2013

2013; 35: 549–554

TWELVE TIPS

Twelve tips for teachers to encourage studentengagement in academic medicine

AARON LAWSON MCLEAN1, CHRISTOPHER SAUNDERS2, PRASAD PALANI VELU3, JOHN IREDALE3,KAHYEE HOR3 & CLARK D. RUSSELL3

1Barts and the London School of Medicine and Dentistry, UK, 2University of York, UK, 3University of Edinburgh, UK

Abstract

Background: Recruitment of trainees into clinical academic medicine remains an area of concern across the globe, with clinical

academics making up a dwindling proportion of the medical workforce. To date, few approaches have emphasised early medical

student research involvement as a solution to the decline of the clinician-scientist.

Aim and method: We identify 12 tips that all medical teachers can adopt to foster medical student participation in research

and encourage student engagement with academic aspects of medicine throughout their time as an undergraduate. These

recommendations are based on a comprehensive review of the international literature and our personal experience of research-

focussed interventions and activities as medical students.

Conclusion: Through these 12 tips, we provide a practical framework for enhancing medical student exposure to research at

medical school. This has the potential to inspire and maintain student interest in the varied role of the clinical academic and could

contribute to reversing the downward trend that has occurred in this field over recent times.

Introduction

Recruitment into clinical academic medicine remains an area

of concern across the globe. In the United Kingdom, for

example, clinical academics make up only 6% of the medical

workforce and numbers are falling. Further, there are fewer

young doctors entering this field and 63% of the clinical

academic workforce is now aged over 46 compared with

53% in 2004 (Fitzpatrick 2011). Similar concerns have been

expressed in the United States and in Europe, emphasising that

this is an issue of international relevance (Ley & Rosenberg

2005; Sheridan 2006).

In addition to their clinical roles, clinical academics make

substantial contributions to undergraduate and postgraduate

medical teaching. Perhaps most significantly, their research,

whether it is basic, translational or clinical, plays a pivotal role

in bridging the divide between bench and bedside.

The Walport Report (MMC & UKCRC 2005) examined the

decline in doctors becoming clinical academics and attributed

it, as others have (Goldacre et al. 1999; Clark & Smith 2003),

to uncertain and unattractive career pathways. While the

recommendations included in this report led to the develop-

ment of a simpler and more flexible academic training

pathway in the United Kingdom, until now few approaches

have emphasised early medical student research experiences

as a solution to the international decline of the clinician-

scientist (Solomon et al. 2003).

In this article, we identify 12 tips to encourage student

engagement with academic aspects of medicine and foster

participation in research throughout their time as an under-

graduate. These recommendations are based on a

comprehensive review of the international literature and our

personal experience of research-related activities as medical

students.

Given the central place of evidence-based medicine (EBM)

within modern medical practice, these tips are relevant to all

medical teachers, regardless of specialty or whether or not

they are clinical academics themselves. Early exposure to

academic aspects and lines of questioning within medicine has

the potential to increase students’ subsequent involvement in

research and teaching (Segal et al. 1990; Reinders et al. 2005;

Goldacre et al. 2011), and effect an improvement in the health

of the clinical academic workforce.

The tips are presented according to their relevance

to students’ needs and development throughout their time

at medical school, while acknowledging that students can

become involved in this field to varying depths of engagement.

We emphasise that there is place for input across the course

of the medical degree and that stepwise encouragement that is

tailored to the interests, time-resources and career aspirations

of the student is likely to prove most beneficial.

Tip 1

Provide opportunities for students to participate inresearch within their undergraduate curriculum

Most students express an interest in research (de Oliveira et al.

2011). However, student involvement in research varies

significantly between different medical schools and countries.

Some medical schools offer the option of an intercalated

Correspondence: A. Lawson McLean, Department of General Surgery, Newham University Hospital, London E13 8S, UK. Tel: (44) 020 7363 9021;

fax: (44) 020 7363 8255; email: aaronlm@doctors.org.uk

ISSN 0142–159X print/ISSN 1466–187X online/13/070549–6 � 2013 Informa UK Ltd. 549DOI: 10.3109/0142159X.2013.775412

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degree, typically taken immediately prior to the clinical years,

or offer dual MD–PhD courses or alternative thesis-based

programmes of research. These allow students to become

immersed in a full-time programme of scientific investigation

and the undertaking of an intercalated degree correlates with

later interest in pursuing medical research (McManus et al.

1999). Periods of research can be incorporated into under-

graduate curricula by allowing students to pursue further study

in a field of particular interest to them through student-selected

components (SSCs). It is recommended that approximately

one-third of the undergraduate course should be structured to

include SSCs, enabling students to ‘learn about and begin to

develop and use research skills’ (General Medical Council

2003), and ensuring that all students have at least some

experience of research upon graduating.

Tip 2

Incorporate the teaching of key research methodol-ogies into the curriculum

The benefit of providing medical students with a grounding in

research methodology is twofold: facilitating academically

minded students to pursue research in the future, but also

equipping all clinicians with the ability to understand and

apply the research of others, irrespective of whether an

academic career is sought.

Critical appraisal teaching over several weeks improves

students’ knowledge in this field, as measured by written tests

(Norman & Shannon 1998). Interestingly, such interventions

targeted at resident-level doctors are less effective, emphasis-

ing the importance of incorporating this teaching into under-

graduate curricula. There is great variation in teaching the

methodology that underpins evidence-based medicine and, for

the most part, such teaching is limited in scope and execution

(Finkel et al. 2003).

A study of Croatian medical students found that participa-

tion in a research methodology course was associated with a

more positive attitude towards science (Vujaklija et al. 2010).

Therefore, we suggest that practical techniques should also be

taught, such as statistics and trial design, as well as basic

laboratory skills, which could be taught during the preclinical

years in practical sessions. This would give students grounding

in the techniques used in a range of research programmes, as

well as the confidence to critically analyse the methods of

published studies.

Tip 3

Emphasise the importance of EBM, its basis inresearch, and the need to broach new questions

Effective teaching of EBM is important for lifelong learning

(Hatala & Guyatt 2002), and participation in research offers

students the opportunity to learn how the evidence base is

derived, assessed, and ultimately utilised for patient care.

Demonstrating the relevance of research to clinical practice

allows students to better understand the rationale behind

clinical decision-making and provides them with ideas for new

research questions.

. Take time to discuss with students landmark trials in your

field that have contributed to evidence-based guidelines

that are now in common practice.

. Introduce students to patients with interesting presentations

or pathology. Such cases may highlight gaps in current

evidence-based practice, focussing a student’s literature

search to address specific clinical questions. This can be

supplemented by practical workshops centring on litera-

ture-searching skills, which can result in improved clinical

question-writing, search strategy formulation, article selec-

tion, and incorporation of evidence into students’ notes

about patients’ problems (Sastre et al. 2011; Just 2012).

. Involve students in any audits being carried out in the

department. A clinical audit can be a useful tool to

introduce students to the process of systemically gathering

evidence on effective clinical practice, and a successful

audit will help develop the skills necessary for other types

of study design. Medical students have commented that

engaging in audit was a useful experience (Nikkar-Esfahani

et al. 2012).

Tip 4

Involve students in the practicalities of research, fromplanning to execution

Most medical students who become involved in projects join

well-established research groups and contribute to work that is

already ongoing (MacDougall & Riley 2010). However,

experience in preparing project proposals, addressing the

ethical issues surrounding research, identifying potential

sources of funding, and becoming familiar with the grant

application process are all valuable learning points for the

aspiring researcher. Supervisors have a key role to play in

introducing students to the culture of research and affording

them opportunities to understand and apply targeted research

concepts, with the aim of increasing their competence in these

domains (Cruser et al. 2009). This can be achieved by

providing clear project descriptors that should be explicit

about the research skill development opportunities that will be

provided (Murdoch-Eaton et al. 2010).

In addition, a sound understanding of research practicalities

can be inculcated into students through the following

approaches:

. Encouraging students to prepare mock project proposals

prior to starting their project.

. Setting a clear timeframe with sensible goals and expecta-

tions; recognising and removing potential logistical pro-

blems; and cultivating student self-efficacy (MacDougall &

Riley 2010).

. Identifying potential sources of funding and encourage

students to apply for them.

. Highlighting the importance of research ethics when setting

a research question and encouraging students to contribute

to applications made to research ethics committees.

A. Lawson McLean et al.

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. Integrating students into their research group. By participat-

ing as an active member of the group, the student will not

only learn about working within a team, but will also

appreciate the roles of different team members.

Tip 5

Expose them to the wider research community atyour institution

The opportunity to observe how research findings can be

applied to clinical problems is an excellent way to stimulate

interest in clinical research amongst medical students. All

medical students can be involved in this through encouraging

and facilitating student attendance at departmental research

meetings, journal clubs, grand rounds, symposia, and semi-

nars. In the case of journal clubs, these sessions can be useful

platforms for students to learn skills essential for EBM, such as

good reading skills (Linzer et al. 1988). In our opinion, other

benefits of student participation at these events include the

following:

. Stimulating an interest in the relevant field.

. Keeping up to date with the latest research and ‘hot topics’

in the field.

. Gaining an appreciation of the various research methodol-

ogies used.

. Opportunity to network with clinicians and academics from

the field.

. Seeing doctors familiar from a clinical setting, discussing

research they are involved in, and emphasising the place of

the clinician-scientist in modern medicine.

Tip 6

Be an academic mentor (or help them find one)

The influence of mentorship in supporting trainee doctors

pursuing an academic career is well documented in a number

of specialities, including radiology, emergency medicine, and

primary care (reviewed by Straus et al. 2006). A lack of such

mentorship and aspirational role models has been identified as

an obstacle to academic careers, with women particularly

affected (Jackson et al. 2003; Borges et al. 2010; Mulla et al.

2012). Borges et al. (2010) identified a lack of mentoring

programmes specifically aimed at students interested in

exploring academic medicine, highlighting an unmet need in

fostering the next generation of clinical academics.

Provision of mentorship for academically inclined students

may enhance uptake of academic training, and we propose

that mentors can support students in a number of ways:

. Help students to identify achievable research projects.

. Encourage students to develop teaching skills.

. Highlight opportunities for students to present their own

work, and attend research events.

. Advise students on how they can balance their clinical

learning with research interests.

. Demonstrate the rewards of a career in academic medicine.

Tip 7

Support students to present and publish theirresearch

Clinicians can encourage students to present their research

projects, and can also support them in preparing their research

for publication.

For example, 90% of medical students graduating from

Stanford University, USA, had been involved in research,

resulting in 75% publishing manuscripts and 52% presenting

their findings at a national meeting (Jacobs & Cross 1995). The

majority of these students were motivated by their experience

and aspired to pursue research in the future. Medical student

research productivity is demonstrated internationally. Of

medical students at the University of Wurzburg, Germany,

66% who had undertaken projects produced a Medline-

indexed publication (Cursiefen & Altunbas 1998). In the

Netherlands, 14.5% of all graduating medical students had

published (van Eyk et al. 2010). A survey of British medical

students from all years of study found that 14% had submitted

manuscripts for publication, 60% of which had been accepted

(Griffin & Hindocha 2011). Significantly, this study found that

only 11% were comfortable with the process of manuscript

submission, highlighting the importance of assisting students

with this process.

Facilitating opportunities for students to present and

publish their research need not be onerous, yet it has the

potential to further engage students with the academic

process. Importantly, students who publish during medical

school or residency are more likely to choose academic

medicine as a career (Ledley & Lovejoy 1992).

Tip 8

Encourage students to appraise and respond tocurrent research

Critical appraisal and scientific writing are both important skills

relevant to the practice of academic medicine. However,

opportunities to improve scientific writing skills are limited and

students may not always have the opportunity to author

manuscripts for publication. An important but often under-

utilised avenue to improve scientific writing skills is the writing

of letters to journal editors in response to published work.

Senior medical students are often able to critically appraise

scientific literature to identify areas for improvement.

Educators can encourage students to present their critique in

the form of a succinct letter to the editor and can advise on the

appropriateness of their criticisms and clarify finer points. As

these letters generate dialogue surrounding advances in

medical science and form an important part of post-publication

peer review (Liesegang 2010), they can foster a student’s

interest in academic medicine by making them feel a part of

the wider research community. Published letters also serve as

objective evidence of a student’s interest in a particular field of

medicine and academic medicine in general (Hanratty &

Lawlor 1999).

Promoting academic medicine to students

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Tip 9

Promote student-led teaching initiatives

Clinical academics have a key role in the planning and delivery

of undergraduate and postgraduate training (MMC & UKCRC

2005). As such, students who wish to take on an academic role

will need to develop appropriate teaching skills. An avenue

through which this can be achieved is student-led near-peer

teaching, an adjuvant to medical education that is becoming

increasingly popular, with studies showing its efficacy in

teaching students a range of topics including prescribing,

clinical examination, and cardiology (Sengupta et al. 2007;

Wallace et al. 2011; Silbert & Lake 2012). These schemes

provide students with opportunities to gain experience of

teaching and to develop their teaching skills (Hill et al. 2010).

We feel that clinicians can encourage students to become

involved in teaching by:

. Contributing to teaching skills courses and workshops for

students, which can help students develop a basic under-

standing of learning theory and fundamental pedagogical

principles.

. Exposing students to relevant teaching resources, including

journals and meetings relevant to medical education.

. Assisting in the design and provision of near-peer teaching

programmes. Educators can advise on the appropriateness

of the content delivered and provide expert feedback to

students on their teaching skills.

Tip 10

Embrace a bottom-up approach to student partici-pation in research

Student-run academic medicine societies are now a prominent

part of the undergraduate landscape at a number of medical

schools (Funston & Young 2012). They provide interested

students with the opportunity to attend educational events

aimed at developing skills relevant to research and academic

medicine. Attendance at such events has been shown to

increase medical students’ interest in research and considera-

tion of this as part of their future career (Funston et al. 2011). A

similar student-run group for dental students has been

described (Guven & Uysal 2011). Interestingly, students who

had been a member of this society were more likely to be

accepted for a PhD programme, compared to students who

had not.

Societies can organise a range of events for students

(Funston et al. 2011):

. Workshops covering topics such as presentation skills and

abstract-writing.

. An approach combining journal clubs with student-written

‘letters to the editor’ has proven successful (Edwards et al.

2001; Green & Johnson 2007). This allows students to

develop their communication and writing skills by drafting a

clear and concise summary of their critique.

. Presentation evenings, giving students the opportunity to

present research in which they are currently involved in a

relaxed and informal atmosphere.

Student-led academic medicine societies offer unique

opportunities for students to develop an interest in research

and academia while pursuing their medical degree, and there

is emerging evidence of the effectiveness of this bottom-up

approach.

Tip 11

International curriculum-based approaches tostudent research involvement

In addition to extracurricular involvement, various curriculum-

based approaches have been taken to increase medical

students’ exposure to research.

. The intercalated bachelor’s or master’s degree has been

a longstanding and internationally practised approach to

encourage early student research participation. While it is

most often optional, some institutions make it mandatory

(Morrison 2004). An intercalated degree has been shown

to correlate reliably with greater interest (McManus et al.

1999) and active pursuit of a career in research

(Nguyen-Van-Tan et al. 2001). In contrast, medical

students in Germany must write a thesis to acquire the

title of ‘medical doctor’, and a scientific degree project is

compulsory within the Swedish curriculum (Nikendei

et al. 2009; Lindgren et al. 2011).

. The integrated MD–PhD model is a more selective

approach that has been advanced in North America.

Although successful in producing clinician-scientists, it

requires significant infrastructure (Andriole et al. 2008).

. Research exchange schemes and electives, which give

students the opportunity to undertake a period of

research at an institution abroad, should be encouraged

to promote collaboration. A Canadian implementation of

the research elective significantly increased students’

interest in pursuing academic careers and enhanced

their research skills (Houlden et al. 2004). In Europe,

the bachelor–master system propagated by the Bologna

Process should theoretically increase the inter-institutional

and international opportunities available to medical

students in pursuit of master’s-level research opportunities

(Patrıcio & Harden 2010).

. In the United Kingdom, the Academic Foundation

Programme provides mentorship from established clinical

academics, training in research methodology and pro-

tected research time for newly graduated junior doctors,

while allowing them to simultaneously achieve funda-

mental clinical competencies. Of those undertaking these

two-year programmes, 77% express a desire to continue in

acadaemia, emphasising the importance of providing an

early, structured introduction to the clinical academic

career pathway (Lyons et al. 2010).

A. Lawson McLean et al.

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Tip 12

Highlight the potential career pathways within inacademic medicine

The Walport Report has had significant implications for the

career structure of medical academia (MMC & UKCRC 2005);

medical graduates are fortunate that there are a number of

structured training pathways now available to develop a

career in academic medicine. However, students may not be

aware of these opportunities or of how they can develop

their interest in research after medical school (O’Sullivan

et al. 2009). It is important to emphasise that it is never too

late to foster an interest in research and that there are various

routes into the field of medical academia. In addition,

research can take many forms, from lab-based basic research

to large-scale epidemiological studies, and students should be

aware that they can combine a clinical career with active

research involvement.

Careers fairs and information evenings are a good way to

actively engage with interested students and for researchers at

all stages to share their experiences and enthusiasm, as well as

promote academic medicine (Winyard et al. 2006). In addition,

the Internet affords a wealth of opportunities to deliver

information to students and we suggest that institutions may

consider developing a website that details their own academic

training programmes. Making this information available, in

whatever form, is essential to ensure that students are well

informed about the full range of academic career options open

to them at each stage of their training.

Conclusion

Students’ research experiences at medical school can result in

them developing knowledge and skills in domains such as

critically appraising literature, analysing data and writing for

publication (Frishman 2001; Houlden et al. 2004). Moreover, it

can result in tangible research products (including conference

presentations and journal publications), enhance the quality of

their applications for later specialist training (Nikkar-Esfahani

et al. 2012), and may lead to subsequent enthusiasm for a

career in academic medicine. Importantly, undergraduate

research experience can enhance postgraduate research

productivity irrespective of the duration of the undergraduate

research experience (Dyrbye et al. 2008).

In modern undergraduate curricula, great emphasis is

placed on training future clinicians to practise EBM.

However, it is important to recognise that the health of EBM

relies not only on inculcating a respect for research

methodology and faculties for critical appraisal, but on

encouraging active participation in research activities by

future clinicians. All medical teachers can play a role in

promoting this engagement, not just ‘academics’.

It remains to be seen whether these interventions will lead

to students progressing their research involvement beyond

medical school, into postgraduate medical training or at MD/

PhD level. Nevertheless, exposure to research at medical

school has the potential to inspire and maintain student

interest in the heterogeneous role of the clinical academic and

reverse the downward trend that has occurred in recent times.

Notes on contributors

AARON LAWSON MCLEAN, MBChB, is an Academic Foundation

Programme trainee in North East Thames.

CHRISTOPHER SAUNDERS, MBChB, is a PhD student at the University of

York, pursuing interdisciplinary research in infectious diseases.

PRASAD PALANI VELU, MBChB, is a Foundation Year 1 doctor on the

South-East Scotland Academic Foundation Programme.

JOHN IREDALE, DM, FRCP, FMedSci, is the Professor of Medicine and

Dean of Clinical Medicine at the University of Edinburgh. He divides his

time between clinical practice in hepatology and research. He is also the

Director of the MRC Centre for Inflammation Research.

KAHYEE HOR, MBChB, is a Foundation Year 2 doctor on the South-East

Scotland Academic Foundation Programme.

CLARK D. RUSSELL, BMedSci (Hons), is a final-year medical student at the

University of Edinburgh. He is chairman of the National Student Association

of Medical Research (NSAMR), a student-run initiative that fosters research

opportunities for undergraduate medical students and promotes their

exploration of career pathways within academic medicine.

Declaration of interest

The authors report no conflicts of interest. The authors alone

are responsible for the content and writing of the article.

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