Re-imagining medical student research education – University of NSW

Re-imagining medical student research education – University of NSW

In 2020, the UNSW medical school approved a proposal to leverage the most successful aspects of its research training program – determined by student and supervisor feedback – and to provide high-performing students with an additional qualification from the research year. 

Why was the project undertaken?

For more than 15 years, a research component known as the Independent Learning Project (ILP) has been an integral component within the UNSW Medicine program.

The ILP spans Year 4 of the six-year undergraduate program and was designed to be a supervised research project in any field relevant to medicine, ranging from laboratory benchwork to fieldwork in Aboriginal and Torres Strait Islander communities to clinical audit. The intention to develop students’ research and critical evaluation skills through the project was backed up with surveys of students and supervisors undertaken regularly, to improve the research year experience (Hunt et al; Uebel et al., 2021).

In 2020, a proposal to leverage the most successful aspects of the ILP (determined by student and supervisor feedback) and to provide high-performing students with an additional qualification from the research year was approved. The main aim of these changes was to enhance the educational opportunities for students in their research year, and tailor the program to their needs and interests with the introduction of a blended research/coursework paradigm.

How was the project implemented?

Due to the nature and extent of our research curriculum redesign, an extensive consultation process was undertaken, which included all heads of schools and institutes within the Faculty of Medicine & Health, all affiliated medical research institutes and the UNSW Medical Society (student-run body). Upon approval, a series of online webinar events was run for students, research supervisors and schools to facilitate implementation of the program.

Program level enhancements – giving students a choice to build their own research program

Following a change in eligibility criteria, an increased proportion of students can now undertake a BSc (Med) Honours program. Previously, only the top 30 students were invited into the program, based on their weighted average mark. We also changed the structure of the research year by reducing the research component (previously 100%) to enable integration of a compulsory course on value-based health care in clinical practice as well as advanced coursework (Honours only). This change has allowed us to offer specialised teaching, especially in emerging research fields, that complements the research experience. For example, a student undertaking an Honours research project in personality disorders can now select an advanced course in Mental Disorders, Personality Disorders and Crime offered by the school of Psychiatry; this would both add value to the research project and allow the student to study alongside people outside the medical program.

In 2021, over 80% of Year 4 medical students selected to undertake the BSc (Med) Honours program (all eligible students selected this option). For 2022, we have further refined the Honours program to give students the choice of a research-intensive or coursework-intensive experience. As a result, students can now select from one of the following streams:

1. ILP – 21 hours per week of research activities over a 30-week block. This is a less demanding program and students can complete their general education requirements alongside the research project.
2. BSc (Med) Honours – Research Intensive – 28 hours per week of research activities over a 34-week block, plus seven hours per week of advanced coursework. Students select one course from a list of 30+ that complements their research project. For example, statistical or qualitative methods, cancer pathology, health data science, molecular pharmacology, human genetics, health leadership, workforce management.
3. BSc (Med) Honours – Coursework Intensive – 14 hours per week of research activities over a 34-week block, plus 21-hours per week of advanced coursework related to a predetermined specialisation. For example, in 2022, students can undertake a BSc (Med) Honours in Clinical Artificial Intelligence (AI), which consists of four advanced courses in AI [1] and a research project that will complement the coursework. Students successfully completing this program will obtain a BSc (Med) Honours – Clinical AI (specialisation). Other coursework intensive streams are being developed for 2023.

Figure 1. A schematic representation of the 3 main options available to UNSW Year 4 medical students. In Year 3, students approach potential supervisors across UNSW and our affiliated medical research institutes to negotiate a research project in Year 4. During that process, they select the stream they would like to undertake based on their interests. Please note, entry requirements for Honours are based on a minimum WAM of 65 obtained from years 1-3.   

Coursework level changes – Research with Aboriginal and Torres Strait Islander peoples 

As part of our research education redesign agenda, Dr Brett Biles, Director of Indigenous Health Education at UNSW, developed a curriculum on researching with Aboriginal and Torres Strait Islander peoples that all medical students must engage with during their research year. This consists of a series of online teaching modules (Aboriginal and Torres Strait Islander history; Cultural competence in Aboriginal and Torres Strait Islander Health Care; Research with Aboriginal and Torres Strait Islander peoples) and the following workshops run across the Year 4 medicine program:  

I. Self-awareness, positionality and reflective health care  

II. Ethical frameworks and principles in Aboriginal and Torres Strait Islander research 

III. Collaboration in Aboriginal and Torres Strait Islander research.  

These fundamental changes were embedded in our research program in 2021, with the overall goal of teaching the next generation of clinical researchers the importance of researching with Aboriginal and Torres Strait Islander peoples in a culturally safe and respectful way. These online modules are currently assessed via a reflection activity in the Honours program, but in 2022 this assessment will be moved to our new compulsory course Value-Based Health Care in Clinical Practice. 

Coursework level changes – Using scientific methods to improve health care delivery 

In 2022, a new compulsory course titled Value-Based Health Care in Clinical Practice will be integrated into the Year 4 curriculum (ILP and BSc (Med) Honours). This course aims to extend the research experience gained during ILP or Honours and enable students to apply evidence to inform their decision making in clinical practice.   

Students will gain an understanding of the meaning of ‘value’ in healthcare, and how to apply research evidence to re-design models of care that improve efficiency and create value for patients. This course will equip students with the principles of quality improvement (e.g. plan-do-study-act, lean six sigma, quality management), outcomes measurement (e.g. patient-reported outcomes, health-related quality of life) and economic analysis (e.g. cost-effectiveness, opportunity costs) to lead service transformation and professional development in preparation for future medical practice.    

Applying improvement methodology and drawing on their research experience, students will submit a substantial project report focusing on value-based interventions to improve Indigenous health within acute care or community settings.   

In summary, the Year 4 Medicine program will enable students to develop and apply their research skills in the context of clinical practice, with a focus on Aboriginal and Torres Strait Islander health and wellbeing. Our approach of giving students with diverse research interests a variety of research options complimented by advanced coursework is intended to enable students to tailor their education in research to their needs and interests, and maximise the impact of the research year on their future career opportunities and contributions to research. 

What is the project achieving? 

The overall aim of our research teaching redesign project was to enable UNSW medical students to build a research program based on their interests and future goals. The program has now evolved to the point where students can select a research topic of interest (pre-clinical or clinical), the level of research undertaken (ILP, coursework or research intensive) and the courses they would like to study that can enhance their research experience. This has also allowed us greater flexibility to alter our research program by introducing new advanced coursework at any point, based on emerging fields of medical research. It also allows increased diversity of areas and topics for students to pursue. 

Benchmarking and Evaluation   

In 2019, a network of academic leads of MD research from Australian medical schools was initiated by Professor Wendy Hu (Western Sydney University), with the aim of exchanging and developing best practice in enhancing student research experience and program governance. As early participants, this facilitated our alignment of student learning outcomes, research and supervisor training, and assessment marking. The network continues to grow and provide benchmarking for our research teaching in medicine at a national level.        

Finally, a major assessment for both the ILP and Honours year is a final research report written in the form of a manuscript suitable for submission to a peer-reviewed journal. We are currently undertaking an audit to identify published outputs from Year 4 medicine student research projects, as well as a qualitative study exploring the experiences of students and supervisors of the Year 4 program. Preliminary data demonstrates that the proportion of students who published has increased from 28% in 2007 to 50% in 2015. 

References  

Uebel K; Iqbal MP; Carland J; Smith G; Islam MS; Shulruf B; Nathan S, 2021, ‘Factors Determining Medical Students’ Experience in an Independent Research Year During the Medical Program’, Medical Science Educator, http://dx.doi.org/10.1007/s40670-021-01340-9. 

Hunt JE, Scicluna H, McNeil HP. Development and evaluation of a mandatory research experience in a medical education program: the Independent Learning Project at UNSW. Medical Science Educator. 2011;21(1):78–85. 

[1] 1. Context of health data science 2. Computing for health 3. Machine learning 4. Clinical AI

PDF of case studies available here: Research in the Medical Curriculum, Volume 1 – A window on innovation and good practice 2022