Introduction

Training medical students in research is of paramount importance, as it allows them to develop the skills necessary to carry out their clinical practice, such as bibliographic search, critical reading, hypothesis formulation, and decision making.¹ Thus, in medicine, undergraduate theses are part of the initial research experience and are a strategy used to increase university scientific production.² Worldwide, however, the publication rate of these studies is less than 33%,^3,4,5which hinders the validation and dissemination of the findings made by the students and halts the research process.

In Peru, the Peruvian Association of Medical Schools established that the undergraduate human medicine curriculum should include an applied research component with emphasis on research methodology.⁶ Likewise, the University Law in force (Law 30220 of 2014), which governs the operation of universities in the country, establishes that the submission of a thesis is mandatory to obtain a bachelor's degree or professional degree.⁷

At present, the scientific research process, which includes theses, is complete only if the works are published in an indexed scientific journal, since their publication helps to disseminate knowledge and submit the research to a quality evaluation by academic peers.^2,8However, it has been reported that the frequency of publication of medical undergraduate theses in indexed journals in Peru is very low, ranging from 1% to 23.6%.^9-17

Likewise, Peruvian studies have identified barriers and limitations to the completion of theses by undergraduate medical students, which include administrative procedures, preparation and submission of the thesis, approval of the research protocol, request for the assignment of a thesis advisor, nomination of the thesis jury,^18,19self-perceived lack of research knowledge, insufficient time or resources,²⁰ and unavailability of trained advisors.²¹ However, there are no studies addressing the barriers and limitations perceived by new graduates regarding the publication of their theses, which is relevant both to understand the current context of medical programs and to implement measures aimed at encouraging the publication of undergraduate works in scientific journals.

In view of the foregoing, the objectives of this research were to identify the barriers and limitations to publishing undergraduate theses written by recently graduated physicians from seven Peruvian universities in indexed scientific journals and to determine the factors associated with their intention to publish.

Materials and methods

Results

The median age of the participants was 25 years (P25-75: 24-27) and 55.09% were female. The response rate of the questionnaire by medical graduates was 39.57% (167/422) distributed as follows: 80.00% from UNSAAC (32/40), 42.50% from UPAO (34/80), 39.09% from UCSM (43/110), 35.71% from UAC (15/42), 40.00% from UNP (8/20), 26.00% from UPeU (13/50), and 27.50% from UNSA (22/80). Furthermore, 63.47% studied at a private university and UCSM was the university with the highest participation (25.74%), followed by UPAO (20.35%), and UNSAAC (19.16%) (Table 1).

Regarding participation in research activities during their undergraduate studies, 38.92% of the physicians were members of a student scientific society, 36.53% took extracurricular research courses, 35.93% participated in the scientific writing of a text, 26.35% participated in research projects other than their thesis, and 10.78% published at least one scientific text during their undergraduate studies (Table 1).

Regarding the aspects related to the elaboration of the thesis, 59.88% of the participants reported having received help in the completion of some part of the thesis, with statistical analysis being the section in which most help was received (49.10%). On the other hand, 24.55% reported having committed scientific fraud other than plagiarism (fabrication or falsification) of some section in their thesis, with the number of respondents (14.97%) and the respondents' answers (11.38%) being the most altered data. Also, 17.37% reported having plagiarized or copied some section of their thesis, with the methodology (13.77%) being the section with the highest percentage of plagiarism or copying. Finally, 42.52% had the intention of publishing their undergraduate thesis; of these, 28.74% reported only having the intention of publishing it, 11.38% were in the process of publishing it, and 2.40% had already published it (Table 1).

Regarding barriers to thesis publication, participants mostly reported agreeing or strongly agreeing with insufficient knowledge on how to make a submission to a scientific journal (71.85%), failure to access advisors with experience in scientific research (68.26%), and priority to pursue a medical specialty (67.07%) (Figure 1).

Figure 1: Perceived barriers to undergraduate thesis publication (n=167).

Source: Own elaboration.

Concerning the evaluation of the association between the intention to publish and the factors considered, the adjusted Poisson regression model found that the older the age, the lower the frequency of intention to publish, as it was lower in participants aged 27-33 years compared to those aged 23-24 years (aPR: 0.62; 95%CI: 0.51-0.75). The other factors did not show a statistically significant association (Table 2).

Discussion

The present study found that 6 out of 10 physicians (59.88%) received help to prepare their thesis, most frequently in the statistical analysis section (49.10%). In addition, 24.55% reported having committed some kind of scientific fraud (fabrication or falsification of information) when preparing some section of their thesis, with the number of respondents (14.97%) and the information collected (11.38%) being the sections that were most frequently altered. Plagiarism was also a common occurrence during the preparation of the theses, as it was established that 17.37% had engaged in this malpractice.

With respect to reported barriers and limitations to publishing their theses, lack of knowledge on how to do so (71.85%) and lack of access to advisors with experience in scientific research (68.26%) were the most reported by the participants. Finally, the frequency of publication of the theses was low (2.40%), although the frequency of intention to publish was considerable (42.52%).

Although there are no studies that evaluate the intention to publish undergraduate theses among newly graduated physicians, the frequency of publication of undergraduate theses in health science programs has been studied. In Peru, for example, Mamani-Benito et al. ⁹ conducted a study in which they analyzed 482 theses approved between 2016 and 2018 carried out by health sciences students (medicine, nursing, nutrition, and psychology) from 4 universities in the department of Pun, finding a publication rate in indexed scientific journals of 1% (5 theses).⁹ In turn, Taype-Rondán et al. ¹⁰ reported that only 2.7% of the 74 undergraduate theses approved between 2000 and 2009 at the Faculty of Human Medicine of the Universidad San Martin de Porres were published. In the case of the Universidad Nacional Mayor de San Marcos, Valle & Salvador,¹² in a bibliometric study that included 93 human medicine theses written between 1998 and 2008, found that only 11.8% of them were published in an indexed scientific journal.

Studies conducted in other Peruvian universities have also documented a low frequency of publication of undergraduate medical theses. For example, Castro-Maldonado et al. ¹³ reviewed 221 theses completed between 2006 and 2014 at the Universidad Nacional Pedro Ruiz Gallo and found that only 9 (4.1%) were published, while Atamari-Anahui et al. ¹⁷ analyzed 398 theses from UNSAAC approved between 2000 and 2012 finding that only 20 (5.02%) were published. On the other hand, at the Universidad Peruana Cayetano Heredia, higher publication frequencies of medical theses have been reported: 17.6% of 482 theses and 19.79% of 192 theses in the periods 2000-2003¹⁷ and 2006-2008,¹⁶ respectively.

Other countries also report variable rates of thesis publication, although some studies report considerably higher frequencies. For example, in France, Benotmane et al. ³ reported a medical thesis publication rate of 11.3% among the 2 150 students who submitted theses between January 1, 2001, and December 31, 2007, at the Université de Lille², while in Finland, Nieminen et al. ⁴ found that 23.8% of the 256 medical and dental theses submitted at the University of Oulu between 2001 and 2003 were published. Similarly, Al-Busaidi & Alamri⁵ reported a higher publication rate of medical theses in New Zealand, as they found that 32.7% of the 153 theses accepted at Otago Medical School between January 1995 and December 2014 were published in scientific journals.

It should be pointed out that while 42.52% of the respondents in the present study intended to publish their thesis, it is likely that this intention will not lead to a scientific publication since 11.38% reported being in the process of publishing it and only 2.40% reported having already published it, and this publication rate is similar to the one reported in some of the studies mentioned above.^9-11,13,17It should also be noted that the period between the completion of the theses and the possibility of publishing them was short, so the final number of theses that were published may be underestimated. Moreover, it should be recognized that the universities evaluated are not the ones with the highest scientific production in Peru.

One finding worthy of note in the present study is that almost half of the respondents reported that they had received help in the statistical analysis during the elaboration of their thesis; however, no similar research addressing this aspect was found. This result is difficult to interpret since it could be concluded that the statistical analyses in some of the theses were advanced and therefore required specialized assistance, while in others, such analyses were not so complex.

Regarding scientific integrity, it was found that 17.37% of the participants in this study reported having committed plagiarism, mainly in the methodology and introduction sections. This finding differs from the report by Saldaña-Gastulo et al., ²⁴ who evaluated 33 theses of medical students from a public university in Peru, finding evidence of plagiarism in 81.81%. Bearing in mind that plagiarism in the present study was evaluated by means of self-reporting, it is to be expected that the frequency reported is lower than what would be found with objective evaluations such as the one carried out in the study by Saldaña-Gastulo et al. ²⁴ or in studies using anti-plagiarism software. In any case, this highlights the need to improve thesis evaluation processes in the universities evaluated.

In the present study, 24.55% of the participants committed some type of scientific fraud, other than plagiarism, in some section of their thesis. Making up or misreporting the number of respondents and their responses were the most frequently reported unethical behaviors. In 2009, Fanelli,²⁵ through a systematic review and meta-analysis, reported a frequency of fabrication, modification or falsification of data or results of 1.97% (95%CI: 0.86-4. 45) among US and UK scientists mainly, but other studies have found much higher frequencies, such as the one by Okonta & Rossouw,²⁶ in which 133 researchers attending a scientific conference in Nigeria in 2010 were surveyed using the Scientific Misconduct Questionnaire-Revised (SMQ-R), finding that 42% reported falsifying or plagiarizing data in their research.

Although the percentage of participants who committed plagiarism in the present study is within the range reported worldwide, this figure illustrates how much of a problem scientific fraud is in undergraduate medical thesis research in Peru. In this sense, although theses are part of the gray literature, it is advisable to incorporate scientific integrity committees following the recommendations included in the Código Nacional de la Integridad Científica del Consejo Nacional de Ciencia, Tecnología e Innovación Tecnológica ²⁷ (National Code of Scientific Integrity of the National Council of Science, Technology and Technological Innovation, CONCYTEC by its acronym in Spanish) to ensure integrity, intellectual honesty and truthfulness in scientific research activities, as well as to enable a responsible execution and dissemination of the results of scientific research.

This could be explained by the fact that, as reported by Carnero et al.,²⁸ there are several factors in developing countries that can facilitate plagiarism in the context of higher education, such as lack of training in responsible research behavior; poor writing skills; tolerance of this practice during educational and professional activities; lack of institutional policies and supervision by academic centers and scientific journals; differences in the perception of intellectual property and of this misconduct; generalized corruption; and cultural differences in the perception of values. Furthermore, it has been described that the use of questionable research practices has been associated with students' attitudes towards such practices,²⁹ so it is necessary to strengthen research ethics competencies during undergraduate studies, as well as among health professionals, in the country and in the region. Likewise, the frequency of falsification of information should be corroborated in further studies that evaluate this issue in more detail.

Conclusion

In the present study, less than half of the participants intended to publish their undergraduate thesis as a scientific article in indexed journals and the publication rate at the time of this study was low. The most frequently reported barriers to thesis publication were insufficient knowledge of how to make a submission to an indexed journal and lack of access to experienced research advisors. On the other hand, it was found that 24.55% of the respondents had committed scientific fraud other than plagiarism (fabrication or falsification of data) and 17.37% had committed plagiarism, which were important reasons for not considering the future publication of their theses. Finally, being older was associated with a lower intention to publish the thesis.