|Year : 2017 | Volume
| Issue : 1 | Page : 31-36
Research experience of resident doctors who attended research methodology courses of the National Postgraduate Medical College of Nigeria
Emmanuel A Jeje1, Olumide A Elebute1, Bolaji O Mofikoya1, Michael A Ogunjimi1, Taiwo O Alabi1, Oyenike O Ekekezie2
1 Department of Surgery, Lagos University Teaching Hospital, Ijanikin, Lagos, Nigeria
2 National Postgraduate Medical College of Nigeria, Ijanikin, Lagos, Nigeria
|Date of Web Publication||9-May-2017|
Olumide A Elebute
Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, PMB - 12003
Source of Support: None, Conflict of Interest: None
Introduction: For over three decades, the National Postgraduate Medical College of Nigeria (NPMCN) has been vested with the responsibility of overseeing postgraduate medical training. The main objective of this study was to assess the residents’ perception of research as well as challenges faced in pursing seamless research during their training. Materials and Methods: This study was a cross-sectional descriptive survey in 2013. Self-administered questionnaires were distributed to the participants of the annual research methodology workshop in all the 15 faculties of the NPMCN. The questionnaires assessed the residents’ previous exposure to research, their publication history and their trainers’ input to their own research. Statistical analysis was performed using the Statistical Package for the Social Sciences version 20 software. Results: Four hundred and one resident doctors, out of a total of 415 who attended the course, completed the questionnaires during the study period (96.6% response rate). There were 269 (67.0%) males and 132 (33.0%) females, giving a male-to-female ratio of 2:1. About three-quarters of them admitted that their exposure to research during training was grossly inadequate. Twenty-five percent of them were involved in a previous research before residency training, and a further 70% of respondents were involved in their trainers’ research work. Ninety-four percent in our study identified a lack of dedicated time to be spared for research as a major obstacle to research. Conclusion: Contribution and exposure to research among postgraduate trainees in Nigeria are low. Lack of dedicated time for research was viewed as the major obstacle to research by most residents.
Keywords: Postgraduate, research, resident doctor
|How to cite this article:|
Jeje EA, Elebute OA, Mofikoya BO, Ogunjimi MA, Alabi TO, Ekekezie OO. Research experience of resident doctors who attended research methodology courses of the National Postgraduate Medical College of Nigeria. Niger Postgrad Med J 2017;24:31-6
|How to cite this URL:|
Jeje EA, Elebute OA, Mofikoya BO, Ogunjimi MA, Alabi TO, Ekekezie OO. Research experience of resident doctors who attended research methodology courses of the National Postgraduate Medical College of Nigeria. Niger Postgrad Med J [serial online] 2017 [cited 2020 May 30];24:31-6. Available from: http://www.npmj.org/text.asp?2017/24/1/31/205970
| Introduction|| |
A resident doctor is a graduate of a medical college who is actively involved in a Postgraduate Medical Educational programme and is being trained in a specialized field of medicine. The resident doctor, as he/she is popularly referred to, is both a learner and health care provider. Postgraduate education has been defined by the Higher Education Commission in the United Kingdom ’as consisting of programmes that are more advanced than undergraduate study, usually undertaken by those who already hold undergraduate degrees’. Postgraduate medical training or residency programme, as it is sometimes called, affords the trainee the opportunity to build on a foundation of knowledge laid down during the undergraduate period and allows him/her to concentrate on a specific field in the vast ocean of knowledge, thus broadening his/her knowledge base in that area of interest. The corollary of this form of ‘parochial learning’ is specialization which inevitably translates into greater competency and through concerted research, expansion of the frontiers of knowledge in that field of medicine.
Research plays an important role in postgraduate training. Generally speaking, it emboldens critical judgement, promotes both imagination and self-education as well as enhances knowledge acquisition. In medical world, research permits periodical appraisal of current practice thereby fostering clinical practice that is evidence-based (i.e. evidence based medicine) and by tasking the clinician’s analytical skills improve patient evaluation. This has the potential of impacting positively on patient’s care.,, The relevance of research in the medical world is, thus, indisputable, and this may explain why it has become an integral part of the curricula of several Postgraduate Medical Colleges in the world.,
The curriculum of the National Postgraduate Medical College of Nigeria (NPMCN), for instance, requires that during their training, all residents should be encouraged to engage in an investigative project under respective faculty guidance and supervision. This indicates the need for broad involvement in scholarly activities including participation in journal clubs, conferences and researches that would result in publication or presentation at regional and national scientific meetings.
As part of the prerequisite for their exit examinations, prospective candidates are expected to submit a research thesis. This requirement and the research methodology workshop organized by the college, which aims to strengthen the research prowess of the specialist registrar, have become statutory. The incorporation of dissertation, which requires dedicated research time into the fellowship programme of the NPMCN, is a testimony to the recognition of the importance of research in postgraduate medical education. The role of research in medicine cannot be overemphasized, as it adds to knowledge, corrects old views as well as creates new concepts.
The competency-based curriculum for the residency programme is designed to train specialist with definite competence in four areas of professional practice: clinical problem solving, research, education as well as health service management. While the NPMCN has continued to oversee postgraduate medical training in Nigeria for over three decades,, there has been a lack of local studies to ascertain the residents’ perception of what ought to be the highpoint of postgraduate training. Previous studies have shown that most individuals who perform research during training continue to do so at the onset of their professional career.,
There is a need to undertake research at each level of our healthcare using appropriate technology. Residents should be able to demonstrate problem-solving ability by designing and implementing a simple research project relevant to the needs of his local environment. Without an in-depth knowledge and experience in research, it would be difficult to participate in the exit examinations, as success at these exams is largely hinged on good research acumen, which in turn demands active involvement in research work. Furthermore, a researcher must be apt at challenging known facts, contributing his experience into the existing body of knowledge and engage in auditing practices.
There is a paucity of literature globally on research among postgraduate medical trainees. A detailed online search did not reveal any study of this nature from African authors. The objective of this study was, thus, to ascertain the residents’ research experiences and attitude to research, identify what they considered as peculiar pitfalls or challenges faced in achieving a research oriented postgraduate training.
| Materials and Methods|| |
Consent for the study was obtained from the College Registrar of the NPMCN.
The study was conducted at the Conference Hall of the Sickle Cell Centre, which is an annex of the Lagos University Teaching Hospital, Lagos. Residents from various training institutions in the Federation convened at this venue in the month of March and August of the year 2013 for research methodology workshops that was organized by the NPMCN.
The study population consisted of different cadres of resident doctors coming from virtually all the training institutions in the country who were undergoing postgraduate medical education in one of the 15 faculties of the NPMCN namely: 1. Anaesthesia; 2. Dental Surgery; 3. Family Medicine; 4. General Dental Practice; 5. Ophthalmology; 6. Obstetrics and Gynaecology; 7. Otorhinolaryngology; 8. Paediatrics; 9. Public Health; 10. Internal Medicine; 11. Orthopaedics; 12. Radiology; 13. Psychiatry; 14. Surgery; and 15. Pathology.
Sample size and sample technique
A pre-tested, structured questionnaire that was based on our study objectives was designed and initially administered to residents in our own institution, that is, the Lagos University Teaching Hospital. Demographic details, research activities, resident doctor’s attitude to research and difficulties encountered in initiating and performing research were all included.
The outcome of the preliminary study was used to produce the final 25-item questionnaire which consisted of biographical questions, questions focusing on previous enrollment in research methodology courses or training, participation in journal club meetings during residency training, authorship of or contribution to published works and involvement in trainer’s research. A list of possible obstacles to research such as lack of motivation, absence of dedicated time for research, lack of value attached to research, the lack of recognition of locally conducted research and belief that research was not essential to professional development were posed, and the respondents were asked to grade the importance of these factors as obstacles to achieving a research oriented training, using a modified 3-point Likert scale strongly agree, fairly agree and disagree.
A convenience sampling technique was employed in the main study. The questionnaires were administered to participants during their lunch break. All the 415 participants to the workshop were eligible for the study but only four hundred and one responded. All the participants were fully briefed on the aims of the study, and the questionnaires were administered by individuals other than the authors. The study was a cross-sectional descriptive study. Self-administered questionnaires were distributed to participants of the two annual research methodology workshops of NPMCN in 2013.
Statistical analysis was performed using the Statistical Package for the Social Sciences version 20 software (Released 2011. IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp.). The demographic details were characterized using descriptive statistics so as to obtain measure of central tendencies and dispersion. Responses to multiple choice questions were summed and listed in order of frequency. Categorical variables were analyzed using chi square test. A P value <0.05 was considered statistically significant. A correlation matrix was generated using Spearman’s correlation statistical analysis (r) to determine the correlation coefficient between items. An absolute value of 0.0–0.39 revealed a weak relationship, whereas values of 0.40–1.0 reflected a moderate to strong relationship between items.
| Results|| |
Out of a total of 415 resident doctors, 401 completed the questionnaires during the study period (96.6% response rate). There were 269 (67.0%) males and 132 (33.0%) females, giving a male-to-female ratio of 2:1 [Table 1]. Majority of the respondents fell within the age bracket of 31–40 years [Table 1]. A sizeable number of the respondents (366; 91.3%) were over 5 years post basic medical training. Three hundred and seventy-six (93.7%) were Senior Registrars II in their various areas of discipline [Table 1].
Postgraduate trainees’ research experience
A total of 304 (75.8%) said they would be eligible for fellowship exams within the next 1 or 2 years. With respect to exposure to previous research training, only a quarter of the residents admitted having a prior training [Table 2]. One hundred and fifty (38.3%) had journal review meetings monthly, and a further 89 (22.6%) respondents claimed that their reviews were held on a weekly basis [Table 3]. Majority of the residents (298; 74.3%) in this study admitted that their exposure to research during their postgraduate training was grossly inadequate [Table 4]. Over half (209; 52.0%) of the respondents were involved in research work prior to postgraduate training. Two hundred and seventy-two (67.8%) claimed they were actively involved in their trainer’s research and 144 (35.9%) were contributors to research publications during their residency training [Table 3]. Three hundred and eight respondents (76.8%) in our study agreed that the outcome of local researches would impact positively in future clinical practice [Table 4]. Also observed was a positive weak correlation between participation in research prior to residency and contribution to publication during postgraduate training (r = 0.2, P = 0.02) [Table 5]. From our study, we noticed that participation in journal meetings had a positive weak bearing with contribution to a published research work during a residency training (r = 0.3, P = 0.0001) [Table 5]. We equally observed that residents who were involved in their trainers’ research were more likely to be contributors to published works (r = 0.3, P = 0.0001) [Table 5].
|Table 5: Effect of resident doctors’ demographic and previous exposure to research to their contribution to published research work|
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Obstacles to research
A vast majority of respondents (376; 93.8%) in our study identified a lack of dedicated time to research as a major obstacle to research. Close to half of the residents in our study (206; 71.8%) pinpointed to a lack of knowledge of research as an obstacle, whereas a lack of motivation for research and a lack of value attached to research were implicating factors identified by 27 and 12% of the respondents, respectively.
Trainers–trainee collaboration in research
A majority of the respondents believe that collaboration between trainers and trainees in research is lacking (194; 48.4%), and in centres where this exists in 55% of the residents claim that their trainers contribute to their research effort by suggesting research topics and granting access to journals, whereas a minority (2; 0.5%) admitted that their trainers were instrumental in the award of grants for their research [Figure 1].
Improving research interest among residents
A total of 376 (93.8%) agreed to the notion of encouraging the residents to be greatly involved in research. A further 357 (89.0%) proposed the provision of grants, availability of paid research or the sponsorship of national research competitions as plausible ways to improve the prospects of research among the resident doctors [Figure 2].
|Figure 2: Suggestions proposed on how to increase interest in research among resident doctors|
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| Discussion|| |
Majority of the respondents (93.7%) in our study were either first or second year senior registrars. This is understandable considering the fact that the entire duration of training in the various specialties ranges from 5 to 6 years (the duration being evenly divided between junior and specialist registrar levels), and that the college expects that each resident doctor submit a research proposal within a year of assumption of the specialist registrar post.
A quarter of the respondents in our study had been previously exposed to some research training. Pawar et al. in India, however, witnessed a much higher exposure to research training (64%). In contrast to our study, which had a broader scope, Pawar’s study was very much limited to second and third year residents. This may have contributed to the comparably higher rate in Pawar’s study.
About three-quarter of residents (298; 74.3%) in the study admitted that their exposure to research during their postgraduate training was inadequate. This finding is similar to that of Aslam’s, wherein 67.3% of the 55 respondents in their study expressed dissatisfaction with their research education. Aslam alluded this finding to poor training facilities and awareness as the reason for the poor research activity. We believe this to be true in our setting. The health sector is grossly underfunded, and this has had its toll on research in our nation. This could equally explain the abysmally low exposure to research witnessed in our study, even in those who were Senior Registrar II (32.1%) staff.
About a third (35.9%) of the respondents were contributors to many a published works. These results tally with that of Khan et al. who obtained a figure of 32.6% in a similar study. We believe that this is unacceptably low considering the fact that over 60% of the residents were undergoing their postgraduate training in teaching hospitals which are the highest echelon of tertiary health care in the nation, wherein research and publication are the sine qua non.
One of the hallmarks of the postgraduate training is active participation in research. Any perceived hindrance from the residents’ perspective to achieving this laudable objective needs to be identified and appropriately addressed to create an enabling environment that would foster a seamless ‘research-centred’ training. This could be achieved by adopting a two pronged approach, directed at the trainees and the trainers. First, as revealed from our study, there is a strong link between exposure to research methodology before residency training and active participation in postgraduate research. Vujaklija et al. found that medical students attitude towards research improved dramatically, when participation in a research training course was made compulsory. This finding was corroborated by Hren et al. in their report of over 900 students. Incorporating such a research methodology into the basic medical undergraduate curriculum may significantly improve the general perception to research particularly in postgraduate programme. Aside this, creating an enabling environment for research during postgraduate training is crucial. Our study lends credence to the importance of journal club meetings, as we found a positive, weak correlation between attendance at such meetings and contribution to research work. Journal club meetings are beneficial because they allow for the critical review of other studies, thereby, sharpening critical appraisal skills. Therefore, making all the journal club meetings mandatory by all the faculties in the college would be a right step forward. Furthermore, residents must be made to present their proposals early enough in their training to the faculty staff of their departments.
Second, it was observed from our study that there exists a mutual relationship between participation of the residents in their trainer’s research and motivation on the part of the residents to research. This highlights the vital role of trainers in encouraging research among postgraduate trainees; this is achievable by actively engaging the latter in the trainers’ research. Trainers should afford them the opportunity of partaking in data collection, literature reviews and data analysis. We are of the opinion that targeting them at the junior residency post before attainment of senior or specialist registrar status would be most ideal. Furthermore, the recent introduction of advanced research methodology workshop for trainers by the NPMCN is a welcome development, because it would serve to make the trainers more proficient in research and to be more competent in transmitting these skills to their trainees.
A vast majority of respondents (376; 93.8%) in our study identified a lack of dedicated time to research as a major obstacle to research. Our study closely approximates that of Aslam et al. who reported a figure of 89% in their study of postgraduate residents in Pakistan. The findings of both our study and that of Aslam sharply contrast that of Giri et al., wherein 60% claimed a lack of time as a major factor hampering research activities among residents. The lack of time for research could be adduced to the vast postgraduate medical curriculum that the residents are forced to cope with, coupled with their ‘round the clock’ clinical responsibilities.
Our study focused on residents who underwent research methodology training organized by the NPMCN in the year 2013. This study may need to be replicated over several years so that a more accurate position of residents regarding research could be obtained. Arguably, the number of residents recruited in the study and the findings so obtained may not be a true reflection of the entire research experiences of the body of resident doctors in the entire federation and, therefore, may not be valid to serve as a basis for any decision-making by relevant authorities.
Furthermore, although many medical schools in the country have a research methodology in their undergraduate curriculum, most respondents never appreciated that they ever had such a formal training from our study. This is most probably true, because they did not consider whatever exposure they may have had as research methodology or the training was never given or further still, the exposure was considered insufficient to make them ‘research savvy’, that is, the exposure did not make them competent to be a ‘stand alone’ researcher that the postgraduate medical training demands. Further studies would, therefore, be necessary to ascertain what components of research methodology such as formulation of research questions, hypothesis, data collation and analysis may not have been adequately captured by the undergraduate curriculum.
In addition, it would be pertinent to know the impact of the research methodology organized by NPMCN on the research activities of resident doctors who underwent such a training. This could be achieved by attempting to answer the hypothetical question: ‘Does the Research Methodology course organized by NPMCN positively impact research activities of resident doctors?’
| Conclusion|| |
Contribution and exposure to research among postgraduate trainees in Nigeria are low. Positive but weak correlations existed between both residents’ participation in research prior to residency and residents involvement in journal meetings and to their contribution to a published research work during a residency programme. Lack of dedicated time for a research was viewed as the major obstacle to research by most residents.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]