Evaluation of student-led “Association for Support and Propagation of Innovation, Research, and Education” (A.S.P.I.R.E) in empowering undergraduate medical students in research: A 2-year longitudinal study

INTRODUCTION Association for Support and Propagation of Innovation, Research and Education (A.S.P.I.R.E) was established as the undergraduate research wing of Seth G. S. Medical College and King Edward Memorial Hospital, Mumbai, in 2019.1,2 Its aim was to promote and facilitate scientific innovation and research by providing peer mentorship and maximizing research opportunities for undergraduate medical students. In the Indian context, the National Medical Commission implemented the Competency Based Medical Education (C.B.M.E) curriculum for undergraduate medical (M.B.B.S) students of India in 2019, which proposed the concept of "research electives." However, it lacks provisions for adequate training and capacity building of medical students in research. Thus, academic research becomes a completely extra-curricular activity, implying that the students have to learn everything on their own, beyond their already hectic schedule. The role of A.S.P.I.R.E was to provide a sustainable hands-on learning environment, which can be a part of a medical students' routine academic schedule. This study is a self-evaluation of A.S.P.I.R.E, its activities and the impact it has been able to bring about since its inception. MATERIALS AND METHODS A single arm, non-randomized, prospective, interventional study was undertaken for a period of 2 years from February 2021 to 2023. The study design was inspired from the Kirkpatrick model of program evaluation.3 M.B.B.S students of the first professional year, who were enrolled in the institute in November 2020, were included as the study participants. A minimum sample size of 90 was calculated, However, considering non-participation of 20% and a dropout rate of 50%, the entire class of 250 students was invited to participate in this study.4 Four validated questionnaires Supplementary Table 1 were used to assess the feedback, knowledge, attitudes, motivation, perceived skills, and practices of the students. Detailed timeline of administration of each questionnaire and interventions conducted are summarized in Supplementary Figure 1 and our previous report.2 Data was analyzed using JASP software, in which descriptive statics, paired t-test, and Wilcoxon's signed rank were employed at a significance level of P < 0.05.Supplementary Table 1: Study tools and outcome variablesSupplementary Figure 1: Time of participant recruitment and questionnaire administration during the projectRESULTS Responses of 92 participants were included (21 withdrew consent and dropped out of the study). Over the course of the 1st year, there was a significant increase in knowledge score (12.8 ± 3.8 vs. 19.3 ± 4.8, P = 0.001) as well as significant increase in the knowledge score for each module that was conducted. With regard to the post-session feedback, mean ratings for all the sessions were 5.7 ± 1.6 for quality of content delivered and 6.3 ± 1.9 for interactions and doubt solving. There was also a significant change in the Research Attitudes (42.50 interquartile range (IQR) 8.00 vs. 54.00 IQR 12.25 P = 0.001), Research Motivation Scores (29.00 IQR 15.00 vs. 42.00 IQR 18.00, P = 0.001) and Perceived Research Skills Score (36.00 IQR 37.25 vs. 67.00 IQR 36.00 P = 0.001) In terms of research practices, 44 research projects were initiated by 29/92 (31.5%) Students' in the study cohort over the course of 2 years. Among these, each student was involved in a median of 2 (IQR 2.25) projects and a maximum of 11 projects. Student's self-rated median extent of involvement in research projects was more than 5 for literature search, deciding study design, ethical clearance, data collection, and manuscript writing. However, their involvement was relatively less in steps such as sample size calculation, questionnaire designing, and statistical analysis, indicated by a median score of 4 or less. Interventions undertaken by A.S.P.I.R.E have been summarized in Supplementary Table 2. Detailed results have been depicted in Supplementary Table 3, Supplementary Figures 2-4 and the qualitative feedback received has been provided in the Supplementary Panel.Supplementary Table 2: Description of Interventions undertaken by Association for Support and Propagation of Innovation, Research, and EducationSupplementary Table 3: Change in knowledge scores of students over the course of 1 yearSupplementary Figure 2: (a) Change in research attitudes. (b) Change in research motivation. (c) Change in perceived research skills. IQR: Interquartile rangeSupplementary Figure 3: Extent of involvement of students in the projects undertaken by them. (n = 29, rated on a 7-point Likert scale)Supplementary Figure 4: Number of research projects undertaken and students involved in themSupplementary Panel: Qualitative feedbacks from students and professorsDISCUSSION Our 2-year evaluation indicates that the program effectively enhanced participants' knowledge, attitudes, and skills related to research in the medical field, and thus, empowered them to undertake research projects, effectively read scientific literature and practice evidence-based medicine. Although previous studies on undergraduate research mentorship have found similar results, many of these interventions have been in the form of short courses and electives conducted either online or offline.4–6 Some of the already established student research councils in the country are operational in Kasturba Medical College, Mangalore and All India Institute of Medical Sciences, New Delhi, India.5 A.S.P.I.R.E stands out from the rest in having an exclusively peer-based mentoring approach, well-defined student team structure, annual teaching module, and a variety of novel initiatives like the research database. Over the span of 4 years, over 8 medical colleges nationally and internationally have adopted the working model of ASPIRE.2,6,7 Our evaluation, though comprehensive, has certain limitations and biases in the form of absence of control group, selection, social desirability, hawthorn, and pygmalion bias. Furthermore, the study was conducted in a single-institutional setting, which may limit the generalizability of the findings to other contexts or institutions, even though multiple institutions have already adapted our working model. Financial support and sponsorship The study and its interventions were funded by Seth GSMC Gymkhana, Seth GSMC and KEMH Mumbai. Conflicts of interest Investigators of this study have held and/or still hold leadership positions at ASPIRE.