Of the faculty and staff members, 6 (67%) were male while 3 (33%) were female. 3 (33%) had over 10-year tenure, 5 (56%) over 5 years and 1 (11%) below 5 years. 4 (44%) were clinical faculty members and 5 (56%) were non-academic and research support staff.
Nine (50%) of the graduates were male and nine (50%) were female. Of the 18 graduate respondents, 5 (28%) had published successfully and were academically affiliated in their current role whereas only 2 (11%) with publications did not have an academic affiliation.
The socio-demographic data of the study participants is presented below (Table 1 and 2).
Four themes emerged from the data; graduates’ attitudes to research publication were informed by the ease or difficulty of their research journeys, the departmental culture affected both residents and faculty’s research output and lack of time and research expertise alongside a culture of prioritization of clinical duties over research hindered research activity.
Graduates’ challenging experiences with conducting and publishing research
Most graduates described difficult research journeys, which discouraged them from publishing their dissertations. The process of topic selection, proposal development, seeking ethics approval and completing their dissertations on time, sometimes without adequate faculty support was stressful and off-putting to many. To compound these difficulties, many of them had had minimal prior exposure to research during undergraduate training.
‘You struggle to come up with a [research] question probably with very minimal input from your program director or from your senior faculty. Then even getting people to support you to develop that idea is challenging’(R6).
As a result, many respondents described themselves as having a generally negative attitude towards research, not seeing it as particularly valuable, especially when considering their immediate career paths after graduation.
‘Why am I being forced to do this after my studies? After my Masters, I am done, I’m never going to publish and I’m never going to teach, I just want to treat patients’ (R6).
‘…. people really do not see the point of even having a dissertation in the first place’ (R16).
Faculty and program directors who were interviewed agreed with this assessment.
‘They [residents] look at research as that really difficult problem, or that thing you have to do to make sure you graduate but if you had a choice, you wouldn’t do it’(F2).
‘They say is that the worst part about a post graduate program is the dissertation’ (F3).
Departmental research culture matters
The departmental culture also impacted both residents’ and faculty attitudes to research. More research-oriented departments stimulated stronger interest in it and, consequently, more resident publications. Additionally, faculty from more research-oriented departments were more willing to supervise and oversee residents’ publications before and after graduation. Thus, residents who trained in departments that had a positive research culture benefited immensely, enjoyed and embraced the research process and were mentored to publish their dissertations.
‘There are departments that publish more frequently than others and maybe this could be accountable to the fact that they have Chairs who are more attuned to research part of the academic track than those other departments where Chairs or Programme Directors or supervisors are more focused on clinical work. This percolates down to the residents, and it is infectious in the sense that it influences how everyone in the department perceives certain things including research’ (F6).
Conversely, in departments with weaker research cultures, residents struggled. Faculty with little or no experience and training in research were reluctant to participate in research or supervise and mentor residents. This engendered in residents a lack of interest in research and publishing.
‘It wasn’t really something in the department maybe that’s why I also didn’t take it up more seriously or give it more priority’(R2).
Many of the departments do not have support from faculty who have exposure to research. It’s only a few of them who have that exposure so sometimes it’s a bit challenging for somebody where the student plus the faculty are groping in the dark when it comes to matters research (R1).
Prioritisation of clinical work over research
Both residents and faculty reported a culture of prioritization of clinical duties over research. This resulted in a conflict of priorities, with clinical work winning out in most instances.
‘…. I don’t think the system was very conducive for that [research]. Because they tend to prioritize your clinical duties as opposed to research’ (R2).
‘……You can make it here as a very good clinician without being able to do research’ (F2).
Publication challenges despite institutional support mechanisms
Both faculty and residents acknowledged the institution’s effort and facilitation in various ways to create an enabling environment for research and publications. These included weekly departmental journal clubs, regular faculty academic rounds, facilitation to attend local and international research workshops/conferences and research funding. Research training through a robust curriculum was particularly helpful for residents without prior research exposure. Other resources included an online and physical library, access to various online databases, and the establishment of a research support unit.
‘The fact that we have a research department and statisticians and all that, to me that is good support from the institution and having dedicated faculty’ (R14).
‘The curriculum was supportive enough to enable me to know what to write, which format and what to put where’ (R9).
Despite this institutional support, and even when some of the above challenges were overcome, residents who were keen to publish still encountered challenges with the process of journal selection, the editorial process of converting their dissertations to a manuscript, meeting the stringent journal requirements and dealing with rejection from journals. Interestingly, article processing charges were not a barrier to publishing, given the institution’s funding support for those willing to publish.
Of the eighteen graduate respondents, five had published successfully and were academically affiliated in their current role whereas only two with publications did not have an academic affiliation. The rest had not published and were not in academically affiliated positions. Only two of the respondents without prior research experience had managed to publish successfully.
Strategies to improve the publication rate of residents’ research
Strategies suggested by the respondents for improving the publication rate include support in early identification of a viable research topic by residents. As faculty were sometimes too inexperienced in research to guide topic selection, both faculty and residents recommended faculty development and engagement in research methodology, process and supervision skills.
‘…. at least one of the faculty should be funded to maybe undertake an MSc in epidemiology’ (R18).
‘Ensure that faculty are also engaged in research. Not just the residents’ research but their own research as well such that they get exposed because you cannot supervise a resident to do research yet you yourself don’t do any research’ (F2).
Respondents suggested some curriculum changes that would improve residents’ experience of research and publication. Importantly, a curriculum revised to give more protected time for residents to carry out their research. They suggested that some of the teaching and support for residents should be offered online, to enable them to engage with material asynchronously. This would allow them flexibility in learning, which could mitigate the problem of clinical versus academic time management. Another desirable curriculum change for residents was the introduction of an academic writing skills course.
Surprisingly, making the publication of residents’ research a mandatory requirement for publication was a popular recommendation from both faculty and residents.
‘One of the requirements is that by the time you want to sit for your final exam you must have sent a manuscript to a journal’ (F1).
Finally, the introduction of an institutional journal to disseminate their work was suggested. This was recommended, despite the existence of an institutional research repository (AKU Commons).
‘The institution should go through the whole process and start an institutional journal…. that becomes your stepping ground into publishing before you start looking for the big ones’ (F1).
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