We report poor level of knowledge towards research (mean score 36.9%) amongst Pakistani post graduate trainees. About 80.2% of the trainees scored in the first two quartiles of knowledge score.
Better results were observed on the attitude score (mean 47%). Our findings are in dispute with our previous work amongst undergraduate medical students at Aga Khan University who had fared better on both knowledge (mean 49%) and attitude scale (mean 53.7%).[6
Even though residents who were trained at private medical schools scored better on both knowledge and attitudes scale compared to residents from government run schools, their overall mean score on both knowledge and attitude scale was inadequate. These scores reflect grave inadequacies of health research training at medical schools across the country. Furthermore limited research activities, poor funding and lack of mandatory research assignments in government institutions leaves students desensitized to research and compounds the inadequate health research training at this level. A pilot survey reporting on the attitudes of PGMTs' towards research cited poor research training and awareness as two most important factors for poor research activity in the country[7
Residents' knowledge and attitudes towards health research did not improve significantly with increasing years of training at the university hospital, in contrast to earlier trend of improving scores seen in medical students with year of medical education[6
]. This underlines the shortcomings of the curricula in imparting research skills to residents. In Pakistan PGMTs' are required to submit a research dissertation to College of Physicians and Surgeons Pakistan (CPSP_Pakistan's residency and fellowship training accreditation body) in order to be eligible for fellowship examinations. The university hospital also arranges research skills workshop for interns and first year residents. The aim of these workshops is to introduce basic statistics and epidemiology to the trainees. However, no mandatory manuscript writing workshops, research projects or research thesis are part of curriculum.
Each PGME program has a regular schedule of academic activities throughout the year including Journal clubs'; Evidence based Medicine sessions and research presentations. However the lack of increase in research related knowledge as residents' progress through training is a cause of concern. Previous studies have shown that frequent journal club activity helps trainees stay abreast with current literature, improve knowledge of research methodology, biostatistics and impart critical thinking skills[8
]. Effective journal club activity requires club existence to be over 2 years with over 50% attendance[9
]. Failure to see an improvement in knowledge scores could be due to poor attendance and lack of teaching of critical reading skills in club activity. The same can be extrapolated to other such academic forums. HEC (higher education commission) in Pakistan has made over 20,000 journals freely accessible to over 250 public and private universities across the country[10
]. All residency programs must make an effort to organize regular journal club activities with mandatory attendance along with special workshops in critical reading and manuscript writing.
Gender was not a significant predictor of knowledge about health research, though males scored higher significantly on the attitudes scale. Type of residency did not affect trainee knowledge score. Overall 71.5% of trainees felt confident in interpreting and writing a research manuscript, however only 7.5% claimed the ability to do so without assistance. Only 65(34.7%) of trainees had published at least one research manuscript. While choosing a journal for manuscript submission those who had previously published considered, International publications to be the most important factor whilst open access was considered to be the least decisive. Perceptions about international journals are that their circulation is greater making manuscript publication in these journals desirable. Trainees may not give considerable importance to their work being part of an open access journal as most journals in the country are freely available through the Higher Education Commission to both public and private universities and thus can be easily accessed by them and their peers.
Limited time was the most important factor cited by residents in not being able to engage in research. Residency is a period of intense clinical training, punctuated by post graduate examinations at various levels of training. The levels of stress and work are physically and mentally exhaustive for the trainee. On average residents in Pakistan work about 80 hours a week and no legislation defines the upper limit of working hours. A study from AKUH reported over 46% residents to be morbidly stressed while 55% were under mild stress[11
]. In this climate of clinical training, research is difficult to pursue. Limited infrastructure and lack of research funding were the second most important factors for not being able to engage in research. In Pakistan public funding for research is limited. Whatever funding is available does not provide financial security to the individual. Thus, there is little incentive to pursue research. Further more dearth of academic liberty, poor funding, and uncertain career options influence poor research output and brain drain according to recent survey of Pakistani students sent abroad for doctoral training[13
]. Consequently 52.4% of trainees did not plan to pursue clinical research in future, yet most 72% recognized that PGMTs should be actively involved in research.