Modern medicine, as we practice it today, began with trial and error, and has evolved over time. Central to this process is the quality of research, which drives evidence generation. It is evidence—not just logic and gut feeling—that we rely on. Naturally, learning the art of research, to generate and understand emerging evidence, is paramount during the many years of medical education and clinical practice.

The importance of research to doctors in training

A sound knowledge of the intricacies of medical research is as important as knowing the functioning of the human body and the diseases that affect it. Gone are the days where medicine was practised based on anecdotes and personal experiences. With the ushering in of evidence-based medicine, the cornerstone of medical practice, is good quality and reliable medical research.

To put it simply, a simple antibiotic that is given to you for an infection is prescribed because it was found to be beneficial in clinical trials. Why a doctor chooses a particular test to diagnose a condition or orders a blood test for a patient is determined by the outcome of research. Therefore, a proper understanding of research is undoubtedly an essential tool in a doctor’s toolkit. This knowledge is also crucial to identify poorly-done research and avoid its futile or potentially harmful recommendations from turning into practice.

However, one of the greatest shortcomings of the Indian medical education system is the lack of structured teaching in medical research. As surprising as it may sound, not all doctors possess this skill set of not only conducting research, but also understanding and interpreting research.

Poor research training - a multi-faceted problem

Most undergraduate students are not taught research. The requirement of a good foundation in statistics also makes learning research challenging and often less interesting, as the dislike for numbers is often what pushes people to pursue medicine. Knowledge of the human body—its physiology, the what, when and how of diseases, and the principles of diagnosis and treatment—is far more intriguing to students.

For most medical students, their first exposure to research occurs during Community Medicine postings in their third year. As scientific critical thinking but rote learning is the requirement to clear all exams, undergraduate research is considered an ‘extracurricular activity’ and not actively encouraged in most institutions. This leads to nearly all medical students graduating to become doctors without knowing even the basics of research. Postgraduate training continues to leave this gap unaddressed. The mandatory thesis submission during postgraduate training in fact, worsens the situation.

Mandatory thesis - a flawed model

Postgraduate training, also known as residency, in India, is typically a three-year programme, with some exceptions. One striking difference from undergraduate training—aside from the fact that residents are now practicing doctors—is the thesis requirement. Like most professional courses, residency mandates the completion of a thesis. In an ideal scenario, a resident is supposed to select a topic of interest, get it approved by their mentor, draft a research protocol, obtain ethics approval, and conduct a proper research project. That is the intended process. However, in most institutions, this is not what happens.

Students choose a postgraduate course more often based on the influence of their seniors or on their NEET (National Eligibility cum Entrance Test) rank, without an understanding of the nuances of the subject, due to a lack of substantial real-world exposure to the speciality. The first few months of residency therefore, are gruelling, as one seeks to stay afloat amidst unrealistic working hours and overwhelming work while at the same time trying to gain the specialist specific necessary skills and knowledge.

During this phase, most universities require the resident to also plan the thesis. Without any formal training in conducting research, minimal to no departmental support, and no dedicated time allotted for research, planning an ethically and scientifically relevant study becomes a formidable task.

A thesis topic is often forced on residents by their guides, impacting their interest not only in research but also in the subject. Without a sound knowledge of research methodologies and lack of a proper understanding of the speciality subject, a study protocol is drafted in haste, and often lacks the scientific rigor to be beneficial to anyone. The mandatory nature of the thesis makes it something that just needs to be finished somehow, rather than an exercise of enquiry to advance medical science.

Barring the field of Community Medicine, where research is a core subject, once the research protocol is approved, students often receive minimal support on how to conduct the study. Students in departments with heavy patient loads often find it impossible to work on their thesis due to unrealistic working hours that also demand dedicated patient care. The study is therefore often sidelined until submission is around the corner, two years later.

At this point, conducting a meaningful study is no longer feasible. Consequently, many residents resort to fabricating data or paying third parties to write their theses. This practice not only undermines the value of research but, with the current requirement for a mandatory publication, also leads to the widespread publication of fraudulent research.

This lack of support and structured training fosters disinterest, leading to a cycle in which one resident submits a fake thesis and later advises junior students to do the same.

Existing solutions half-hearted

To address this, many universities have introduced mandatory research methodology workshops and biomedical statistics courses. While this is a move towards educating residents, it must be emphasised that a one-week workshop is not synonymous with training in research. A one-week workshop in research is equivalent to a week-long workshop in neurosurgery for every doctor who has never been taught how to hold a scalpel.

The real focus should be on teaching doctors on how to read and understand research by providing hands-on research training without the pressure of mandatory submission. Residents should be encouraged to participate in ongoing studies conducted by faculty members—without the burden of a compulsory thesis. Not every practising doctor needs to know how to conduct research but every doctor needs to be able to understand and interpret research.

For those interested in research, there should be provision for dedicated time for learning and conducting research. A combination of MD-PhD programs could facilitate this. Notably, the United States and Canada have integrated MD-PhD programs to facilitate clinical and research training. South Korea’s MD-PhD program, initiated in 2005, emphasises the need for economic support and stable employment for physician-scientists. Australia has implemented innovative approaches, such as the Clinician-Scientist Track (CST), which allows students to pursue a research Masters concurrently with their medical degree, with the option to transition to an MD-PhD. Evidently research needs to be inculcated as a culture through proper training and not as a mandatory exercise without any guidance.

We simply do not need too many ill-informed, untrained cooks, meticulously spoiling the quality of the broth. Bad evidence is worse than no evidence. Training in research is a specialty in itself, and pressuring residents to conduct and publish a full-blown study in the form of a thesis is akin to enabling each passenger on a flight to steer the aircraft for a short duration.

It is time to shift our perspective and recognise that not every training doctor requires homework or imposed deadlines to develop valuable skills. The sooner we acknowledge this, the better our medical education system will be.

(The authors’ views are personal and based on conversations with students across different medical colleges in India. Dr. Karun Saathveeg Sam is an internal medicine physician and a clinical researcher. drkarunsam@gmail.com; Dr. Parth Sharma is a community physician and a public health researcher parth.sharma25@gmail.com)