Abstract
Context: The number of physician-researchers in the United States is in decline. Osteopathic medical schools must examine strategies for increasing the number of trained clinical researchers.
Objectives: To assess the interest of first- and second-year osteopathic medical students in taking an elective research course during their third and fourth years of medical school; and to examine the relationship among students' personal characteristics, previous research experience, and elective research courses.
Design: Fifteen-question, self-administered, cross-sectional survey.
Setting: Edward Via Virginia College of Osteopathic Medicine in Blacksburg in September 2004.
Participants: First- and second-year osteopathic medical students.
Main Outcome Measures: Personal characteristics, previous research experience, and research elective interest (8-week vs 12-week course; and clinical/population vs basic science focus).
Results: The response rate was 83.9% (N=255 [149 first-year students; 106 second-year students]), with 51% women responding. Approximately 72% of students had worked on a research project at some time during undergraduate or medical training, and 42% had completed an undergraduate, data-based thesis. Students reported greater interest in a 12-week elective (34%) than an 8-week elective (23%), and two thirds preferred a clinical and/or population to a basic science focus.
Conclusions: Colleges of osteopathic medicine must develop research training and mentoring programs to foster such interests in their students, and innovative recruitment approaches need to be developed for DO/PhD degree programs. These strategies will help provide meaningful research education and experiences to osteopathic medical students.
The number of physician researchers declined to a 25-year low during the 1990s.
1 As a profession, osteopathic medicine struggles to support the development of physicians with the education and experiences necessary for careers in medical research. Colleges of osteopathic medicine (COMs) must foster the development of a legion of physician researchers to continue our understanding of the human body, the evaluation of potential new therapies, and the creative problem solving necessary to manage health in all of its aspects.
In 2004, the American Association of Colleges of Osteopathic Medicine reported that only 0.2% (N=26) of osteopathic medical students were enrolled in dual DO/PhD programs, and these numbers appear to be declining.
2 And while the DO/PhD track provides one of the most direct avenues for training academic physicians, it is beleaguered by barriers to attracting qualified students.
3 Among these barriers is the extra time needed to complete the program—a minimum of 1 year longer than the DO degree track. At the same time, many students envision an academic appointment as less financially fruitful than full-time medical practice, an important factor when one considers the educational debt load most new practitioners bring to their careers.
4 Still others are concerned about the overwhelming emphasis given to extramural funding and the difficulty achieving it.
5 Although the combined-degree track is a respectable route for the motivated student, it should not be envisioned as the only pathway to medical research.
Not all future researchers need to have completed a dual-degree program. Many of these individuals will engage in industry-sponsored projects, assuming an important role in the project but not in its overall design and management. Still others will be interested in advancing the medical community's knowledge in a specific area of interest, accessing interdisciplinary research networks, and collaborating with colleagues with more advanced backgrounds in methodology and statistics. It is our job as educators and mentors to provide educational opportunities to develop the interests, skills, and experiences that will foster ethical and meaningful research during students' medical school years and beyond.
Structured research opportunities and electives in an academic setting provide the opportunity for future physicians to explore the world of medical science. Such experiences early in training have been shown to positively correlate with long-term, continued research interests.
1,6
As part of the strategic planning process for the research curriculum within the Edward Via Virginia College of Osteopathic Medicine (VCOM) (Blacksburg), we wanted to determine the interest of our first- and second-year osteopathic medical students in an elective clinical research rotation. Licciardone and colleagues
7 published a brief report in 2002 on this topic. In the current study, we sought to determine students' interest in taking a third- or fourth-year summer research elective; to identify their interest in basic science vs clinical and/or population research, and their interest in an 8- vs 12-week course; and to assess the relationship of respondent characteristics and previous research experience to interest in the research elective.
A 15-question self-administered survey was conducted with first-year and second-year students at VCOM during September 2004. Prior to data collection, exempt status was granted for the project by VCOM's institutional review board following review of the study's methods and survey instruments.
All members of the VCOM freshman and sophomore classes were invited to participate in this brief survey. For first-year students, the survey was completed during the first 15 minutes of one lecture hour. The principal investigator (A.M.P.) provided a brief explanation of the project to students and emphasized the voluntary nature of participation. Surveys were handed out and collected by a research assistant (H.L.).
During the study period, VCOM's sophomore class was on a 10-day recess. Using the VCOM mail server, the survey instrument was distributed to the second-year students as an e-mail attachment. The body of the e-mail and the survey tool contained an explanation of the project, the emphasis on voluntary participation, and two options for returning the survey. Respondents could return the completed survey as an e-mail attachment or print a hard copy and return it to the project office after hours.
In an attempt to obtain a more complete response rate, the survey was re-sent to the second-year students following the break using the same process as described for the first-year students. Students were asked to complete the survey only if they had not already done so. First-year students were not given the option to return surveys by e-mail.
The data collection instrument was a two-page, self-completed survey that took approximately 5 minutes to complete (Figure). The data gathered in the survey was categorized into three components:
All data were entered into electronic files and analyzed using SPSS statistical software (version 11.0 for Windows; SPSS, Inc; Chicago, Ill). Descriptive statistics were computed independently for each class of students. Relationships of interest in the research elective and other variables (respondent characteristics, previous research experience) were analyzed using χ2 and Mann-Whitney U tests.
The response rate was 83.9%. Of 304 students, 255 completed and returned the survey (
Table 1). First-year students were more likely than second-year students to respond to the survey (96.8% [149/155] vs 71.1% [106/149]; χ=35.09,
P<.001). Just over half of the respondents in each class were women, a number that is in proportion with the total class makeup.
Most survey respondents identified having been involved with research in one form or another (
Table 2), although there was great variability in the type and extent of experiences. Most first-year and second-year students had taken at least one undergraduate statistics course (69.8% and 73.6%, respectively), and only slightly fewer had taken at least one undergraduate research methods course (63.8% and 59.4%, respectively). Only about two in five had completed a data-based undergraduate thesis, while one in five had gone on to complete some type of graduate program. Of those earning a masters and/or PhD degree, just over half completed a data-based thesis.
Both groups of students favored a 12-week over an 8-week research elective (
Table 3). In all, approximately one third of the students indicated that they were “likely” or “very likely” to participate in a 12-week elective. Students were twice as likely to be interested in a clinical or population-based research elective compared with basic science research. No statistically significant associations were observed between elective interest and other variables (
Table 4).
These data provide a foundation from which VCOM will develop a curriculum that is of interest to students during their third and fourth years of training. The college will then be better able to associate students' intent with their elective selection, research activities, and long-term academic productivity.
Data from future surveys on this topic will provide a stronger foundation for predictive models of personal characteristics, previous research experience, and interest in research electives, which will allow us to better target student interests and justify extramural funding to governmental agencies and nonprofit institutions. Larger sample sizes will allow greater statistical power to bring out, or to diminish, the trends observed in the current data.
On the surface, the data demonstrate a meaningful interest in research on the part of VCOM students. This finding is not unlike that of Licciardone and colleagues
7 and their study of first- and second-year osteopathic medical students. Although their overall response rate was lower than the current report (78% vs 84%), they reported similar rates of interest in a clinical research elective, with one in three students expressing interest in such an opportunity. We did not, however, see the decrease in interest from first-year to second-year students. It should be noted that Licciardone and colleagues
7 purposely focused on clinical research, whereas the current report encompasses human (clinical and/or population) and basic science research interests.
Other reports continue to demonstrate the disparity in the number of female vs male physicians. For example, Lloyd and colleagues
8 found that 34% of 1985–1997 graduates of the Penn State College of Medicine (Hershey) were participating in research projects. Of these respondents, only 28% were women. Our data suggest that women are as interested as men in pursuing opportunities in medical research. It is a challenge to COMs to pay particular attention to fostering the research interests of both male and female students during their training years.
Although this project provides important data for planning and implementation, the results should be interpreted in light of their limitations. Respondents were recruited from only one COM—and one that clearly emphasizes the research aspects of its mission not only to faculty, but also to potential students as they proceed through the interview process.
9
If this mission leads to recruitment of students who have a greater interest in research, it may somewhat undermine the study's external validity. At the same time, there is limited evidence to suggest whether interest in research expressed during the first and second years of medical school is associated with behavior during the last 2 years of training or beyond. Finally, certain terms used in the questionnaire were open to broad interpretation by respondents because of the brevity of the survey instrument. For example, questions on previous research classes and data-based projects were general in their parameters and may have diluted the potential association between past experiences and current interests.
Even with these limitations, we cannot ignore the number of students indicating an interest in this research elective. Providing a solid academic background in research coupled with hands-on experience with a mentored project will develop a cadre of osteopathic physicians with the skills to support multi-institutional research projects. Some of these students will be motivated enough to continue on and develop independent research programs. Either pathway will benefit the osteopathic medical profession and the larger medical community.