Research training during residency.

In India, the 3-year urology postgraduate training also involves doing a research project (written as thesis). A student gets not more than 2 years to do this project as it takes some time for the students to adjust in a new environment after joining, conceptualizing, planning and writing protocol, getting ethical clearances, etc., Furthermore, the project has to be submitted at least 6 months before the exit examination and generally has little or no funding.

Since the student should have an interest in the topic, it is important that this is selected by the student herself/himself under the guidance of his/her mentor (guide). It is expected that the student will collect data honestly and ethically and will not falsify and inflate it. At some institutes, it is mandatory to publish the results of the completed project as an “original article” in an indexed journal. As the project is timebound, many students and guides find it difficult to choose an appropriate topic. Furthermore, after completing the project, the data generated may not be sufficient to address the research question and may fail to get published.

How is new knowledge generated? An important step is to develop the habit of “critical thinking.” It is important that students reflect on whatever they read and do. In Kolb's cycle of learning, reflective observation and abstract conceptualization are essential for “deep learning” [Figure 1].[1] Many Indians are rote learners and therefore acquire only “superficial” knowledge.[2] However, only when students “reflect” or think deeply about a condition, will they develop better understanding about the topic. Reflection is an ongoing process. A learner who is moving in Kolb's cycle will break the cycle into a spiral and new knowledge/insight will emerge [Figure 2]. Thus, for the research to be useful, a student who is doing a project should develop new insight on the topic. The guide should encourage the student for deep learning. It is likely that if a student sincerely executes the project and reflects on it, she/he will develop transformative ideas that can then be published [Figure 2].

Figure 1

Kolb's cycle of learning

Figure 2

Transformative learning

Although numerous original urological articles are published from India, articles describing novel concepts are rare. In 2010, Heldwein et al. published a list of “classic articles.”[3] They identified articles published over a 50-year period between 1955 and 2009 in urology journals and looked at the citations of each article. They labeled articles with more than 100 citations as “classic.” Of 97,554 articles published during this time, 1239 articles were cited more than 100 times. Only 2 articles from India could be identified in this list. My personal communication with the authors revealed that both these articles were by Dr. DD Gaur who designed a simple device to create retroperitoneal space for performing retroperitoneal laparoscopic surgery.[45]

Recognizing the problem of time limitation and funds, students often find it difficult to choose a topic. Retrospective analysis of data is often not the option as the records may be incomplete. Identifying a timebound, prospective meaningful study that does not require funds is a challenge. This problem can partly be overcome if we focus on problems that are relevant for our country.[6] Innovative research on conditions such as chyluria and genitourinary tuberculosis is lacking. For example, a PubMed search using key word “chyluria” shows only 8 articles (1 from India) published in 2017 and 15 articles published in 2016 (4 from India). These numbers are dismal when we realize that more than 40% of the world's burden of lymphatic filariasis (LF) lives in India. Approximately 1100 million people across the globe are living in endemic regions for LF and exposed to risk of infection. The World Health Organization declared LF as a “neglected” tropical disease initiating “The Global Program for Elimination of Lymphatic Filariasis.” Chyluria occurs in up to 10% of patients with filariasis.[789]

In the last few years, the emphasis on publications has increased. This pressure to publish received reinforcement from the Medical Council of India where they made publications mandatory for promotions.[10] It is now probably the right time to inculcate the importance of “deep learning” and “research” among the residents. Rather than the quantity, it is probably more important to focus on quality and choose meaningful topics that are relevant for our community.

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Conflicts of interest

There are no conflicts of interest.