Cultivate…. research an attitude and learning a passion.

Sir,

Apropos to your interesting and thought provoking editorial in Indian Journal of Orthopedics - cultivate… research an attitude and learning a passion;1 your comments on research attitude and learning aptitude among orthopedic trainees in India. We more than agree that our apparently mundane clinics and the hospital wards and the patients thereof are the vivid, yet nearly unexplored research materials in themselves. We however do not quite agree to the editorial conclusion that attitude for research and passion for learning alone should compensate for the shortage of manpower and insufficient infrastructure across the country. Certain teaching institutes have ad hoc research associate position supported by Indian Council of Medical Research etc., who are engaged in specific projects and loosely attached to the department with a rare opportunity or formal authority and responsibility in inspiring trainees to do research. Medical research often ends up in papers based on not so high quality study; published in low impact journals. Patent right for the technology is a far cry. We do not have any regular or sanctioned posts in research positions in any of the medical colleges like a research assistant professor leading from the front in a formal manner; encouraging research to trainees. Since sanctioned posts cannot be created without the long drawn financial and bureaucratic implications, we can have honorary adjunct faculty and visiting research faculty position from diverse disciplines like biotechnology, engineering, statistics, philosophy, etc., May be we can have a small, but dedicated medical R and D Department for the much-needed liaising with other departments, other researcher institutes, funding agencies and investing quality time with the trainees to inculcate their minds toward research and scientific inquiry for the benefit of humanity.

Having said so, we also understand that higher education doesn’t involve spoon feeding, and it's more of a self-directed learning. Self-directed learning is a continuous engagement in acquiring, applying and creating knowledge and skills in the context of an individual learner's unique problems.2 Effectively supporting self-directed learning is however, one of the critical challenges in supporting lifelong learning. It creates new challenging requirements for learning technology. On other words, the role of such research faculty is to stop being a sage on the stage and be rather a guide on the side.3 Capacity building through development of research infrastructure is not easy even when funds become available. Wasteful expenditure due to improper planning and injudicious acquisition of funds for procurement of costly equipment's were reported from time to time.4

We did small initial questionnaires based study5 among 117 doctors with a postgraduate qualification of a tertiary care teaching institute in which we tried to explore three areas - What they feel about medical research (attitude), why they do research work and their approach to publish research work? The aim of our study was to explore the trend and factors responsible for defining the ambit of medical research and to evaluate the effect of various factors affecting the attitude and enthusiasm of specialist doctors engaged in scientific research in medical institutes. Out of the 117 participants in this single institute based study 62% participants feel that research is for the benefit of the society, but 37% felt that research work actually rather help build personal profile. Thankfully, about 61% would like to get involved in research work; 27% of the participants were neutral, and 11% don’t like to get involved further in any kind of research activities. Out of these 11% nonbelievers of research, about 17% see it as extra workload, whereas 21% cited inadequate infrastructure for not doing research. About 38% of participants even feel that research is not a priority given India's limited medical resources of manpower and fund. Overall about 22% participants alleged wastage of manpower and resources in irrelevant studies, whereas 77% were of the opinion that there is already a shortage of manpower and money in the health sector and research increases burden on India's health care system. About 50% of the participants however feel that research work helped in their clinical practice. However, 41% opined that research work done by them has no practical application, but it did help to build their personal profile. The key factor negatively affecting the current trends in medical research was cited as lack of manpower and resources by over 77%. Lack of research infrastructure was allegedly cited by 21% for not doing research currently. About 37% of participants did research under pressure to publish at some point of time. General lack of interest in research was found in as high as 62% of the fraternity.

We also tend to disagree with the editorial conclusion that the attitude for research and passion for learning alone can increase the potential and utility of surgeon multifold and help in compensating for the shortage of manpower and insufficient infrastructure.1 Both Raman Effect and malaria cycle was discovered in India; winning the Nobel awards early on without having much facility, but things have changed phenomenally since then. It may not be inappropriate to say that, since we often cannot help, but do away with research under the pressure of continuity of care. No doubt, for the surgical fraternity, it is a time to pause for introspection and ponder about the need for sincere and regular scientific inquiry that is the mother of all research. However, shall we not put specific hours in a day for research alone? Should we have or afford to have research holiday in a week in teaching institutes at least. It is a trade-off for a country like ours. Do we have support system to retain and nurture talents further? We feel that it is humanly impossible for busy clinicians and surgeons to do quality research in time and resource constrained atmosphere across the country. Lack of documentation of clinical records in easily retrievable manner and paucity of quality time to crystallize our genuine or instinctive thoughts are major factors. We also wonder how many medical colleges and medical universities in this country actually earmark annual funds/research budget for supporting such intuitive and self-directed learning process. Research and not regulations promotes quality research, but can we not involve the Medical Council of India and Indian Council of Medical Research to do something radical in this regard; e.g. to enact regulations to include research infrastructures as prerequisites to ensure and maintain quality medical education instead or is it that putting our own house in order should be our first priority.

There is regional inequality in the standard of care, inconsistency in treatment protocols and guidelines or at times there are no national guidelines available for specific therapy. There is for instance no clear national guideline confirming duration of antitubercular therapy for treating musculoskeletal tuberculosis.6 Fraternity like pediatrics and cardiology etc., are marching ahead with region specific guidelines and much more enthusiasm than surgical discipline in this regard. Qualitative research is severely lacking in surgical fields. Evidence based research is essential for a resource deficient country to reduce the burden of doubtful interventions. That will also make our treatment cost effective yet highly scientific and ethical by following the Hippocratic doctrine of do no harm.