Medical Science Educator (2022) 32:495–502

https://doi.org/10.1007/s40670-022-01542-9

ORIGINAL RESEARCH

Research Education in Medical Curricula: a Global Analysis

Matthieu Pierre1,2   · Martina Miklavcic1,3 · Marc Margulan1,4 · Javier Shafick Asfura1,5

Accepted: 23 March 2022 / Published online: 4 April 2022

© The Author(s) under exclusive licence to International Association of Medical Science Educators 2022

Abstract
Background  Research is a key component of medical practice, with involvement of medical students crucial for the future of
healthcare. A major limitation for medical students is the lack of exposure to research education and projects. The purpose
of this study was to analyse the exposure of medical students worldwide to research education and opportunities and their
satisfaction with research in their curriculum and compare results between regions.
Methods  The International Federation of Medical Students Associations (IFMSA), through its Research Standing Committee,
developed a questionnaire to understand the current situation worldwide regarding medical students’ access to research and
research education in the medical curriculum. Students from all years from across the five regions of the IFMSA were eligible.
Results  A total of 619 responses representing 290 universities and 88 countries were received. Although 97.6% of medical
students believed that research should be approached in their education, only 19.6% considered it was sufficiently addressed.
Regarding education, only 36% of all respondents reported having specific mandatory research courses, with higher percent-
ages in the Asia–Pacific and European countries. Even though an association between research opportunities and research
participation was found, only 30% of students reported having specific places in research teams. Lastly, 39.3% had never
participated in a research project.
Conclusion  Research education is a vital component of medical education, and medical students consider its inclusion as
essential for their education. However, not enough emphasis on research education is placed across the globe, with most
students seeking research opportunities to train themselves outside the formal curriculum.

Keywords  Medical students · Research · Curriculum · Education

Introduction have a role as scholars, in which they should have the com-
petency to contribute to the creation and dissemination
In the past decades, the medical curricula have evolved from of knowledge and practices applicable to health [2]. This
traditional lectures to problem-based learning and use of includes understanding the scientific principles of research,
a competency-based approach [1]. According to the Can- applying research ethics, contributing to research, formulat-
MEDS 2015 Physician Competency Framework, physicians ing research questions and selecting appropriate research
methods as well as communicating research outcomes to
professionals and patients.
* Matthieu Pierre The importance of research competencies for physicians
matpierr@vub.be
has been shown through studies demonstrating that research-
1
International Federation of Medical Students’ Associations active healthcare institutions and providers appear to pro-
(IFMSA), Copenhagen, Denmark vide better care and achieve better patient outcomes [3–6].
2
Faculty of Medicine, Free University of Brussels (VUB), Clinicians should demonstrate the ability to evaluate their
Laarbeeklaan 103, 1090 Jette, Brussels, Belgium own practices thoroughly, with the use of research tools. For
3
Faculty of Medicine, University of Ljubljana, Ljubljana, example, all clinical guidelines are based on research stud-
Slovenia ies such as systematic reviews and meta-analysis, therefore
4
Faculty of Medicine, University of Duisburg-Essen (UDE), impacting clinicians’ decisions when diagnosing and treat-
Essen, Germany ing patients [7].
5
Faculty of Medicine, National Autonomous University In order to ensure physician participation in research,
of Honduras (UNAH), Tegucigalpa, Honduras education and training in medical research should be

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496
included in medical education [8]. In fact, research experi-
ence is not only beneficial for physicians, but also appears
to benefit medical students [9]. As medical graduates must
show the ability to apply evidence-based medicine in their
clinical practice, research for medical students improves
their skills to critically analyse literature, ask the right
questions and analyse data [10, 11]. This may help stu-
dents to become physicians with a deeper appreciation,
understanding and use of diagnostic techniques, as well
as an evidence-based approach to medical problems. Fur-
thermore, conducting research educates medical students
to keep a record of their work in a complete, accurate and
ethical way. These skills are transferable and applicable to
clinical practice [12].
Research in medical school promotes professional devel-
opment of a medical graduate. A study conducted in six
countries found that 87% of medical students had been
involved in some form of research, but only 34% had articles
accepted or published in journals while in medical school
[13]. Another study amongst international medical students
only found that half were involved in research during medi-
cal school [14]. In contrast, several US-based studies found
that up to 79% of their medical students had completed or
were currently writing a manuscript of their research [15,
16]. Professional development through research was seen
through a longitudinal study demonstrating that the percent-
age of students with publications is higher in the top 25%
of funded residency programmes in the USA [17]. Not only
publications and research presentations but university credits
for undertaking research can enhance the competitiveness of
a medical student to get their desired residency [12].
In medical school, research can be approached through
theoretical research education or through research activities
and experience, either mandatory, elective or extracurricular.
However, there are still many barriers for medical student
involvement in research. Several studies have found that
the main factors limiting research work include insufficient
supervision, lack of time and lack of institutional incentive
[18, 19]. These barriers are reflected in the inclination of
medical students to pursue a career in research. A multi-
country study failed to find an increase in inclination towards
a research career over the course of medical school, possibly
due to the medical curricula, current methods of research
education and absence of good research role models [13].
However, several medical student research programmes and
initiatives have shown promising results with an increasing
number of students interested in pursuing a research career
after involvement in research projects [10, 20, 21]. Further-
more, an Irish study found that students with research com-
petencies showed more motivation to continue in research
[22]. Another key factor to consider is the perception of
medical students, where 91 to 94% of medical students
would include research in their curriculum [15, 19, 21].
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Medical Science Educator (2022) 32:495–502
Most studies have focused on research activities, such as
special programmes, and have not assessed research educa-
tion within medical curricula. Moreover, studies have been
limited to select universities and have not compared regional
education systems. The purpose of the present exploratory
study is to describe the exposure of medical students world-
wide to research education and research opportunities and
their satisfaction with research in their medical curriculum
and to compare results between regions.
Materials and Methods
Study Design and Target Group
A quantitative descriptive, cross-sectional study was con-
ducted to assess medical students’ opinions and experience
with research education in their institutions. The target
group included medical students and recently graduated
medical students off all years from across the five regions
of the International Federation of Medical Students’ Asso-
ciations (IFMSA) (Africa, Americas, Asia–Pacific, Eastern
Mediterranean Region and Europe). Pre-medical students
were not included. Within this study, universities were not
contacted directly.
Questionnaire Development
An online questionnaire consisting of 16 questions was
developed, available in English. Questions included basic
demographic questions, dichotomous (‘yes/no’) questions
regarding research education and opportunities in their uni-
versity as well as multiple choice questions with predefined
answers. The questions were organised in 3 thematic blocks:
the first block explored the demographics of the partici-
pants, the second one focused on research education in their
medical faculty, and the third block covered their personal
experience with research. The block investigating specific
research competencies was designed by compiling compe-
tencies found in relevant studies [23–25], without inclusion
of soft skills. All questions were of closed type and manda-
tory to fill out. The questionnaire took an average of 5 to
10 min to complete. The questionnaire was developed by
an international working committee of IFMSA focusing on
research education and piloted by medical students prior to
distribution.
Sampling and Questionnaire Distribution
The questionnaire was distributed through formal and infor-
mal IFMSA channels, namely, mailing lists, international
IFMSA events and social media, targeting medical students
worldwide. Participants were also recruited through their
Medical Science Educator (2022) 32:495–502 497

national student representatives who disseminated the ques-
tionnaire to the target population in the medical faculties
of their home country. Participation was completely volun-
tary, and full confidentiality was maintained as no personal
identifiable information was collected through the question-
naire. The questionnaire was available for a total period of
2 weeks, in January 2019.
Data Analysis
Data was entered into an Excel database (Microsoft Inc.,
Richmond, WA), which was used to generate descriptive
results. Descriptive statistics were used to describe demo-
graphic characteristics, research education, participation
and opportunities using frequencies and percentages for
categorical variables. Results were presented to compare
regions. The Chi-square test was used to compare categori-
cal variables. All statistical analyses were performed in
SPSS v. 26, and p values of ≤ 0.05 were considered statisti-
cally significant.
Ethics
This study obtained approval from the International Federa-
tion of Medical Students’ Associations Executive Board in
January 2019. All procedures used in this study comply with
the Declaration of Helsinki 1975, as revised in 2008. Study
participation was voluntary, and informed written consent
was obtained from each student.
Results
A total of 619 responses were received. One response
was excluded due to incoherent personal information
given regarding region, country and university. Therefore,
618 were taken into further consideration for analysis.
The overall response rate between regions was 50 from
Africa (8.1%), 323 from Americas (52.3%), 71 from the
Asia–Pacific (11.5%), 46 from the Eastern Mediterranean
region (7.4%) and 128 from Europe (20.7%). In total, partici-
pation from 290 universities representing 88 countries was
recorded. The demographics of the students who responded
to the questionnaire are described in Table 1.
The survey found that 97.6% of participants believed
that research should be approached in medical education.
This was seen across all years of studies and regions. When
being asked if research is sufficiently included in their medi-
cal curriculum, 31.4% of respondents stated it is not, 49%
answered that it is only partially included, and 19.6% agreed
that research is sufficiently addressed in their curriculum.
Regional analysis of the responses can be found in Table 2.
The Asia–Pacific (35.2%) had the highest percentage of
answers mentioning sufficiently included research educa-
tion in their curriculum, while a high percentage of respond-
ents from Africa (48%), Eastern Mediterranean (45.7%) and
Europe (39.8%) expressed that research is not sufficiently
addressed in their curriculum.
Within the survey, medical students were asked about
the way research education is approached in their medical
curriculum (Table 2). Overall, only 36% of all respond-
ents reported having specific mandatory courses tackling
research. Responses showed clear regional differences.
Students from the Asia–Pacific (52%) and Europe (52%)
reported having more mandatory courses compared to stu-
dents from other regions (Americas 32%, Eastern Mediter-
ranean 26% and Africa 10%).
Answers regarding research opportunities provided by
their universities were collected (Table 2), with the majority
(51.9%) of respondents stating they have research opportuni-
ties provided by the university only if they personally reach
out to the investigators. Only 30% of respondents had access
to specific places in research teams. The highest percentage
of research opportunities was found amongst students from

Table 1  Characteristics of the study population according to region and year of studies

Current year of studies Africa Americas Asia–Pacific Eastern Mediterranean Europe Total

1st 3 13 3 5 2 26 (4.2%)
2nd 5 47 23 4 15 94 (15.2%)
3rd 6 88 18 12 28 152 (24.6%)
4th 13 61 17 11 37 139 (22.5%)
5th 19 55 6 8 25 113 (18.3%)
6th 1 43 1 1 17 63 (10.2%)
7th 0 4 1 2 0 7 (1.1%)
8th 2 7 0 1 0 10 (1.6%)
Recently graduated 1 5 2 2 4 14 (2.3%)
Total 50 (8.1%) 323 (52.3%) 71 (11.5%) 46 (7.4%) 128 (20.7%) 618

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Table 2  Comparison of research education and research opportunities according to region

Total (n = 618) Africa (n = 50) Americas (n = 323) Asia–Pacific (n = 71) Eastern Europe (n = 128)
Mediterranean
(n = 46)

Is research education addressed sufficiently in your medical curriculum?

Yes 121 (20%) 6 (12%) 65 (20%) 25 (35%) 8 (17%) 17 (13%)
No 194 (31%) 24 (48%) 82 (25%) 16 (23%) 21 (46%) 51 (40%)
Partially 303 (49%) 20 (40%) 176 (54%) 30 (42%) 17 (37%) 60 (47%)
How is research education approached in your medical school?
Specific mandatory courses 222 (36%) 5 (10%) 102 (32%) 37 (52%) 12 (26%) 66 (52%)
Part of some courses 143 (23%) 13 (26%) 89 (28%) 15 (21%) 6 (13%) 20 (16%)
Specific elective courses 56 (9%) 0 24 (7%) 8 (11%) 9 (20%) 15 (12%)
Extracurricular opportunities 154 (25%) 25 (50%) 85 (26%) 9 (13%) 17 (37%) 18 (14%)
Not approached at all 43 (7%) 7 (14%) 23 (7%) 2 (3%) 2 (4%) 9 (7%)
Does your school provide research opportunities for medical students?
Yes, there are specific places 184 (30%) 10 (20%) 100 (31%) 30 (42%) 11 (24%) 33 (26%)
for students
Yes, if I personally reach out to 321 (52%) 15 (30%) 167 (52%) 31 (44%) 23 (50%) 85 (67%)
investigators
No 113 (18%) 25 (50%) 56 (17%) 10 (14%) 12 (26%) 10 (8%)
Have you ever taken part in any kind of research project?
Yes, as lead investigator 52 (8%) 2 (4%) 31 (10%) 8 (11%) 3 (6.5%) 8 (6%)
Yes, as part of a research team 213 (34%) 21 (42%) 111 (34%) 22 (31%) 24 (52%) 35 (27%)
Yes, during a short-term 110 (18%) 8 (16%) 50 (15%) 9 (13%) 3 (6.5%) 40 (31%)
placement (exchange,
internship)
No 243 (39%) 19 (38%) 131 (41%) 32 (45%) 16 (35%) 45 (35%)

the Asia–Pacific with 42% of respondents having specific Discussion

places in research teams, while 50% of African respond-
ents answered that their school did not provide any research
opportunities. Regarding participation in research projects
(Table 2), 39.3% of respondents had never participated in
a research study, while only 8.4% had led an investigation.
Out of the 375 respondents having taken part in a research
opportunity, only 27.4% (n = 103) took part in the research
project because it was mandatory by the university. Further-
more, there is an association between research opportunities
provided by medical schools and participation in research
projects (as lead investigator or as part of a research team)
(p = 0.001). Similarly, a significant association between
increasing year of studies and participation in research pro-
jects was found (p = 0.003).
To better understand the specific research competencies
taught in medical curricula worldwide, students were also
asked which competencies they received from their universi-
ties, either through mandatory or elective courses. The spe-
cific research competencies can be found in Fig. 1. Lastly,
students were asked whether they had published an article or
presented their research at a conference. Only 10.3% (n = 64)
respondents had published a research article.
Our exploratory study has shown that a strong majority of
medical students (97.6%) believe that research should be
approached in medical education. However, only 19.6% of
participants agreed that it is sufficiently addressed in their
medical curriculum. These results clearly demonstrate a
global lack of proper research education in medical schools
as part of the official curriculum and show that there is a big
demand for curricular change.
Within our survey, we found that only 35.9% of par-
ticipants’ curriculum requires mandatory research courses,
highlighting that majority of participants are not educated
about medical research. While a previous study amongst
international students compared high-income versus low-
income countries [14], the present study aimed at com-
paring regions. A major limitation is the limited number
of responses from several regions, such as Africa, the
Asia–Pacific and the Eastern Mediterranean Region, mak-
ing it difficult to draw well-based conclusions, also due to
the heterogeneity of medical curricula. However, the limited
data does show some trends. Surprisingly, considerable dif-
ferences could be seen between regions with more than half

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Medical Science Educator (2022) 32:495–502
Fig. 1  Frequency of research competencies taught in medical school
of Asia–Pacific and European students reporting mandatory
research courses, while the percentage in other regions was
much lower. Only 7% of students reported that research was
not approached at all in their education. However, 25% of
students could only find research education through extra-
curricular education, further highlighting the need for proper
implementation of research education and incentives. It is
important to note that students might not recognise some
research training or opportunities as ‘formal research train-
ing’ or ‘mandatory research courses’. However, as most
medical students believe research is necessary within medi-
cal curricula, this underlines the necessity for formal cur-
ricular implementation or at least for a more systematic and
structured way of organising research courses. Several stud-
ies have already suggested benefits from mandatory research
courses and electives [10–12]. De Oliveira et al. suggested it
is not only important to make research courses mandatory, it
is also crucial to ensure that all aspects, ranging from techni-
cal aspects to hypothesis writing and presentation of results,
are adequately taught [19]. This was also suggested in a
longitudinal study where no change in inclination towards
research or a research career was seen throughout medical
studies [13].
Our results suggest that less than one third of students
have access to formal research opportunities and that for-
mal research education and opportunities might be the
bottleneck to the conduction of evidence-based medicine.
It is possible that the reports regarding research opportu-
nities are underrepresented as responders from first years
of medical school might not be aware of all opportunities.
51.9% of respondents reported that research opportunities
499
exist only when personally reaching out to investigators,
and 18.3% of students even reported that no research
opportunities and placements are available at all for them.
Yet, these results have a very broad variance depending on
regions. While in Europe 65.9% reported having research
spots when personally reaching out to investigators, 50%
of African medical students reported not having any
research opportunities at all. A review reported elective
research projects as the most common research opportu-
nities [9]. However, most studies are US-based or have
focused on specific research programmes of universities.
The literature reports variable percentages of involvement
in research projects by medical students. A study amongst
Canadian students showed that 43% of students had no
involvement in research projects during medical school
[26], and a Brazilian study only had 47% of students
involved in research [19], while other studies reported up
to 87% involvement in research [13]. Although this study
suggests regional differences in research opportunities,
especially for African medical students, further studies
are needed to confirm these differences and investigate
underlying determinants. While it is still unclear whether
research activity in medical school should be mandatory
or elective, it is concerning to see that regional or national
location can have an impact on availability of research
opportunities [9]. Therefore, an initial step should be taken
by medical schools and research centres to provide elective
research opportunities for students without opportunities.
Regarding participation in research, almost 40% of our
respondents stated that they never participated in a research
project, without considerable differences between regions.
13
500
34.5% had been part of a research team and only 8.4%
had led an investigation themselves. Another interesting
finding is that 17.8% of students participated in a short-
term placement such as research exchange or an intern-
ship, which indicates that there is a role of extracurricular
research opportunities and placements. These results also
confirm the different degrees of involvement in research.
With unclear literature about this topic, this underlines the
necessity to investigate to which degree medical students
should be involved in research. Our findings also confirm
that there is a direct correlation between research opportu-
nities offered by the university and research participation
of the students which further emphasises the importance of
providing proper research opportunities in formal medical
curricula. Some universities have already shown that imple-
mentation of research training programmes is effective both
in increasing knowledge and competency in research but
also in motivating students towards a career in research
[10, 27]. For example, Norway has implemented the Stu-
dent Research Programme to recruit medical students to
research, which has led to an increase in recruitment of
physicians with interest to pursue research [20]. However,
despite local initiatives found in the literature and student
motivation to be involved in research, our results clearly
demonstrate the lack of research opportunities and involve-
ment across all regions.
The survey also investigated which research competencies
are currently taught in medical curricula worldwide either
as a part of elective or mandatory courses. Our results have
shown that there is a big gap between different aspects of
research that are officially taught in medical schools (Fig. 1).
Some topics such as basic technical aspects, hypothesis for-
mation, bibliography search and research ethics are regularly
being addressed as part of the curriculum globally. On the
other hand, some important topics that might be crucial for
future physicians are not included in the curriculum sys-
tematically — for example, critical appraisal, reflection on
implications and limitations of research and Open Science
as well as presentation of scientific findings and academic
writing. Although there are existing competency-based
frameworks for physicians [28–31] and clinical research pro-
fessionals [32], research competencies and frameworks for
medical students and graduates are scarce in the literature.
Further work is needed to define which research compe-
tencies and skills should be included in medical curricu-
lum and to what degree. Furthermore, the implementation
of structured programmes for scientific training accessible
to all students should be explored [19]. One such example
of a programme in the UK uses a curriculum designed at
teaching research skills incrementally to complete a research
project at the end. However, this requires proper theoretical
research training and experiential learning through research
opportunities and supervision [24].
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Medical Science Educator (2022) 32:495–502
It is somehow surprising that only 10.3% of respondents
published a research article. A possible explanation is the
inclusion of students from all years of education, while
studies have shown that research productivity and output
increase throughout medical training [26]. However, a multi-
country study reported variable percentages of students who
had published an article while in medical school, from 9%
to as high as 76% depending on the school [13]. It is unclear
why these differences in student publications between coun-
tries and schools exist, possibly due to variable research
opportunities or research publications as an important factor
for residency applications. Another possible explanation for
low scientific output of medical students could be the lack
of formal training in academic writing and dissemination of
research as shown in this study.
There are several limitations to this study. Firstly, results
are based on self-reported questionnaires by medical students.
Although these measures are often used in cross-sectional
studies, responses can be subject-dependent and are subject to
recall bias and cultural differences in observation and report-
ing, especially in responses regarding research education and
competencies received. Further studies are required to tar-
get universities formally and objectively. Secondly, there are
differences in medical education systems worldwide, impos-
ing significant limitations on comparisons of research in the
medical curriculum between countries and regions. Several
countries require previous degrees (sometimes research-ori-
ented), while others do not. Therefore, more thorough inves-
tigations exploring specific requirements for medical schools
as well as the background of medical students are necessary
to be able to compare countries more objectively. Thirdly,
although there are participants from 88 countries, the number
of responses per university is considerably low. There is also
an unequal distribution between regions, with an overrepre-
sentation of students from the Americas region. Given the
large geographic distribution, the sample size of individual
countries is low. Lastly, due to the dissemination of the ques-
tionnaire amongst members of a non-governmental organisa-
tion advocating for research education, there is a selection bias
towards students who might have more access to extracur-
ricular research education and opportunities.
Conclusion
The data presented in this exploratory study shows that
research in the medical curriculum is insufficiently
addressed throughout all regions. Although almost all par-
ticipants recognise the importance of research education,
most students did not receive mandatory research courses.
Furthermore, this study is the first to make a global analysis,
suggesting considerable regional differences in both research
education and research opportunities. Consistent with the
Medical Science Educator (2022) 32:495–502
literature, these results suggest that not all students have
access to research opportunities. However, regional analy-
sis suggests that African students have less opportunities
than students from other regions, while European students
often need to reach out to investigators personally to pursue
research. The literature presents several examples of suc-
cessful research education without compromising other ele-
ments of the medical curriculum. Due to the limited data, it
is difficult to draw specific conclusions. To enhance research
education throughout all regions and countries, further stud-
ies are needed to understand how research education can be
incorporated in a sustainable manner. Furthermore, under-
standing the research competencies medical students should
master will help to incorporate research education equally
throughout medical schools.
Availability of Data and Material  The datasets generated during and/or
analysed during the current study are available from the corresponding
author on reasonable request.
Declarations  D, et al. Scholarly research projects benefit medical students’
Ethics Approval  Ethics approval was described in the Methods section.
Consent to Participate  Study participation was voluntary and informed
written consent obtained from all individuals.
Consent for Publication  Consent for publication was obtained from all
individuals before study participation.
Conflict of Interest  The authors declare no competing interests.
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