Knowledge, attitudes, and practices toward research among Oman medical specialty board residents.

OBJECTIVES: The Accreditation Council for Graduate Medical Education has mandated residency programs to teach the basic principles of research in residency programs. This study aimed to assess the research knowledge, attitude, and practice among the Oman Medical Specialty Board (OMSB) residents. Secondarily, it aimed to asses associations between different factors and research-related knowledge, attitude, and practice.
MATERIALS AND METHODS: This cross-sectional study was conducted among all residents who were involved in OMSB various training programs in the academic year 2018/2019. A validated self-administered questionnaire was used. Hard copies of the questionnaire were delivered to residents in addition to the online forms. Data were entered using EpiData entry software and analyzed using SPSS version 24.
RESULTS: A total of 256 residents participated in the study with a response rate of 46.5%. Around 55% of included residents have poor knowledge level, and 44% have moderate knowledge level. The study showed that the majority (93%) of the residents have positive research attitude. However, the practice domain showed that only 27.8% of residents have published articles as first or coauthor. Lack of time was reported as a major hindrance in nearly two-thirds of the residents. Lack of training (56%), lack of research-focused curriculum (47%), and lack of effective supervision (46%) were among major reported obstacles beside others.
CONCLUSIONS: This study showed that OMSB residents have inadequate knowledge and lagging research practices, but a positive attitude toward research. This emphasizes the need for research-focused curricula and further training. In addition, applying new regulations, including mandatory manuscript submission, may improve the practice status. Copyright:

Introduction

Research training is an essential part of medical education to promote critical thinking and reasoning skills and to develop a positive attitude among resident physicians toward their scientific research during their medical career. With a special focus on residency trainees, the Accreditation Council for Graduate Medical Education (ACGME) has mandate residency programs to teach the basic principles of research, beside other scholarly activities.[1] It is thought that research training is linked with better clinical performance, enhanced critical thinking skills, and increased future interest in academic medicine among residents.[23]

A couple of international studies with different results was conducted in different settings to assess knowledge, attitude, and practice toward medical research among residents. Two studies carried out in Canada and Pakistan showed that the majority of residents are unwilling to spend personal time for research.[45] However, two other studies conducted in India and Saudi Arabia showed that residents have a fair knowledge and positive attitude toward research, but has poor practice in conducting research.[67] Another study conducted in Ethiopia reported that attitude toward research was positive, but their knowledge of research made their practice inadequate.[8] A study that assessed physicians’ perceptions and practices toward evidence-based medicine showed that physicians’ knowledge and practice was not up to the acceptable level.[9] Another study conducted among family medicine residents in Saudi Arabia reported that half of the residents were not willing to practice research. It was reported that getting the research published and the lack of statistical support in the same study.[10]

In Oman, the Oman Medical Specialty Board (OMSB) is the only resident training center in Oman. Currently, it trains around 550 residents in 18 medical and surgical residency training programs. As the OMSB follows the ACGME,[11] it takes the responsibility in advancing residents’ knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care.

In the OMSB, research becomes a mandatory component during residency training.[12] Currently, research-related activities in OMSB include monthly journal clubs, couple of research methodology courses, and data analysis training sessions for junior and senior residents, respectively.[13] In addition, residents are assigned two research blocks (rotations of 4-week duration) and offered one-to-one consultations with an epidemiologist/statistician whenever needed.[13] Furthermore, each resident is supervised by a mentor for his mandatory research, and a research subcommittee in each program organizes and monitors all research activities within the program.[13] Therefore, providing evidence of a completed research project became one of the completion of training requirements in the OMSB.[12]

To the best of our knowledge, literature regarding knowledge, attitude, and practice toward medical research among residents is lacking as there is no local studies addressed this issue up-to-date. Therefore, the purpose of this study is to assess the research-related knowledge, attitude, and practice among the OMSB residents in 2018/2019. The secondary objective of the study is to assess the associations between different factors including specialty programs and year of residency with the research-related knowledge, attitude, and practice.

Materials and Methods

Design and target population

This study was a cross-sectional survey, conducted on all OMSB residents in the academic year 2018/2019. All the 552 residents were invited to reach a good response rate.

Data collection

A well-designed questionnaire was used for the survey. The questionnaire was developed initially by the research team, by reviewing previous similar studies and conducting a focus group discussion. Then, the questionnaire was validated using content validation after being reviewed and rectified by subject-matter experts.[14] In addition, the survey was piloted initially on a small number of residents (10 residents) to estimate the time required to complete the questionnaire and to determine the comprehensibility of the questions. Finally, it was refined accordingly and Cronbach's alpha, and content validation ratio (CVR) were calculated to ensure the validity and reliability of the survey tool among the study sample. Cronbach's alpha was reported (using the total sample) to be 0.93 for attitude items and 0.7 for perceived barriers (mean of 0.82 for both). For CVR, items with CVR score of 0.99 were only retained in the final questionnaire.

To increase the response rate, hard copies of the questionnaire were delivered to residents during academic days, journal clubs, and end of rotation meetings in various programs. In addition, online forms were sent through e-mails, with instructions not to duplicate the response if already submitted in any form. The questionnaire consists of 21 multiple choice questions, out of which, 1–7 are knowledge-based, 8–14 are attitude-based, and 15–21 are practice-based questions. All participants were provided with sufficient time to fill the questionnaire. The study objectives and other details were explained to the residents at the time of the survey, and informed consent was obtained as well. For the electronic copy, filling the questionnaire was considered consent, and this was clarified in the cover page of the survey.

Data collection and data entry were done by a trained research team (two residents) who were not among the study participants. Data revision for coding, entry, and cleaning was done before the analysis. Data entered using EpiData entry software.

Data analysis

IBM SPSS Statistics, Version 22.0. Armonk, NY: IBM Corp was used for statistical analysis. A Likert-scale was used to determine resident attitude level (1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree). In addition, mean ± standard deviation (SD) and total score in each dimension (knowledge, attitude, and practice) were calculated. Cutoff points were settled (as shown in results tables) to categorize each dimension into a poor, moderate, or good level. Associations were assessed by Chi-square test and t-test according to the nature of data.

This study was ethically approved by the OMSB Research Ethics Committee.

Results

A total of 256 residents responded to the survey (response rate 46.4%). Among the respondents, 187 (73%) were female and 68 (27%) were male. About one-fourth of them were doing surgical programs and 63% and 11% of them were doing medical and diagnostics programs, respectively. More than half of the included samples were from pediatric, family medicine, emergency medicine, and internal medicine programs. Around half of them were in senior residency years. About 66% got their MD degree from Sultan Qaboos University, 29% from Oman Medical College, and 5% graduated from international colleges. About 55% joined the OMSB within 1 year from MD graduation, 25.3% within 2 years, and around 20% within 3 or more years. Table 1 illustrates the characteristics of the study sample.

Table 1

Distribution of demographic characteristics

Variables	n (%)
Program
Surgical	66 (25.8)
Medical	161 (62.9)
Diagnostics	29 (11.3)
Residency level
Junior (residency year 1-2)	129 (51.0)
Senior (year 3 or above)	124 (49.0)
Residency year level
R1	39 (15.4)
R2	90 (35.6)
R3	64 (25.3)
R4	46 (18.2)
R5	12 (4.7)
R6	2 (0.8)
Gender
Male	68 (26.7)
Female	187 (73.3)
College graduated from
SQU	167 (65.7)
OMC	74 (29.1)
Abroad	13 (5.1)
Time from MD to joining OMSB (years)
1	85 (55.2)
2	39 (25.3)
≥3	30 (19.5)

SQU: Sultan Qaboos University, OMC: Oman Medical College, OMSB: Oman Medical Specialty Board, MD: Medical school graduation

Knowledge and attitude toward research

The mean ± SD, median, and interquartile range (IQR) of the knowledge score w 3.38 ± 1.01 (out of maximum score of 7), 3.0, and 3–4, with minimum of 2 and maximum of 6. The mean ± SD, median, and IQR of the percentage score of the attitude (out of 100%) was 85.33% ± 14.28%, 86.7%, and 80%–96.7%, with minimum and maximum of 20% and 100%, respectively. About 55% of the residents have poor knowledge levels, 44% had moderate, and nearly 1% of them had good knowledge levels. However, 93% of them had a good attitude, 5% had moderate, and only nearly 3% of them had poor attitude levels. Table 2 shows details related to knowledge and attitude levels in the studied sample.

Table 2

Distribution of knowledge, attitude, and practice categorized levels

Domain	n (%)
Knowledge level
Poor (≤3 out of 7 questions)	142 (55.5)
Moderate (4-5 out of 7)	112 (43.7)
Good (>5 out of 7)	2 (0.8)
Attitude level
Poor (≤50%)	7 (2.7)
Moderate (50%-70%)	11 (4.3)
Good (>70%)	238 (93.0)
Published an article as 1st author
Yes	28 (11.0)
No	227 (89.0)
Number of 1st author publications
0	227 (90.4)
1	19 (7.6)
2 (out of the 28 residents who published, 4 did not respond)	5 (2.0)
Published an article as coauthor
Yes	50 (19.8)
No	202 (80.2)
Number of coauthor publications
0	202 (80.5)
1	48 (19.1)
2 (out of the 50 residents who published, 1 did not respond)	1 (0.4)
Published as 1st or coauthor
Yes	71 (27.8)
No	184 (72.2)
Attended a conference
Yes	131 (52.0)
No	121 (48.0)
Presented in a conference
Yes	51 (20.2)
No	201 (79.8)
Residency year of proposal submission of OMSB project
During R1	47 (30.9)
During R2	80 (52.6)
During R3 or above	25 (16.4)
OMSB mandatory project current stage
Not yet submitted a proposal	94 (38.2)
Awaiting ethical approval	19 (7.7)
Got ethical approval	16 (6.5)
Data collection	53 (21.5)
Data analysis	25 (10.2)
Results/manuscript reporting	28 (11.4)
Submitted for publication	11 (4.4)
Involved as a principal investigator in other research
Yes	51 (20.5)
No	198 (79.5)
Involved as coinvestigator in other research
Yes	67 (26.8)
No	183 (73.2)
Days spent in research work during the last research block (1-month rotation)
0-5	34 (20.4)
6-10	38 (22.8)
11-15	39 (23.4)
>15	56 (33.5)

OMSB: Oman Medical Specialty Board

Knowledge level differs significantly between training programs, reaching >90% in some and <30% in others. However, there was no difference in knowledge level between medical, surgical, and diagnostic specialties. Among junior residents, 55% have moderate/good knowledge, compared to 32% of seniors, which was statistically significant (P < 0.001). Other demographic factors, such as gender, time lag between MD graduation and OMSB entrance, and college of graduation, did not show any statistical significance. Table 3 shows the association results between knowledge levels and sociodemographics.

Table 3

Association results between knowledge level and sociodemographics

Variables	Poor knowledge (n=142), n (%)	Moderate/good knowledge (n=114), n (%)	P
Program
Pediatrics	27 (46.6)	31 (53.4)	0.003
Internal medicine	18 (72.0)	18 (28.0)
Family medicine	19 (57.6)	19 (42.4)
Emergency	14 (51.9)	14 (48.1)
Surgery	8 (66.7)	8 (33.3)
Hematology	3 (50.0)	3 (50.0)
Histopathology	3 (50.0)	3 (50.0)
Obstetrics and gynecology	13 (76.5)	4 (23.5)
Microbiology	1 (16.7)	5 (83.3)
Anesthesia	6 (100.0)	-
ENT	4 (28.6)	10 (71.4)
Orthopedics	6 (46.2)	7 (53.8)
Psychiatry	5 (62.5)	3 (37.5)
Radiology	11 (64.7)	6 (35.3)
OMFS	-	2 (100.0)
Ophthalmology	-	2 (100.0)
Dermatology	4 (100.0)	-
Program
Surgical	37 (56.1)	29 (43.9)	0.911
Medical	90 (55.9)	71 (44.1)
Diagnostics	15 (51.7)	14 (48.3)
Residency level
Junior (R1-R2)	58 (45.0)	71 (55.0)	<0.001
Senior (R3 and above)	84 (67.7)	40 (32.3)
Residency year
R1	17 (43.6)	22 (56.4)	0.004
R2	41 (45.6)	49 (54.4)
R3	43 (67.2)	21 (32.8)
R4	33 (71.7)	13 (28.3)
R5	8 (66.7)	4 (33.3)
R6	-	2 (100.0)
Gender
Male	41 (60.3)	27 (39.7)	0.393
Female	100 (53.5)	87 (46.5)
Time lag between MD graduation and OMSB entrance (years)
≤1	51 (60.0)	34 (40.0)	0.577
2	23 (59.0)	16 (41.0)
3 and above	21 (70.0)	9 (30.0)
College graduated from
SQU	84 (50.3)	83 (49.7)	0.094
OMC	47 (63.5)	27 (36.5)
Abroad	9 (69.2)	4 (30.8)
Attitude level
Poor/moderate	12 (66.7)	6 (33.3)	0.462
Good	130 (54.6)	108 (45.4)

ENT: Ear-nose-throat, OMFS: Oral and maxillofacial surgery, SQU: Sultan Qaboos University, OMC: Oman Medical College, OMSB: Oman Medical Specialty Board, MD: Medical school graduation

We did not observe any statistically significant association between various studied factors, including residency programs, residency levels, gender, time lag between MD graduation and OMSB entrance, and college of MD graduation with the attitude levels (P > 0.05). Table 4 shows detailed association results between attitude levels and sociodemographics.

Table 4

Association between attitude level and sociodemographics

Variables	Poor/moderate (n=18; ≤70%), n (%)	Good (n=238; >70%), n (%)	P
Program
Pediatrics	4 (6.9)	54 (93.1)	0.899
Internal medicine	2 (8.0)	23 (92.0)
Family medicine	4 (12.1)	29 (87.9)
Emergency	2 (7.4)	25 (92.6)
Surgery	1 (8.3)	11 (91.7)
Hematology	-	6 (100.0)
Histopathology	1 (16.7)	5 (83.3)
Obstetrics and gynecology	1 (5.6)	16 (94.1)
Microbiology	-	6 (100.0)
Anesthesia	-	6 (100.0)
ENT	-	14 (100.0)
Orthopedics	1 (7.7)	12 (92.3)
Psychiatry	-	8 (100.0)
Radiology	2 (11.8)	15 (88.2)
OMFS	-	2 (100.0)
Ophthalmology	-	2 (100.0)
Dermatology	-	4 (100.0)
Program
Surgical	3 (4.5)	63 (95.5)	0.561
Medical	12 (7.5)	149 (92.5)
Diagnostics	3 (10.3)	26 (89.7)
Residency year
R1	3 (7.7)	36 (92.3)	0.857
R2	5 (5.6)	85 (94.4)
R3	4 (6.3)	60 (93.8)
R4	3 (6.5)	43 (93.5)
R5	2 (16.7)	10 (83.3)
R6	-	2 (100.0)
Residency level
Junior (R1-R2)	8 (6.2)	121 (93.8)	0.805
Senior (R3 and above)	9 (7.3)	115 (92.7)
Gender
Male	4 (5.9)	64 (94.1)	0.787
Female	14 (7.5)	173 (92.5)
Time lag groups (years)
≤1	6 (7.1)	79 (92.9)	0.398
2	1 (2.6)	38 (97.4)
>2	3 (10.0)	27 (90.0)
College graduated
SQU	13 (7.8)	154 (92.2)	0.284
OMC	3 (4.1)	71 (95.9)
Abroad	2 (15.4)	11 (84.6)
Knowledge level
Poor (≤3)	12 (8.5)	130 (91.5)	0.462
Moderate (4-5)	6 (5.3)	108 (94.7)

ENT: Ear-nose-throat, OMFS: Oral and maxillofacial surgery, SQU: Sultan Qaboos University, OMC: Oman Medical College

In relation to the perceived barriers, nearly two-thirds of the studied residents reported insufficient time as a major hindrance to pursue research, 42% reported lack of technical and logistic supports (including financial support), 46% reported lack of effective supervision, 56% reported lack of training skills, 43% reported resident lack of interest, and 47% reported lack of research-focused curriculum as major hindrances. Table 5 shows the frequency distribution of perceived barriers.

Table 5

Distribution of perceived barriers

Type of barrier	Not a hindrance, n (%)	Minor hindrance, n (%)	Major hindrance, n (%)
Time	17 (6.6)	77 (30.1)	162 (63.3)
Technical and logistic support (including financial support)	26 (10.2)	123 (48.0)	107 (41.8)
Supervision	33 (12.9)	106 (41.4)	117 (45.7)
Training skill	18 (7.0)	96 (37.5)	142 (55.5)
Resident lack of interest	20 (7.8)	127 (49.6)	109 (42.6)
Curriculum	28 (10.9)	108 (42.2)	120 (46.9)

Research-related practice among residents

Nearly one-third of the residents have published an article as the first author or as coauthors. 11% of them published as first author and around 20% published as coauthors. Around 52% have attended conferences, out of which, 20% presented in conferences. At the time of this study, nearly two-thirds (62.5%) of them have submitted their proposals related to the OMSB mandatory project, out of which, around 31% only submitted during their first residency year. About 47% of the residents were involved as principal investigators or as coinvestigators in other research projects.

Around 15.8% of residents are in manuscript writing publication stage, however, residents who are currently in their R4 or above constituted 23.7% of the total sample. Nearly 43% of residents who were assigned a research block, spent <10 days working on their research projects in the whole block. However, around one-third of them only spent more than 15 days. Table 3 illustrates the detailed patterns of research practices among residents.

Discussion

This is the first study done in Oman addressing the research-related knowledge, attitude, and practice among the OMSB residents. Results from this study showed inadequate knowledge and lagging practices among residents toward research but highlighting a good research attitude.

In this study, we found that the knowledge level in research among residents was ranging from poor to moderate, and very low proportion showed good knowledge level. This result is in consistency with another study conducted in Ethiopia and Pakistan.[815] On the other hand, another study conducted in India showed higher knowledge level than our study.[6] This variation may be related to difference in research training, availability of resources, and resident-related factors such as interest of doing research. In this regard, medical schools should strengthen research training in their curricula, allowing better chance for understanding research concepts among graduating doctors before joining residency training. However, residency programs should also review their research curricula and academic activities related to research.

In addition, we observed that there is a significant difference between junior and senior residents in the level of knowledge which can be explained by ongoing development in research training across residency years. In addition, there was a significant difference in knowledge level between training programs, reaching >90% in some, and <30% in others which may be attributed to a higher competition and acceptance requirement in different training programs to some extent. However, this may reflect the differences across different training programs in the research curricula. This issue should be given more attention in future studies.

In relation to other factors, such as gender, time lag between MD graduation and OMSB entrance, and college of graduation, there was no significant difference in knowledge level across different categories of these factors.

Most of the residents in our study showed positive attitude toward research. They agreed that research is essential in the practices of medicine and patient care. The majority of the residents believed that research is an important part of training program and they are willing to do research in future. This is consistent with a study done in Saudi Arabia which found that around 93.7% believed that research should be a mandatory part during residency.[7]

In addition, our study found that the research practice domain is lagging among OMSB residents as the number of publication output was very low and a great proportion were late in their research stage related to their OMSB mandatory project. Furthermore, a small percentage of residents participated in research before residency years. In contrast, a study done in Saudi Arabia found that around 30.4% had conducted research during residency,[7] which is consistent with the observation in the present study. This lag in research practices may be attributed partially to the lagging regulations applied for the minimum requirements of residency graduation in different setting.

The major perceived barriers of doing research among residents observed in this study are lack of time (63.3%), lack of training (55.5%), and lack of research-focused curriculum (46.9%). Similarly, these barriers were observed in other studies conducted in India and Saudi Arabia.[67] These barriers should be addressed by training programs by reviewing research curricula, increasing the allocated time, and providing more research training opportunities. In addition, residents should be allocated sufficient time during which they should not be hindered with in-house calls and other clinical activities.

However, two other studies done in Canada and Pakistan showed that the most of residents are not interested to spend time doing research.[45] Other barriers, such as lack of technical and logistic supports and lack of effective supervision, were also reported and should be given more attention. Therefore, research supervisors should be equipped with research knowledge and skills. In this regard, keeping research training records should be taken in consideration when recruiting research supervisors. In addition, trainers should spend reasonable time in their research supervision and should actively participate in sharing research knowledge and skills with their residents.

This study is not limitation free. The relatively low response rate is a common problem in surveys. However, the investigators have used different means to reach the target population, taking into consideration that using Slovin's formula the required sample size is around 227. Second, the number of items for each domain in the validated questionnaire was shorten to around seven items. However, this was decided among the research team and the subject matter experts who validated the questionnaire to shorten the time required for filling the survey, which may affect the subject participation dramatically.

Conclusions

This study is the first of its kind in OMSB and of great importance to review the research needs for training residents and their supervisors in the near future. This study showed that OMSB residents have inadequate knowledge and lagging research practices, but have positive attitudes toward research. In the light of this study results, research training should be started early before residency training and should be reinforced during residency. Moreover, research mentors should be equipped with research knowledge and skills.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.