Case reports and research productivity among Syrian medical students: Review, reality, and suggested solutions.

Medical students are precious seeds for better future medical research. Case reports writing may represent a relatively simple first step for beginners. Only 47 case reports are published in the literature by Syrian Medical Institutions compared to more than 500 case reports in a comparable country in the last 5 years. Many obstacles stand against developing fruitful research environment in Syria. Increasing awareness to research productivity in Syria along with comparative analysis is discussed in this article.

INTRODUCTION

Case report is a type of medical literature that represents unique presentation, describes unusual findings or documents a rare disease. Case reports are valuable not only due to the fact that they describe unusual cases, but also they provide an important base for further and more reliable research studies. Usually, limited usefulness in evidence-based practice and bedside clinical decision are expected from such reports. Participation of medical students in research has made important changes in the history of medicine. For instance, in 1921 insulin discovery and purification was made by the researcher Frederick Banting and his 2nd year medical student assistant Charles Best.[1] Multiple reports described the basic principles of writing case reports.[2] This is the first review that focuses on Syrian research productivity in case reports and highlights the medical student's activity in this field of medicine.

WHY SHOULD MEDICAL STUDENTS START WITH CASE REPORTS?

Case report is a simple research writing experience. It is a primitive step for medical students in practicing manuscripts writing and a valuable publication exercise for beginners. Its methodological simplicity may promote the students’ abilities in searching the literature, discuss and report their rare clinical findings, enhance their readings, and improve their writing skills. In addition, it could enrich the curriculum vita that distinguishes the authors among their peers and help in pursuing better future academic careers.

METHODS

We explored all common literature search engines (PubMed, Medline, Google Scholar) for all published case reports with the following keywords: (Syria, Syrian Medicine, Damascus University, Aleppo University, Tishreen University, Albaath University, Alforat University, Alkalamoon University, Damascus, Aleppo, Latakia). In the search options, we included articles that the first or last authors are from a Syrian Medical Institution. By comparative analysis, we chose another Arab country that contains the same number of medical schools and similar populations’ background which is Tunisia. We compared publications achievements and the number of published case reports.

RESULTS

Only 47 case reports from Syrian medical institutes are available in the online published medical literature [Figure 1], 38% of them were published in the period of 2010–2014, 54% from Damascus University, 82% were indexed in PubMed. Eighteen percent of the published case reports are in the field of cardiology, and the majority of cardiology cases are published by the Cardiovascular Surgical Center at Damascus University. Thirteen percent of the cases were in dentistry, 11% in nephrology and oncology [Table 1]. We were not able to determine if any medical students were involved as authors. Comparing these results to case reports published from Tunisia, we found more than 500 published case reports indexed by PubMed in the last 5 years.

Figure 1

Published case reports since 1980

Table 1

Published case reports from Syrian Medical Institutions

DISCUSSION

This article aims to highlight Syrian medical student's activity in the medical research field, focusing on case reports. Here, we try to explore the main reasons for poor research productivity and possible solutions.

Medical students understanding of being a physician-scientist is crucial. Although they believe in the importance of research, actions toward obtaining opportunities are lacking. Burgoyne et al.[3] stated that medical students have a narrow definition of research and what it entails, according to his study; the majority of medical students who are not interested in a career incorporating research, answered that they will avoid it because of the isolation from patients and clinical practice. In Syria, the only research experience medical students get exposed to during their 6-years medical school is the practical part of preventive medicine during their fifth year, which represents a small cross-sectional study, as part of the curriculum and a mandatory requirement to pass to the sixth year, which lacks any planned intentions to allow student to apply creative ideas or open doors for more discoveries, adding to the fact that schools do not have supportive systems for writing skills or experience in publications.

Diab et al.[4] showed a major deficiency in research productivity in the Syrian medical community. The published medical papers from Syria are in the second level behind agriculture publications, and count only 593 papers which represents the total number of publications from Syrian Medical Institutions.[4] This gap has many reasons; primarily is the lack of research educative materials and support system at the medical schools levels.

The importance of focusing on medical students comes from what Diez et al.[5] demonstrated; medical students who were involved in research projects while they were at the medical school had superior research productivity after graduation. In addition, National Institute of Health (NIH) presented an excellent model[6] when they responded to the alarm they identified with the decreased number of physician-scientists in the United States. Many attempts focusing on MD/PhD programs tried to reverse this trend, but NIH focused on medical students. They reported their experience and success when they sponsored Medical Student Research Fellowship Programs for 25 years at the University of Tennessee Health Science Center and Vanderbilt University, NIH program enrolled medical students in summer research projects with a specific program and scientists mentorship. After follow-up, the vast majority of students conducted additional research after their medical student research experience, and a large number of students were doing research or had published or presented their work at scientific meetings. Many obstacles prevent medical students from conducting research were discussed in the medical literature, but in the Middle East World, a cross-sectional study conducted at the King Saud University in Saudi Arabia[7] showed that lack of professional supervisor, training courses, along with time and funding were the most important causes observed. In Syria, one study evaluated medical students’ educational background in evidence-based medicine (EBM), the authors found a significant positive attitude toward improving EBM knowledge and students requested adding EBM to their medical school curriculum.[8]

CONCLUSION

The multifactorial reasons for lacking case reports productivity in Syria, especially among medical students, fall in the big picture of major deficiency in research and reflect the weak supportive system. Focusing on medical students is strategic and a pivotal step to face the existing reality. Practical research workshops supported by a national board with defined goals, professional supervision by faculty members who have experience in writing skills, introducing attractive and creative opportunities in the school curriculum, are all important requirements for proper environment for future scientists.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.