Perceptions, barriers, and practice of medical research of family medicine residents in Medina, Saudi Arabia.

BACKGROUND: Health research training is an important part of medical education. The aim of this study was to assess the perceptions, barriers, and practices of medical research of family medicine residents in Medina, Saudi Arabia.
MATERIALS AND METHODS: A cross-sectional study was conducted among family medicine residents in the Joint Program of Family Medicine Post-Graduate Studies in Medina, Kingdom of Saudi Arabia. The data was collected using a validated tool. SPSS was used for data analysis; frequencies and percentages obtained for categorical variables. Student's t-test and ANOYA performed to compare attitude score by sociodemographic variables. Chi-square test was to assess association between attitude and motivation with gender; all test performed at 0.05 significance level.
RESULTS: One hundred residents participated in this study with a response rate of 76%. Forty-seven percent were men, 58% were year 1 or year 2 residents, 52% were 27 years or younger, and 65% were married. The males had a significantly higher average attitude score (45.2 ± 6.5) than the females (42.0 ± 6.9, P = 0.02). About half of the residents were not willing to conduct research. Seventy-five of participants had done some research (75%). A cross-sectional study design was the most common type of study that had been used by participants (71%). More than half (58%) had done the research because it was obligatory in the curriculum. The most important barriers to medical research were difficulty in publishing (37%) and the lack of statistical support (36%).
CONCLUSIONS: The male residents had more positive attitude toward research. Half of the residents were not willing to conduct research. The main barriers were difficulty in getting the research published and the lack of statistical support. Copyright:

Introduction

The research activity of postgraduate medical trainees promotes better clinical care, critical reasoning, and lifelong learning.[1] Training in health research is, therefore, an important part of medical education.[23] To conduct research, adequate knowledge, practical skills, and the right attitude are essential.[4] Previous studies of physicians in Kingdom of Saudi Arabia (KSA) and India showed a positive attitude toward research.[567] The majority of resident doctors undertake research projects in the 2nd or 3rd years of residency.[7] In India, the percentage of residents who had done research as shown in previous studies ranged from 4% to 31%.[78] The lack of research training, lack of time, work-related stress, and lack of supervisors were perceived as barriers to doing research.[56791011] Case reports were the main types of research projects that residents had participated in.[5] The major motivation for the conduct of research was to improve patient care.[10] A review of literature showed that there is no data related to attitude, practice, and barriers for family medicine residents in Medina, KSA against medical research. This study's aim was to assess this in family medicine residents.

Materials and Methods

This cross-sectional study was conducted among 132 family medicine residents in the Joint Program of Family Medicine Post-Graduate Studies, Medina, KSA, between October and January 2018–2019. The residency program is currently composed of 3 years of in-hospital training and a year at a primary health-care center. Residents begin their research in the 2nd year of residency. Residents of all levels from year 1 to year 4 were approached.

The questionnaire used in this study was a validated tool that had been used in several previous studies.[1213] Questionnaire was sent to participants via email and comprised of four sections. First part included sociodemographic characteristics such as age, gender, academic year, and marital status. The second part had 14 items that assessed residents' attitude to research. Each item was answered on a 5-point Likert scale and ranged from 1 (strongly disagree) to 5 (strongly agree). All questions on attitude were summed up to obtain the total attitude score. The third part assessed the research practice of participants such as publication, oral and/or poster presentation. The last part investigated the barriers that discouraged residents from conducting or participating in research.

The analysis was done using Statistical Package for the Social Sciences (SPSS®) (version 22.0, IBM, Armonk, NY, USA). Descriptive statistics was used to obtain frequency and percentage for categorical variables, and obtain mean and standard deviation for continuous variables. Test of normality was performed for the total attitude score. Test of internal consistency of the total attitude score yielded a Cronbach alpha = 0.87. ANOVA test and t-test were used to assess the associations between the attitude score and sociodemographic variables. Chi-square test was employed to compare practice and motivation between males and females. A P < 0.05 was used as the level of significance.

Ethical approval for the study was obtained from the Institutional Review Board in AL Madinah. Participation in this study was completely voluntary, and confidentiality and anonymity assured. Written consent was obtained from those who agreed to participate.

Results

One hundred residents out of 132 agreed to participate in this study, giving a response rate of 76%. Majority were females,52% were aged 27 years or less, highest percentage of the residents was in R1 level (32%), and 65% married [Table 1].

Table 1

Sociodemographic characteristics of the family medicine residents in Medina (n=100)

Characteristics	Number (%)
Age (years)
≤27	52 (52.0)
>27	48 (48.0)
Gender
Male	47 (47.0)
Female	53 (53.0)
Residency year
R1	32 (32.0)
R2	26 (26.0)
R3	25 (25.0)
R4	17 (17.0)
Marital status
Single	35 (35.0)
Married	65 (65.0)

Table 2 shows the association between attitudes and sociodemographic characteristics. The average attitude score for the males was significantly higher (45.2 ± 6.5) compared to the females (42.0 ± 6.9, P = 0.02). There was no significant association between attitude and other sociodemographic characteristics.

Table 2

Comparison of family medicine residents attitude scores by sociodemographic characteristics

Variables	Mean±SD	P-Value
Age (years)
≤27	43.6±6.4	0.933
>27?	43.5±7.6
Gender
Male	45.2±6.5	0.02
Female	42.0±6.9
Residency year
R1	42.8±5.7	0.092
R2	42.5±6.1
R3	43.9±6.3
R4	43.5±9.7
Marital status
Single	43.8±7.0	0.746
Married	43.3±6.9

SD=Standard deviation

Of the 100 participants, 48% agreed that the 2nd year of residency was the best time to start practice in research. About half of the residents did not want to do any research. Seventy-five of participants had done some research. Only six residents had undertaken more than three research projects (7.7%). Of those, who had participated in research, 62 (79.5%) had done so in data collection and 45 (57.7%) in literature review and the writing of a proposal. A cross-sectional study was the most common type of study design undertaken by participants (90.7%). The majority of residents did not read medical journals regularly (81%). Less than half (43%) had any publication in a journal and 39% had presented posters or research papers at a conference. Most of them (69%) would carry out research in the future, but would not choose research as a career option [Table 3]. After stratifying by gender, there were no significant differences between male and female except in the writing of proposals. Males were more likely to engage in the writing of proposals (P = 0.003) [Table 4].

Table 3

Practices of family medicine residents in Medina towards research

Questions	Yes N (%)	No N (%)
Are you willing to participate in a workshop on research methodology	66 (66.0)	34 (34.0)
Are you willing to conduct clinical-related research?	44 (44.0)	56 (56.0)
Are you willing to conduct community-related research?	45 (45.0)	55 (55.0)
Have you participated in research?	75 (75.0)	25 (25.0)
Do you read journals regularly?	19 (19.0)	81 (81.0)
Do you have any publication in a journal?	43 (43.0)	57 (57.0)
Have you presented a poster or research paper at a conference?	39 (39.0)	61 (61.0)
What was your contribution in the research project you participated in? (n=75)
Literature review	45 (57.7)	30 (40.0)
Proposal writing	43 (57.3)	32 (42.7)
Data collection	62 (79.5)	16 (20.5)
Data entry	43 (57.3)	32 (42.7)
Data analysis	29 (38.7)	46 (61.3)
Writing the manuscript	29 (38.7)	46 (61.3)
Submission of the manuscript to the journal	22 (29.3)	53 (70.7)
What type of research project have you participated in? (n=75)
Case report	6 (8.0)	69 (92.0)
Case series	0	75 (100)
Cross-section	68 (90.7)	7 (9.3)
Case-control	3 (4.0)	72 (96.0)
Clinical trial	6 (8.0)	69 (92.0)
Review article	0	75 (100)

Table 4

Research practices of family medicine residents in Medina by gender

	Male		Female		OR (95% CI)	P-Value
	Yes N (%)	No N (%)	Yes N (%)	No N (%)
Are you willing to participate in a workshop on research methodology	34 (72.3)	13 (27.7)	32 (60.4)	21 (39.6)	1.7 (0.7-4.0)	0.208
Are you willing to conduct clinical-related research?	21 (44.7)	26 (55.3)	23 (43.4)	30 (56.6)	1.1 (0.5-2.3)	0.897
Are you willing to conduct community-related research?	23 (48.9)	24 (51.1)	22 (41.5)	31 (58.5)	1.4 (0.6-3.0)	0.456
Have you participated in research?	36 (76.6)	11 (23.4)	39 (73.6)	14 (26.4)	1.2 (0.5-2.9)	0.728
Do you read journals regularly?	11 (23.4)	36 (76.6)	8 (15.1)	45 (84.9)	1.7 (0.6-4.7)	0.290
Do you have a publication in a journal?	22 (46.8)	25 (53.2)	21 (39.6)	32 (60.4)	1.3 (0.6-3.0)	0.469
Have you presented a poster or a research paper at a conference?	21 (44.7)	26 (55.3)	18 (34.0)	35 (66.0)	1.6 (0.7-3.5)	0.273
What was your contribution in the research project you participated in? (n=75)
Literature review	24 (66.7)	12 (33.3)	21 (53.8)	18 (46.2)	1.7 (0.7-4.4)	0.258
Proposal writing	27 (75.0)	9 (25.0)	16 (41.0)	23 (59.0)	4.3 (1.6-11.6)	0.003
Data collection	31 (86.1)	5 (13.9)	31 (79.5)	8 (20.5)	1.6 (0.5-5.4)	0.449
Data entry	21 (58.3)	15 (41.7)	22 (56.4)	17 (43.6)	1.1 (0.4-2.7)	0.866
Data analysis	13 (36.1)	23 (63.9)	16 (41.0)	23 (59.0)	0.8 (0.3-2.1)	0.662
Writing the manuscript	15 (41.7)	21 (58.3)	14 (35.9)	25 (64.1)	1.3 (0.5-3.2)	0.608
Submission of the manuscript to the journal	14 (38.9)	22 (61.1)	8 (20.5)	31 (79.5)	2.4 (0.9-6.9)	0.081
What type of research project have you participated in? (n=75)
Case report	3 (8.3)	33 (91.7)	3 (7.7)	36 (92.3)	1.1 (0.2-5.8)	0.919
Case series	1 (2.8)	35 (97.2)	0 (0)	39 (100)	1 (0.9-1.0)	0.295
Cross-section	35 (97.2)	1 (2.8)	33 (84.6)	6 (15.4)	6.4 (0.7-55.7)	0.061
Case-control	1 (2.8)	35 (97.2)	2 (5.1)	37 (94.9)	0.5 (0.04-6.1)	0.604
Clinical trial	4 (11.1)	32 (88.9)	2 (5.1)	37 (94.9)	2.3 (0.4-13.5)	0.340
Review article	0 (0)	36 (100)	1 (2.6)	38 (97.4)	1.0 (1.0-1.1)	0.333

OR=Odd ratio, CI=Confidence interval

About 50% of residents felt motivated to conduct research to improve their research skills, and more than half (58%) conducted research because it was compulsory (part of the curriculum) [Table 5]. After stratifying by gender, males were more likely to be motivated by the following: “positive achievement on curriculum vitae” (P = 0.002), improves research skills (P = 0.009), and “to have research published” [Table 6].

Table 5

Motivation of family medicine residents in Medina to conduct research (n=100)

Questions	Yes %	No %
What motives you to conduct research?
Because it is compulsory (part of the curriculum)	58	42
Fulfill your interest in research	24	76
Facilitate your acceptance into the residency program of choice	35	65
Positive accomplishment on your CV	52	48
Improve your research skills	50	50
To have your research published	35	65

CV=Curriculum vitae

Table 6

Motivation of family medicine residents in Medina to conduct research, stratified by gender

	Male		Female		OR (95% CI)	P-Value
	Yes N (%)	No N (%)	Yes N (%)	No N (%)
What motivates you to conduct research?
Because it is compulsory (part of the curriculum)	25 (53.2)	22 (46.8)	33 (62.3)	20 (37.7)	0.7 (0.3-1.5)	0.359
Fulfill your interest in research	15 (31.9)	32 (68.1)	9 (17.0)	44 (83.0)	2.3 (0.9-5.9)	0.081
Facilitate your acceptance into a residency program of choice	19 (40.4)	28 (59.6)	16 (30.2)	37 (69.0)	1.6 (0.7-3.6)	0.284
Positive accomplishment in your CV	32 (68.1)	15 (31.9)	20 (37.7)	33 (62.3)	3.5 (1.5-8.1)	0.002
Improve your research skills	30 (63.8)	17 (36.2)	20 (37.7)	33 (62.3)	2.9 (1.3-6.6)	0.009
To have your research published	23 (48.9)	24 (51.1)	12 (22.6)	41 (77.4)	3.3 (1.4-7.7)	0.006

OR=Odds ratio, CI=Confidence interval, CV=Curriculum vitae

The most important barriers that deter residents from the conduct of medical research were the difficulty in publishing research during residency (37%), followed by lack of statistical support (36%). The barriers to conducting research least mentioned were the lack of funding (7%) and the absence of rewards and motivation (6%) [Table 7].

Table 7

Barriers deterring family medicine residents in Medina from conducting research

Obstacles	Totally disagree %	Disagree %	Neutral %	Agree %	Totally agree %
Lack of interest	17	11	25	29	18
Lack of time due to being over-burdened with educational activity including examinations	8	15	21	24	32
Inadequate facility for research	8	13	26	21	32
Difficulty in transportation	19	37	9	21	14
Gender of the resident	28	38	10	18	6
Other personal commitments such as marriage, family.	13	22	27	19	19
Lack of interest by the program/guide	12	11	36	23	18
Lack of reward and/or motivation	6	14	24	26	30
Inadequate support by mentors/assistants	12	14	28	22	24
Lack of research curriculum	15	14	26	18	26
Difficulty in obtaining a research supervisor	17	18	17	19	29
Inadequate training in research during residency	12	10	26	22	30
Lack of statistical support	12	10	18	24	36
Inadequate financial support	7	9	25	24	35
Lack of allocated research time	25	34	15	17	9
Difficulty in obtaining approval for the study	14	19	24	19	24
Unavailability of the samples (or patients)	9	24	21	25	21
Difficulty in following up study subject (or patients)	27	41	10	18	4
Poor accessibility to database (files)	11	9	25	25	30
Difficulty in presenting research during residency	15	7	24	23	30
Difficulty in publishing research during residency	10	9	23	21	37
Acknowledgment for contribution to research	14	34	13	18	21

Discussion

The aim of this study was to assess the perceptions, barriers, and practices of medical research of family medicine residents in Medina, Saudi Arabia.

Our study found that male residents exhibited a significantly higher positive attitude towards research than females. Other surveys support this finding.[1014] In this study, more than half of the residents had no publication in a journal (57%). This finding was comparatively lower than what was reported by an earlier Indian study in which 85% of residents had no publication.[15] Another study reported that 96% of tertiary care hospital residents had no publications.[7]

Research is an extremely crucial element in the advancement and improvement of health care services provided to the public.[13] In this study, 69% of the participants said they would carry out research in the future. This finding was lower in comparison to a previous study[15] which found that 88% of the study population would carry out research in the future. Our study found that only 39% of residents had done poster presentations or read a research paper at a conference. This finding was lower than the study reported by Pawar et al.[7] in which 44% of the participants had made poster presentations or read a research paper at a conference.

The major reasons cited for the paucity of research activity in this study are the difficulty in publishing research during residency and the lack of statistical support while in a study of Jordanian family physicians[11] the lack of time (68.8%) was the main barrier. Similar findings were also reported in a previous Indian study.[15] Some of the ways to facilitate the publication of research are the shift of the emphasis of postgraduate education from the theoretical, and the provision of assistance to residents in gaining access to journals. The lack of statistical support was the second barrier, so providing the assistance of statisticians could solve the problem.

This study has a number of limitations. Residents from only one city were the study subjects, so future research will have to be a multi-city design to assess the extent to which it is possible to generalize the results of this study to cover all family medicine residents in KSA.

Conclusions

The positive attitude score was <50% and was higher among male residents. The majority of residents did some research. The main barriers were the difficulty in publishing research and the lack of statistical support. There is a need to improve the existing medical education system to foster research culture among residents. Residents should be given full support with statistical analysis and publication.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.