Factors associated with participation in Research by Very Early Career Doctors in a Lower Middle-Income Country in Africa: A Multi-Centre Study

Background: Research is beneficial for the professional growth of a doctor


Introduction
Research basically entails all the systematic activities involved in investigating a well-thought out specific problem and the issues surrounding it, as well as reporting findings for the purpose of 1 advancing knowledge and practice.Benefits of being actively involved in research activities include promotion of critical thinking and analytical skills; helping to clearly define career interests; expanding on knowledge and understanding of a chosen field; and building a synergistic community between peers and organizations both within and 2 outside their work environment.As part of a vibrant scientific community, research advances knowledge, builds confidence in scientific processes, informs policy formulation and is the 3 backbone of evidence-based practice.Very Early Career Doctors (VECDs) are a subset of Early Career Doctors (ECDs) who are usually less than 10 years in practice and are of a lower cadre than senior registrars and senior medical officers for those in residency training or non-training positions 4 respectively in the Nigerian medical health system.They include house-officers/interns, medical officers and registrar as against senior medical 5,6 officers and senior registrars.They are unique being at the formative stage of their medical career.There is an increased global attention on the need for early involvement of doctors in research.The Royal financial support.VECDs working in Nigeria are still coming to grasps with their new career and face challenges of long work hours, poor remuneration, burnout issues, lack of mentorship and training.However, we do not fully understand the levels of their engagement in research and the factors that affect it particularly at a stage in their career when it is not compulsory.Available studies on research involvement of doctors in Nigeria are single centre studies in selected geopolitical zones and the study population 7,9 involved all cadre of physicians.Furthermore, a previous report also from CHARTING study exploring research among resident doctors demonstrated that publication and grantsmanship 9 rates were very low.This study focused on VECDs, a unique subset of ECDs, with their own peculiar 7 challenges.We took a more holistic approach by utilizing amore robust database of VECDs from all geopolitical regions of Nigeria, to produce a more generalizable result.Furthermore, VECDs are research engagement.Potential predictors which were recorded based on existing literature included number of children, years since graduation, years of practice, number of hours engaged in research and academic activities weekly, number of call duties weekly, additional qualifications, if presently working in a university-affiliated centre, being a surgical resident (because it was assumed surgical residents have longer working hours), previous research methodology training, and perception of enhancing effect of research on personal career.Data Analysis: All data was analysed in Statistical Package for Social Sciences (SPSS) v.23 (IBM Corp., Armonk,NY).Means and standard deviations were reported for normally distributed continuous variables, while frequencies and proportions were used to summarize categorical variables.Pearson's chi-square test was used to determine the association between potential predictors and outcome variables.Multivariate analysis was done using logistic regression to assess the independent predictors and compute the adjusted odds ratio after controlling for confounders.A significance level of <0.05 was predetermined as the acceptable cut-off in ascertaining statistical significance.

Results
Response rate, missing data A total of 476 respondents were included in this study with some form having missing data ranging from 0% (sex) to 12% (age).Since missing data level was <20% overall, a complete case analysis was done for each variable.

Description/Summary of population
The mean age of respondents was 31.2 ± 5.0 years, with a range of 22 years to 52 years.Table 1 summarizes the sociodemographic distribution of VECDs that participated in this study.The male:female ratio was 1.86:1.00,with half of the respondents being married.Registrars made up about half of all respondents.Participation rates differed across centres from 3% to 25%.Most (74.2%)VECDs that participated in this study had graduated from medical school within five years; had practiced for seven years or less (81.7%) and about 95% had been at their current jobs for five years or less.More than half of all VECDs spent >7 4 Nigeria.Sampling method: A multi-staged sampling technique was employed.At the first stage, nine hospitals were selected from the six geopolitical zones using simple random sampling using a list of all hospitals where VECDs work as a sampling frame.The second stage involved the selection of five departments from each selected hospital using simple random sampling.At the final stage, all eligible VECDs were recruited from each selected department in each hospital.These participants were a subset of the larger participants of the CHARTING-1 study comprising interns, all medical/dental officers below the rank of principal medical officers and all residents (junior and senior).The following personal and work-related factors showed significant positive associations with ever having participated in any research work on bivariate chi-square analysis: less than 40 years of age (p =0.038), 5 years or less since graduation (P = 0.016), 4 years or less on current job (P = 0.001) and working in a university affiliated centre (P = 0.011) (Table 4).There was also an observed significant positive association between having ever had any previous undergraduate research methodology training and ever participating in a research work (P<0.001).Participants who agreed with the statement that research will enhance their career were more likely to have ever participated in a research work compared to those who were undecided or disagreed with the statement (p hours per week on research activities with 71.6% working in tertiary hospitals that were affiliated with a university (Table 2).
Although majority of respondents (81.5%) had been involved in research, less than half of them (40.7%) had presented their work in research forums.While further exploring their level of inclusion in the research project, less than 10% of the respondents had local (9.2%)and international publications (8.0%), had participated as first authors (6.9%), or had received research grants (1.7%).
In spite of these low rating, most respondents (96.1%) agreed that VECD should be more involved in medical research (Table 3).The difference in male:female participation rates was not significant (83% vs 78%, p = 0.077).This observation was in spite of the limitation of the study sample in the South-Eastern Nigeria study to only one state in the region, and a highly skewed sex ratio with 80% male participants which do not reflect the national demographic profile of ECDs and as such not directly comparable to the present 18 study.The study however, unlike the present, observed that time constraints, funding and mentorship significantly predicted research engagement independently.It should however be noted that males in developing nations have been reported to have more time to spare outside work hours and thus may have modified the effect between time constraints and research participations leading to positive associations.As with this study, time constraints was not identified as a significant predictor of research involvement by 13 a Pakistani study.However, this was in sharp contrast to majority of studies which used comparative analysis and observed positive associations between time dedicated to research and 13,17,19 research participation.
Perhaps the nature of the present study design which utilized a crosssectional approach and thus incapable of monitoring temporal trend may be a pointer.Research involvement in the present study was investigated without any time constraints and as such may have occurred even before participants started dedicating more time to research activities.However, there is need for VECDs to be intentional in setting aside pre-scheduled time weekly in spite of their tight work schedule to engage in research activities.Group collaboration with regular meetings will indeed prove useful in enhancing their research engagement.A majority of participants agreed with the statement that research will enhance their career and these were more likely to have ever participated in a research work compared with those who were undecided or disagreed with the statement.This highlights the fact that VECDs have identified the need for research involvement for future career 1 9 advancement.However, Ulrich etal had contradictory findings with no positive association observed between research participation and intentions for future career in research among 19 trainee residents.Their findings could affirm the hypothesis that research engagement among residents is mostly due to the compulsory research pre-requisite for completion of residency training and not necessarily the need for future career advancement.However, the present study did not include senior residents, whom this requirement pertains to, as part of its population and may be the reason for the opposing observations.Junior residents may be involved in research as part of assistance rendered to senior residents and consultants in the area of data collection mostly, and this may form a mental image they may wish to aspire to especially if such seniors are their mentors.The personal career growth of doctors is hinged on scientific research and publications and is an important criterion when competing for lucrative opportunities in both the national and international space.VECDs, because of the overwhelming nature of their work, may see research as non-critical to their present career advancement which is focused on rendering clinical services and succeeding in their practice.The need for proper critical appraisals of available evidence and its utilization to inform best practices is essential for practicing clinicians and public health specialist in this everevolving climate.A research engagement toolkit for Nigerian doctors, 3 which has proved useful in other countries, highlighting the need for research engagement, ways to participate in research, easy access to grants, targeted research opportunities, and resources on research presentation and publishing

Vol.14 No3. July, 2021
More detailed description of the sampling methods are published in the CHARTING study Ibom Med.J.

Table 4 . Relationship between personal and work-related factors and VECDs participation in research Have you ever participated in any research work Yes
*P-values reported are based on Pearson's chi-square test o significance Ibom Med.J. Vol.14 No3.July, 2021 Ogechukwu Mary-Anne Isokariari et al Factors associated with participation in Research...

Table 5 . Undergraduate and post graduate research methodology training and VECDs research participation
*P -values reported are based on Pearson's chi-square test of significance