Medical Students’ Publications and Research Engagement after a Mandatory Research Project Course: A 10-Year Retrospective Cohort Study

Medical Students’ Publications and Research Engagement after a Mandatory Research Project Course: A 10-Year Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Medical Students’ Publications and Research Engagement after a Mandatory Research Project Course: A 10-Year Retrospective Cohort Study Riitta Möller, Agnieszka Szwajda, Maria Shoshan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9140312/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Integrating research competencies into medical education is essential for high-quality healthcare. While rarely required, publishing is frequently used as an indicator of students’ research achievement. However, few studies have investigated medical students’ publication outcomes following a mandatory research project course. This retrospective cohort study explored publication rates, Ph.D. enrollment, and associated factors among 2,592 medical students who completed such a mandatory course between 2010 and 2020. In total, 782 students (30.2%) collectively published 1,545 unique publications. Completing elective research introductory courses (OR 1.35; 95% CI 1.05–1.73), lower age (OR 0.97; 95% CI 0.95–0.99), and conducting an epidemiological (OR 1.60; 95% CI 1.19–2.15) or a clinical study (OR 1.37; 95% CI 1.08–1.74) were associated with subsequent publishing. Students who published within 4 years more often completed the course on time than non-publishing students. A total of 374 (14.4%) students enrolled in doctoral studies. These students were younger (p = 1.9e-13), more often men (p = 0.016), and had more frequently completed a basic science project (p = 4.996e-11) and elective introductory courses (p < 0.00001) than the non-Ph.D. students. Our results suggest that curricular research foster medical students’ publication activity but not necessarily an academic career. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research medical students undergraduate research scholarly project master’s thesis publication outcomes Ph.D. studies Figures Figure 1 Figure 2 Figure 3 Introduction Due to the growing emphasis on evidence-based medicine, medical students must understand research methodologies and how to make decisions based on scientific literature and systematic evidence synthesis in complex clinical situations 1 , 2 . Thus, integrating research competencies into medical education is necessary for the quality of future healthcare. Students’ degree projects, also called scholarly projects, student theses, or research projects, may provide such training in concrete research. Ideally, they may offer students an opportunity for academic development, foster engagement with scientific research, and benefit their future careers 3 – 5 . However, there is a lack of empirical evidence regarding whether students’ experiences result in continued research engagement once the project course ends. Overall, there is no uniform way to incorporate students into ongoing research during medical school 6 . Research projects may be either mandatory or elective 7 – 9 . The projects may also vary in scope and possible research areas, as some medical programs have courses comprising a few weeks of mainly theoretical tutelage, whereas others provide hands-on experience in real-world research settings, often over at least one semester 9 . Moreover, some programs offer core medical research topics from which students may choose, while others also accept projects involving, for example, clinical quality improvement, medical education, or community programs. How the outcomes of research project courses are defined and assessed may also differ 9 , 10 . In medical education, the focus is usually on the knowledge, skills, and attitudes achieved by the students rather than on the actual content in the projects. Thus, such courses usually have intended learning outcomes aligned with the overarching outcomes of the entire program. However, although publication is generally not a requirement, some universities focus on the number of manuscripts submitted or published in peer-reviewed journals as well as presentations at a scientific conference as indicators to reflect the outcome of the course 3 , 5 , 11 – 14 . Existing studies show a wide variation in the publication rates of medical students’ reports. In addition to research courses being mandatory or elective, this disparity may be due to the varying definitions of “publication” and different follow-up periods. A recent study from the United States involving almost 12,000 new interns found that 39% had co-authored PubMed-indexed publications during medical school, but it was not specified whether the curricula involved mandatory or elective research projects, nor the duration of the project 15 . Other studies from the United States and New Zealand, reporting results from 7- to 10-week elective courses, found publication rates ranging from 24% to 93% 5,12 . Regarding mandatory research projects, a study from the United States by Dyrbye et al. 16 found that 41% of medical students published one or more research reports, while Shen et al. 17 from China reported a publication rate of 27%. A more detailed study from the Netherlands with data on more than 2,000 medical students found that 27.7% of mandatory research training resulted in peer-reviewed scientific publications 14 . In their setting, the students have 4-to-6 months of full-time, authentic, hands-on research experience with the possibility of extending their project time by 5 or 10 weeks. A retrospective study from Sweden, where all medical students had a mandatory research project of 20 weeks, showed that 149 of 446 (33%) students had published their course report data as scientific papers after the course 18 . These results are in line with our previous study, in which 31% of medical students had reported that they had published or submitted a paper based on their mandatory project 19 . However, differences in follow-up duration across these studies limited the comparability of the outcomes. Beyond curricular research, some medical schools also offer extracurricular research introductory courses to support students’ scientific engagement and career development as future researchers. These may include short-term courses—such as Summer Research Schools—or extended programs that span several months 20 , 21 . A qualitative study by Nazha et al. 22 found that students who participated in an extracurricular research course reported increased motivation to pursue academic research. Furthermore, Wang et al. 23 showed that students who engaged in extracurricular research were likelier to contribute to scientific publications. However, there is still a lack of studies comparing long-term academic engagement among students who participated in extracurricular research courses versus those who did not. One benefit of the curricular research project is that students may use it as a stepping stone toward a future career as researchers. Indeed, it has been found that those who publish during medical school are likelier to pursue academic careers 6 . Skovgaard et al. 24 reported that 13% of Danish medical students who participated in an elective pre-graduate research program were later enrolled in a Ph.D. program. Similarly, a Swedish study by Möller and Shoshan 19 found that 9% of approximately 600 medical students who had completed a mandatory research project course had registered for Ph.D. studies two years later. Overall, the transition from medical school to Ph.D. studies is relatively underexplored, as most medical graduates tend to pursue clinical practice or other forms of postgraduate medical training. In summary, understanding how often medical students publish after completing a mandatory research project is important because publications serve as an objective indicator of sustained research engagement, provide insight into the long-term educational impact of the course, and help evaluate how undergraduate research training may support the development of future physician-scientists. Therefore, more studies with uniform definitions and methods to understand research involvement and productivity across programs are needed. This study aimed to examine medical students’ journeys toward research involvement following a mandatory research project course by studying publication rates and Ph.D. enrollment and to investigate the factors associated with these outcomes. Materials and methods Study design This is a retrospective cohort study comprising 20 medical student cohorts over a 10-year period (2010–2020), examining the students’ research areas, original publications, and Ph.D. admission. Students were followed up until the spring semester of 2024. This cut-off allowed for lag time between project completion and peer-reviewed publication, as well as admission to doctoral studies. The study was reviewed by the Swedish Ethical Review Authority (Dnr 2022-00611-01) and was conducted in accordance with the World Medical Association Declaration of Helsinki and its revision in 2024. Since the study was based solely on database data, the review board waived written informed consent for participation. Context The context of this study is a single-faculty university, Karolinska Institutet (KI), Stockholm, Sweden that offers around 30 bachelor’s and master’s level programs in medicine and other health professions. Research has a high profile at our university and accounts for about 85% of our total annual revenue. KI employs approximately 3,000 researchers and has about 200 affiliated researchers, such as clinically active researchers or visiting scholars. Approximately 50% of the researchers were women. At the time of the study, the medical program spanned 5.5 years (11 semesters). Each semester lasts 20 weeks and corresponds to 30 European Credit Transfer and Accumulation System (ECTS) credits. The medical curriculum was designed as research-integrated education and comprised a scientific thread with 1–2 days of instruction per semester in statistics, epidemiology, evidence-based medicine, critical appraisal of literature, and research ethics. In 2014, a 3-week scientific methods course was introduced in semester 5, replacing the previous scattered short teaching activities across various courses. Structure and content of the research project course The overall aim of the mandatory 20-week research project course, undertaken in semester 8 of the 11-semester program, is to deepen students’ understanding of scientific methods, enhance their ability to evaluate research papers, and foster critical thinking, all of which are essential for practicing evidence-based medicine. The detailed intended learning outcomes are presented in Supplementary information. The projects involve authentic empirical research in basic, clinical, or translational science, usually within a research group. Students are free to apply for a project in their area of interest. The main supervisors must be active researchers in the area with at least a Ph.D. degree. The progress of the projects is monitored by faculty coordinators with at least a Ph.D. degree. Each coordinator is responsible for approximately 10 students per semester, arranges two seminars (project report and examination), and gives students criterion-based individual feedback on the projects, thereby ensuring that the projects are carried out according to the rules and regulations at our university. As a final examination, each paper presents an individual research report of about 20–35 pages in accordance with the university’s guidelines. Although the report must be modeled on a standard scientific publication in the field, the students are not allowed to present a multi-author manuscript aimed at being submitted to a scientific journal. However, after completing the course, students may continue to collaborate with their supervisors and publish their results as an extracurricular scientific publication. No financial support is given to the students or supervisors to cover the publication expenses. Extracurricular research introductory courses At KI, medical students may apply for three extracurricular research introductory courses before taking the curricular research project course – a 7-week summer research school (10.5 ECTS credits), FOLÄK 1 (8 weeks; 12 ECTS credits), and FOLÄK 2 (12 weeks; 18 ECTS credits). FOLÄK 2 requires the completion of FOLÄK 1. Prior to 2019, FOLÄK 1 and FOLÄK 2 were offered as a single 30-ECTS course (FOLÄK). Doctoral education Medical students at KI may also embark on research education in parallel with or after their undergraduate studies. The general eligibility requirement for doctoral education is at least 240 ECTS credits (approximately 160 weeks), of which at least 60 ECTS credits are for an advanced level or a degree at an advanced (second-cycle) level. KI hosts approximately 2,000 doctoral students, all of whom are female. Roughly 380 new Ph.D. students are admitted annually. Participants In total, 2,847 medical students were registered on the mandatory research project course during a 10-year period from the fall semester of 2010 to the fall semester of 2020. As no course was offered in the spring semester of 2014 due to a curriculum change, students from 20 semesters, i.e., 20 courses, were included. Consequently, the follow-up time could range from 4–14 years per student but was at least 4 years for all the included students. Of the registered students, 239 were excluded. The exclusion criteria were discontinued studies, absence of a written report required for examination, or the report appearing as a duplicate in the database due to the student having taken up the course for more than one semester. Thus, 2,592 were included in the study. Data collection Data on students, their supervisors, and the area of the research projects were retrieved from the database of the Department of Medical Epidemiology and Biostatistics at KI, which is routinely used for students’ research project proposals. The database is maintained in the Lime CRM program. Data on assessment results were retrieved from the web-based learning management systems used in the course (Pingpong and Canvas), and data on Ph.D. admissions were obtained from the Swedish nationwide web-based system for higher education study documentation and administration (Ladok). Data on students’ and supervisors’ co-publications were retrieved from PubMed. Procedures and definitions Categorization of the research areas Students’ research areas were categorized as follows – Basic Science, Epidemiology and Public Health, Clinical Research, Qualitative Research, Systematic Review, and Other. This process was completed using a reference group of 6 persons, including 4 senior researchers in different fields of medicine and two of the authors (RM; MS) of this paper. Each final written report was reviewed and categorized by the authors, and the data were transferred to the database. Any uncertainties were resolved by consensus. Assessment results The summative assessment was based on the examiners’ evaluation of the written report and the coordinators’ evaluation of the final oral presentation and opposition to another student’s report and oral presentation. Students passing the course within the allocated time were defined as those who passed the regular assessment at the end of the course or the following re-assessment, approximately 2 months later, before the next regular summative assessment. Scientific publications Scientific publications were defined as original research papers, including systematic reviews. Letters to the editor, meeting abstracts, and corrections to previously published material were excluded. We identified publications by combining the main supervisor’s last name and initial(s) with the student’s last name and initial(s) using a regular expression (regex). Only supervisors affiliated with KI and/or Region Stockholm (a regional public body responsible for healthcare within Stockholm County, Sweden) who had verified their publications using the Bibliometric Verification Toolkit at KI were included. All names were double-checked manually against the names in the student lists. In order to identify possible changes in names before the search procedure, the students’ names were checked in Ladok, and if there had been any changes, both the name at the time of the course and the new name from Ladok were used in the literature search. Some false negatives are inevitable, as supervisors may have refrained from verifying their publications using the toolkit and the students may have published together with their co-supervisors instead of the main supervisor. Data analysis We used descriptive statistics to describe the demographic variables. Differences in research area distribution and gender differences in research area selection were analyzed using the chi-square test. Mean age differences between students were assessed using an independent two-sample t-test. For assessment outcomes, students were categorized into two groups – (1) those who passed within the allocated time and (2) those who passed or failed late, i.e., at least two semesters after course completion. Mean age differences between groups were compared using an independent two-sample t-test. Differences in categorical variables were assessed using chi-square tests. Assessment results were compared between students who participated in introductory extracurricular research courses and those who did not using a chi-square test. To identify student- and project-related factors associated with publications, logistic regression models were applied, adjusting for age at the course registration, gender, research area, and prior completion of any research introductory courses. P-values <0.05 were considered statistically significant. All analyses were performed using the R software (version 4.2.1). Results Participants, research areas, and supervisors In total, 2,592 students (of whom 1,392, i.e., 53.7%, were female) were included in the study (Table 1). The median age was 26 years (range 21–57). A majority of the students chose projects within clinical science (Table 1). There was some fluctuation over time in the proportions of selected research areas, but overall, we did not observe any major differences between the semesters (data not shown). Furthermore, no differences were observed in the students’ median age (26 years) and gender across the different research areas except for qualitative research projects that were more often carried out by female students (p = 0.043). Table 1. Demographics of students and research areas of the mandatory research project course (n = 2592). Abbreviations: ECTS, European Credit Transfer System During the 10-year evaluation period, there were 1,000 unique main supervisors, of which 425 were female. A total of 45 supervisors (24 male, 21 female) had supervised at least 10 times each, collectively accounting for 771 student projects—amounting to almost one-third of the included projects, the majority of which (72%) were clinical. Furthermore, 14 of these 45 supervisors (8 male, 6 female) had supervised 20 or more student projects each, adding up to 363 (14.8%) student projects. Assessment results Of the entire population, 1909 (73.6%) students (of whom 1073, i.e., 56.2% were female) passed the course within the allocated time. The majority of this group completed a clinical science project (Fig. 1). Moreover, 527 (20.3%) students (of whom 259, i.e., 49.1% were female) passed the examination during the subsequent semester. Thus, 94% of the students completed the course within one year. Additionally, 86 students (2.6%) (of whom 30, i.e., 44.1% were female) passed within two or more semesters after the end of the course. Gender was a predictor when students who passed the course within the allocated time were compared to those who failed or passed the course 2 semesters or more after the end of the course. The proportion of men increased in the groups that took longer to pass; the longer the time to completion, the higher the proportion of males (p = 2.6e-05). Those who failed or passed more than 2 semesters after the end of the course were older than those who passed the examination earlier (p-value = 0.012). When those who passed within the allocated time were compared to those who passed or failed late, i.e., more than two semesters after the end of the course, the latter group were found to have completed basic science projects more often (27%) than the former (18%) (p-value = 0.02). There was no significant difference (p = 0.06) in the proportion of epidemiological and public health projects between the groups. Furthermore, there was no significant difference in the rate of passing within the allocated time between students who had taken part in one or more of the research introductory courses and those who had not (p = 0.19). Scientific publications Of the 2,592 students, 782 (30.2%; 55.1% female) were co-authors of at least one publication, resulting in a total of 1,798 publication events. We noted that 253 publications included more than one of the included students as a co-author, as students were permitted to collaborate on the same research projects, provided that each pursued an individual research question. This resulted in a total of 1,545 unique publications. During the whole follow-up period, which ranged from 4 to 14 years per student, the publication frequency peaked at 3 years after course registration (Fig 2). We also examined publication patterns specifically within the 4 years after students were registered on the course. The choice of time interval was based on the fact that a 4-year follow-up could be applied to all included students. During follow-ups, altogether 932 unique publications representing 666 (25.7%) students were published (Fig 3). Publication frequency varied among these 666 students: 500 published one paper, 83 published 2 papers, and 83 published more than 2 papers. Altogether, 85% of all students who published did so within 4 years from the date of course registration, with an average time-to-publication of 2.6 years. To trace the potential continuity between students’ project choices and scholarly output in the future, we compared their research areas in the research project course and the research area(s) of their publications. Of the 1,545 publications, 1,490 (86.3%) were within the same research area as the students’ original project (Table 2). Assuming that the distribution of research areas is the same among the publications and the students’ projects, we could expect 345 (19.7%) of the publications (Table 1) to fall within the category of basic science. However, there were 108 more basic science publications than expected. Conversely, qualitative studies were published less frequently than expected (Table 2). Table 2. Comparison of distributions of research areas in students’ publications and course projects when both belonged to the same research area (n = 1490). Publications co-authored by several students were counted only once. Type of study Number of unique publications % of all publications % of all student projects (%) Clinical Science 766 51.4 58.6 Basic Science 397 26.6 19.7 Epidemiology and Public Health 280 18.8 15.6 Qualitative Research 29 2.0 2.7 Systematic Reviews 11 0.7 0.9 Other 7 0.5 2.5 Total 1490 100 100 We then applied a multivariate logistic regression model, with publishing a paper as an outcome and gender, age at course registration, students’ research area, and previous completion of research introductory courses as predictors. The results showed that lower age (OR 0.97; 95% CI (0.95–0.99); p = 0.00017), completing a introductory research course (OR 1.35; 95% CI (1.05–1.73); p = 0.021), and conducting an epidemiological (OR 1.60; 95% CI 1.19–2.15; p = 0.0015) or clinical study (OR 1.37; 95% CI 1.08–1.74; p = 0.008) (compared to basic science as a reference) were associated with publishing. Interestingly, 558 of the 666 (83.8%) students with publications within 4 years had passed the course within the allocated time compared to 1,350 out of the 1,926 (52%) students who did not publish within 4 years (p = 4.846e-12). Finally, approximately 15% of the 666 students had attended one or more elective research introductory courses. Ph.D. studies Among the student population, 374 (14.4%) registered as Ph.D. students at our university during the entire follow-up period (4–14 years). When comparing students who began their Ph.D. studies versus those who did not, we found that the former were younger at the time of course registration (25.6 vs. 27.4 years, p = 1.9e-13) and that the proportion of men was significantly higher (52.1% vs. 47.9%, p = 0.016). Moreover, a significantly higher percentage of Ph.D. students had chosen a basic science study as a course project (32% vs. 18%, p = 4.996e-11) and a significantly lower percentage had conducted a clinical study (48% vs. 60%, p = 7.861e-06). Finally, a significantly higher proportion of Ph.D. students had carried out research introductory courses before the research project course (p < 0.00001). Discussion Mandatory research projects in authentic research environments in medical education aim to foster scientific thinking, develop methodological and research ethics competence, and promote scholarly communication. While a scientific publication is not an intended outcome of our course, it represents a possible and meaningful extension of the project, indicating continued collaboration with the supervisor beyond the mandatory curriculum 14,18 . Our study showed that about one-third of the 10-year cohort of medical students were co-authors of at least one peer-reviewed paper, most of which were of the same type as the chosen course project. Lower age, completing an extracurricular research introductory course, and conducting an epidemiological or clinical study were associated with publishing. During the follow-up period, 14% of the included students were registered for Ph.D. studies at our university. Interestingly, a clear majority of the students who published within 4 years had passed the course within the allotted time. Given the scarcity of studies on publication outcomes following a mandatory research project course 12,14,16,18,25-27 addressing this gap is essential to understanding how such courses may contribute to scholarly productivity and development of academic skills. Therefore, the study by den Bakker et al. 14 provides a critical benchmark for interpreting our results. Their study included 10 cohorts of Dutch medical students comprising more than 2,000 participants and found that 27.7% of medical students published their findings from the mandatory research project in peer-reviewed papers, reviews, and meeting abstracts. The average time-to-publication was also comparable between our study (2.6 years) and that of van Bakker et al. 14 (2.4 years). Similarly, a recent study by Björklund et al. 18 from Sweden, based on 446 students, observed a publication rate of 33% following a mandatory research project; however, they also counted posters as publications. As we have considered only peer-reviewed papers, comparing these results with ours is constrained by this and other methodological differences in tracking the publications and contexts of the courses. Despite these variations, both studies present results consistent with ours: About one-third of medical students are co-authors of a publication after their mandatory research project. While existing research on assessment focuses on, for example, how assessment influences learning processes and performance 28 , we have not found any previous studies examining the factors associated with assessment outcomes in research project courses. Such studies are likely complicated by the fact that assessment practices vary across institutions. At some universities, the project report is graded by the supervisor, whereas others use more or less detailed assessment criteria and rely on examiners who are not involved in the project. KI employs the latter system. In our study, gender, age, and type of project were associated with the time taken to complete the course, with older, male students who conducted basic science projects requiring a longer time to pass. The underlying reasons remain uncertain but may relate to the fact that (experimental) basic science research involves a more unpredictable or time-consuming data collection process and dependence on specific practical skills than, for instance, register-based studies. Thus, rather than student ability, project design or content may affect time-to completion. The type of research project could be linked to publication rates. According to den Bakker et al. 14 , the project-level factors that showed the strongest and most consistent association with publishing were conducting research with academic medical centers, undertaking clinical or laboratory projects, and having a supervisor with a Ph.D. 14 . These factors illustrate the contextual differences: All our student projects are connected to our university, and all supervisors are required to have a relevant Ph.D. degree. Nevertheless, our results are partly consistent with those of den Bakker et al. 14 , as students undertaking clinical or epidemiological and public health projects were likelier to publish, whereas students engaged in basic science (“laboratory”) projects published less often. However, with the assumption that publication outputs reflect the distribution of students’ research areas, basic science projects accounted for over 100 more publications than expected. We can only speculate that this is due to experimental basic science projects appealing to students with an already grounded interest in and/or experience with molecular bioscience, which in turn predisposes them to having an interest in further studies and publication. One student-related factor associated with publication in our study was age at course registration, suggesting that younger students may be likelier to sustain research engagement. To the best of our knowledge, no other studies have directly examined the effect of age on publication practices among medical students. However, previous studies have indicated that early involvement in research is associated with later scientific activity 4,6,29 . While age is unlikely to have a direct causal effect, it may serve as a proxy for other underlying circumstances, such as fewer competing personal responsibilities or greater flexibility. These findings highlight the need for future studies to examine how demographic characteristics, such as age, influence research outcomes. Another student-related factor associated with publication was participation in introductory research courses. Many medical schools offer extracurricular courses that provide practical research experience and prepare students for future doctoral studies 30 . Although these courses differ widely in content and structure 6,31-34 , studies have reported gains in research competence, technical skills, and motivation for research 30,35,36 . Despite considerable variation in publication rates, limitations related to self-reported outcomes, and short follow-up periods 33,35 , studies show that students from such programs are likelier to publish than their fellows without that experience 37 . Our results confirmed that participation in extracurricular research courses increases the odds of having been published after a mandatory research project course. We cannot provide any causal explanation, but it should be kept in mind that these students had a pronounced early interest/pre-existing interest/ intrinsic motivation 38 in research that motivated them to pursue publication. Note that students who published their research within the 4-year window more often completed the course within the allocated time than those who did not publish, indicating an association between early academic progression and subsequent scholarly output. Although causality cannot be inferred, this pattern may reflect underlying characteristics that also facilitate later publication, such as project structure, supervision support, or students’ motivation for research. Thus, timely course completion may serve as a marker of student-related and project-related conditions that jointly influence both short-term assessment results and subsequent academic productivity. We have not found any previous studies on whether students’ performance predicts the subsequent publication of their research reports. There is an evident knowledge gap in the literature regarding the link between mandatory curricular research during medical school and later enrollment in Ph.D. studies. In our previous survey on medical students, 9% had enrolled in a Ph.D. program within 2 years of completing the course while 34% reported an intention to pursue a Ph.D. 19 . Among Dutch medical students who completed a mandatory research project, those who published their work were 1.74 times likelier to enroll in a Ph.D. program 14 . However, only 11% of the students answered the survey concerning postgraduate research engagement. Here, we found that 14% of the student cohort were later registered for Ph.D. studies at our university. As a comparison, during the 14-year period before the research project course was introduced in 2010, 42 KI-trained medical doctors, on average, commenced Ph.D. studies annually, implicating that the number of Ph.D. students has not increased since the course was implemented. It should be noted that doctoral enrollments only at our university were captured, so the true proportion of Ph.D. students is plausibly higher. Interestingly, compared to students who did not go on to pursuing Ph.D. studies, those who did were younger at the time of course registration, more often men, had carried out extracurricular research introductory courses before the research project course, and chose a basic science study as a course project. Although any causality cannot be inferred from the current data, demographic factors and early academic choices may shape the transition from undergraduate research to doctoral education. This study has several strengths. First, it is based on a large, well-characterized study population and a comprehensive longitudinal follow-up, providing substantial statistical power. Second, the use of multiple high-quality data sources, including institutional project databases, learning management systems, Ladok registry data, and systematically verified publication records, contributes to high validity. Third, the detailed categorization of research project types and careful verification of publications add precision to the outcome measures. Fourth, the long follow-up period (4–14 years) allows for a robust assessment of publications and progression to Ph.D. studies. Finally, the study context of a mandatory, authentic 20-week research project with standardized supervision requirements and assessment procedures provides a unique opportunity to evaluate research engagement in a setting where all students participate, thereby reducing the selection bias that is typically present in elective research programs. Our study has several limitations. The observational nature limits the ability to draw causal inferences and to understand the temporal dynamics of the impact of research projects. The number of publications is probably underestimated as we were not able to find all supervisors in our bibliometric verification system. Moreover, the number of Ph.D. students is likely higher, as our analysis was limited only to the students who began their doctoral training at our university. Differences in follow-up duration across cohorts may influence comparability with other studies. Supervisor-level variables, such as level of experience, publication activity, or mentoring style, may influence student outcomes. Finally, the participants included in this study were from a single research-intensive medical faculty, limiting the external validity and generalization to other populations. Different institutions or programs might have varying support structures, training environments, and student demographics that could affect the outcomes. Conclusion A substantial proportion of medical students remained engaged in research after completing a mandatory research project course. About one-third had coauthored at least one scientific paper 4 years after the mandatory research project course and 1 in 7 progressed to Ph.D. studies. Younger age, participation in extracurricular research introductory courses, and selecting a clinical or epidemiological project were associated with publication and taking up basic science projects were associated with subsequent Ph.D. registration. However, most of the students published only one paper. These results highlight the importance of early research exposure and structured research training as potential contributors to sustained academic involvement. Thus, our results suggest that curricular research is linked to medical students’ publication activities rather than to launching an academic research career. Declarations Author contributions All authors contributed substantially to the manuscript. RM conceived the study and acquired funding. RM, AS and MS contributed to study design. RM and MS contributed to data collection. RM, AS and MS analyzed and interpreted data. RM wrote the first draft of the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Data availability The datasets generated during and/or analyzed during the current study are not publicly available due to privacy and legal issues but are available from the corresponding author on reasonable request. Acknowledgements The authors want to express sincere gratitude to the educational administration at the Department of Medical Epidemiology and Biostatistics for their assistance with access to course data and documentation. We thank Anna Hedman and Ebba Lindqvist for their valuable assistance with data collection. We are also indebted to the many students, supervisors and coordinators whose engagement over the years formed the foundation of this study. Funding declaration This study was supported by Karolinska Institutet under grant FoUI-985747. The funding agency has no role in the study design, data collection, analysis, interpretation of the results, or manuscript writing. Additional Information The learning outcomes for the 20-week research project course is provided in the Supplementary Information file. Competing Interests Statement: The author(s) declare no competing interests. References Dawes, M. et al. Sicily statement on evidence-based practice. BMC Med Educ 5 , 1, doi:10.1186/1472-6920-5-1 (2005). Howard, B., Diug, B. & Ilic, D. Methods of teaching evidence-based practice: a systematic review. BMC Med Educ 22 , 742, doi:10.1186/s12909-022-03812-x (2022). George, P., Green, E. P., Park, Y. S. & Gruppuso, P. A. A 5-year experience with an elective scholarly concentrations program. Med Educ Online 20 , 29278, doi:10.3402/meo.v20.29278 (2015). Waaijer, C. J. F. et al. Scientific activity by medical students: the relationship between academic publishing during medical school and publication careers after graduation. Perspect Med Educ 8 , 223–229, doi:10.1007/s40037-019-0524-3 (2019). Huang, D. et al. Longitudinal Outcomes of Medical Student Research Mentorship: a 15-Year Analysis of the Radiation Oncology Mentorship Initiative. J Cancer Educ 38 , 153–160, doi:10.1007/s13187-021-02091-2 (2023). Amgad, M., Man Kin Tsui, M., Liptrott, S. J. & Shash, E. Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis. PLoS One 10 , e0127470, doi:10.1371/journal.pone.0127470 (2015). Laidlaw, A., Aiton, J., Struthers, J. & Guild, S. Developing research skills in medical students: AMEE Guide No. 69. Med Teach 34 , e754–771, doi:10.3109/0142159X.2012.704438 (2012). Ommering, B. W. C., van den Elsen, P. J., van der Zee, J., Jost, C. R. & Dekker, F. W. Using an Extracurricular Honors Program to Engage Future Physicians Into Scientific Research in Early Stages of Medical Training. Med Sci Educ 28 , 451–455, doi:10.1007/s40670-018-0565-y (2018). Carberry, C. et al. Curriculum initiatives to enhance research skills acquisition by medical students: a scoping review. BMC Med Educ 21 , 312, doi:10.1186/s12909-021-02754-0 (2021). Riiser, K., Kalleson, R., Holmen, H. & Torbjørnsen, A. Integrating research in health professions education: a scoping review. BMC Med Educ 23 , 653, doi:10.1186/s12909-023-04615-4 (2023). Conroy, M. B. et al. Scholarly Research Projects Benefit Medical Students' Research Productivity and Residency Choice: Outcomes From the University of Pittsburgh School of Medicine. Acad Med 93 , 1727–1731, doi:10.1097/ACM.0000000000002328 (2018). Alamri, Y. et al. Publication rates of, and attitudes toward, summer research projects: 10-year experience from a single institution in New Zealand. Adv Med Educ Pract 10 , 263–271, doi:10.2147/AMEP.S198789 (2019). DiBiase, R. M. et al. A medical student scholarly concentrations program: scholarly self-efficacy and impact on future research activities. Med Educ Online 25 , 1786210, doi:10.1080/10872981.2020.1786210 (2020). den Bakker, C. R., Ommering, B. W., van Leeuwen, T. N., Dekker, F. W. & De Beaufort, A. J. Assessing publication rates from medical students' mandatory research projects in the Netherlands: a follow-up study of 10 cohorts of medical students. BMJ Open 12 , e056053, doi:10.1136/bmjopen-2021-056053 (2022). Tumin, D. Nationwide Analysis of Medical Student Publications upon Entry into Residency. Med Sci Educ 34 , 31–35, doi:10.1007/s40670-023-01920-x (2024). Dyrbye, L. N., Davidson, L. W. & Cook, D. A. Publications and Presentations Resulting From Required Research by Students at Mayo Medical School, 1976-2003. Academic Medicine 83 , 604–610 (2008). Shen, J., Qi, H., Liu, G., Li, X. & Fang, Y. The impact of a curriculum-based research training program on medical students' research productivity and future research interests: a longitudinal study. BMC Med Educ 24 , 836, doi:10.1186/s12909-024-05841-0 (2024). Björklund, M., Massoumi, R. & Ohlsson, B. From master's thesis to research publication: a mixed-methods study of medical student publishing and experiences with the publishing process. BMC Med Educ 24 , 75, doi:10.1186/s12909-024-05060-7 (2024). Möller, R. & Shoshan, M. Medical students' research productivity and career preferences; a 2-year prospective follow-up study. BMC Med Educ 17 , 51, doi:10.1186/s12909-017-0890-7 (2017). Speirs, V., Abu-Eid, R. & Kyaw Myint, P. Engaging undergraduate medical and dental students with academic medicine: The Aberdeen INSPIRE summer school. PLoS One 18 , e0293633, doi:10.1371/journal.pone.0293633 (2023). Xu, P., Pfeiffer, S., Boland, F. & Stevens, N. T. Developing Research-Oriented Health Professionals: Understanding Students' Perceptions and Needs for Extracurricular Research Opportunities. J Med Educ Curric Dev 12 , 23821205241307781, doi:10.1177/23821205241307781 (2025). Nazha, B., Salloum, R. H., Fahed, A. C. & Nabulsi, M. Students' perceptions of peer-organized extra-curricular research course during medical school: a qualitative study. PLoS One 10 , e0119375, doi:10.1371/journal.pone.0119375 (2015). Wang, G. et al. The effects of long-term extracurricular scientific research on the medical students: Insight from Jinan University Medical School. Biochem Mol Biol Educ 49 , 535–545, doi:10.1002/bmb.21499 (2021). Skovgaard, M., Okkels, N., Christensen, M. K., Telinius, N. & Hauge, E. M. Publication rate and PhD enrolment following a medical pre-graduate research programme. Dan Med J 62 (2015). Laskowitz, D. T., Drucker, R. P., Parsonnet, J., Cross, P. C. & Gesundheit, N. Engaging Students in Dedicated Research and Scholarship During Medical School: The Long-Term Experiences at Duke and Stanford. Academic Medicine 85 , 419–428, doi:10.1097/ACM.0b013e3181ccc77a (2010). Al-Busaidi, I. S., Wells, C. I. & Wilkinson, T. J. Publication in a medical student journal predicts short- and long-term academic success: a matched-cohort study. BMC Med Educ 19 , 271, doi:10.1186/s12909-019-1704-x (2019). Salmi, L. R., Gana, S. & Mouillet, E. Publication pattern of medical theses, France, 1993-98. Med Educ 35 , 18–21, doi:10.1046/j.1365-2923.2001.00768.x (2001). Patenaude, B., Hogan, R. E. & Manguvo, A. Exploring the Dynamics of Medical Students' Exam Performance in Relation to Study Habits, Growth Mindset, Confidence Levels, and Demographics. Med Sci Educ 34 , 371–378, doi:10.1007/s40670-024-01976-3 (2024). Ommering, B. W. C., van Blankenstein, F. M., Waaijer, C. J. F. & Dekker, F. W. Future physician-scientists: could we catch them young? Factors influencing intrinsic and extrinsic motivation for research among first-year medical students. Perspect Med Educ 7 , 248–255, doi:10.1007/s40037-018-0440-y (2018). Ommering, B. W. C., van Blankenstein, F. M., van Diepen, M. & Dekker, F. W. Academic Success Experiences: Promoting Research Motivation andSelf-Efficacy Beliefs among Medical Students. Teach Learn Med 33 , 423–433, doi:10.1080/10401334.2021.1877713 (2021). Solomon, S. S., Tom, S. C., Pichert, J., Wasserman, D. & Powers, A. C. Impact of medical student research in the development of physician-scientists. J Investig Med 51 , 149–156, doi:10.1136/jim-51-03-17 (2003). Reinders, J. J., Kropmans, T. J. B. & Cohen-Schotanus, J. Extracurricular research experience of medical students and their scientific output after graduation. Medical Education 39 , 237–237, doi:10.1111/j.1365-2929.2004.02078.x (2005). Chang, Y. & Ramnanan, C. J. A review of literature on medical students and scholarly research: experiences, attitudes, and outcomes. Acad Med 90 , 1162–1173, doi:10.1097/ACM.0000000000000702 (2015). Parker, S. M., Vona-Davis, L. C. & Mattes, M. D. Factors Predictive of Publication Among Medical Students Participating in School-Sponsored Research Programs. Cureus 13 , e18176, doi:10.7759/cureus.18176 (2021). Conover, G. M., Monk, M. B., Nigli, S. & Awalt, A. Early Exposure of Medical Students to a Formal Research Program Promotes Successful Scholarship in a Multi-Campus Medical School. Med Sci Educ 34 , 1091–1103, doi:10.1007/s40670-024-02098-6 (2024). Alnajjar, J. S. et al. Impact of an Extracurricular Research Course on Medical Students: A Quasi-Experimental Study. Adv Med Educ Pract 16 , 461–470, doi:10.2147/AMEP.S509323 (2025). Langhammer, C. G., Garg, K., Neubauer, J. A., Rosenthal, S. & Kinzy, T. G. Medical Student Research Exposure via a Series of Modular Research Programs. J. Invest. Med. 57 , 11–17 (2009). Ommering, B. W. C., van Blankenstein, F. M., Wijnen-Meijer, M., van Diepen, M. & Dekker, F. W. Fostering the physician-scientist workforce: a prospective cohort study to investigate the effect of undergraduate medical students' motivation for research on actual research involvement. BMJ Open 9 , e028034, doi:10.1136/bmjopen-2018-028034 (2019). Additional Declarations No competing interests reported. Supplementary Files Supplementaryinformationscireports260315.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 19 Apr, 2026 Editor assigned by journal 18 Apr, 2026 Editor invited by journal 15 Apr, 2026 Submission checks completed at journal 10 Apr, 2026 First submitted to journal 10 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9140312","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":625919401,"identity":"e42e2c34-42ca-49fe-a85f-7945dc886760","order_by":0,"name":"Riitta Möller","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYDACZsYGCIOdGcioSOAhRktjwwG43jPEaGFgYERoYWxLIKzevJ25/fGHGoZofqB1jyvnpckw8B8+gFeLzGGQw44x5M5sZmw2PLsth4dBIg2/VRJgv7Ax5G44zNgm2bitAqiFx4AILf/AWtp/Ns4BauE//4GwloNtEFuATKDDGHLw6gBrmXG2TwLsF8mGY2k8bBJpBBzGf/zBh4pvNrn97M0HPzbUJNvz8x9+gN8aqE4Ek40Y9aNgFIyCUTAK8AMAfhhCV4oNb8IAAAAASUVORK5CYII=","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":true,"prefix":"","firstName":"Riitta","middleName":"","lastName":"Möller","suffix":""},{"id":625919402,"identity":"0eac3473-5b81-4db2-9439-a64ffc389ba6","order_by":1,"name":"Agnieszka Szwajda","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Agnieszka","middleName":"","lastName":"Szwajda","suffix":""},{"id":625919403,"identity":"7877849e-f2eb-4f82-927a-1f17a87e29c3","order_by":2,"name":"Maria Shoshan","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Shoshan","suffix":""}],"badges":[],"createdAt":"2026-03-16 16:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9140312/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9140312/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108007512,"identity":"42292647-a759-4522-b97a-d220ea83206b","added_by":"auto","created_at":"2026-04-28 13:00:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50171,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRelation between research area and time taken to pass the examination\u003c/strong\u003e. Based on the total number of students within each research area over the entire follow-up period, the percentages of students in each research area who passed the course within the allocated time (dark blue), passed during the subsequent semester (clear blue), and passed one year or later after the course (light blue).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9140312/v1/a7c175e2487f53bf91fd18fa.png"},{"id":108007367,"identity":"1300f27e-6b96-4d1b-a5c2-0d2f23a2659d","added_by":"auto","created_at":"2026-04-28 12:59:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":51988,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe number of publications events per student in relation to time since course registration\u003c/strong\u003e. Each student’s publication record is presented separately, resulting in publications appearing multiple times when more than one student was a co-author. In total, 1,798 publication events are plotted against the time between registration on the course and the year of publication.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9140312/v1/e6271ae0ddc8c617380d3556.png"},{"id":107998448,"identity":"eddb028f-dbad-4478-a351-f622f0926c90","added_by":"auto","created_at":"2026-04-28 11:34:56","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":25479,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe publication rates of all students (n = 666) who had published at least once within 4 years after the course registration.\u003c/strong\u003e X axis: number of publications; Y-axis: number of students.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9140312/v1/79118c6b9f7d5737b6ef3721.png"},{"id":108008790,"identity":"d7efe754-1b1d-4f81-b12c-30ffbcfbe984","added_by":"auto","created_at":"2026-04-28 13:08:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":432901,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9140312/v1/216f0a72-ab20-4b8d-af04-e2bbc556fb28.pdf"},{"id":107998446,"identity":"920f9fb7-cc70-440f-932e-206b58c66ab7","added_by":"auto","created_at":"2026-04-28 11:34:56","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":19440,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryinformationscireports260315.docx","url":"https://assets-eu.researchsquare.com/files/rs-9140312/v1/03b56a04f7d2a3219176e4ff.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Medical Students’ Publications and Research Engagement after a Mandatory Research Project Course: A 10-Year Retrospective Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDue to the growing emphasis on evidence-based medicine, medical students must understand research methodologies and how to make decisions based on scientific literature and systematic evidence synthesis in complex clinical situations \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Thus, integrating research competencies into medical education is necessary for the quality of future healthcare. Students\u0026rsquo; degree projects, also called scholarly projects, student theses, or research projects, may provide such training in concrete research. Ideally, they may offer students an opportunity for academic development, foster engagement with scientific research, and benefit their future careers \u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. However, there is a lack of empirical evidence regarding whether students\u0026rsquo; experiences result in continued research engagement once the project course ends.\u003c/p\u003e \u003cp\u003eOverall, there is no uniform way to incorporate students into ongoing research during medical school\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Research projects may be either mandatory or elective\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The projects may also vary in scope and possible research areas, as some medical programs have courses comprising a few weeks of mainly theoretical tutelage, whereas others provide hands-on experience in real-world research settings, often over at least one semester\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Moreover, some programs offer core medical research topics from which students may choose, while others also accept projects involving, for example, clinical quality improvement, medical education, or community programs.\u003c/p\u003e \u003cp\u003eHow the outcomes of research project courses are defined and assessed may also differ \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In medical education, the focus is usually on the knowledge, skills, and attitudes achieved by the students rather than on the actual content in the projects. Thus, such courses usually have intended learning outcomes aligned with the overarching outcomes of the entire program. However, although publication is generally not a requirement, some universities focus on the number of manuscripts submitted or published in peer-reviewed journals as well as presentations at a scientific conference as indicators to reflect the outcome of the course\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eExisting studies show a wide variation in the publication rates of medical students\u0026rsquo; reports. In addition to research courses being mandatory or elective, this disparity may be due to the varying definitions of \u0026ldquo;publication\u0026rdquo; and different follow-up periods. A recent study from the United States involving almost 12,000 new interns found that 39% had co-authored PubMed-indexed publications during medical school, but it was not specified whether the curricula involved mandatory or elective research projects, nor the duration of the project\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Other studies from the United States and New Zealand, reporting results from 7- to 10-week elective courses, found publication rates ranging from 24% to 93%\u003csup\u003e5,12\u003c/sup\u003e. Regarding mandatory research projects, a study from the United States by Dyrbye et al.\u003csup\u003e16\u003c/sup\u003e found that 41% of medical students published one or more research reports, while Shen et al.\u003csup\u003e17\u003c/sup\u003e from China reported a publication rate of 27%.\u003c/p\u003e \u003cp\u003eA more detailed study from the Netherlands with data on more than 2,000 medical students found that 27.7% of mandatory research training resulted in peer-reviewed scientific publications\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. In their setting, the students have 4-to-6 months of full-time, authentic, hands-on research experience with the possibility of extending their project time by 5 or 10 weeks. A retrospective study from Sweden, where all medical students had a mandatory research project of 20 weeks, showed that 149 of 446 (33%) students had published their course report data as scientific papers after the course\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. These results are in line with our previous study, in which 31% of medical students had reported that they had published or submitted a paper based on their mandatory project\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. However, differences in follow-up duration across these studies limited the comparability of the outcomes.\u003c/p\u003e \u003cp\u003eBeyond curricular research, some medical schools also offer extracurricular research introductory courses to support students\u0026rsquo; scientific engagement and career development as future researchers. These may include short-term courses\u0026mdash;such as Summer Research Schools\u0026mdash;or extended programs that span several months\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. A qualitative study by Nazha et al.\u003csup\u003e22\u003c/sup\u003e found that students who participated in an extracurricular research course reported increased motivation to pursue academic research. Furthermore, Wang et al.\u003csup\u003e23\u003c/sup\u003e showed that students who engaged in extracurricular research were likelier to contribute to scientific publications. However, there is still a lack of studies comparing long-term academic engagement among students who participated in extracurricular research courses versus those who did not.\u003c/p\u003e \u003cp\u003eOne benefit of the curricular research project is that students may use it as a stepping stone toward a future career as researchers. Indeed, it has been found that those who publish during medical school are likelier to pursue academic careers\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Skovgaard et al.\u003csup\u003e24\u003c/sup\u003e reported that 13% of Danish medical students who participated in an elective pre-graduate research program were later enrolled in a Ph.D. program. Similarly, a Swedish study by M\u0026ouml;ller and Shoshan\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e found that 9% of approximately 600 medical students who had completed a mandatory research project course had registered for Ph.D. studies two years later. Overall, the transition from medical school to Ph.D. studies is relatively underexplored, as most medical graduates tend to pursue clinical practice or other forms of postgraduate medical training.\u003c/p\u003e \u003cp\u003eIn summary, understanding how often medical students publish after completing a mandatory research project is important because publications serve as an objective indicator of sustained research engagement, provide insight into the long-term educational impact of the course, and help evaluate how undergraduate research training may support the development of future physician-scientists. Therefore, more studies with uniform definitions and methods to understand research involvement and productivity across programs are needed. This study aimed to examine medical students\u0026rsquo; journeys toward research involvement following a mandatory research project course by studying publication rates and Ph.D. enrollment and to investigate the factors associated with these outcomes.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a retrospective cohort study comprising 20 medical student cohorts over a 10-year period (2010\u0026ndash;2020), examining the students\u0026rsquo; research areas, original publications, and Ph.D. admission. Students were followed up until the spring semester of 2024. This cut-off allowed for lag time between project completion and peer-reviewed publication, as well as admission to doctoral studies. The study was reviewed by the Swedish Ethical Review Authority (Dnr 2022-00611-01) and was conducted in accordance with the World Medical Association Declaration of Helsinki and its revision in 2024. Since the study was based solely on database data, the review board waived written informed consent for participation.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eContext \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe context of this study is a single-faculty university, Karolinska Institutet (KI), Stockholm, Sweden that offers around 30 bachelor\u0026rsquo;s and master\u0026rsquo;s level programs in medicine and other health professions. Research has a high profile at our university and accounts for about 85% of our total annual revenue. KI employs approximately 3,000 researchers and has about 200 affiliated researchers, such as clinically active researchers or visiting scholars. Approximately 50% of the researchers were women. \u003c/p\u003e\n\u003cp\u003eAt the time of the study, the medical program spanned 5.5 years (11 semesters). Each semester lasts 20 weeks and corresponds to 30 European Credit Transfer and Accumulation System (ECTS) credits. The medical curriculum was designed as research-integrated education and comprised a scientific thread with 1\u0026ndash;2 days of instruction per semester in statistics, epidemiology, evidence-based medicine, critical appraisal of literature, and research ethics. In 2014, a 3-week scientific methods course was introduced in semester 5, replacing the previous scattered short teaching activities across various courses. \u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eStructure and content of the research project course \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall aim of the mandatory 20-week research project course, undertaken in semester 8 of the 11-semester program, is to deepen students\u0026rsquo; understanding of scientific methods, enhance their ability to evaluate research papers, and foster critical thinking, all of which are essential for practicing evidence-based medicine. The detailed intended learning outcomes are presented in Supplementary information. The projects involve authentic empirical research in basic, clinical, or translational science, usually within a research group. Students are free to apply for a project in their area of interest. The main supervisors must be active researchers in the area with at least a Ph.D. degree. The progress of the projects is monitored by faculty coordinators with at least a Ph.D. degree. Each coordinator is responsible for approximately 10 students per semester, arranges two seminars (project report and examination), and gives students criterion-based individual feedback on the projects, thereby ensuring that the projects are carried out according to the rules and regulations at our university. As a final examination, each paper presents an individual research report of about 20\u0026ndash;35 pages in accordance with the university\u0026rsquo;s guidelines. Although the report must be modeled on a standard scientific publication in the field, the students are not allowed to present a multi-author manuscript aimed at being submitted to a scientific journal. However, after completing the course, students may continue to collaborate with their supervisors and publish their results as an extracurricular scientific publication. No financial support is given to the students or supervisors to cover the publication expenses. \u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eExtracurricular research introductory courses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt KI, medical students may apply for three extracurricular research introductory courses before taking the curricular research project course \u0026ndash; a 7-week summer research school (10.5 ECTS credits), FOL\u0026Auml;K 1 (8 weeks; 12 ECTS credits), and FOL\u0026Auml;K 2 (12 weeks; 18 ECTS credits). FOL\u0026Auml;K 2 requires the completion of FOL\u0026Auml;K 1. Prior to 2019, FOL\u0026Auml;K 1 and FOL\u0026Auml;K 2 were offered as a single 30-ECTS course (FOL\u0026Auml;K). \u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDoctoral education\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical students at KI may also embark on research education in parallel with or after their undergraduate studies. The general eligibility requirement for doctoral education is at least 240 ECTS credits (approximately 160 weeks), of which at least 60 ECTS credits are for an advanced level or a degree at an advanced (second-cycle) level. KI hosts approximately 2,000 doctoral students, all of whom are female. Roughly 380 new Ph.D. students are admitted annually. \u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eParticipants \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn total, 2,847 medical students were registered on the mandatory research project course during a 10-year period from the fall semester of 2010 to the fall semester of 2020. As no course was offered in the spring semester of 2014 due to a curriculum change, students from 20 semesters, i.e., 20 courses, were included. Consequently, the follow-up time could range from 4\u0026ndash;14 years per student but was at least 4 years for all the included students. Of the registered students, 239 were excluded. The exclusion criteria were discontinued studies, absence of a written report required for examination, or the report appearing as a duplicate in the database due to the student having taken up the course for more than one semester. Thus, 2,592 were included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData on students, their supervisors, and the area of the research projects were retrieved from the database of the Department of Medical Epidemiology and Biostatistics at KI, which is routinely used for students\u0026rsquo; research project proposals. The database is maintained in the Lime CRM program. Data on assessment results were retrieved from the web-based learning management systems used in the course (Pingpong and Canvas), and data on Ph.D. admissions were obtained from the Swedish nationwide web-based system for higher education study documentation and administration (Ladok). Data on students\u0026rsquo; and supervisors\u0026rsquo; co-publications were retrieved from PubMed.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eProcedures and definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCategorization of the research areas\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents\u0026rsquo; research areas were categorized as follows \u0026ndash; Basic Science, Epidemiology and Public Health, Clinical Research, Qualitative Research, Systematic Review, and Other. This process was completed using a reference group of 6 persons, including 4 senior researchers in different fields of medicine and two of the authors (RM; MS) of this paper. Each final written report was reviewed and categorized by the authors, and the data were transferred to the database. Any uncertainties were resolved by consensus.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAssessment results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe summative assessment was based on the examiners\u0026rsquo; evaluation of the written report and the coordinators\u0026rsquo; evaluation of the final oral presentation and opposition to another student\u0026rsquo;s report and oral presentation. Students passing the course within the allocated time were defined as those who passed the regular assessment at the end of the course or the following re-assessment, approximately 2 months later, before the next regular summative assessment.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eScientific publications \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eScientific publications were defined as original research papers, including systematic reviews. Letters to the editor, meeting abstracts, and corrections to previously published material were excluded. We identified publications by combining the main supervisor\u0026rsquo;s last name and initial(s) with the student\u0026rsquo;s last name and initial(s) using a regular expression (regex). Only supervisors affiliated with KI and/or Region Stockholm (a regional public body responsible for healthcare within Stockholm County, Sweden) who had verified their publications using the Bibliometric Verification Toolkit at KI were included. All names were double-checked manually against the names in the student lists. In order to identify possible changes in names before the search procedure, the students\u0026rsquo; names were checked in Ladok, and if there had been any changes, both the name at the time of the course and the new name from Ladok were used in the literature search. Some false negatives are inevitable, as supervisors may have refrained from verifying their publications using the toolkit and the students may have published together with their co-supervisors instead of the main supervisor. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used descriptive statistics to describe the demographic variables. Differences in research area distribution and gender differences in research area selection were analyzed using the chi-square test. Mean age differences between students were assessed using an independent two-sample t-test. For assessment outcomes, students were categorized into two groups \u0026ndash; (1) those who passed within the allocated time and (2) those who passed or failed late, i.e., at least two semesters after course completion. Mean age differences between groups were compared using an independent two-sample t-test. Differences in categorical variables were assessed using chi-square tests. Assessment results were compared between students who participated in introductory extracurricular research courses and those who did not using a chi-square test.\u003c/p\u003e\n\u003cp\u003eTo identify student- and project-related factors associated with publications, logistic regression models were applied, adjusting for age at the course registration, gender, research area, and prior completion of any research introductory courses. P-values \u0026lt;0.05 were considered statistically significant. All analyses were performed using the R software (version 4.2.1). \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipants, research areas, and supervisors\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn total, 2,592\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003estudents (of whom 1,392, i.e., 53.7%, were female) were included in the study (Table 1). The median age was 26 years (range 21\u0026ndash;57). A majority of the students chose projects within clinical science (Table 1). There was some fluctuation over time in the proportions of selected research areas, but overall, we did not observe any major differences between the semesters (data not shown). Furthermore, no differences were observed in the students\u0026rsquo; median age (26 years) and gender across the different research areas except for qualitative research projects that were more often carried out by female students (p = 0.043).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e \u003cstrong\u003eDemographics of students and research areas of the mandatory research project course (n = 2592).\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1777375603.png\" width=\"802\" height=\"888\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: ECTS, European Credit Transfer System\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDuring the 10-year evaluation period, there were 1,000 unique main supervisors, of which 425 were female. A total of 45 supervisors (24 male, 21 female) had supervised at least 10 times each, collectively accounting for 771 student projects\u0026mdash;amounting to almost one-third of the included projects, the majority of which (72%) were clinical. Furthermore, 14 of these 45 supervisors (8 male, 6 female) had supervised 20 or more student projects each, adding up to 363 (14.8%) student projects.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment results\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the entire population, 1909\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(73.6%) students (of whom 1073, i.e., 56.2% were female) passed the course within the allocated time. The majority of this group completed a clinical science project (Fig. 1). Moreover, 527 (20.3%) students (of whom 259, i.e., 49.1% were female) passed the examination during the subsequent semester. Thus, 94% of the students completed the course within one year. Additionally, 86 students (2.6%) (of whom 30, i.e., 44.1% were female) passed within two or more semesters after the end of the course.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGender was a predictor when students who passed the course within the allocated time were compared to those who failed or passed the course 2 semesters or more after the end of the course. The proportion of men increased in the groups that took longer to pass; the longer the time to completion, the higher the proportion of males (p = 2.6e-05). Those who failed or passed more than 2 semesters after the end of the course were older than those who passed the examination earlier (p-value = 0.012). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen those who passed within the allocated time were compared to those who passed or failed late, i.e., more than two semesters after the end of the course, the latter group were found to have completed basic science projects more often (27%) than the former (18%) (p-value = 0.02). There was no significant difference (p = 0.06) in the proportion of epidemiological and public health projects between the groups. Furthermore, there was no significant difference in the rate of passing within the allocated time between students who had taken part in one or more of the research introductory courses and those who had not (p = 0.19).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eScientific publications\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf the 2,592 students, 782 (30.2%; 55.1% female) were co-authors of at least one publication, resulting in a total of 1,798 publication events. We noted that 253 publications included more than one of the included students as a co-author, as students were permitted to collaborate on the same research projects, provided that each pursued an individual research question. This resulted in a total of 1,545 unique publications. During the whole follow-up period, which ranged from 4 to 14 years per student, the publication frequency peaked at 3 years after course registration (Fig 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe also examined publication patterns specifically within the 4 years after students were registered on the course. The choice of time interval was based on the fact that a 4-year follow-up could be applied to all included students. During follow-ups, altogether 932 unique publications representing 666 (25.7%) students were published (Fig 3). Publication frequency varied among these 666 students: 500 published one paper, 83 published 2 papers, and 83 published more than 2 papers. Altogether, 85% of all students who published did so within 4 years from the date of course registration, with an average time-to-publication of 2.6 years. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo trace the potential continuity between students\u0026rsquo; project choices and scholarly output in the future, we compared their research areas in the research project course and the research area(s) of their publications. Of the 1,545 publications, 1,490 (86.3%) were within the same research area as the students\u0026rsquo; original project (Table 2). Assuming that the distribution of research areas is the same among the publications and the students\u0026rsquo; projects, we could expect 345 (19.7%) of the publications (Table 1) to fall within the category of basic science. However, there were 108 more basic science publications than expected. Conversely, qualitative studies were published less frequently than expected (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Comparison of distributions of research areas in students\u0026rsquo; publications and course projects when both belonged to the same research area (n = 1490).\u0026nbsp;\u003c/strong\u003ePublications co-authored by several students were counted only once. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"555\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of unique publications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% of all publications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% of all student projects (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eClinical Science\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e766\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e51.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e58.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eBasic Science\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e26.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eEpidemiology and Public Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eQualitative Research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eSystematic Reviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWe then applied a multivariate logistic regression model, with publishing a paper as an outcome and gender, age at course registration, students\u0026rsquo; research area, and previous completion of research introductory courses as predictors. The results showed that lower age (OR 0.97; 95% CI (0.95\u0026ndash;0.99); p = 0.00017), completing a introductory research course (OR 1.35; 95% CI (1.05\u0026ndash;1.73); p = 0.021), and conducting an epidemiological (OR 1.60; 95% CI 1.19\u0026ndash;2.15; p = 0.0015) or clinical study (OR 1.37; 95% CI 1.08\u0026ndash;1.74; p = 0.008) (compared to basic science as a reference) were associated with publishing. Interestingly, 558 of the 666 (83.8%) students with publications within 4 years had passed the course within the allocated time compared to 1,350 out of the 1,926 (52%) students who did not publish within 4 years (p = 4.846e-12). Finally, approximately 15% of the 666 students had attended one or more elective research introductory courses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePh.D. studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the student population, 374 (14.4%) registered as Ph.D. students at our university during the entire follow-up period (4\u0026ndash;14 years). When comparing students who began their Ph.D. studies versus those who did not, we found that the former were younger at the time of course registration (25.6 vs. 27.4 years, p = 1.9e-13) and that the proportion of men was significantly higher (52.1% vs. 47.9%, p = 0.016). Moreover, a significantly higher percentage of Ph.D. students had chosen a basic science study as a course project (32% vs. 18%, p = 4.996e-11) and a significantly lower percentage had conducted a clinical study (48% vs. 60%, p = 7.861e-06). Finally, a significantly higher proportion of Ph.D. students had carried out research introductory courses before the research project course (p \u0026lt; 0.00001).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion ","content":"\u003cp\u003eMandatory research projects in authentic research environments in medical education aim to foster scientific thinking, develop methodological and research ethics competence, and promote scholarly communication. While a scientific publication is not an intended outcome of our course, it represents a possible and meaningful extension of the project, indicating continued collaboration with the supervisor beyond the mandatory curriculum\u003csup\u003e14,18\u003c/sup\u003e. Our study showed that about one-third of the 10-year cohort of medical students were co-authors of at least one peer-reviewed paper, most of which were of the same type as the chosen course project. Lower age, completing an extracurricular research introductory course, and conducting an epidemiological or clinical study were associated with publishing. During the follow-up period, 14% of the included students were registered for Ph.D. studies at our university. Interestingly, a clear majority of the students who published within 4 years had passed the course within the allotted time.\u003c/p\u003e\n\u003cp\u003eGiven the scarcity of studies on publication outcomes following a mandatory research project course\u003csup\u003e12,14,16,18,25-27\u003c/sup\u003e addressing this gap is essential to understanding how such courses may contribute to scholarly productivity and development of academic skills. Therefore, the study by den Bakker et al.\u003csup\u003e14\u003c/sup\u003e provides a critical benchmark for interpreting our results. Their study included 10 cohorts of Dutch medical students comprising more than 2,000 participants and found that 27.7% of medical students published their findings from the mandatory research project in peer-reviewed papers, reviews, and meeting abstracts. The average time-to-publication was also comparable between our study (2.6 years) and that of van Bakker et al.\u003csup\u003e14\u003c/sup\u003e (2.4 years). Similarly, a recent study by Bj\u0026ouml;rklund et al.\u003csup\u003e18\u003c/sup\u003e from Sweden, based on 446 students, observed a publication rate of 33% following a mandatory research project; however, they also counted posters as publications. As we have considered only peer-reviewed papers, comparing these results with ours is constrained by this and other methodological differences in tracking the publications and contexts of the courses. Despite these variations, both studies present results consistent with ours: About one-third of medical students are co-authors of a publication after their mandatory research project.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile existing research on assessment focuses on, for example, how assessment influences learning processes and performance\u003csup\u003e28\u003c/sup\u003e, we have not found any previous studies examining the factors associated with assessment outcomes in research project courses. Such studies are likely complicated by the fact that assessment practices vary across institutions. At some universities, the project report is graded by the supervisor, whereas others use more or less detailed assessment criteria and rely on examiners who are not involved in the project. KI employs the latter system. In our study, gender, age, and type of project were associated with the time taken to complete the course, with older, male students who conducted basic science projects requiring a longer time to pass. The underlying reasons remain uncertain but may relate to the fact that (experimental) basic science research involves a more unpredictable or time-consuming data collection process and dependence on specific practical skills than, for instance, register-based studies. Thus, rather than student ability, project design or content may affect time-to completion. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe type of research project could be linked to publication rates. According to den Bakker et al.\u003csup\u003e14\u003c/sup\u003e, the project-level factors that showed the strongest and most consistent association with publishing were conducting research with academic medical centers, undertaking clinical or laboratory projects, and having a supervisor with a Ph.D.\u003csup\u003e14\u003c/sup\u003e. These factors illustrate the contextual differences: All our student projects are connected to our university, and all supervisors are required to have a relevant Ph.D. degree. Nevertheless, our results are partly consistent with those of den Bakker et al.\u003csup\u003e14\u003c/sup\u003e, as students undertaking clinical or epidemiological and public health projects were likelier to publish, whereas students engaged in basic science (\u0026ldquo;laboratory\u0026rdquo;) projects published less often. However, with the assumption that publication outputs reflect the distribution of students\u0026rsquo; research areas, basic science projects accounted for over 100 more publications than expected. We can only speculate that this is due to experimental basic science projects appealing to students with an already grounded interest in and/or experience with molecular bioscience, which in turn predisposes them to having an interest in further studies and publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne student-related factor associated with publication in our study was age at course registration, suggesting that younger students may be likelier to sustain research engagement. To the best of our knowledge, no other studies have directly examined the effect of age on publication practices among medical students. However, previous studies have indicated that early involvement in research is associated with later scientific activity\u003csup\u003e4,6,29\u003c/sup\u003e. While age is unlikely to have a direct causal effect, it may serve as a proxy for other underlying circumstances, such as fewer competing personal responsibilities or greater flexibility. These findings highlight the need for future studies to examine how demographic characteristics, such as age, influence research outcomes.\u003c/p\u003e\n\u003cp\u003eAnother student-related factor associated with publication was participation in introductory research courses. Many medical schools offer\u0026nbsp;extracurricular courses that provide practical research experience and prepare students for future doctoral studies\u003csup\u003e30\u003c/sup\u003e. Although these courses differ widely in content and structure\u003csup\u003e6,31-34\u003c/sup\u003e, studies have reported gains in research competence, technical skills, and motivation for research\u003csup\u003e30,35,36\u003c/sup\u003e. Despite considerable variation in publication rates, limitations related to self-reported outcomes, and short follow-up periods\u003csup\u003e33,35\u003c/sup\u003e, studies show that students from such programs are likelier to publish than their fellows without that experience\u003csup\u003e37\u003c/sup\u003e. Our results confirmed that participation in extracurricular research courses increases the odds of having been published after a mandatory research project course. We cannot provide any causal explanation, but it should be kept in mind that these students had a pronounced early interest/pre-existing interest/ intrinsic motivation\u003csup\u003e38\u003c/sup\u003e in research that motivated them to pursue publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNote that students who published their research within the 4-year window more often completed the course within the allocated time than those who did not publish, indicating an association between early academic progression and subsequent scholarly output. Although causality cannot be inferred, this pattern may reflect underlying characteristics that also facilitate later publication, such as project structure, supervision support, or students\u0026rsquo; motivation for research. Thus, timely course completion may serve as a marker of student-related and project-related conditions that jointly influence both short-term assessment results and subsequent academic productivity. We have not found any previous studies on whether students\u0026rsquo; performance predicts the subsequent publication of their research reports.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere is an evident knowledge gap in the literature regarding the link between mandatory curricular research during medical school and later enrollment in Ph.D. studies. In our previous survey on medical students, 9% had enrolled in a Ph.D. program within 2 years of completing the course while 34% reported an intention to pursue a Ph.D.\u003csup\u003e19\u003c/sup\u003e. Among Dutch medical students who completed a mandatory research project, those who published their work were 1.74 times likelier to enroll in a Ph.D. program\u003csup\u003e14\u003c/sup\u003e. However, only 11% of the students answered the survey concerning postgraduate research engagement. Here, we found that 14% of the student cohort were later registered for Ph.D. studies at our university. As a comparison, during the 14-year period before the research project course was introduced in 2010, 42 KI-trained medical doctors, on average, commenced Ph.D. studies annually, implicating that the number of Ph.D. students has not increased since the course was implemented.\u0026nbsp;It should be noted that\u0026nbsp;doctoral enrollments only at our university were captured, so the true proportion of Ph.D. students is plausibly higher. Interestingly, compared to students who did not go on to pursuing Ph.D. studies, those who did were younger at the time of course registration, more often men, had carried out extracurricular research introductory courses before the research project course, and chose a basic science study as a course project. Although any causality cannot be inferred from the current data, demographic factors and early academic choices may shape the transition from undergraduate research to doctoral education.\u003c/p\u003e\n\u003cp\u003eThis study has several strengths. First, it is based on a large, well-characterized study population and a comprehensive longitudinal follow-up, providing substantial statistical power. Second, the use of multiple high-quality data sources, including institutional project databases, learning management systems, Ladok registry data, and systematically verified publication records, contributes to high validity. Third, the detailed categorization of research project types and careful verification of publications add precision to the outcome measures. Fourth, the long follow-up period (4\u0026ndash;14 years) allows for a robust assessment of publications and progression to Ph.D. studies. Finally, the study context of a mandatory, authentic 20-week research project with standardized supervision requirements and assessment procedures provides a unique opportunity to evaluate research engagement in a setting where all students participate, thereby reducing the selection bias that is typically present in elective research programs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur study has several limitations. The observational nature limits the ability to draw causal inferences and to understand the temporal dynamics of the impact of research projects. The number of publications is probably underestimated as we were not able to find all supervisors in our bibliometric verification system. Moreover, the number of Ph.D. students is likely higher, as our analysis was limited only to the students who began their doctoral training at our university. Differences in follow-up duration across cohorts may influence comparability with other studies. Supervisor-level variables, such as level of experience, publication activity, or mentoring style, may influence student outcomes. Finally, the participants included in this study were from a single research-intensive medical faculty, limiting the external validity and generalization to other populations. Different institutions or programs might have varying support structures, training environments, and student demographics that could affect the outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA substantial proportion of medical students remained engaged in research after completing a mandatory research project course. About one-third had coauthored at least one scientific paper 4 years after the mandatory research project course and 1 in 7 progressed to Ph.D. studies. Younger age, participation in extracurricular research introductory courses, and selecting a clinical or epidemiological project were associated with publication and taking up basic science projects were associated with subsequent Ph.D. registration. However, most of the students published only one paper. These results highlight the importance of early research exposure and structured research training as potential contributors to sustained academic involvement. Thus, our results suggest that curricular research is linked to medical students\u0026rsquo; publication activities\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003erather than to launching an academic research career.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed substantially to the manuscript. RM conceived the study and acquired funding. RM, AS and MS contributed to study design. RM and MS contributed to data collection. RM, AS and MS analyzed and interpreted data. \u0026nbsp;RM wrote the first draft of the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are not publicly available due to privacy and legal issues but are available from the corresponding author on reasonable request. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors want to express sincere gratitude to the educational administration at the Department of Medical Epidemiology and Biostatistics for their assistance with access to course data and documentation. We thank Anna Hedman and Ebba Lindqvist for their valuable assistance with data collection. We are also indebted to the many students, supervisors and coordinators whose engagement over the years formed the foundation of this study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Karolinska Institutet under grant FoUI-985747. The funding agency has no role in the study design, data collection, analysis, interpretation of the results, or manuscript writing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe learning outcomes for the 20-week research project course is provided in the Supplementary Information file. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests Statement:\u003c/strong\u003e The author(s) declare no competing interests.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDawes, M.\u003cem\u003e et al.\u003c/em\u003e Sicily statement on evidence-based practice. \u003cem\u003eBMC Med Educ\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e, 1, doi:10.1186/1472-6920-5-1 (2005).\u003c/li\u003e\n\u003cli\u003eHoward, B., Diug, B. \u0026amp; Ilic, D. 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Fostering the physician-scientist workforce: a prospective cohort study to investigate the effect of undergraduate medical students\u0026apos; motivation for research on actual research involvement. \u003cem\u003eBMJ Open\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, e028034, doi:10.1136/bmjopen-2018-028034 (2019). \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"medical students, undergraduate research, scholarly project, master’s thesis, publication outcomes, Ph.D. studies","lastPublishedDoi":"10.21203/rs.3.rs-9140312/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9140312/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntegrating research competencies into medical education is essential for high-quality healthcare. While rarely required, publishing is frequently used as an indicator of students\u0026rsquo; research achievement. However, few studies have investigated medical students\u0026rsquo; publication outcomes following a mandatory research project course. This retrospective cohort study explored publication rates, Ph.D. enrollment, and associated factors among 2,592 medical students who completed such a mandatory course between 2010 and 2020. In total, 782 students (30.2%) collectively published 1,545 unique publications. Completing elective research introductory courses (OR 1.35; 95% CI 1.05\u0026ndash;1.73), lower age (OR 0.97; 95% CI 0.95\u0026ndash;0.99), and conducting an epidemiological (OR 1.60; 95% CI 1.19\u0026ndash;2.15) or a clinical study (OR 1.37; 95% CI 1.08\u0026ndash;1.74) were associated with subsequent publishing. Students who published within 4 years more often completed the course on time than non-publishing students. A total of 374 (14.4%) students enrolled in doctoral studies. These students were younger (p\u0026thinsp;=\u0026thinsp;1.9e-13), more often men (p\u0026thinsp;=\u0026thinsp;0.016), and had more frequently completed a basic science project (p\u0026thinsp;=\u0026thinsp;4.996e-11) and elective introductory courses (p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001) than the non-Ph.D. students. Our results suggest that curricular research foster medical students\u0026rsquo; publication activity but not necessarily an academic career.\u003c/p\u003e","manuscriptTitle":"Medical Students’ Publications and Research Engagement after a Mandatory Research Project Course: A 10-Year Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-28 11:34:52","doi":"10.21203/rs.3.rs-9140312/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-20T02:47:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-19T02:04:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-15T10:47:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-10T09:25:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-04-10T08:45:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"52616754-4e6b-4482-a5e7-7e0374408580","owner":[],"postedDate":"April 28th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":66613683,"name":"Health sciences/Diseases"},{"id":66613684,"name":"Health sciences/Health care"},{"id":66613685,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-04-28T11:34:52+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-28 11:34:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9140312","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9140312","identity":"rs-9140312","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}