Medical Research Conduct and Publication during Higher Education in Syria: Attitudes, Barriers, Practices, and Possible Solutions

Abstract

Background: The huge workload on doctors especially residents, who are the main health care providers in public hospitals, in addition to the vanishing incomes and lack of personal safety during the decade-long Syrian crisis, led to further hurdles in the focus on research. Postgraduate students in the medical and paramedical fields must conduct original research projects as part of their graduation requirements. However, this does not reflect on research publications coming from Syria. Methods: This is a nation-wide cross-sectional study targeting medical, dental, and pharmacy postgraduate students who are at the phase of planning for their required projects. The questionnaire aimed to capture their attitudes toward research, perceived barriers, and previous research experiences in order to suggest evidence-based recommendations. Results: The sample consisted of 429 residents representing about 22% of the target population. Nearly all the participants had positive opinion toward the important role of medical research and the significance of their participation. Agreement was also clear regarding perceived barriers, including the lack of adequate training and research facility. Seventy-one percent of the participants were not involved in any research before the time of their master theses, less than 13% of them had submitted an article for publication, and less than 5% had submitted more than one paper. Despite that, high-quality internet connectivity and rich English writing skills were associated with further research experiences. Additionally, mentors' support and self-paced learning of research skills had significant positive impact on students' research contributions with odds ratios of 2.04 [[95% Confidence Interval]: 1.02–4.06] and 2.68 [1.48–4.84], respectively. Conclusion: Lack of training and mentorship, in addition to several common barriers to medical research, hampered residents' capacity of conducting and publishing research despite their positive attitudes toward it. Nevertheless, the variance within our sample exposed a promising window for implementing low-cost institutional and individual solutions such as peer-run self-paced training opportunities and long-distance mentoring.

Analyzing the efficacy of a decade-long endeavor: extracurricular medical research training amidst the turmoil of Syria

“…These workshops are also widely recognized as an effective tool for promoting medical research in low-and middle-income countries (LMICs) (23)(24)(25). In Syrian, they were suggested as an attainable alternative to address the shortcomings of the research curriculum (10,16). Previous reports assessing individual interventions that targeted research skills including EBM and academic writing in Syria highlighted the knowledge-enhancing effects of their workshops (11,13,14,26), or at least improvement limited to attendees' confidence (27), or perceived skills (15).…”

“…We can attribute that to the fact that medical personnel in Syria, even those who have never conducted any research project, generally reported high attitudes towards research (10,16), and this does not apply to the poor research-related knowledge repetitively reported (21,28,29). The weak impact of workshops on attitudes can also be due to the limited effectiveness of workshops in addressing certain research barriers, such as language, internet connection, and time availability (10,11,16,29), thus, hindering attitudes strengthening towards medical research. Despite that, when it comes to studying the improvement in research productivity, trainings on research skills can achieve it in several pathways ( Fig 6).…”

“…The vast majority of in-house trainings, as well as some online workshops, in our analysis relied heavily or completely on under-or postgraduate peer trainers with wider research experiences and higher research-related knowledge and attitudes. This role of peers was particularly underlined in countries grappling with significant training gaps and depletion of professionals, as reported in the Syrian case (10,11,13,16). The reliance on peers in such settings is both justified and indispensable, as peer-led training presents a practical and affordable solution that alleviates the burden on professors and faculty members (39,40).…”

“…Our study further underscored that these two forms of peer-support are of comparable value in the gained knowledge, attitudes, and practice. Interestingly, both of these methods were significantly more valuable to beneficiaries than the previously deemed substandard curricular research training (10,11,16), suggesting them as an established solution for the dearth of expertise in Syria (13).…”

“…It was quite evident that these interventions lacked a consistent pattern across the different cities and varied in terms of content, delivery, and targeted group(s). This lack of organization can be attributed to the fact that they were in most cases driven by the needs in their proximity, which suggests a significant room for improvement if they become tailored based on up-to-date representative assessments of the needs and barriers towards research (10,13,16,21). On the other hand, we assume that the lack of institutional collaborations constrained the amplitude of benefit, especially from in-house workshops, to specific groups and locations.…”