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Medical students’ perceptions of anundergraduate research elective
ROBYN L. HOULDEN, JAMILA B. RAJA, CHRISTINE P. COLLIER, ALBERT F. CLARK& JENNIFER M. WAUGHDepartments of Medicine, Pathology, and Biochemistry, Queen’s University Faculty of HealthSciences, Kingston, Ontario, Canada
SUMMARY Recent years have seen a steady decline in the number
of new physician-investigators (Association of American Medical
Colleges, 2000). To encourage medical students to select research
careers, the Queen’s University Faculty of Health Sciences
curriculum includes a mandatory Critical Enquiry elective in the
2nd year. An anonymous written survey was administered to
medical students before and after the elective to determine their
perceptions of the value of the elective and its impact on their
decision to pursue a career in medical research. There was
a significant increase in the number of students expressing an
interest in pursuing a research career following the elective
(35–42%, p ¼ 0.029). Students recognized other benefits includ-
ing the development of critical appraisal, information literacy,
and critical thinking skills; and the opportunity to select an area
of and form contacts for postgraduate training. Even students who
choose not to pursue careers in medical research perceive benefits
to a mandatory undergraduate research elective.
Introduction
At Queen’s University, the undergraduate medical curricu-
lum includes a mandatory minimum eight week ‘‘Critical
Enquiry’’ elective. The purpose of this elective is to allow
each student a block of time, free from other academic
assignments, to pursue in depth a medically-related hypoth-
esis of the student’s choice. A comprehensive literature
search must be performed and a final written report
submitted. The area of research may be from the basic,
clinical, or social sciences; or the humanities. Students may
arrange the elective with the supervisor and at the location
of their choice. The elective block is placed immediately prior
to the summer vacation to afford the opportunity of exten-
ding the project into the summer months.
This study was performed to investigate students’
perceptions of the value of this research experience and
whether it impacted their decision to pursue a career
in research.
Methods
The medical class of 2002 was surveyed immediately prior
to and shortly after their Critical Enquiry elective. Students
were asked to complete an anonymous three page survey
containing nine closed ended questions related to their
perceptions of the value of the elective, their interest in a
career in medical research, and the skills acquired from the
elective. The survey was developed in collaboration with
experts in medical education and medical students involved
in the elective. It was pilot tested on a sample of students for
clarity and construct validity. The Wilcoxon Singed-Rank
test was used to compare pre- and post- Critical Enquiry
elective data.
Results
Sixty students completed both surveys out of a class size
of 71 (85% response rate). Sixty percent of respondents were
male and 40% were female. Age ranged from 22 to 41 years
(43% were 22–24 years; 43% were 25–27 years; 14% were
over 28 years of age). Twelve percent had completed
a BA, 73% had completed a BSc, 1 had completed a
B.Eng, 28% had completed a Masters, and none had
completed a PhD. The majority reported research experience
prior to medical school.
Before the Critical Enquiry elective, 50% of students
felt they had had sufficient exposure to research to
Correspondence: Dr. Houlden, Kingston General Hospital, 76 Stuart
Street, Kingston, ON K7L 2V7, Canada. fax: þ613-548-6105; email:
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confidently make a decision regarding a career in medical
research. Following the elective, this number increased
to 77% (p<0.001). Before the elective, 35% of students
expressed an overall interest in pursuing a career in medical
research. Following the elective, this number increased to
42% ( p¼ 0.029). At the end of the elective, 29% of female
students and 39% of male students expressed an overall
interest in a career in medical research.
Before starting the elective, 40% of students felt it would be
useful in helping them with their decision whether to pursue
a career in medical research compared to 53% after
( p ¼ 0.084). As a result of the elective, 47% of all students
stated they were more interested in medical research; 6%
reported they were less interested; and 47% reported the
elective had had no impact on their decision to pursue a career
in research. Of the 32 students who perceived the elective to be
valuable, 63% stated that as a result of the elective, they were
more interested in medical research; 6% reported they were
less interested; and 31% reported the elective had had no
impact on their decision to pursue a career in research.
Students expressed the greatest interest in pursuing
research involving clinical trials and medical education
(Table 1).
Seventy-six percent of students expected a publication
as a result of the elective; 47% expected a presentation;
75% reported making ‘‘contacts’’ that would be useful for
postgraduate training; 62% reported the elective had helped
them decide which area of clinical medicine to pursue.
Students reported an increased sense of confidence for
a variety of skills including 53% for performing a literature
search, 47% for critical appraisal of the literature, 43% for
problem formulation, 33% for survey design,
6% for laboratory skills, 32% for statistical analysis,
68% for manuscript preparation, 33% for clinical skills,
and 32% for presentation skills.
Eighteen percent of students reported spending 6 or less
weeks on their project, 45% reported spending 7–12 weeks,
38% reported spending over 12 weeks.
For male students, the five most important factors
influencing their decision to pursue a career in medical
research was the perceived quality of life of their past research
mentors, followed by their prior research experience, the
need to compete for grants and publish, other personal
aspirations, and family commitments (Table 2). For female
students, the most important factor was their prior research
experience followed by other personal aspirations, family
commitments, need to compete for grants and publish,
and perceived job satisfaction of past research mentors.
Discussion
Overall, the Critical Enquiry elective assisted students
in being more confident about their decision whether to
pursue a research career. There was a significant increase
in the number of students expressing an interest following
the elective with more male students interested than
female students. Over half the class found the elective
useful in making their decision; however, many students
had already formed their decision about a research career
before the elective. Pre-medical school research experience
appeared to play a major role in this decision. The Critical
Enquiry elective rarely had a negative effect on students
Table 2. Students’ perceptions of factors influencing their decision to pursue a medical
research career.
Positive Negative No
Contributing factors influence influence influence
Prior research experience 38% 38% 23%
Additional research training required 7% 45% 48%
Perceived quality of life of mentors involved in research 32% 23% 45%
Perceived job satisfaction of mentors 40% 15% 45%
Student debt 2% 43% 55%
Family commitments 13% 42% 45%
Other personal aspirations 7% 42% 52%
Limited job opportunities in research 3% 38% 58%
Need to compete for grants and publish 2% 75% 23%
Lack of recognition for academic efforts 0% 30% 70%
Patient care responsibilities 8% 37% 55%
Table 1. Interest in pursuing a medical research career according to type of research.
Type of research
Before elective
(% of students surveyed)
After elective
(% of students surveyed)
Clinical trials 51% 55%
Medical education 28% 33%
Basic science 17% 17%
Epidemiology 17% 17%
Ethics 10% 8%
History of medicine 2% 2%
Medical informatics 3% 3%
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who had expressed an interest in research prior to the
elective. Duke University School of Medicine has repor-
ted similar satisfaction amongst their students for a man-
datory 8 or 12 month research experience in the 3rd year
(Blazer et al., 2001).
Conclusion
The Critical Enquiry elective appears to increase student
confidence in their decision to pursue a career as a physician
investigator and may encourage some students in selecting
this career path. However, students recognize other benefits
including the development of critical appraisal, information
literacy, and critical thinking skills; and the opportunity to
select an area of and form contacts for postgraduate training.
Practice point
Notes on contributors
DR. ROBYN HOULDEN is an associate professor in the Faculty of
Health Sciences of Queen’s University and an endocrinologist
at the Kingston General Hospital. She is actively involved
in undergraduate, postgraduate and continuingmedical educa-
tion, and the recipient of eight teaching awards.
JAMILA RAJA is an undergraduate student in the School of
Medicine and assisted with this project during her Critical
Enquiry elective.
DR. CHRISTINE COLLIER is an associate professor in the
Faculty of Health Sciences of Queen’s University and
a clinical chemist at the Kingston General Hospital.
She coordinates the TIPS (Teaching Improvement Project
System) program at Queen’s.
DR. ALBERT CLARK is a professor in the Faculty of Health
Sciences of Queen’s University and a biochemist.
He coordinates the Critical Enquiry elective for 3rd year
medical students.
JENNIFER WAUGH is an undergraduate student in the Faculty
of Arts and Science at Queen’s University.
References
ASSOCIATION OF AMERICAN MEDICAL COLLEGES (AAMC) (2000) Breaking
the Scientific Bottleneck, Clinical Research: A National Call to Action,
(Washington, DC, Association of American Medical Colleges).
BLAZER, D., BRADFORD, W. & REILLY, C. (2001) Duke’s 3rd Year:
a 35-year retrospective, Teaching and Learning in Medicine, 13,
pp. 192–198.
Evidence-based medicine teaching in theMexican Army Medical School
MELCHOR SANCHEZ-MENDIOLADepartment of Pediatrics, Central Military Hospital and Mexican Army Medical School, Mexico
SUMMARY Training of medical students must include the skills
necessary to use advances in scientific research. Evidence-based
medicine (EBM) has been incorporated in undergraduate programs
in several countries, a process that has not been well studied in
developing countries’ medical schools. An EBM course was
incorporated into the curriculum of the Mexican Army Medical
School. In the first year of its implementation it was given to half the
fifth- and sixth-year groups. At the end of the semester, a previously
validated questionnaire designed to evaluate the effectiveness of
EBM teaching was administered. In total, 67 students took the
course and 64 did not. A significant increase in the self-assessment of
critical appraisal skills and the self-reported use of the Cochrane
Library were found. There was a significant increase in the attitudes
score, 22.9� 5.9 (mean� SD) in the non-EBM group vs.
28.8� 3.2 in the EBM group (p<0.001), and a trend towards
higher scores in the knowledge domain, 1.89� 3.3 in the non-EBM
group vs. 2.56� 3.6 in the EBM group (p>0.05). EBM concepts
can be taught in a developing country medical school, with a short-
term gain in attitude and probably in knowledge.
Introduction
The training of medical students must include the skills to use
scientific advances. The strategy of evidence-based medicine
(EBM) has been proposed as a method to learn and practice
medicine by finding, appraising and using quality biomedical
research, with the ultimate goal of providing quality healthcare
(Sackett et al., 2000). There are published studies that
describe medical schools’ experiences in teaching EBM to
� Even students who choose not to pursue careers in
medical research perceive benefits to a mandatory
undergraduate research elective such as the develop-
ment of critical appraisal, information literacy, and
critical thinking skills; and the opportunity to select an
area of and form contacts for postgraduate training.
Correspondence: Lt. Col. M.D. Melchor Sanchez-Mendiola, Department
of Pediatrics, Hospital Central Militar, A.P. 35-561, Mexico, D.F.
11649. Tel: (525)557-3100, ext. 1411; fax: (525)557-9743; email:
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