Raising the bar in academic research in India – Need of the hour

Evidence-based medicine was born in the late 1980s in Canada when a few illustrious doctors, including David Sackett and Archie Cochrane, started a silent revolution by incorporating current evidence in deciding patient care.[1] Subsequently, this movement was carried forward by several others, including Gordon Guyatt, who coined the term evidence-based medicine.[2] With increasing recognition that evidence might be meaningless unless patient values and clinical expertise are combined while making decisions, the idea of evidence-informed health care came into vogue. The number of scientific papers published in peer-reviewed journals has shot up exponentially, partially due to this emphasis on evidence-informed health care. International societies use high-quality data from systematic reviews and randomized controlled trials to develop guidelines that have become the cornerstone of the algorithmic management of several diseases. Concurrently, academic regulators in many countries identified research acumen and output as an important performance index for faculty. Although late, the National Medical Commission (NMC) (erstwhile Medical Council of India [MCI]) also realized this and promulgated clauses to make research publications an important criterion for the eligibility of medical teachers in Indian medical schools.[3] As early as 2012, the MCI regulated that promotion to the post of Associate Professor or Professor would require the faculty to have published at least two or four research articles, respectively. The initial regulations mandated publications in any indexed journal but with print versions only and in a journal of that specific specialty. Further, case reports were also accepted as publications for the purpose of promotions. However, in subsequent amendments, these were modified, and currently, systematic reviews, original research articles, and case series are considered acceptable.[3] The indexing agencies were also revised to include MEDLINE, PubMed, Central Science Citation Index, Science Citation Index Expanded, Embase, Scopus, and Directory of Open Access Journals. Although the intent behind such regulations and revisions is laudable, several issues remain unaddressed at the ground level. The specification of indexing bodies and types of articles acceptable to be considered for eligibility have ensured to a large extent that faculty engage in higher quality research and do not fall prey to predatory journals.[4] Yet, the amount of meaningful research output is minuscule. A good number of faculty use postgraduate dissertations as a convenient pathway for obtaining publications. While authorship in a paper born out of such dissertations is not bad, the contribution of faculty to the process must be substantial. Otherwise, it may be as good as ghost authorship.[5] A substantial number of faculty are content publishing a collection of two or three interesting cases as case series, with no actual robust data collection or analysis. While case series are useful to educate readers about unique presentations, laboratory paradigms, or rare diagnoses, the authors learn very little from them in terms of developing a research protocol, informed consent process, research ethics, data collection, and statistical analysis.[6] Since many faculty are content publishing case series or dissertations, the involvement and interest in participating in faculty development programs focusing on research methodology are quite low. The NMC has mandated the completion of an online basic course in biomedical research to ensure that faculty attain basic competency in doing research.[3] However, on the ground, there seems to be no real translation of these competencies as evidenced by the poorly prepared research proposals and ignorance about research ethics prevalent among faculty. These deficiencies also reflect in postgraduate training where journal clubs are a recommended form of learning.[7] In many institutions, journal clubs are conducted akin to any other topic discussion, with a lot of emphasis on the subject content rather than the critical appraisal of the paper with a view of teasing out the well-done areas and the pitfalls. The faculty are not equipped to facilitate journal clubs in a way that would identify the pros and cons of the study, including a thorough discussion on methodology, statistical tests, and the implications of results. Such poorly facilitated journal clubs may not serve the purpose of building critical thinking and appraisal skills among postgraduates. These skills are extremely important as they start independent practice later. In short, while a lot is being done by the regulators to raise the bar of research acumen in academic institutions, there is scope for improvement. All stakeholders have major roles to play if these are to become successful. The NMC must continue to monitor that the regulations are revised in a timely manner to include high-quality research as eligibility criteria for teachers. Limiting case series to one among the mandated number of publications may be the first step in this direction. The medical schools have a great responsibility to help the NMC attain this goal. While the NMC regulations are minimum standard requirements, individual institutions could develop their own standards over and above these for promotions and pay revisions. Further, incentivizing high-quality research and supporting faculty who are engaged in serious research will help the cause. Narrowing the spectrum of acceptable indexing bodies and types of articles and scrutinizing the extent of contribution to each paper may be additional strategies. Streamlining research content in the curriculum such as the inclusion of modules on evidence-based medicine and clinical research in later phases of the MBBS curriculum, besides the current exposure in community medicine, will ensure that faculty also acquire basic competencies in the same. This, in turn, will enhance such competencies in postgraduate training. To conclude, India is probably heading in the right direction to promote quality research among faculty in medical schools. Yet, the movement needs periodic evaluation, constant surveillance, and active timely revisions to ensure that high standards of research and its output are attained as well as maintained. This undoubtedly will lead to improved quality of graduates passing out of our medical schools and lift the overall quality of medical education in India.

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