Inspiring the next generation of clinician researchers

Inspiring the next generation of clinician researchers

What was the main aim of this program?

The JCU six-year undergraduate MBBS degree is the only medical program based entirely in northern Australia and has demonstrated success in producing graduates who serve rural, regional, and remote communities [1,2]. Inspiring and supporting the next generation of clinician researchers to address the health and health care challenges of these communities is a key part of the mission of the JCU MBBS course.

The medical Honours program is JCU’s flagship program for providing practical research training to medical students and provides a solid foundational experience for future clinician-researchers. The program adopts a learn by doing approach, enabling students to lead an original study in collaboration with a team of advisors who are expert in the field of specialty and/or research design.

Students are offered two pathways in recognition of differences in time and infrastructure requirements between research disciplines, and to cater to student workload preferences:

1. MBBS Honours: A part-time overload conducted over two academic years (any time from MBBS Year 5 to Post-Graduate Year 5)
2. B Med Sci Honours: A full-time year of study requiring students to defer medical studies for 12 months (any time after successfully completing Year 3). This is the preferred option for students undertaking projects requiring significant laboratory time.

Entry to both pathways is dependent on students attaining a grade point average >5.0 in the three preceding years of the MBBS course (or two preceding years if commencing B.Med.Sci Hons in MBBS Year 4). The MBBS Honours (option 1) is the most commonly pursued, often over Years 5 and 6 of the medical degree, with most students conducting clinical studies reflective of their own professional interests.

The overarching learning objective for both pathways is to equip graduates with knowledge and skills in quantitative and/or qualitative research methods, through critical analysis, evaluation and application of scientific approaches relevant to a defined research question. The Honours program provides hands-on experience in all aspects of research project management, including preparation of proposals, ethics and governance processes, data collection, analysis and presentation, and academic writing.  Collectively, this equips graduates with the tools to reflect upon the connection between research and everyday medicine, and provides them with skills to undertake future independent research.

The JCU MBBS Honours degree utilises a co-supervision model, which simultaneously contributes to the creation of the clinical-researcher workforce and, by matching clinical and academic supervisors, strengthens the link between university and healthcare partners to boost research capacity within regional, rural, and remote Australia.

Integration with other components of the MBBS curriculum

All MBBS students are given a broad education in research fundamentals (e.g. basic epidemiology, bioethics, Cochrane review critique and interpretation) as part of the standard curriculum. ‘Research Showcases’ are mandatory sessions (one per semester) in Years 1-3, with three to four research-active academics providing short presentations on an active project relevant to curriculum content. Presentations focus on how research questions and appropriate study design were developed, followed by a facilitated panel discussion to address student questions and focus on a fundamental research skill. Compulsory curriculum items are supplemented by optional activities to build on research skills, including a regular journal club, selectives to provide training in research methodologies, and internal competitive schemes to support original research projects led by research curious students (e.g. the Amuthan Medical Research Bursary). 

How was the program implemented?

Whole of year information sessions regarding the Honours program are provided during Years 3 and 4 of the MBBS course. These optional sessions outline the structure of the course and academic entry requirements. Interested students are encouraged to identify and approach potential advisors, with a view to developing a project of mutual interest. Site coordinators play a significant role in matchmaking and student counselling during this time. Ultimately, ~10-15% of the MBBS cohort commence the Honours program.

In common with the undergraduate medical program, the Honours program shares a large geographical footprint for day-to-day learning, with advisory teams spanning a diverse range of specialties. It is important that Honours research opportunities are available across the region (including rural sites) and designated research active staff in Mackay, Cairns and Townsville act as site coordinators and on-the-ground pastoral and academic support. Program oversight is provided by a central Honours Committee, incorporating a central coordinator, site coordinators, senior academics (e.g. Head of Foundation Studies, Associate Dean, Research) and active researchers. The Honours Committee oversees student assessment, with dedicated administrative support. Academic committee members and outside experts also deliver compulsory seminars throughout the course of the candidature to provide relevant training on research skill (e.g. bioethics, working with Aboriginal and Torres Strait Islander researchers and participants, qualitative/quantitative analyses, literature reviews). These seminars are designed to support training provided by students’ advisory teams and allow students to communicate with the Honours team to discuss issues and progress. Student representatives are valued, invited members of the Honours Committee but play no role in the assessment process.

The Honours program is structured so that teaching sessions scaffold students’ research skill development, relevant to the preparation of assessment pieces. Honours assessments reinforce and assess the learning objectives listed earlier and, importantly, are designed to develop research dissemination skills – the entry and exit seminars cultivate both oral presentation and answering questions in the research context, and most students will take the option of preparing their literature reviews and final thesis as draft journal manuscripts. Both streams of the JCU medical Honours program comprise five formal assessments in addition to compulsory hurdles throughout the candidature [see Table 1].

Table 1: Assessment pieces within the JCU MBBS honours program

How has the impact of this program been evaluated?

Staff reflections

Since 2017, students within the medical Honours program have been named authors on ~100 HERDC C1 publications. Assessment of these publications suggests that the students have regularly contributed to research agendas outside their primary focus (often as second assessors for systematic reviews), indicating broad application of learned skills. Author affiliations demonstrate that students across all sites are conducting high-quality research worthy of publication.

The central Honours team works consistently to build and maintain the advisor and assessor pool to support our Honours students. Herein, engagement with research active academics across JCU, adjuncts/full academic title holders and colleagues within the NHMRC-accredited Tropical Australian Academic Health Centre remains a key ongoing priority.

Student reflections

The student experience of the Honours program has been formally assessed using qualitative approaches and published as an academic paper [3]. Findings highlight that students enter the program as novice researchers, experience a steep learning curve, then exit with confidence in their research abilities. This is supported by the below testimonies from Honours alumni who have successfully leveraged their Honours experience to embark on the clinician researcher pathway.

Elzerie de Jager MBBS Hons (Years 5 and 6 overload): Dr de Jager completed the embedded JCU MBBS Honours program in 2015-16. Her project, examining the effects of the World Health Organization (WHO) Surgical Safety Checklist on postoperative outcomes, resulted in two first author publications in the World Journal of Surgery. These two papers – a literature review  and an original investigation – now have over 100 citations.

‘During the sixth year of medical school, I was able to present my work at conferences in Australia, Thailand, Japan, and Sweden. Through my research, I secured and completed an internship program at the WHO headquarters in Geneva, Switzerland, where I contributed to 11 WHO technical reports of safety in primary care and medication safety.’

Graduating medical school with first class Honours allowed Dr de Jager to transition straight into a part-time external PhD program examining surgical equity metrics. After a year in the program, whilst simultaneously completing her internship year at Townsville University Hospital, she was recruited to do a Postdoctoral Fellowship at Harvard Medical School’s Center for Surgery and Public Health.

‘The Honours project certainly set my career on a trajectory into academic success. The Honours project taught me the basics of how to do research: planning a research project, writing a literature review, writing ethics applications, analysing data, writing papers, submitting papers to a journal or conference, responding to reviewers’ comments, and presenting papers at conferences.’

‘The process also taught me soft skills like balancing research whilst completing clinical training requirements and learning how to work effectively with my advisors. The risk of integrating research into clinical training is that the clinical training can be compromised. This is rationalised by examining the time that students divert from clinical training into completing research projects. What is sometimes overlooked is that doing research can make students better clinicians. My research taught me how to manage my time, prioritise tasks, understand the evidence behind clinical care decisions, and gave me a greater understanding of how the healthcare system functions. I have no doubts that this made me a better doctor.’

Visai Muruganandah B Med Sci Hons: As an aspiring clinical scientist with interests in the field of infectious diseases, Dr Muruganandah wanted to undertake formal training in vaccine development and testing as a part of his medical degree.

‘The B.MedSci (Hons) program at JCU provided me with the ideal opportunity to take a hiatus from my medical studies so I could dedicate my focus to developing these skills. I was able to fully immerse myself in a project at a biomedical institution as a full-time student. This allowed me to take advantage of opportunities such as learning to use cutting edge technologies, presenting regularly at journal clubs, interacting with scientists from other disciplines, presenting my research to diverse audiences as well as building relationships between clinical staff and scientists. The flexibility to take this hiatus from medical studies at any point after the third year of the degree means that students can tailor the timing of their research training to suit their career aspirations.’

Dr Muruganandah chose to complete the Honours program after the third year of the MBBS degree to build upon the basic science theory (immunology and microbiology) that was delivered in the third year of the course.

‘This allowed for a seamless transition, from learning basic science theory, to then applying this theory to cutting edge research, before transitioning into the clinical years of my medical training.’

Dr Muruganandah is now working clinically and has continued to leverage his JCU MBBS Honours experience as an emerging clinician researcher.

‘Having completed this Honours program, I have maintained professional relationships with several scientists, which has now turned into ongoing collaborative work. Even now, four years since I undertook the B.MedSci (Hons) program, I am continuing to engage in research with the academic groups and scientists who served as my mentors/supervisors. Having now developed a solid grounding in biomedical research, my future ambitions are to undertake further training in clinical projects. The eventual goal is to be trained in both biomedical research as well as clinical research, bringing the science developed on the laboratory bench to patients in the clinic.’  

References

[1] Woolley T, Sen Gupta T, Bellei M (2017). Predictors of remote practice location in the first seven cohorts of James Cook University MBBS graduates . Rural and Remote Health 17: 3992.

[2] Sen Gupta T, Johnson P, Rasalam R, Hays R (2018). Growth of the James Cook University medical program: Maintaining quality, continuing the vision, developing postgraduate pathways. Medical Teacher. 40(5):495-500

[3] Anderson EM, Johnston K, Gunnarsson R, Larkins S (2018). Perceptions of a research honours programme embedded in a Bachelor of Medicine, Bachelor of Surgery degree: “The worst and best years of my life”. Focus on Health Professional Education. 19 (1), 1–11.