2012; 34: 705709

TWELVE TIPS

Twelve tips for introducing students to research and publishing: A medical students perspective
NIGEL TAPIWA MABVUURE
Brighton and Sussex Medical School, UK

Abstract
Background: Medical students claim to have inadequate opportunities to conduct research, whilst some do not know how to make the initial steps. There is a need for medical educators to not only direct students to research opportunities but also to counsel them on the attitudes required for the students success in a research environment. Aim: This article gives educators 12 tips on guidance that might help motivated medical students when starting their research careers. The various opportunities for students to participate in research are also identified. Method: Tips were devised from personal experience and a review of the literature. Results: The 12 tips are: (1) Educate students on the benefits of research. (2) Encourage students to take the initiative to create opportunities for themselves. (3) Encourage students to undertake extracurricular research. (4) Encourage students to network with other researchers. (5) Encourage students to engage with student-selected components of their courses. (6) Encourage students to apply for summer research programmes. (7) Encourage students to attend scientific conferences. (8) Advise students to consider intercalated degrees. (9) Encourage students to do research during elective placements. (10) Make students aware of the MBPhD courses. (11) Emphasise research as a learning process and reduce focus on output. (12) Advise students to balance their academic and research interests. Conclusions: The 12 tips highlight important attitudes for students to take in research as well as highlighting various opportunities for research.

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Introduction
Medical history is littered with several examples of extraordinary student contributions to medical science. Heparin, insulin, the sinoatrial node, Raynauds phenomenon, spermatozoa, the Fogarty catheter and ether anaesthesia are just some examples of enduringly important discoveries by medical students (Fogarty et al. 1963; Stringer & Ahmadi 2009). These were extraordinary achievements, which, as anyone au fait with the rigours of medical school will know, required rare qualities and serendipity at times. This cannot be expected of every medical student. However, scientific contributions need not be famous to be valuable, and there is much valuable work that students can contribute to. As a senior medical student with some experience of research, I am frequently asked by juniors how they can begin to make their own impression in the field. Whilst I am mostly encouraging, I feel that perhaps this advice should come from medical educators who have more research experience than my 4 years to also inspire the students. A recent study found that only 14% of British medical students had submitted an article for publication (Griffin & Hindocha 2011). Worryingly, 55% of this cohort had not taken part in research due to lack of opportunities, whereas at Stanford University in California, 90% of students had carried out a research project (Jacobs & Cross 1995). Seventy-five percent of these projects were published and 52% presented at

national meetings. At the Albert Einstein College of Medicine, New York, 90% of project reports by 69 final-year students were accepted for publication (Frishman 2001). Whilst differences in medical school curricula could explain these discrepancies, it is also interesting to note that American medical students are all postgraduates who have likely been involved in undergraduate formal or extracurricular research projects. However, it is possible to learn fundamental research skills and techniques as an undergraduate and apply these to a productive research career. In this article, I provide tips to educators on how to effectively counsel their students who might be interested in research. These tips are based on answers to the questions I had when I started out in research.

Tip 1
Educate students on the benefits of research
The research activity of students benefits both the student and their institutions, and medical student publications can significantly increase a facultys research output (Jacobs & Cross 1995; Cursiefen & Altunbas 1998; Frishman 2001). Students also develop experience of hypothesis formulation, critical literature analysis, literature review and data collection skills after carrying out research projects (Jacobs & Cross 1995;

Correspondence: Nigel Tapiwa Mabvuure, Brighton and Sussex Medical School, Audrey Emerton Building, Eastern Road, Brighton BN2 5BE, UK. Tel: 00447581 442 551; fax: 01273 52 33 72; e-mail: bsms1491@uni.bsms.ac.uk
ISSN 0142159X print/ISSN 1466187X online/12/0907055 2012 Informa UK Ltd. DOI: 10.3109/0142159X.2012.684915

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Frishman 2001; Solomon et al. 2003; Houlden et al. 2004). These are necessary skills for any doctor wishing to engage in evidence-based medical practice. All specialties in the United Kingdom require that applicants into specialty training demonstrate an understanding of research, including awareness of ethical issues by providing evidence of relevant academic & research achievements, e.g. degrees, prizes, awards, distinctions, publications, presentations (MMC 2011). In many conversations I have had with doctors who are trapped in the bottleneck between basic medical or surgical and specialty training, many wished they had embarked on research earlier in their careers. Such is the importance of research that entry into a competitive specialty is almost impossible without evidence of prior participation. Research participation can, therefore, be a good way of proving ones interest in a specialty and standing out at interviews and selection centres.

The following tips are also a summary of the opportunities available to British medical students but may also apply to foreign medical schools. Students can make a suitable choice early in their careers if they are aware of the different opportunities at the start of their research.

Tip 4
Encourage students to network with other junior researchers
Forming collaborative teams with registrars and junior doctors may increase student awareness of opportunities in hospitals. This also has the benefit of developing important team working skills. There is less chance of a student carrying out a doomed project when working in a team as deficiencies in projects can be identified earlier. Another area with which students may struggle with is in knowing where to start and how to develop an interest if they do not have one. The UK Medical Students Association (UKMSA) recognises this and on its website (www.ukmsa.org) provides a facility where students can register their interest in carrying out either laboratory or clinical research projects including audits. Researchers can, therefore, contact this organisation should they require student input. The UKMSA also offers free advice on how students could improve their medical school essays to a publishable standard. Most medical students should be able to take advantage of this facility using university essays they may have written. Once a student has identified their particular research interest, it may be more beneficial for their learning to focus on that area. The internet can be a useful resource to discover local research strengths and priorities. Most medical school websites will provide detailed biographies and contact details of their researchers.

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Tip 2
Encourage students to take the initiative to create opportunities for themselves
The claim by medical students that they lack opportunities to participate in research is an astounding one. A lack of opportunity needs to be differentiated from a lack of motivation or initiative on the students part, or a failure to take advantage of opportunities when they are presented. It seems likely that in the course of a 5-year degree programme (six for students who intercalate), most students will encounter opportunities to become involved in research. After all, 35% of medical students at a London medical school did not think a greater emphasis should be placed on research in the medical curriculum (Rosenthal & Ogden 1998). There could, however, be a genuine lack of awareness of these opportunities as shown by Burgoyne et al. (2010). Medical educators must, therefore, increase awareness of the many undergraduate research opportunities. This requires initiative and motivation from the student to approach the people that can facilitate their entry into research.

Tip 5
Encourage students to engage with student-selected components of their courses
The UK General Medical Council stipulated that up to a third of curricular time at UK medical schools should be a component where the student chooses areas they wish to learn more about; student-selected components (SSC; Richardson 2009). This should provide ample opportunity for students interested in research to pursue this interest further. Despite the fact that the medical schools from which students were surveyed by Griffin and Hindocha (2011), all offer substantial research or SSC opportunities from the first year of study, some students still felt that they had no opportunity to participate. Many SSCs are typically carried out over 68 weeks, which may be insufficient for a laboratory research study, but should be adequate for publishable work including clinical audits, essays and literature reviews. Making students aware of which options are available in advance might help them to choose those which offer the most benefit. SSCs should not be seen as a break from the difficulty of core material, as can be tempting, but an opportunity to carry out original, in-depth study from which some students have published in the past.

Tip 3
Encourage students to undertake extracurricular research
In both university and hospital study environments, there will be academics and clinicians carrying out a huge amount of research. The keen medical student should find the initiative to approach researchers with suggestions of projects that are in line with the researchers interests, either via e-mail or in person. I have found most researchers willing to mentor medical students who approach them in this way. Students with prior research experience may find this easier as they will likely have experience in reviewing literature and writing research proposals. Students might be discouraged when busy researchers do not respond promptly or at all and may not even read the students correspondence. Another polite e-mail reminder or visit in person may be necessary at this stage. 706

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Tip 6
Encourage students to apply for summer research programmes
There are various funding schemes for students who wish to carry out research during their vacation periods. They pay students a stipend for a period of time to allow them to subsist whilst researching subjects of interest. This is in recognition of the fact that many students work during their vacation periods and may not afford to take up fulltime research studentships. Losing earnings might make this option less attractive to postgraduate students whose tuition fees are not paid for by the Student Loans Company. Research has shown that the majority of students enrolled on vacation research fellowships carry out further research in later years at medical school, have an increased interest in academic medicine and are more likely to publish or present their work (Solomon et al. 2003). My interest in research stemmed from one of these summer research studentships. Whilst it did not result in published work, I started to appreciate the scientific way of thinking and learned new laboratory techniques. It was also a good way of supporting my claim to be interested in research in later successful research grants.

Tip 8
Advise students to consider intercalated degrees
Intercalation is when a medical student departs from their medical training for a year to join the final year of another degree, usually scientific, thereby gaining the full Bachelor of Science degree. Most British students who submitted articles for publication were intercalating students (Griffin & Hindocha 2011). This is in keeping with previous studies, which showed that students who intercalated had a greater interest in research than their counterparts (McManus et al. 1999) and tend to perform better in their subsequent clinical medical studies. As an added incentive, they are also more likely to gain their first choice hospitals for foundation training (Mahesan et al. 2011). One possible barrier to intercalation is the cost of an extra degree. This may be due to misinformation rather than fact. The National Health Service (NHS) pays for tuition fees for all medical Home students (British nationals and permanent residents) from their 5th year of study onwards. A student who intercalates between the third and fourth year of their medical degree, therefore, has their fourth and fifth years paid for by the NHS. Those who do not intercalate only have their fifth year paid. Therefore, the maximum total tuition fee loan for intercalating and non-intercalating students is the same. The NHS also offers non-repayable means-tested bursaries to students from their fifth year of study, unlike the Student Loans Company facilities in earlier years of the degree. Intercalating students can, therefore, apply for the same grants and bursaries to cover their costs as they do in earlier years. Intercalated degrees cost no more than other BSc degrees but may cost more if a student chooses to carry out an intercalated Masters degree. However, students should be counselled to consider the potential downsides to intercalating such as losing a years worth of earnings as a doctor (Nicholson et al. 2010). Furthermore, individual circumstances may not allow a student this option, and they should be made aware of the possibility of doing postgraduate research degrees as an alternative.

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Tip 7
Encourage students to attend scientific conferences
Vacation research studentships are usually awarded via competitive application. It may, therefore, be advantageous if a student has shown prior interest in research by perhaps presenting their SSC work at a student research conference. The Student British Medical Journal (BMJ) website (student.bmj.com/student/notice-board.html) lists national and international student conferences where students can present their work and see the research output of other students. Presenting at these conferences adds valuable points to students applications for foundation training following medical school as well as the opportunity to have an abstract published. Between them, the student BMJ, UKMSA (www.ukmsa.org) and the National Student Association of Medical Research (www.nsamr.org) list most but not all the available funding and conference opportunities. However, a student may find that their particular research interest is not covered by these resources. Educators can also help their students by directing them towards appropriate professional society meetings and conferences, many of which accept submissions of a high quality from students. An example is the Sir John Ellis Student Prize run by the Association for the Study of Medical Education, which funds the students research as well as conference attendance expenses. Students may also benefit from becoming associates or members of particular societies, in line with their interests, to increase their awareness of relevant events.

Tip 9
Encourage students to do research during elective placements
Most medical students have the chance to spend some time in a medical setting of their choice, including foreign countries. Motivated students can ask their elective supervisors at their destinations to be included in the hosts research activities. Students with well-organised plans also have the opportunity to apply for funding to various institutions, which fund these electives. From my experience, students are more likely to secure funding if their elective plans include some research components. For students visiting resource poor settings, service evaluation studies could be both educational for the student and informative for the host. It is known that research electives encourage students to consider academic medicine (Houlden et al. 2004). Many students choose elective

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destinations where pathologies rarely seen in developing countries may present more frequently. This is a chance for students to write and submit medical case reports for publication. Some journals cater preferentially to trainee doctor- and medical student-written case reports, a good way to get published. However, ethical obligations should be taken into consideration when carrying out research on human subjects, even in foreign countries. Brighton and Sussex Medical School requires all its students intending to carry out such research during electives to apply for ethical approval from its own Ethics Committee. Instead of regarding ethical approval applications as laborious and off putting, students should note that having submitted an ethical approval application can be an impressive addition to their CV. Elective placements also give students the opportunity to work in completely new healthcare systems and gain experiences, which diligent students can reflect on. Indeed some journals consider and have published reflective medical student elective reports.

Students can feel under pressure to regard publication as the sole goal to their endeavours. This could easily lead to disillusionment, which educators should attempt to avoid by pointing out that the skills students learn in any one project can be transferred to future work. Part of the process of avoiding disillusionment starts by choosing organised supervisors who are as motivated as the student. Students should be wary of supervisors who take too long to respond to correspondence and who do not clearly define the goals of research (Detsky & Detsky 2007). Even after publishing, researchers are interested in their work being cited by their peers. This may not happen for student researchers, but the quality of work should supersede ones undergraduate status.

Tip 12
Advise students to balance their academic and research interests
Ultimately, medical school is about qualifying as a doctor, and it must be emphasised that early involvement in research is beneficial but not essential. Passing exams, on the other hand, is vital. Students must, therefore, prioritise their medical education above extracurricular research activities. Those students undertaking extracurricular activities need additional time management skills over and above those required for the normal medical course. Research, by definition, involves answering questions, but these questions are likely to differ substantially from those with which students are confronted in final examinations. However, apart from being a relentless time-consumer, my research activities have helped me develop an inquisitiveness that I feel has also benefited my clinical reasoning.

Tip 10
Make students aware of the MBPhD courses
This is perhaps the research opportunity, which is least publicised. Although 74% of US medical universities offer these programmes (Fisher 1981), only three UK universities currently do. Even medical students already enrolled at other universities can transfer onto these courses after intercalating. These degrees offer medical students the opportunity to carry out a 3-year PhD before completing their clinical studies. However, because of the significant time and financial commitments required, these degrees are perhaps more tailored towards students who are firmly motivated to pursue careers in academic medicine. Needless to say, for these students, the chance to carry out research for the highest academic qualification is most welcome. Students should carefully consider their circumstances and aspirations before making such a commitment, which potentially affects all aspects of their lives. Students who do not wish to commit the extra time needed for research as undergraduates should be aware that they could still pursue research careers as postgraduates and should, therefore, not feel pressured.

Conclusion
This article provides general tips, which may enable a student to identify opportunities to start their research career. The advice to students should include how to choose supervisors and to accept occasional failure as part of the learning process. Students are also to be encouraged to create non-traditional opportunities such as networking with other junior researchers, such as junior doctors. It may also benefit students to provide them with a directory of basic research training opportunities. It is also important that students are warned against neglecting their primary medical education in pursuit of publication. A healthier research attitude includes appreciating other means of disseminating their work such as poster presentation and critical commentary on published work.

Tip 11
Emphasise research as a learning process and reduce focus on output
Of course, students should also be made aware that participation in research does not always guarantee publishable results. Fogartys catheter was famously rejected by three journals for being dangerous (Stringer & Ahmadi 2009). Rejection should not be taken as a personal attack but as constructive criticisms from which one can learn. To avoid disillusionment with research, students should have honest expectations. They should also be encouraged to engage in academia via other respectable ways such as letters, opinion pieces, case reports and critical appraisal of literature. 708

Acknowledgements
I wish to acknowledge Kishan Moosai and alex Cumberworth for reviewing the manuscript and offering sound advice and constructive criticism. 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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Notes on contributor
NIGEL TAPIWA MABVUURE, BSC (HONS), is a 4th-year medical student at the Brighton and Sussex Medical School. He won a Wellcome Trust biomedical vacation research scholarship as a 2nd year. He intercalated and gained a first class degree in Biomedical Sciences at the University of Brighton, prior to taking up a 2-month Honorary contract as a plastic surgery research assistant at the Queen Victoria Hospital, East Grinstead. A paper from this work is currently under Peer review and has been accepted for presentation at the 2012 Society for Academic and Research Surgery conference. He then carried out a research elective in plastic surgery, which received travelling scholarships from the British Association of Plastic, Reconstructive and Aesthetic Surgeons, Richard Thatcher grant, Royal College of Surgeons (Edin)/Ethicon, Southdown Trust and the Gilchrist Foundation.

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