Mandated Medical Research in India- A few thoughts

The Medical Council of India has made research publications as an essential consideration of or measure of competence for promotion of faculty in medical institutions in India. Guidelines for counting research publications include publications in indexed journals, original research, published in a national or international journal, only the first and second authors can claim the paper against their “count”, and publication in E journals will not be considered.  Faculty are expected to publish at least two research papers over a period of four years. 

As with most ideas, there are pros and cons to this idea as well.

There are several benefits to this mandatory requirement.

  1. It encourages junior and mid level faculty to consider and engage in research
  2. It brings the concept of health research to the fore of discussion and may lead to the development (or more uniform development) of research infrastructure and resources across the country
  3.  Critical thinking and problem solving may become more of the norm across a wider spectrum and consequently lead to improvements in various areas of health care

There are some limitations to these guidelines especially a lack of clarity on what maybe considered as original research, giving credit only to the first two authors of a paper,  the choice of indexed databases, and the exclusion of e journals.

A few papers have explored these issues (see article by Bavdekar SBarticle by Aggarwal R ).

In principle, the idea is good and seeks to bridge a possible (I think it is real) disconnect between clinical research and clinical practice. Clinical research works under a premise of the larger good and the individual result may be subsumed under a larger good or good for the majority. Clinical practice, however, has to focus on the individual who needs care and has to consider if what may work for the majority will actually work for the individual.

I think it is essential that the Medical Council of India considers a few important steps that can add value to the process.

  1. Building or upgrading the skill and core competencies for health research. It is essential that the MCI and other  healthcare stakeholders invest in skills development for health research across all medical practitioners. This development should not be limited to Government Teaching Hospitals but should be inclusive of the private sector and the large not for profit sector that operates under the large umbrella of non governmental organizations. These competencies should include quantitative and qualitative sciences, economics, quality of life, biostatistics and outcomes, especially patient related outcomes.
  2. Building or upgrading skills for communicating research outputs moving away from speculative narrations to in-depth analyses reflecting critical thinking.
  3. Developing an all inclusive national level forum to help with the development of standardized unbiased research protocols. These can help to walk investigators through various aspects of the development of a research project including statistical power, sample size, minimization of bias, study designs etc.
  4. Build skills on medical and research ethics including the setting up of independent ethics committees or institutional review boards at different levels.
  5. Have continuous self paced programs (with assessments) to build the capacity as well as help faculty stay abreast of developments in research methods.

In the longer term, the Medical Council of India should also consider restructuring the medical curriculum such that clinical research and practice are intertwined right through the entire period of medical education. Currently, the student dissertations are meant to facilitate this process, however, this has to be expanded further and integrated well with medical practice and teaching.

I also feel that the focus on an optimal number of publications, although good, is not ideal especially when one considers the number of predatory journals now available and the possibility of paying for publications (these may be indexed journals as well). I think the focus should rather be on the “effectiveness” or “impact” of the paper translating to improvements in patient care or structural aspects of health care. A good research study may take time and even one good paper that brings an improvement in patient care is worth more than n number of research papers that do not translate to an appreciable improvement.

The focus, for us, should not just be clinical (or public health) research but has to shift to research that improves outcomes for the individual and the larger community. This is important as there are so many research or medical journals and so many articles on any given topic. Most of what we do read may not be applicable or may be translated into clinical practice for several reasons including study designs, validity, reproducibility,  interpretations, value additions etc.  It may be a good idea to use this opportunity to bring a focus on locally relevant, applicable, accessible solutions to local problems rather than aim for a certain number of publications. This does translate to the need to develop indices to assess papers in this manner (more work!). The use of such an index may also help reduce “wasteful resource utilisation” for not so useful research that just adds to the numbers (and confusion).

A long way off the mark maybe, but personally, i feel the MCI should restructure the entire medical curriculum bringing in community health as the cornerstone of the curriculum (especially in the undergraduate streams). Additionally, the MCI should  consider the health of the community around the institution as a mandated requirement for re-certification as a teaching institute.  To me, this brings about an immediate relevance and impact for the research and blends it well with health care.









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