1 Is Research Methodology Taught in the Undergraduate Syllabus?

Although basic statistical concepts are covered during the Preventive Medicine posting in the majority of medical schools in India there is no attention paid to research. However, globally many leading universities encourage their undergraduates to do research. A classic example of this was in 1923 when Charles Best was an undergraduate at the University of Toronto, he together with Banting and Mcleod, discovered insulin. Banting shared the Nobel Prize money that he was subsequently awarded with his student Best. Another Nobel laureate, Alan Hodgkin, won the Nobel Prize in 1972 for his work on nerve transmission that he had begun as an undergraduate in Cambridge, England.

Medical colleges should be the institutions where the greatest amount of research takes place. Even if the undergraduate does not do it, he or she should be inspired to do research by following the examples of his/her post-graduate seniors and faculty. At the post-graduate level, writing a thesis has been made compulsory by many medical councils in this country but, as everyone knows, it is a chore, usually copied from someone else’s work and rarely published [1].

There are now more than 542 teaching medical institutions in India producing 79,798 medical graduates. However, there is practically no research activity and 91.2% of interns have no research skills at all [2]. Fifty-seven percent of these institutions had published not a single paper that was indexed between 2005 and 2014. This is probably true of most developing countries. One of the indices for ranking universities worldwide is on the basis of their research output and very few from developing countries are included in the top 200 positions.

2 What Is the Brain Drain?

The brain drain is a term that describes the relocation and loss of a skilled worker such as a doctor, nurse, or scientist who leaves the country of his/her birth to move to a more developed nation in pursuit of a better quality and standard of life. This also generally means a higher remuneration, exposure to a progressive skilled environment, and a more stable political situation where there is less corruption (Fig. 4.1) [3]. Data suggest that close to 90% of the brain drain for physicians were to just five nations: the USA, UK, Australia, Canada, and Germany [4]. The main contributor nations are from Asian countries, i.e., India, Pakistan, and Sri Lanka. The migration process starts immediately after receiving an MBBS degree or a PhD. However doctors who have migrated can still play a big role in the upliftment of the country of their birth by doing collaborative research or by teaching students. This may be a way how a brain drain can be converted to a ‘brain gain’. There are many associations of doctors which have been formed in the USA and UK precisely with these objectives. India has the largest diaspora in the world. Although the brain drain decreases the research output from the country of origin it can be an opportunity to foster collaboration and improve the research of the host country.

Fig. 4.1
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Reasons for the brain drain from India

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3 Is an Internship a Good Time To Do Research?

In one study half of the interns (54.2%) stated that internship was not the appropriate time for the exposure to research, as their priority during the internship was to study for entrance examinations to post-graduate courses [2]. However, data from the Netherlands suggest that as students have different types of incentives, interests and determinations the best time to position the research-related internship in a medical programme should be flexible and should be not only after, but also before the clinical clerkships [5].

4 What Are the Requirements of Research During Post-Graduation?

The basic requirement for post-graduation or super specialization for various degrees like MD, MS, MCh, DM is writing a dissertation or thesis. Such dissertation is also needed for the FCPS in Pakistan and Bangladesh. It is considered to be a passport to sit for the exit examination. Although there are at least 22,000 theses produced every year very little of the output gets converted into a final publication anywhere.

The University Grants Commission currently requires PhD scholars to publish at least one manuscript in a peer-reviewed journal and present two papers at conferences or seminars before they submit their doctoral theses for assessment. Such rules are not there for Master’s degrees [6]. The conversion rate of a dissertation to a research manuscript is low and was reported only in about one-third of PhD students [1]. The last 10 years data has also shown a declining trend in the conversion of theses to papers.

5 How Can We Increase the Student-Based Research Activities in Our Country?

The two main ways to increase research activity are to use the ‘carrot and stick’ approach.

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Carrot

  1. 1.

    Catch them young—start research during the MBBS course and add marks in the final examination and for selection in post-graduate courses depending on the number and quality of papers published.

  2. 2.

    Give incentives for research at the post-graduate level in selection for faculty appointments.

  3. 3.

    Give awards for theses that get converted into peer-reviewed publications.

  4. 4.

    Faculty promotions should be based on the number and quality of research papers published and their journal impact factors.

  5. 5.

    Link research publications with academic benefits like funding and attending conferences abroad.

  6. 6.

    Provide financial rewards for papers published in prestigious journals following the successful examples of China and other countries.

  7. 7.

    Explain to selectors and administrators how research publication benefits patient care, institution attractiveness to students and faculty, and the image of the college abroad.

Stick

  1. 1.

    Insist that post-graduates publish at least one research paper in an indexed journal before being awarded a degree

  2. 2.

    Base faculty promotions on research publications—20 for Professor, 10 for Associate Professor, and 5 for Assistant Professor.

  3. 3.

    Start a ‘Tenured Faculty’ system depending on the continuing publications of an individual. If they do not reach a specified standard he or she should be asked to leave.

6 Are There Any Journals That Publish Papers Directed Mainly at Students?

These include the Student BMJ, International Journal of Medical Students, American Medical Student Journal, Medical Student Journal, and Medical Student Research Journal. Also, many journals have a special section for students mainly authored by trainees.

In a recent publication, the problems with student medical journals were discussed at length. These included low impact factors, a poor peer review process, lack of visibility in PubMed and other indexing systems, and the low quality of articles [7]. Despite these shortcomings student research should be encouraged not only in these student-friendly journals but also in mainstream publications [8].

All types of articles may be published in student journals ranging from original articles, case reports, letters to the editor, book reviews, commentaries, and images. Not all of them need to be contributed only by student authors.

The Yale Journal of Biology and Medicine is one of the oldest student journals and is also indexed in MEDLINE. It also publishes three theme-based issues in a year [9].

7 How Can We Increase Our Research Output After Post-Graduation?

As a senior resident applying for a post of Assistant professor in an academic institution you will need publications. The same is true for further promotion. ‘Publish or perish’ has become an international watchword that increases the quantity but not the quality of paper writing [10]. This burden and the resulting upsurge in the number of publications has, unfortunately, led to ‘unethical practices and wasteful research’. It has also been stated that the Indians are all about quantity but not quality [11]. The gold standard of research should be such that in ten years the guidelines or treatment suggested in a publication become incorporated into textbooks [11]. Our suggestion is that linking research to salaries may be the biggest boost to output.

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8 Conclusions

  • You should encourage your residents to pursue scholarly activities such as research and publication.

  • Research for post-graduate students is often confined to getting a degree. It is only a passport to appear in examinations.

  • The brain drain in doctors is related to migration for a better quality of life and many migrate after post-graduation to build academic careers. This should be taken as an opportunity by us for collaborative research.

  • The carrot and stick approach may be a good way to increase a nation’s biomedical research output.