Abstract
Context: According to a 2014 survey, 59% of students entering allopathic medical school reported previous research experience. However, limited data exist on the amount of research experience that students have before entering osteopathic medical school. A strong understanding of the research skills and level of interest of first-year osteopathic medical students is essential for developing research programs at osteopathic medical schools. Limited data exist on the amount of research experience that students have before starting osteopathic medical school. A strong understanding of the research skills and level of interest of first-year medical students is essential for developing research programs at osteopathic medical schools.
Objective: To determine the amount of previous research experience of first-year osteopathic medical students, their level of interest in participating in research during medical school, the factors influencing their interest in research, and their research fields of interest.
Methods: First-year osteopathic medical students (class of 2019) at the Western University of Health Sciences, College of Osteopathic Medicine of the Pacific in Pomona, California (WesternU/COMP), and Pacific-Northwest in Lebanon, Oregon (WesternU/COMP-Northwest), campuses were surveyed about their previous research experiences and whether they were interested in participating in research during medical school. Surveys were administered through an anonymous online portal. Responses were evaluated for evidence of interest in conducting research.
Results: Of the 346 osteopathic medical students invited to participate in the study, the response rate was 77% (N=266). A total of 167 from WesternU/COMP and 99 from the WesternU/COMP-Northwest responded. More than 215 students (81%) reported they had participated in research before entering medical school. In addition, 200 students (75%) either expressed a strong interest in participating in research during medical school or were currently conducting research. Among research areas, clinical research was the overwhelming favorite, with 218 students (82%) expressing interest.
Conclusion: First-year osteopathic students may have comparable amounts of research experience as allopathic medical students. Although these findings are limited to 2 campuses of 1 osteopathic medical school, they suggest that first-year osteopathic medical students are highly motivated to participate in research while in medical school.
Osteopathic physicians (ie, DOs) in the United States are granted the same rights and privileges in practicing medicine as their allopathic (ie, MD) counterparts; however, the difference between the 2 types of physicians begins soon after entering medical school. Although unique skills in manual diagnosis and treatment are provided at osteopathic medical schools, greater emphasis is placed on research at allopathic medical schools.
2 To understand the origin of this disparity, an assessment of the research experiences of first-year osteopathic medical students and their level of interest in conducting research while in medical school needs to be determined. Such information might identify specific differences in the perceptions of allopathic vs osteopathic medical students with regard to research. With the single graduate medical education accreditation system, the promotion of research in osteopathic medical schools may not only be important to advance the osteopathic medical field, but also may ensure that osteopathic medical students are equally competitive as their allopathic counterparts for residency programs.
Studies have shown that research experience is a consistent characteristic of graduating medical students who place into residency training programs for competitive specialties.
3,4 A survey of program directors showed that participation in research is an important factor used in the selection of applicants for interviews, with an overall score of 3.7 on a 5-point scale where 5 is considered “very important.”
5 A report from the National Resident Matching Program (NRMP) showed that senior allopathic medical students from allopathic medical schools in the United States who applied to residency programs had an average of 2.8 research experiences, with 90% reporting at least 1.
3 Allopathic medical students are actively participating in research during their medical training; the research experiences of first-year allopathic medical students increased by 1.5-fold (59% vs 90%) by the time they graduated medical school.
4 In contrast, 2014 data for osteopathic programs from the National Matching Services Inc indicated that only 47% of osteopathic medical students who matched into their first-choice program had at least 1 research experience,
6 and data on the research experiences of the first-year class of osteopathic medical students were unavailable. Taken together, these findings indicate a need to obtain more information on the research experiences of osteopathic medical students to better prepare them for applying to residency programs.
The Association of American Medical Colleges (AAMC) tracks research experiences of first-year medical students as part of their annual survey of allopathic medical schools.
4 Although a similar survey is conducted by the equivalent osteopathic organization—the American Association of Colleges of Osteopathic Medicine—data on research experience is not reported.
7 The 2014 AAMC survey found that many students who entered allopathic medical schools had previous research experience (59%), and of those who spent a year or more between college and entering medical school, many (48%) reported spending the interim period working or volunteering in research. Because applicant pools for allopathic and osteopathic medical schools overlap, it is assumed that osteopathic medical school applicants have similar experiences; however, to the authors’ knowledge, the extent is unknown.
The American Osteopathic Association’s Council on Research stated in the
2013-2022 Research Strategic Plan for the Osteopathic Medical Profession that one of its principles is “to enable a culture of osteopathic research within the osteopathic family. To be successful in this regard, all facets within the osteopathic medical profession must actively support clinical and translational research.”
8
In a similar regard, Clark and Blazyk
2 advocated for a “culture of inquiry and scientific exploration” in osteopathic medical schools. When assessing the state of research at osteopathic medical schools, 1 factor that has yet to be reported is the perceptions of first-year students toward research. What are their levels of research experience before entering medical school? What is their level of interest in research while in medical school? Are they specifically interested in certain areas of research? In the present study, we sought answers to these questions, which we believe will provide important insight into how to specifically invigorate research within the osteopathic medical profession.
We used a descriptive survey study design to investigate the previous research experiences and current perceptions of research from 2 first-year campus cohorts of a single osteopathic medical school. The Institutional Review Board at Western University of Health Sciences approved this project. First-year osteopathic medical students in the class of 2019 at both campuses of the Western University of Health Sciences, College of Osteopathic Medicine of the Pacific in Pomona, California (WesternU/COMP), and Pacific-Northwest in Lebanon, Oregon (WesternU/COMP-Northwest), who had entered medical school 3 weeks earlier were sent an e-mail inviting them to voluntarily participate in an institutional review board–approved anonymous survey on research interests. The invitation provided basic information about the study as well as a statement indicating that submission of the survey by a student constituted informed consent. At the end of the e-mail invitation, a hyperlink to the survey was placed. The survey was administered by the online survey service SurveyMonkey, which allowed for anonymous data collection and concealment of the participants’ identities.
The survey consisted of 11 items: 10 multiple choice questions, with select questions allowing for participants to write in responses, and 1 question asking participants to input their age. Students were provided 15 minutes during a course lecture to complete the survey. The survey remained open for 2 weeks, after which the data were recorded. One reminder e-mail was sent on the last day of the survey. Incomplete responses were excluded from analysis. Data were analyzed with Prism 6 (GraphPad Software, Inc). A 2-tailed χ
2 test was used in most cases, with the exception of Mann-Whitney, which was used to compare age with interest in research. All tests were evaluated at a .05 significance level.
Of the 346 students invited to participate in the study, 266 (76.9%) responded, with 167 of 234 students (74.6%) from the Pomona, California, campus and 99 of 112 students (88.4%) from the Lebanon, Oregon, campus. The sample consisted of 129 men and 137 women with an age range of 21 to 43 years. Forty students (15%) had a graduate or professional degree.
A majority of students (216 [81.2%]) reported that they participated in research before entering osteopathic medical school and, of those, 123 (56.9%) had their research published or presented. When asked if they were interested in participating in research while attending medical school, 200 (75.2%) either expressed interest or were currently participating in research. These responses were then assessed for statistical significance by comparing them with students who were not interested in research (
Table 1).
Sex and age did not significantly influence students’ interest in participating in research during osteopathic medical school (P=.78; P=.74, Mann-Whitney, respectively). Moreover, the field of the students’ bachelor’s degree (basic science vs other: OR, 1.27; 95% CI, 0.69-2.35; P=.44), an advanced degree (OR, 1.21; 95% CI, 0.58-2.52; P=.61), and previous publication (OR, 1.58; 95% CI, 0.89-2.77; P=.12) also did not influence students’ interest in participating in research during medical school. However, previous research experience was significantly associated with current interest (OR, 2.46; 95% CI, 1.28-4.73; P=.006). Of the students with previous research experience, 200 (79%) were interested in or were currently participating in research compared with 66 students (60%) with no research experience. Analysis of a 2×2 contingency table found that the odds of students with previous research experience (interested or currently participating in research) were estimated to be 2.5 times greater than that of students with no previous research experience (OR, 2.46; 95% CI, 1.28-4.73).
Students were asked to choose 1 or more factors that would prevent them from participating in research (
Table 2). Most students (232 [87.2%]) expressed concern about performance in their coursework as the greatest discouraging factor. This answer was followed by difficulty finding a mentor (77 [28.9%]), lack of information about research opportunities (70 [26.3%]), preference for other extracurricular activities (56 [21.1%]), lack of interest (49 [18.4%]), and other (12 [4.5%]). The 12 “other” comments primarily pertained to other obligations, such as spending time with family and military service.
Students were also queried as to the benefits of participating in research while in osteopathic medical school (
Table 2). A majority (242 [91.0%]) indicated that research participation would help them apply for residency. This explanation was followed by building their curriculum vitae (197 [74.1%]), educational value (189 [71.1%]), interest in doing research as a physician (111 [41.1%]), and other (4 [1.5%]). The “other” responses included wanting to “do research that will help illuminate public health issues in the community,” “increasing knowledge of the medical community,” “gain more experience in several ways,” and “enjoy [research] as a hobby.”
The last question, asking students about their research field of interest, allowed students to select 1 or more areas of research (
Figure). An overwhelming majority of students (218 [82.0%]) selected clinical research. This response was followed by basic science (141 [53.0%]), osteopathic manipulative medicine (OMM; 94 [35.3%]), social science (93 [35.0%]), anatomical research (75 [28.2%]), other (10 [3.8%]), and no interest in research (11 [4.1%]). Of the “other” responses, 5 students stated they were interested in public health research, 1 in health care policy, 1 in medical technology and biomedical engineering, 1 in autism research and neurodevelopment, 1 in sports medicine, and 1 in HIV and infectious disease research.
When addressing the lower research participation by students in osteopathic medical schools compared with their allopathic counterparts,
2 it is important to consider whether this disparity is a result of differences between the 2 medical programs or of students’ attitudes toward research. The present data demonstrate that first-year osteopathic medical students at 2 campuses had a strong background in research, with the majority of students reporting previous research experience. Students with previous research experience expressed more than a two-fold greater interest in performing research than their peers who had no research experience. These findings demonstrate that most first-year students were interested in research before entering osteopathic medical school and thus were likely to continue their involvement.
The majority of first-year students who expressed an interest or were actively conducting research also indicated that research at an osteopathic medical school had value. The lack of influence by sex, age, or degree (bachelor’s or graduate) suggests that these students were genuinely interested in participating in research during medical school. Given the wide background of the first-year students who participated in this survey, the high expectations of continuing research at WesternU/COMP and WesternU/COMP-Northwest, and the high value students placed on research for applying to residency programs, more opportunities to participate in research during osteopathic medical school should be created for osteopathic medical students, especially those in their first year.
Among research areas, most students were interested in clinical research, which is comparable to that reported by Pheley et al,
9 in which about 66% of osteopathic medical students preferred a clinical research elective, and Licciardone et al,
10 who reported that 74.2% of osteopathic medical students preferred a clinical research elective. Students in the current study also expressed a strong interest in research in the basic sciences, social sciences, and OMM. With one-third of the students interested in OMM research, increased research support and encouragement is essential to progress the field of OMM.
A small number of students had no interest in any type of research, nor did they want to be actively engaged in research during medical school. This lack of interest may be due to extraneous factors that discourage first-year students from participating in research during medical school (eg, performance in coursework). We found some apparent discrepancies with student feedback: 24.8% of students were not interested in participating in research, 18.4% of students indicated that lack of interest was a discouraging factor, and more than 4.1% stated they were not interested in any research area. This finding might have been influenced by student perceptions to the various questions that they did not need more research experience, the medical school did not offer research fields that interested them, they were interested in research but did not know how to become involved, or they lacked sufficient research experience to become involved during their medical training. These perceptions might be resolved through a combination of the following solutions: emphasizing previous research background when selecting prospective students, encouraging research electives in the third and fourth years of osteopathic medical school, integrating research into the curriculum by allowing research to be a point of emphasis in the first 2 years of osteopathic medical school, and reducing the concerns about coursework performance through a pass-fail grading system, with no individual class rankings, during the preclinical portion of medical school. Such a system would allow students to more freely participate in extracurricular activities. However, each of these proposed solutions has the potential for inadvertent adverse effects on students, faculty, and the administration. Thus, a more appropriate solution may be to institute a more gradual implementation of such changes.
The current study was limited by surveying students at 1 osteopathic medical school. Moreover, the school consists of 2 separate campuses, 1 large urban and 1 small rural campus. Thus, the lack of uniform institutional environment and culture of the students across both campuses may limit comparison of these findings with other colleges of osteopathic medicine. Surveying osteopathic medical students at additional colleges is required to determine whether students at other campuses have similar perceptions toward research. Such findings would provide a more accurate assessment of the perceptions of first-year osteopathic medical students toward research and whether their perceptions are comparable to their allopathic counterparts.
Previous research experience of first-year osteopathic medical students was strongly associated with students’ current interest in performing research during osteopathic medical school. More than three-fourths of the osteopathic medical students surveyed expressed interest in conducting research. Given the limitation of these findings from 2 campuses of a single osteopathic medical school, further research will be required to better assess the students’ perceptions toward research at osteopathic medical schools across the United States.
We thank Airani Sathananthan, MD, for helping us facilitate the administration of the survey. We also thank Michael Lasarev, MS, Oregon Health and Science University, Portland, for his guidance on performing the statistical analysis for our study.