128 (69.6) 172 (57.3) 0.040 Lack of available projects to join 117 (63.6) 180 (60) 0.168 Lack of workshops on research 112 (60.9) 143 (47.7) 0.023 Lack of convenient data systems 87 (47.3) 166 (55.3) 0.007 Faculty members not providing assistance 77 (41.8) 154 (51.3) <0.001 Difficulty writing in English 62 (33.7) 108 (36) 0.427 Lack of financial rewards 62 (33.7) 98 (32.7) 0.053 *Participants could choose more than one factor. Medical Graduates’ Research Practices and Perceptions A comparative cross-sectional study between 2015 and 2017 graduates of King Abdulaziz University e36 | SQU Medical Journal, February 2019, Volume 19, Issue 1 bias or sample bias, as the students may have wanted to over-represent their achievements and the sample of this study only included medical programme graduates. A study conducted in Madinah, Saudi Arabia revealed a direct relationship between students’ academic year and their research involvement.3 Therefore, further research is needed to analyse research practices among students of all academic years to better understand students’ perceptions at all levels of education. Career progression was one of the main motiv- ators for research involvement for both the 2015 and the 2017 graduates, which is similar to findings from studies conducted in King Abdulaziz University, Univ- ersity College Cork and Universiti Sains Malaysia.16,17 Furthermore, peer pressure to carry out research was found to have significantly increased in the 2017 cohort comparing to the 2015 cohort (P <0.001). This increase may be attributed to increasing competition between graduates or the more stringent research recommend- ations implemented by the SCFHS in 2017. Graduates identified many barriers affecting their research participation. Both 2015 and 2017 graduates agreed that lack of time negatively impacted their research practice (73.4% and 66.3%). Similar obstacles to research were reported by medical students in another Saudi Arabian study conducted in five medical schools.18 These findings also concur with those of a study done in the United Kingdom, where 74% of their sample reporting that time constraints acted as a crippling barrier to their research activities.19 The persistence of this obstacle indicates the importance of allocating time dedicated specifically to research. The majority (60%) of the 2017 graduates believed that there was a shortage in the number of available research projects, indicating a need for more enthusiastic faculty members and summer schools to provide more research opportunities for interested students. It is worth noting that starting from 2021, authoring a research project will become a prerequisite for graduation from King Abdulaziz University. This positive change can play an important role in improving students’ future participation in research. The current study noted an improvement in knowl- edge regarding the existence of research methodology training, possibly because of the free workshops cond- ucted by the students’ research unit. This positive change indicates that plans to improve students’ research practice are succeeding; however, more efforts are needed to ensure the adequacy of the given lectures and workshops. This obstacle represents a serious barrier to students’ research practice, as reported in similar studies cond- ucted in Saudi Arabia and Pakistan.9,12 The primary limitation of this study is that the data was collected from the graduates via a data collection tool and not through one-on-one interviews. Qualitative interview-based studies can help researchers better understand graduates’ perceptions of research and find solutions to increase their research involvement. Add- itionally, conducting this study with a larger sample and including graduates and students from several universities and different academic years could give more insight into how to improve students’ and graduates’ practices and perceptions of research. Conclusion This study highlighted positive changes in attitudes and perceptions of research among graduates of a medical programme in Jeddah, Saudi Arabia. However, it still demonstrates the importance of providing more research opportunities and research-based lectures as well as matching supervisors with medical students and recent graduates in order to ensure the quality of their cond- ucted research. c o n f l i c t o f i n t e r e s t The authors declare no conflict of interest. f u n d i n g No funding was received for this study. References 1. Kasulkar AA, Gupta M, Chari S, Kanade HT. Assessment of medical students’ interest in research in central India. 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