Assessment of the Research Interests and Perceptions of First-Year Medical Students at 4 Colleges of Osteopathic Medicine

Methods

We distributed a descriptive survey to first-year osteopathic medical students (class of 2021) at 4 osteopathic medical schools: Western University of Health Sciences College of Osteopathic Medicine of the Pacific (WesternU/COMP) in Pomona, California and WesternU/COMP-Northwest in Lebanon, Oregon; University of Pikeville Kentucky College of Osteopathic Medicine (UP-KYCOM); Marian University College of Osteopathic Medicine (MU-COM) in Indianapolis, Indiana; and West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg. This study was approved or deemed exempt by the institutional review boards at all 4 COMs.

An email was sent to 868 students, who had entered medical school 3 weeks earlier, inviting them to voluntarily participate in the anonymous survey. 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. A hyperlink to the survey was provided at the end of the email invitation. The survey was administered by the online survey service Qualtrics, which allowed for anonymous data collection and concealment of the participants’ identities.

The survey instrument (eFigure) consisted of 15 items: 14 multiple-choice items (7 offered a write-in response and were categorized by the authors by common language or sentiment) and 1 asked participants to specify their age. The survey remained open for 2 weeks, with 1 reminder email sent on the last day of the survey. Incomplete responses were excluded from the analysis. Data were summarized in aggregate form and by institution. Differences across COMs in previous research experience and current participation interest levels were analyzed using a 2-tailed χ² test; P<.05 was considered statistically significant. An odds ratio was used to determine whether interest in participating in research during medical school was associated with previous research experience.

Results

A total of 328 students participated, for an overall response rate of 38% (328 of 868); the response rate for each COM ranged from 25% to 50% (Table 1). Each COM was also represented relatively equally in the final participation group: WesternU/COMP (57 [17%]), WesternU/COMP-Northwest (56 [17%]), UP-KYCOM (69 [21%]), MU-COM (65 [20%]), and WVSOM (81 [25%]) (Table 1). Respondent ages ranged from 20 to 49 years. For the majority of participants (265 [80.8%]; range, 74.1%-87.7%), a baccalaureate degree was the highest degree earned, and basic science was the most prevalent field of study (246 [75.0%]; range, 67.9%-81.5%).

The majority of participants (261 [79.6%]; range, 68.1%-94.7%; Table 2) reported participation in research before entering a COM. Significant differences were found in previous research experience between COMs (χ²=11.87; df=3; P=.008). Most of those with experience (160 [61.3%]; range, 48.1%-68.7%) had published or presented their research findings. When asked whether they were interested in participating in research during medical school, 177 (54%; range, 36.2%-66.7%) either expressed interest or were currently doing research (Table 3). One hundred fifteen (37.5%) also indicated that they might be interested in participating in research. Significant differences were found in interest in participating in research (χ=15.48; df=3; P=.001) between COMs. The odds of interest in research during medical school were 2 times greater for participants with previous research experience than for those with no previous research experience (OR, 2.00; 95% CI, 1.16-3.46). Fifteen participants (4.6%) reported no interest in research (Table 3).

The majority of participants (259 [78.9%]; range, 64.9%-86.4%) affirmed interest in clinical research (Table 3). Level of interest in other research topic areas were: basic science (166 [50.6%]; range, 47.4%-53.8%), anatomical research (108 [32.9%]; range, 22.8%-39.3%), osteopathic manipulative medicine (105 [32.0%]; range, 19.6%-39.1%), social science (101 [30.8%]; range, 26.2%-33.3%), translational research (48 [14.6%]; range, 11.6%-19.3%), applied science (30 [9.1%]; range, 7.2%-10.8%), and other (10 [3.0%]; range, 1.4%-5.4%). Of the “other” answers, 3 participants indicated an interest in exercise physiology and nutrition, and 1 participant each wrote in concussion, social determinants of health, immunology, education, prehospital care, and gene therapy as their areas of research interest.

An overwhelming majority of participants (315 [96.0%]; range, 94.6%-97.1%) indicated that they perceived some level of importance to participating in research during their osteopathic medical school tenure; 124 participants indicated that they felt a research experience was “very” or “extremely” important (range, 27.7%-55.4%). Thirteen participants (4.0%) indicated that research participation during medical school was “not important.” Regarding the question of perceived benefits of participating in research during medical school (Table 4), for which participants could identify more than 1 answer, a majority of participants (274 [83.5%]; range, 75.4%-87.7%) believed that research participation would enhance their competitiveness in residency applications. Other perceived benefits included an opportunity to interact with current faculty (222 [67.7%]; range, 61.4%-75.4%), to develop skills for conducting research as a physician (219 [66.8%]; range, 55.4%-73.7%), and to deepen understanding of curricular concepts (212 [64.6%]; range, 59.6%-76.8%). In open-ended answers, some participants (18 [5.5%]) reported other benefits, including “to aid in the advancement of medicine,” “furthering the DO field by supporting techniques with evidence based research,” “contributing to society, patient care, and improving patient outcomes,” and “developing and sharpening one's ability to critically analyze multivariable problems.” Four participants (1.2%) indicated that research participation was not beneficial.

An overwhelming majority of participants (289 [88.1%]; range, 78.6%-94.7%) thought that research would have a negative effect on their coursework performance. Relatively fewer participants indicated that a preference for other extracurricular activities (115 [35.1%]; range, 28.4%-43.9%) might be a reason to not participate in research. Lack of opportunity for a specific kind of research was a less prevalent concern (38 [11.6%]; range, 7.0%-17.9%). Some students (17 [5.2%]) reported additional concerns, most of which pertained to other types of obligations (eg, spending time with family and military service).

More than half of the participants indicated that monetary compensation would motivate them to engage in research (213 [64.9%]; range, 53.6%-72.5%), as would extra credit in coursework (195 [59.5%]; range, 51.9%-68.1%) (Table 5). Some participants (101 [30.8%]; range, 23.1%-37.0%) reported that an opportunity for a specific type of research might encourage their participation.

Discussion

This study is an extension of previous study by WesternU/COMP-Northwest,¹⁶ in which experience with and attitudes toward research were examined among first-year osteopathic medical students at WesternU/COMP and WesternU/COMP-Northwest. Those data revealed that the vast majority of students reported prior research experience and were interested in participating in research during medical school. Additionally, osteopathic medical students at 1 COM reported that there were perceived barriers and benefits to participating in research during medical school.¹⁶ However, the generalizability of those findings to other COMs was unclear because of the limitation of surveying students at only 1 COM. Using the same survey instrument, with slight modifications for broader distribution, the current study allowed aggregate analysis of cohort-matched osteopathic medical students at 4 COMs and revealed institution-specific differences between students. Similar to Carter et al,¹⁶ the vast majority of students at each COM reported previous research experience (79.6% overall in our study vs 81% in the Carter et al study) and potential participation in research during medical school (89.0% vs 75%). That said, χ² analyses revealed institution-specific differences in research interests and experience, with COMP/WesternU and COMP-Northwest students reporting the highest amount of previous research experience, WVSOM students reporting the highest interest in participating in research, and UP-KYCOM students reporting the lowest amount of research experience and interest in research. Across campuses, the majority of students reported interest in clinical research, which is consistent with Carter et al,¹⁶ Pheley et al,¹⁹ and Licciardone et al²⁰ regarding clinical research electives. Moreover, approximately half of the students in the current study and in Carter et al¹⁶ reported interest in basic science research, while approximately one-third of students in both studies reported interest in osteopathic manipulative medicine research. Notably, interest in research participation during osteopathic medical school was significantly greater for students with previous research experience when compared with students with no research experience. These findings may have important implications for COMs that are considering expanding their research programs and increasing research opportunities for students, potentially through recruitment and admission practices, faculty hiring in particular research areas, and intramural research funding and infrastructure.

Ample evidence shows that research participation provides many collateral benefits to medical professionals, including sharpened critical thinking and lifelong learning skills,^1-4 greater appreciation for evidence-based medicine⁵; and improvement in clinical competency scores.⁶ It is important to keep in mind that the primary benefit ascribed to research participation by students in the current study and in Carter et al¹⁶ was the potential for enhanced competitiveness in residency applications (83.5% vs 91.0%, respectively). This finding is striking considering that, for all available years (2013-2018), nearly half of recent osteopathic graduates reported that their medical school did not devote adequate time to research.^8-13 Previous studies of allopathic medical students reported that they value research participation as contributing to their career development and that it increased their confidence about placement into their desired residency.^21-23 Previous reports^24-26 found that research experience increased the likelihood of allopathic medical students matching into their desired residency program for many specialties. Corresponding data are limited regarding osteopathic medical students.²⁶ Furthermore, the 2018 NRMP Program Director survey indicated that, in certain specialties (eg, radiation oncology, plastic surgery, neurosurgery, interventional radiology), more than 75% of program directors surveyed felt that “demonstrated involvement and interest in research” was a key factor in the selection of applicants for an interview.²⁷ Therefore, it is important to identify the motivations and real or perceived barriers to participating in research during osteopathic medical school.

In the present study and in Carter et al,¹⁶ the overwhelmingly predominant barrier or concern was the potential for research to negatively affect performance in coursework (88.1% vs 87.2%, respectively), which we suspect is due to the time commitment required for conducting meaningful research. Similar barriers to those reported in the current study have been reported by US and international allopathic medical students, including time, funding, research mentor availability, research techniques training, and receiving appropriate acknowledgment for their research contributions.^22,28,29 In the changing landscape of the residency match process, osteopathic medical schools should be encouraged to provide more research opportunities for their medical students because evidence suggests that research experience during medical school correlates with matching into residency programs and is considered a key factor by residency program directors.^25,26 Directly addressing research barriers may lead to increased opportunities for research experience during medical training. For instance, by implementing specific tools and resources (added mentorship, protected time, biostatistical assistance), resident physicians increased their publication and national presentation rates.³⁰ Therefore, institutions that emphasize medical student research should consider instituting similar types of incentives (eg, monetary compensation, dedicated time in the curriculum, or a pass-fail grading system) to encourage research participation.

The current study has several important limitations that may affect its generalization to osteopathic medical students nationwide. First, the response rate (38%) was relatively low. Second, our survey instrument, while anonymous, relied on the accuracy of self-reported information. Third, the experience and perceptions of first-year osteopathic medical students at the COMs may have been influenced by regional or institution-specific factors that were beyond the scope of the study. Similarly, institution-specific admission criteria may have underpinned differences between the COMs. Taking these limitations into consideration, overall consistency was observed between the campuses and our prior study,¹⁶ which had a response rate of 77%. Thus, we cautiously generalize our findings and interpret them in the context of undergraduate osteopathic medical education overall.

Conclusion

Our findings indicate that first-year osteopathic medical students are interested in research, view research experience as valuable, and perceive research experience as beneficial to future career development. These findings should compel COMs to provide sufficient research opportunities and resources to students. We hope that all COMs will address the interests, attitudes, and perceptions toward research of their students, promoting a greater awareness and practice of research within the osteopathic medical community.