A national cross-sectional study on research opportunities and barriers among medical students in Nigeria, with recommendations

Abstract

Background

Clinical and health systems research are essential for advancing global healthcare. Engaging and training medical students in research will foster lifelong evidence-based practice, particularly for the emerging healthcare workforce. This study investigates the involvement of Nigerian medical students in research, identifying key opportunities and barriers to enhance their engagement.

Methods

This cross-sectional, descriptive study used an online survey targeting recent graduates from 42 accredited Nigerian medical schools. A purposive sampling approach selected one federal, state, and private institution from each of Nigeria’s six geopolitical zones. Data were collected between February and June 2024 using a face-validated online questionnaire, which gathered quantitative data and free-text recommendations. The survey was distributed through WhatsApp groups. Descriptive statistics and thematic analysis were employed to explore trends in the data. Ethical approval was obtained from the Jos University Teaching Hospital ethics review board (JUTH/DCS/IREC/127/XXXI/871). Informed consent was secured from each participant prior to participation.

Results

Of the 429 respondents (270 men, 159 women) from 15 universities across all six zones, 92% participated in research during medical school. Men engaged in more research projects than women (p = 0.03). Most respondents participated in two projects, usually group-based, with limited individual projects. Few had presented (20%) or published (17%) their research. Proficiency was highest in developing appropriate research methodologies (54%), while data analysis was the most challenging aspect of research (42%). Participation in research was supported by adequate mentorship for most participants (64%), whereas time constraints(74%), lack of research funding (55%), and inadequate research training (31%) were the main barriers to involvement. Regional differences were noted, with the highest participation by students in the South-South geo-political zone (98%) and the lowest in the South-West (85%). Learners from the South-West had more opportunities to present research at conferences, while those from the South-East had the fewest. Participants advocated for integrating more research opportunities into the medical curriculum, emphasising early skill development, expanding mentorship and networking opportunities, and offering grants to support students in conducting innovative research.

Conclusion

There is a pressing need to enhance structured research opportunities in Nigerian medical education, especially for female medical students. This includes expanding access to training in data analysis, increasing publication and presentation opportunities, and integrating research skills early in the curriculum while addressing barriers like time constraints.

Clinical trial number

Not applicable.

Introduction

Research is a cornerstone of medical education and practice, fostering critical thinking, innovation, and evidence-based healthcare. Early involvement in research provides medical students with essential skills, including data interpretation, academic writing, and a deeper understanding of clinical decision-making processes [1, 2]. Studies from High-Income Countries (HICs) have demonstrated that with appropriate support, student research initiatives can be both feasible and beneficial [3, 4]. However, in many Low- and Middle-Income Countries (LMICs), research opportunities for medical students remain limited [5]. Nigeria, with one of the largest medical student populations in Africa, offers a unique context for understanding the challenges and opportunities related to research engagement in this context [6].

Nigerian medical schools vary widely in terms of geographic location, ownership (public versus private), and resource allocation, which might likely influence access to opportunities [7]. Despite these variations, available data on how medical students across the country perceive and engage with research are either focal or not comprehensive. This is of great concern, as limited exposure to research during medical school can negatively impact the production of future clinician-scientists, a critical cadre for advancing global health priorities [8]. Furthermore, while research initiatives have significantly improved health services and outcomes in the Global North, Sub-Saharan Africa lags behind in conducting research that directly addresses its unique challenges [9]. Barriers to research participation in LMICs are multifactorial [5]. These barriers might be further complicated by challenges specific to Nigeria, such as regional disparities in educational resources and gendered differences, which remain poorly understood [10, 11].

Developing a research-driven educational model in medical schools is essential to strengthening the region’s healthcare system [12]. To achieve sustainable improvements, Africa must cultivate innovative, context-specific solutions by understanding its distinct challenges, shaped by factors such as culture, lifestyle, and climate. Therefore, understanding the research opportunities and barriers experienced by medical students in Nigeria is critical for shaping policies and interventions that enhance research engagement. A national cross-sectional study is justified as it allows for the comprehensive exploration of these factors across diverse regions, gender groups, and school types, providing insights that are both broad and contextually relevant.

This study aims to examine the level of research engagement among Nigerian medical students, identify the available opportunities, explore the barriers that hinder participation, and gather recommendations from recent graduates on ways to enhance research involvement among medical students. The findings will provide actionable evidence to inform curriculum development, capacity-building initiatives, and policy reforms aimed at fostering a research-oriented culture among future healthcare professionals in Nigeria.

Methods

Study design

This study was a cross-sectional study, involving an online survey of recently graduated medical doctors from accredited medical schools across the six geopolitical zones of Nigeria.

Study population

The study targeted the most recent graduating sets from Nigeria’s 42 accredited medical schools, representing a total of 3,355 graduates as per the Medical and Dental Council of Nigeria (MDCN) institutional graduation quota [13]. A purposive sampling approach was used, selecting one federal government-owned, one state government-owned, and one private-owned institution from each of Nigeria’s six geopolitical zones to ensure diverse representation.

National accreditation was defined by inclusion on the MDCN accreditation list at the time of study, while recent graduates referred to the last graduated set of medical students from the medical schools (as of January 2021). We defined ‘recent medical graduates’ as the latest academic set of students who had graduated as medical doctors from Nigerian medical schools. Schools with last graduated sets longer than 2021 were excluded to mitigate recall bias. Incorporating medical doctors with a limit of 2021 into this definition was necessary because some medical schools did not graduate any medical doctors in recent years due to university staff and health workers’ industrial strike actions.

Sample size and sampling technique

The sample size was calculated using a formula for sample size determination for proportions with a margin of error of 5% and a confidence level of 95%, resulting in a minimum required sample size of 345 participants [14]. This approach aimed to enhance the robustness and representativeness of the findings. Purposive sampling was employed to select the participating institutions based on geographical distribution and institutional type (federal, state, private) within the country.

Data collection

Data was collected from February to July 2024. A face-validated, semi-structured, four-section, 35-multiple choice Likert scale and open-ended online e-survey questionnaire (Appendix 1) based on the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was developed and utilised for this study [15]. The survey was developed by a panel comprising experienced Nigerian and international medical educators and recent medical graduates in an iterative process based on peer-reviewed literature and six focus group discussions with graduates. Additionally, pretesting was conducted with a cohort of recent graduates from an institution that was not included in the sampled institutions. The pretesting results contributed to the refinement of the survey.

The survey was distributed through secured class WhatsApp groups (WhatsApp, USA 2024), which are commonly used as communication channels in Nigerian medical schools. The survey included quantitative sections to capture information on research opportunities, barriers, and the extent of involvement in research activities among respondents, as well as a free-text section to capture recommendations for improving research participation among undergraduate medical students in Nigeria. Consent was obtained as respondents were introduced to the investigators and the purpose of the survey. They were informed of the expected duration to fill out the survey and how the data would be stored and utilised. No personal information was collected or stored, and access to data was limited to trained investigators; as such, they were assured of the privacy of their responses. Data was stored on an encrypted platform (Google Drive), and analysed on password-protected, encrypted systems to protect from unauthorised access.

During the period of data collection, the survey distribution team met weekly to evaluate responses and to strategise for more effective dissemination. Log file analysis was used to screen for duplicate entries and atypical time stamps. Only completed surveys were analysed.

Data analysis

Descriptive statistics, including frequencies, percentages, and measures of central tendency (mean, median), were used to summarise the quantitative data. Thematic analysis was employed to examine the free-text recommendations, aiming to identify areas for improving medical education in Nigeria. Statistical analysis was performed using R version 4.1.1. For continuous variables, a Kruskal-Wallis test was used, for categorical variables with cell counts greater or equal to five, a Chi-Squared test was used, and for categorical variables with cell counts less than five, the Fisher’s Exact test was used to evaluate differences in characteristics between categories of respondents. Correlations were assessed between demographic variables (such as gender and institution type) and the extent of research involvement.

Qualitative analysis of free-text recommendations to improve research participation in Nigerian medical schools by recent medical graduates was done using thematic analysis. A series of online consensus meetings of 16 recent medical graduates from 15 Nigerian medical schools were held in which the results were discussed, and the free responses were reviewed, to optimise data analysis.

Ethical considerations

Ethical approval for the study was obtained from the Jos University Teaching Hospital Ethical Committee (JUTH/DCS/IREC/127/XXXI/871). Informed consent was obtained from all participants, and measures were implemented to ensure the confidentiality and anonymity of responses. Participation was voluntary, and no personal identifying information was collected. No funding was received for the survey.

Results

We obtained 429 responses from 15 Universities across the six geo-political zones in Nigeria (Fig. 1).

Fig. 1

Distribution of responses across Nigeria’s six geopolitical zones

Sociodemographic information

Most responses were from medical students in the North-Central region (n = 118, 28%). Students from the University of Maiduguri provided the highest number of responses (n = 62, 14%). In addition, 2023 was the most common graduation year (n = 341, 79%). The ratio between male to female respondents was 1.7:1. Furthermore, 51% of participants attended federal government-owned schools (Table 1). A total of 92% of respondents (n = 394) reported active participation in research activities during their medical school education.

Table 1 Sociodemographic and distribution of responses

Research exposure

The median number of research projects contributed to was two (interquartile range (IQR): 1–2), most of which were group projects. Men had a higher median number of research projects they contributed to, compared to women (p-value = 0.03). Students from state schools had participated in a higher number of group research projects, while students from private schools had participated in a higher number of individual research projects (p-value < 0.001). Federal and private school students tended to have a high number of total research projects contributed to, compared to those from state-owned schools. The North-Central region had the highest number of contributions to group research projects, while students from the North-West and South-South regions contributed to the highest number of individual research projects. Furthermore, students from the North-Central and North-West regions contributed to the most research projects overall. The proportion of students actively participating in research projects varied from 85% (South-West region) to 98% (South-South region) (Table 2). Only 191 (44.5%) of the students had led an individual study.

Table 2 Median number of research projects contributed to and active participation rates

Dissatisfaction with research opportunities during medical education was common, with 46% of female and 43% of male graduates expressing concerns. Students from state-owned medical schools reported the highest dissatisfaction at 48% (Table 3).

Table 3 Graduates’ perceptions of research opportunities in medical education

Opportunities for publication and conference attendance

Most respondents never had the opportunity for conference presentations (n = 342, 80%) or to publish (n = 355, 83%) their research work. The percentage of students who had published in an international, peer-reviewed journal ranged from 3.9% in the North-East to 28% in the South-South. Of those who had published in a local journal, the proportion by geopolitical zone ranged from 1.7% (North-Central) to 6.7% (South-East). No students from the North-East, North-West, or South-West had published in a local journal. Of those who had presented at a local conference, the proportion ranged from 8.2% (South-West) to 29% (South-South), and very few students overall had the opportunity to present at an international conference (n = 7; 1.63%) (Table 4).

Table 4 Opportunities for publication and conference attendance

Barriers and enablers of research participation

The top 3 barriers that prevented participants from engaging in research were a lack of time to commit to research (n = 317, 74%), access to funding (n = 238, 55%), and access to research skills (n = 135, 31%), whereas the top 3 enablers of research activities were presence of supervision and mentorship (n = 274, 64%), time availability (n = 121, 28%) and access to research skills (n = 100, 23%). Students from the South-West region were most likely to report lack of supervision, mentorship, and supportive faculty were a barrier to engagement in research, compared to students from other regions (Appendix 2).

Areas of research proficiency and difficulty in medical education

The area of research where most proficiency was gained through medical school education was methodology (n = 233, 54%), whereas the area of research that respondents found most difficult was formal data analysis (n = 182, 42%). Men were more likely than women to have gained proficiency in software skills (p-value < 0.01) and formal data analysis skills (p-value < 0.01), whereas women were more likely than men to have gained proficiency in administration skills (p-value < 0.01) (Figs. 2 and 3).

Fig. 2

Comparison of research proficiency and challenges in medical education by sex

Fig. 3

Comparison of research proficiency and challenges in medical education by school ownership

Recommendations from recent graduates

A total of 406 (95%) of participants provided free-text recommendations suggesting ways to enhance research participation among medical students. Seven themes identified in the recommendations include expanded integration of research into the medical school curriculum (29.8%), increasing mentorship and networking opportunities (24.7%), providing grants for students to conduct innovative research (22.6%), offering access to skills training such as data analysis (12.8%), and creating opportunities for conference presentations and publications (12.6%) (Table 5).

Table 5 Recommendations by recent medical school graduates

Discussion

This study revealed that although nearly all medical students in Nigeria (92%) reported some form of research engagement, this involvement was largely limited to a single group research project. Fewer than half (44.5%) had the opportunity to lead an individual research project during their six-year medical training (Table 2). This limited research participation indicates that Nigerian medical students often lack the necessary skills to independently conceptualise studies, analyse data, or take on leadership roles in research. In contrast, while research participation among medical students in HICs varies based on institutional requirements and individual interests, they typically undertake multiple research projects before graduation, facilitated by opportunities such as summer research fellowships, intercalated degrees, and dual-degree programmes [16,17,18]. Although studies from individual institutions in Nigeria such as Babcock University, the University of Benin and the University of Lagos have corroborated our findings by highlighting limited research exposure among medical students, this study confirms the grossly inadequate exposure of Nigerian medical students to research on a national scale [19, 20]. The impact of low research exposure may be far-reaching on the health system in Nigeria. While academic clinicians, who conduct the majority of medical research, are often driven by career advancement, clinicians in health services (not in academic positions) remain largely unmotivated to engage in research. This low participation may stem from limited exposure to quality research training and involvement during their undergraduate education, restricting their capacity and inclination to integrate research into their professional practice Consequently, this restricts the generation and application of pragmatic evidence essential for improving patient care [7].

Inadequate time dedicated to research within the Nigerian medical school curriculum, lack of access to funding or grants, and insufficient requisite skills or training are major barriers that prevented them from research participation (Appendix 2). Medical students in Nigeria face a demanding academic schedule comprising extensive coursework, clinical rotations, and practical assessments, often running concurrently in most institutions [21]. This barrier of lack of dedicated time has been highlighted in other studies [19, 22], and specifically discourages engagement in longitudinal or complex studies. In contrast, medical students in certain HICs have dedicated years for research and can often take elective time off to focus on acquiring and utilizing research skills [16, 23, 24]. Balancing these responsibilities leaves little time for extracurricular research.

Another significant barrier is the lack of access to grants and funding. Financial constraints hinder access to essential research tools, such as statistical software, equipment, consumables, and skilled support staff. Students often cannot afford licensing for paid data analysis tools, resulting in minimal practical experience with data analysis. Additionally, many face difficulties accessing updated research articles, journals, and publishing platforms due to the high cost of journal subscriptions and the lack of institutional access in most Nigerian universities. This financial barrier is especially pronounced among students from government-owned federal and state universities, where the majority of Nigerian medical students study. Furthermore, as Nigeria is classified as a middle-income nation, it often does not qualify for full article processing charge (APC) waivers provided by many journals. Consequently, the inability to afford APCs required to publish in reputable journals serves as an additional deterrent for students aspiring to share their research findings [25]. This lack of funding could explain the nationwide limited opportunities to publish research findings observed among students in Nigeria (Table 4). Similar to the findings of this study, a low publication rate (6.9%) was reported among medical students at the University of Lagos [19]. Furthermore, even among Nigerian medical students who successfully published, first authorship was rare, indicating a significant gap in exposure to research leadership [11]. Meanwhile, although publication rates vary among medical students in some HICs, studies have shown that over 30% of students in these countries publish [8, 26, 27].

A lack of research skills and insufficient supervision significantly hinder participation in research. Although most participants reported proficiency in research methodology from their medical school curriculum, they faced challenges with data-related skills (Figs. 2 and 3). The limited emphasis on data training is closely linked to resource constraints and a shortage of faculty expertise [28]. This issue is further exacerbated by inadequate mentorship. More than half of the respondents indicated that mentorship played a crucial role in motivating their involvement in research. However, the instability of academic calendars in many government-owned institutions reduces the time available for mentorship and limits the feasibility of structured, hands-on research programmes. While compulsory research internships could enhance students’ practical experience in data handling and increase their familiarity with research tools, such initiatives remain uncommon in Nigerian medical schools [29].

Another key concern regarding research opportunities for medical students in Nigeria is the limited access to conference presentations (Table 4). While inequitable access to conferences is a common challenge across LMICs, it may be particularly pronounced for Nigerian medical students due to barriers such as limited access to information, restricted networking opportunities, inadequate funding, and the constraints of a demanding curriculum [30].

In contrast, medical students in HICs such as the United Kingdom, the United States, and Canada often benefit from institutional policies that actively promote research exposure [31,32,33]. Although barriers such as time constraints and demanding curricula exist in HICs, many institutions integrate research into the curriculum through electives, summer programmes, and protected time for research activities. Students from these settings also benefit from research grants and opportunities for research assistantships which enable them to be more participatory in research processes [16, 23, 24]. Such practices highlight the importance of institutional support in fostering research involvement.

Given the contextual challenges and limited opportunities for medical students in Nigeria, it is imperative to expand the curricular elements of research for medical students in Nigeria. In addition, creating elective tracks for medical student research fellowships as is the practice in the US might also prove beneficial. While this might extend the graduation time, it will produce doctors who are keen and skilled in measuring results in their practice, applying quality improvement, and generating practice evidence that results in higher quality, more equitable medical care.

Leveraging digital technology and fostering global collaborations will be crucial to supporting research development. Mobile applications and e-learning resources that enable self-paced learning could address gaps in data analysis and technical training. Universities could also adopt open-source software such as R or Python, which are widely used in data science and available at no cost. Training students in these tools would ensure equitable access to data analysis skills without imposing significant financial burdens. Furthermore, global peer mentorship programmes and collaborations with HICs could further enhance research capacity among Nigerian medical students [34]. Initiatives like Research4Life connect students with mentors from HICs, guiding research design, data analysis, and scientific publishing. Regular feedback sessions, virtual interactions, and co-supervision opportunities could help students build confidence in writing and publishing, addressing critical skill gaps. Similarly, institutional partnerships, such as those established under the African Forum for Research and Education in Health (AFREhealth), could offer Nigerian students access to funded research projects, international laboratory facilities, and workshops led by experienced HIC faculty [35]. Specialty interest groups, such as Surgical Interest Group Africa and InciSioN, also play an important role by connecting students with international mentors and providing resources on research methodologies, ethics, and scientific writing. These organisations offer webinars, workshops, and free access to tailored research tools for specific fields. These collaborations would not only expose students to advanced research methodologies but also strengthen local research infrastructure and promote long-term academic engagement [36, 37]. By leveraging digital tools and targeted networks, students can gain practical skills, broaden their professional networks, and enhance their capacity to conduct high-quality research in their areas of interest. These efforts could significantly bridge the gap in research opportunities, empowering Nigerian medical students to contribute meaningfully to global scientific discourse.

The survey revealed gender and regional disparities in research involvement. Male students reported more research projects, higher publication and conference presentation rates, and greater technical proficiency in data analysis and software use. These differences could be attributed to societal expectations, gender stereotypes, mentorship inequalities, and institutional biases. Men are more likely to have mentors with technical expertise, while women are often directed towards administrative roles due to limited female representation in research-intensive faculty positions [38]. Addressing these disparities requires collaborative learning environments where students rotate roles within mixed-gender teams to develop balanced skill sets. Additionally, equal access to technical training, such as mandatory data analysis workshops and programmes can help bridge the gap. Regarding regional differences, students from the South-South region have the highest research participation, while the South-West has the lowest. These differences are influenced by factors such as institutional resources, mentorship, regional funding, and infrastructure.

Recent graduates recommended early exposure to research, structured courses, and more dedicated time for research projects across specialities beyond Public Health, reinforcing the need for curriculum reform. They emphasised mentorship, advocating for more faculty-led guidance and research assistantship opportunities, which could provide students with practical skills while supporting faculty research. Additionally, funding is a major barrier to leading innovative studies and they recommend providing students with grants to catalyse a change. Limited access to literature and datasets hampers literature reviews and secondary studies (Table 5).

Limitations

Several limitations have been noted in this study. The use of purposive sampling to ensure diverse representation across Nigeria’s geopolitical zones and institutional types may not fully reflect the experiences of all Nigerian medical graduates based on the size and diversity of the nation, limiting generalisability. However, our selection of a spread of institutions from each geopolitical zone is an attempt at addressing the extensive institutional diversity of Nigerian medical schools. We also acknowledge the possibility of recall bias from relying on retrospective recollections and the constrained depth of qualitative responses due to the survey format as additional limitations. Richer insights could have been gained through focus group discussions or individual in-depth interviews. Retrospective review of official medical school records or even longitudinal studies following the involvement of medical students in research through school would perhaps be more accurate. However, with low involvement in research, recall bias is likely to be less in this study, compared to where respondents were trying to recall numbers for high volume involvement. Despite these challenges, the study provides a foundation for understanding research engagement among Nigerian medical students. Future studies with broader sampling and mixed-methods approaches are recommended to expand on these findings and explore the appetite for curriculum reform among medical faculty members.

Conclusion

In conclusion, while Nigerian medical students face significant challenges in research participation, structural changes such as curriculum integration and improved mentorship can foster a more supportive environment for research engagement. In Addition, national policies addressing regional and gender disparities and leveraging digital resources and international collaborations can help bridge these gaps, facilitating greater research involvement among medical students in Nigeria. This will lead to the emergence of a new breed of research-driven physicians who can contribute meaningfully to science and address numerous health challenges through unique evidence-based approaches.