This study was undertaken in Qassim University primarily to assess medical students` perception of barriers to their participation in research. To that end, we first investigated personal and research-related factors that could potentially influence students` perception of various research barriers. Overall, students in the present study demonstrate a moderately positive attitude towards research although they acknowledged its educational benefits. Previous studies in Saudi Arabia, Baharian, Kuwait, Ireland, and New Zealand have shown higher levels of positive attitudes [16, 27–29]. This finding could be explained by the considerably high percentage of the participants who opted to remain neutral to the questions related to research enjoyment (34.8%) and excitement (28.3%) in the attitude domain. Nevertheless, this result indicates that although the majority of participants consider research to be valuable, many of them are hesitant and challenged in their ability to possess positive attitudes towards research. This result might be attributed to anxiety in conducting research, insufficient background knowledge in research or lack of ability to apply research skills in real life. As observed, a substantial number of participants were unsure or less confident about how they perceive research. According to Bandura, self-efficacy influences the way people think [30]. Self-efficacy has been defined in the literature as “the confidence to carry out the courses of action necessary to accomplish desired goals” [31]. Positive attitudes have been linked with higher levels of perceived self-efficacy. It has been stated that when students hold positive attitudes towards a particular subject, they are more likely to possess a higher self-efficacy in studying that subject [32]. Self- efficacy is pivotal for student learning and development [33]. Students who are unconfident in the skills they possess are less likely to take part in activities which require those skills, and are also less likely to continue working on those activities when faced with challenges [34].It is noteworthy however that, background and cultural factors can adversely influence students` views of research. A previous review of the literature revealed lower level of positive attitudes towards research in developing countries compared to developed countries [32].
Concerning the willingness of students to undertake research, we found that 77% of participants were willing to take part in any research-related task. In addition, most of the participants in the current study reported that research is important for their future career. The SaudiMEDs framework for undergraduate medical programs in Saudi Arabia has recommended that learning outcomes for all medical graduates should incorporate research skills to enable them to contribute to the advancement of medical practice [24]. Overall, 80% (184/230) of participants in this study had some prior experience of research. Prior evidence has shown that students who participated in research while still at the medical school demonstrated positive reaction toward their research experiences and contributed positively to the published output of their university [6].
Factors influencing students` motivation and willingness to participate in research whilst at medical school have been discussed in literature. Strong extrinsic motivators include; availability of role models such as faculty members, financial reward, and the widespread perception that research provides a career advantage and enhances their chances of entering specialty training [35].Furthermore, students are intrinsically motivated by feeling of competence, clinical relevance of research and ability to work with a group of colleagues [35]. On the other hand, bureaucracy such as time taken to get ethical approval, lack of self-confidence, limited prior research experience, and uncertainties about the possible outcomes of research constitute important research de-motivators [35]. In our context, offering opportunities for collaborative research work as part of a compulsory course work, in addition to students` interest to improve their research profiles might be the main reasons behind their strong willingness to participate in research. A similar finding has been reported by a previous study in Saudi Arabia [27].
Students, however face enormous research barriers. Firstly, lack of time was reported by the vast majority of students .Our finding is consistent with other studies [15, 18, 27, 36–38]. Given the competing and overwhelming study demands in medical schools, it is unsurprising that lack of time is a big research obstacle facing students. The amount of workload is often burdensome, and there is little time left for research during working hours. In addition, frequent examinations, particularly in a problem-based learning curriculum make students prioritize other demands of the curriculum ahead of research. In such a high-pressure environment it is difficult for students to provide protected time for research, particularly those students with lower levels of academic achievement as observed in our study. Not only time is a challenge for students but also for supervisors. Although completing a group research project is a compulsory component of the curriculum, however the allotted time seems insufficient and research opportunities are limited in scope. Interestingly, in the literature various innovative initiatives have produced encouraging results such as the introduction of a five-year multifaceted program into the undergraduate medical curriculum [39], and the use of a web-based platform to enhance the collaboration between students and faculty on extra-curricular research projects [40].
The second barrier reported by students in this study was lack of supervision and guidance. Prior studies have also addressed this barrier [18]. Inadequate support from supervisors, among other factors has been frequently reported as a main reason preventing students from participation in research despite their awareness of the huge benefits linked to it [12].Similarly, we have found that students who have highly acknowledged the educational benefits of research were more likely to perceive lack of supervision as a barrier. This finding could be attributed to students` expectations. At every stage in the research journey students, particularly those who highly value research expect some kind of support and feedback from supervisors. We can reasonably assume that not meeting the expectations of students could have a negative impact on their engagement in research. A previous analysis revealed that supervisor`s support is one of the most significant factors that encourage students of all levels of study to take part in research projects [41] Another study confirmed that medical students can be encouraged to undertake research with appropriate supervision and support from faculty and administrators [39] However, the intensity of daily workload might limit the number of faculty members who are willing to become research supervisors. It has been recommended that potential benefits, including academic promotion obtained through working with students should be clearly explained to supervisors [42]. Furthermore, securing a pool of supervisors ready to work with students is paramount for supporting student research [43].
Lack of research training was the third research barrier addressed in this study. Although formal research instruction is part of the medical curriculum at Qassim College of Medicine, yet a high number of students perceived lack of training as a barrier. Our analysis further showed that students who hold negative attitudes towards research are more likely to report lack of training as a barrier. This barrier could possibly be a consequence of the above two barriers; lack of time, and lack of supervision. It is very likely that the inadequate time devoted for research instruction within the formal curriculum, absence of extracurricular research training programmes, busy timetables for students and faculty, limited supervisor-student interaction, and inadequate support may have jointly resulted in the negative perception of students towards research training. A variety of initiatives have been described in the literature to strengthen research training during undergraduate years [9, 44, 45]. It has been suggested that providing a built-in research training component within the curriculum seems to be a more realistic goal [11], and has already been implemented in several settings including Saudi Arabia [19]. However, since research interest and competence differ among medical students, an alternative approach would be to offer research opportunities only for volunteers and /or high academic achievers. The latter approach has been followed in different countries worldwide[20,21,23 ]. Lastly, lack of research exposure was investigated in this study. Our findings explicitly show that the over 75% of participants identified lack of research exposure and opportunities as an obstacle to their participation in research. Offering research opportunities for medical students during their undergraduate constitutes a real challenge for many medical schools and has commonly been cited in the literature [12, 15, 36]. Apart from the compulsory research project, limited opportunities are available for students at Qassim College of Medicine. Student engagement in research during the clinical years is largely dependent on the interest of students and availability of supervisors. Interestingly, our analysis showed that lack of opportunity was highly ranked by students who are keen and more willing to conduct research. A previous study proposed a model to explain student motivations to conduct research at various levels during their medical programme based on Self-Determination Theory [35]. It suggested that student motivation to do research is higher among students who have completed a compulsory group research project and have embarked on clinical training [35]. Those conditions typically apply to the cohort of students enrolled in the present study. Therefore, it is plausible to explain the high perception of lack of research opportunities as a barrier among students with their increased motivation to do research.