Editorial — Are student research projects good for research and practice?

Evidence-based clinical practice is here to stay (Department of Health, 1999) and itwill undoubtedly benefit patient care. Though not a new concept within the scien-tific field (the earliest clinical trials began around 1800) (Pocock, 1983), the profes-sions allied to medicine are still developing their research base and structures.

One way in which physiotherapy has done this is through undergraduate educa-tion. Students are now almost universally taught the principles of research theoryand practice so that, in time, therapists will have skills to evaluate their practice.

Most students, in all disciplines, undertake research projects. Are these the betenoire of the research, clinical and educational establishments? Do they achieve theiraims as efficiently and effectively as possible? Are they killing clinically based enthu-siasm for research?

The implications of such projects for researchers, educators and, increasingly,clinicians and patients are enormous — and growing. Government policy to increaseaccess to higher education, and therefore student numbers, is costly in terms ofsupervision, space (including clinical and laboratory space) and money (time, equip-ment and consumables). Physiotherapy students are increasingly keen to undertakeclinically based research. This frequently means that they identify topics that canonly be answered through access to patients and therapists.

What implications does this have for day-to-day clinical practice and for researchactivity?

• Many clinicians will have experienced the deluge of questionnaires which arriveon their desks annually, and have been asked for help to validate tools of assess-ment or assistance with subject selection. This is time-consuming, at a time whendemands on the health sector are very heavy — time which often is not avail-able. This may result in poor response rates and co-operation, and in due course,disenchantment with the demands of research from both students and, veryimportantly, experienced researchers.

• There may be a direct effect on patient populations. Many establishments haveclear guidelines as to how often patients may participate in research to avoidundue pressure. Patients occupied with student projects may become unavailablefor other work or treatment.

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• Both these factors can have an effect on larger, more rigorous research projectswhich are being run by experienced staff. Increasingly, researchers who are sub-ject to financial and quality assessment are questioning the appropriateness oflarge numbers of undergraduate students using limited research resources.

Questions must be raised about the ethical implications of conducting studentprojects in clinical locations. Ethical committees have an obligation to consider therigour of research proposals and the likely value of the results (Foster, 1994). Moststudent projects are unlikely to produce quality results. This is not a criticism. Theirprime purpose is to educate the student not to produce high-quality scientific results.Such results are a bonus when they do occur.

It is essential, therefore, to assess the costs and benefits of traditional undergradu-ate projects to researchers, clinicians, patients and students, and to examine alterna-tives. The alternatives must provide students with high-quality learning in the fieldof research. Three possibilities are suggested:

• Firstly, university-based projects may be undertaken in which students act as sub-jects and standard equipment is used. These can provide very effective learningconditions, although removing much of the freedom of choice from the studentand increasing the workload for academic staff.

• Secondly, students may act as research assistants for established projects for ashort period. Though often an excellent option, the scope of learning here maybe limited and there is a risk of students being ‘used’ rather than taught.

• A third and more innovative option is to abandon the traditional single projectand introduce a series of focused exercises in the academic institution. Theseaddress elements comprising a traditional project, for example, research ques-tions, analysis of data and write-ups. They demand high levels of independentwork from students whilst avoiding the costs indicated above. Their focus is toeducate students in the skills necessary for later research projects.

There are, of course, gains and losses with such changes. All models result in thefreeing of clinicians and patients to be involved with quality monitored studies, withcontainment of costs of all kinds. The third model has a number of particular learn-ing benefits in that it allows experience to be gained of a variety of study designs andthat work may be submitted at intervals throughout a course, facilitating feedbackand thus student development.

Losses include the small number of exceptional undergraduate projects which arecurrently produced each year, and the increased teaching load for a small number ofacademic staff. A further loss may be that student research becomes less ‘visible’ inclinical practice; however, this is less of an issue now that many clinicians have beentrained in research theory and practice, and there are an increasing number ofresearchers in the field of physiotherapy.

The primary purpose of student projects is to educate students. This should bedone as effectively as possible, taking into account the cost and benefits to

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researchers and clinical practitioners, to students and educators. It is essential thatthe optimal solution for all these participants is identified and implemented.

REFERENCES

Department of Health (DoH). A First Class Service: Quality in the New NHS. HSC 1999(33), POBox 410, Wetherby LS23 7LN, 1999.

Foster CG. Manual for Research Ethics Committees. London: The Centre of Medical Law and Ethics,King’s College London, 1994.

Pocock SJ. Clinical Trials: A Practical Approach. New York: J Wiley & Sons, 1983.

Sheila S Kitchen Physiotherapy Division

GKT School of Biomedical Sciences London

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