Effectiveness of Structured Training on Knowledge and Attitude Toward Research Among Medical Laboratory Technology Interns

Introduction

Developing research skills among health science students is essential for improving research culture and standards of research work. Research expertise helps health science students to understand the common problems encountered in their practice and to develop solutions to these problems. It also helps in knowing the changing trends in the prevalence, outcome and other related issues in healthcare field.¹ In addition to the existing curriculum, research oriented education encourages the student in terms of logical thinking, innovations in health care and better understanding of research methodology. Research studies have suggested that single most significant factor associated with developing high confidence in research skills is having a greater level of involvement in the projects.²

Lack of awareness, interest, funds, time, and encouragement have been cited as the barriers for research among the undergraduate students of medical and allied courses.³ Integration of research longitudinally into the curriculum has been suggested to promote the practice of evidence-based medicine.^4,5 Engaging in research projects has been proven to improve the confidence of students in their research skills.^1-5

Students in allied health sciences, such as those studying medical laboratory technology (MLT), are least exposed to research methodology, resulting in a limited research output from this group. In this context, it is imperative to conduct studies aimed at improving the research skills, knowledge and attitudes of undergraduate students to analyze the research involvement and research culture within an organization. Additionally, incorporating research projects into the curriculum and providing research training could significantly improve research outcomes and promote practice of evidence-based laboratory medicine.

In this study, we aimed to assess the impact of research training and implementation of research projects on knowledge and attitude of research among BSc MLT interns.

Materials and Methods

Source of data

The students of BSc MLT doing their internship at a college of health sciences were recruited as the participants in this research. This research was approved by Institutional Ethics Committee (FMMC/ FMIEC/265/2023, dated 4th May 2023) and permission from the concerned authorities of the college was obtained to include interns as participants. Voluntary informed consent was obtained from all the interns. This quasi-experimental research was conducted for a duration of one year from May 2023 to April 2024. All the 26 BSc MLT interns of the batch were included as study participants by purposive sampling method.

Data collection

The MLT interns were imparted twenty hours (spanning over a period of three months) of training on research methodology. Qualified and trained faculty of the college of allied health sciences and research centre, were recruited as the trainers. Topics included in the training sessions were, overview of research process, identifying a research problem, literature search and review, writing research question and hypothesis, writing a research protocol, biostatistics, data collection and analysis methods, bibliography, writing a research report and research ethics. Parallelly, students were allotted mentors under whose guidance they undertook research projects and submitted the final research report by the end of internship. The topics of research projects undertaken were, day to day problems encountered in a medical laboratory, quality assurance, laboratory safety, analysis of laboratory tests in various clinical conditions and standardization of methods of analysis of laboratory tests.

Effectiveness of research training and research project on the knowledge and attitude of students was assessed through a pre-test, post-test approach. Pre-test was conducted at the beginning of the internship program and the post-test was conducted at the end of one year internship. Knowledge and attitudes were assessed using validated questionnaires. Feedback was collected from the interns on the effectiveness of the entire programme.

Data analysis

Effectiveness of the research programme was analyzed at Kirkpatrick levels, one (reaction) and two (learning). Significance of the difference in pre-test and post-scores was analyzed using paired t test. The percentage of students scoring “Excellent” (>90%), “Very good” (76-90%), “Good” (61-75%), “Average” (41-60%), “Below average” (</=40%) with regard to knowledge on research in pre-test/post-test were analyzed. Results of “feedback” (reactions) were subjected to thematic analysis. Attitudes were collected and analyzed on a five-point Likert scale, and data were expressed as percentage of students responding under strongly agree/ agree/ neutral/ disagree/ strongly disagree categories.

Results

The 26 MLT interns who participated in this research attended all the research methodology course sessions and completed the research projects allotted to them. Out of the 26 participants, none had prior research experience or training on research methodology except for the basic biostatistics training done during the third year of MLT course.

The knowledge of interns was found to have enhanced significantly after the research methodology course and completion of research projects. The mean post-test score (15.2±1.8) was significantly higher by 56.5% compared to the pre-test score (9.71±2.5); P <.001. As represented in Table 1, the percentage of interns who provided correct response for each question increased post-training. With regard to questions on sample size calculation, use of Boolean operators, criteria for authorship and elements of informed consent documents, less than 50% of the interns provided correct responses, while for the rest of the questions, proportion of interns giving correct responses ranged between 76.9 to 100% (Table 1).

As depicted in Table 2, 8 (30.8%) in pre-test and 25 (96.1%) in the post-test scored more than 40%. Out of 26 interns, one scored very good/ excellent (>75%) in the pre-test, while in post-test, the number of interns scoring >75% was 19 (Table 2).

Overall, interns presented a favourable attitude towards research as evident from the proportion of interns responding positively to the statements on research and training before the commencement of training, and the attitude improved after the training (Table 3). Percentage of interns providing ‘disagree/strongly disagree/neutral responses’ became ‘zero’ in post-test for the statements, “Research is an essential and integral part of health science”, “Research promotes practice of evidence-based laboratory medicine”, “Doing research projects helps to develop research skills”, “It is very essential to conduct training on research for the MLT undergraduates”, and “Research should be integrated into the curriculum of medical laboratory technology”. For the statements depicting negative attitude, “Research is a waste of time and it adversely affects the academic performance”, and “I will do research because of the pressure from my mentors”, the responses of ‘strongly agree/agree’ in pre-test shifted to ‘strongly disagree/disagree’ in the post-test (Table 3).

Open-ended question such as, “What went with this research training programme?” yielded responses such as, “The hands-on activities were particularly helpful in reinforcing key research concepts”, “Research can be done by students with proper guidance from mentors”, and “Gained confidence to participate in research activity”. The interns reported that participating in research alongside internship in various laboratory sections was challenging and suggested to provide allotted time for research in the internship program.

Discussion

In the present study, we analyzed the effectiveness of a structured research training programme along with research project in improving knowledge and attitude regarding research among MLT interns. Significant improvement was observed, as evidenced by higher post-test knowledge scores compared to pre-test scores, along with a more favourable attitude toward research.

The knowledge scores after the research training programme were significantly higher (by 1.5 fold) compared to pre-test scores. The proportion of interns in ‘very good’ and ‘excellent’ categories improved significantly after the research training programme.

The results highlight the effectiveness of the structured training program, which included interactive sessions on research methodology and a research project for each student. However, significant improvement in the knowledge with regard to sample size calculation, use of Boolean operators, criteria for authorship and elements of informed consent documents, was not observed, as evidenced by less than 50% of the students providing correct responses to these questions. Previously, Pallamparthy and Basavareddy reported good knowledge on research methodology among undergraduate medical students at a medical college in Karnataka.³ Similar findings have been reported by other researchers among medical students.⁵ There is a paucity of studies regarding knowledge of research among AHS students. Health sciences students at the University of Saudi Arabia were found to have poor knowledge of research, with only 2.8% of the students demonstrating good knowledge levels, while 66.5% showing poor knowledge levels regarding research.⁶ Concepts such as biostatistics, literature search and research ethics need reinforcement as evidenced from the post-test knowledge data in our study. In a previous study conducted by Sharma et al., among medical undergraduate students, good levels of knowledge were found among 69% students, while only 27.5% of students had knowledge regarding the use of online databases for literature search.⁷

We observed favourable attitudes among MLT interns regarding research during internship and the interactive training sessions. The attitudes further improved after the structured training programme. Previously, Wheelan et al., reported improved research confidence and research involvement among student dieticians after undertaking a research project.² In a study conducted by Pallamparthy and Basavareddy among medical students, sixty percent strongly agreed to include research in the undergraduate curriculum, 57% perceived research to facilitate better understanding of the subject and 40% perceived that research facilitates clinical practice. In this study, 56% medical students had opined that research was not a waste of time and did not interfere with the academics.³ In a study conducted among medical and non-medical students in Pakistan, 67% of the participants opined that research should be mandatory at the undergraduate level.⁸ Among our MLT interns, before the training, 61.5% disagreed with the statement, “Research is a waste of time and causes additional burden”, while the response after training was 80.1%, indicating a shift in the view favouring research during internship.

Almost all the participants agreed that research should be incorporated into the MLT curriculum, both before and after training, with a shift of majority “agree” responses to “strongly agree”. Previously, a research study conducted among medical and non-medical students in Pakistan reported that 35% of the participants suggested to include research as a discipline in the undergraduate curriculum, and 38% felt that research could add to curriculum overload.⁸ Our study subjects (88%) also agreed that research helped to find solutions for day to day problems encountered in the laboratory. Hanif et al., reported that 81% of the students from allied health sciences at an institution in Pakistan perceived research to help in professional development and 68% perceived research to be of relevance in daily life.⁹ Similar reports of favourable attitudes for research among various medical and allied health science students can be found in the literature.^10,11

Our research involving medical laboratory technology interns was unique in that the study participants were from allied health sciences, for whom data on research knowledge and attitudes are scarce. The students demonstrated significant improvement in their knowledge and attitudes toward research. Allied health science students are underrepresented and often not given adequate opportunities to undertake research projects. Implementation of structured research training programme with interactive sessions and research projects for all MLT students is a novel initiative by our institution. Our research had certain limitations, including a limited sample size of 26 participants. Conducting periodic evaluations throughout the research programme could have enhanced the effectiveness of the training. Additionally, increasing the number of training sessions would have been beneficial, considering the extensive scope of research methodology.

Conclusion

Our research revealed effectiveness of structured research training in improving knowledge and attitudes of medical laboratory technology students. Research needs to be incorporated into the curriculum of medical laboratory technology and other courses in allied health sciences to inculcate culture of research among the students. Students need to be trained in research methodology using innovative and interactive teaching-learning methods, and by involving in the research projects during the undergraduate course.

Funding

Nil

Conflict of interest

None declared

Acknowledgement

Authors are grateful to authorities of Father Muller College of Allied Health Sciences for the support and encouragement. We acknowledge the involvement of faculty from biochemistry, pathology and microbiology departments for their role as guides for research projects.