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Kaur et al. BMC Medical Education (2023) 23:502
https://doi.org/10.1186/s12909-023-04475-y BMC Medical Education
*Correspondence:
Rajneesh Kaur
rajneesh.kaur@sydney.edu.au
Full list of author information is available at the end of the article
Abstract
Background Research activities undertaken during University studies contribute to preparation of medical students
for practice of evidence-based medicine. This study aimed to understand medical students’ experiences, perceived
research skills development and satisfaction associated with completion of mandatory research projects.
Methods An online survey was sent to five cohorts of students (n = 1375) from years 2017–2021 at the completion
of their research projects. Univariate analysis was conducted to understand students’ perception of research skills
development, followed by linear regression modeling to explore factors influencing satisfaction with their research
project. Manifest content analysis employing a framework approach was used to analyse qualitative data from
responses to open ended questions.
Results Response rate was 42%, with 513 (89%) returned surveys being complete and included in analysis. Whilst
37% of students felt they had requisite research skills before undertaking the research project, 84% reported they
had these skills after completing the project (χ2 = 8.99, P = 0.02). Mean satisfaction score of the students was 5.0/10
(+/- 2.5, median = 6 (IQR = 3.0–7.0) with 59% of students reporting satisfaction scores higher than the average.
Higher satisfaction scores were reported by those who perceived that: research methods and teaching was useful in
preparing them for conducting research; the research project helped them acquire new skills; the project resulted in
peer-reviewed publication; and, who felt supported by their supervisors. Responses to open ended questions offered
important insights into student experience and emphasised the importance of supportive supervisors and the need
for a dedicated research block in the busy medical program.
Students’ perceived research skills
development and satisfaction after
completion of a mandatory research project:
results from ve cohorts of the Sydney
medical program
Rajneesh Kaur1*, Jonathan Hakim1, Richmond Jeremy1, Genevieve Coorey2, Eszter Kalman3, Rebekah Jenkin4,
David G Bowen1 and Joanne Hart1
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Kaur et al. BMC Medical Education (2023) 23:502
Introduction
e practice of evidence based medicine (EBM) requires
medical practitioners to acquire, appraise and apply the
best research evidence to their clinical practice [1–5].
Research activities such as research projects undertaken
during the medical degree, can assist to equip students
with essential skills to practice EBM [1–5]. It is well doc-
umented that research projects provide medical students
with key research skills and enhance their confidence to
undertake research during their future clinical practice
and professional career [6, 7]. Research activities under-
taken during the medical degree also have the potential
to encourage or deter future participation in research [8].
A poor research experience consequent upon a lack of
understanding of research process, inadequate training
and/or supervision, or lack of time and funding, may lead
students to become disinterested in research [9, 10].
It is therefore important to explore students’ experi-
ences of research and use their feedback to inform the
future design of research projects embeded in the medi-
cal degree. is study aimed to understand medical stu-
dents’ experience and satisfaction with a mandatory
research project and to investigate whether students
considered that the project was helpful in developing
skills for future research activities. Barriers and enablers
to the undertaking of these research projects were also
explored.
Context
In 2014, the Doctor of Medicine (MD) degree at e
University of Sydney introduced a mandatory research
project (MD research project) as part of its graduate cur-
riculum. e students complete an independent research
project under the supervision of a member of the Univer-
sity staff or an affiliate. Students are offered a choice of
project options based, for example, on clinical, biomedi-
cal, epidemiological topics, using public health data, or
based on medical education, information technology,
policy, law and ethics. Students express their preferences
and are matched with their research project and supervi-
sor at the end of first year, after the delivery of the aca-
demic content on research methods and ethics. Both
qualititve and quantitative research methodologies can
be used for projects. e research projects are carried
out in 10 centres including urban clinical schools, two
rural clinical schools and the main campus of the Uni-
versity. Ethics approval, if required for a project, is usu-
ally obtained by the research supervisor before project
commencement, although a small number of students
drafted a complete research protocol (including both sci-
entific and ethics aspects) on a major complex study as
their research project. To prevent project delays or the
need for extensive modification, project progress was
reviewed through regular milestones. Students who did
not have ethics approval in place by the third milestone
(approximately six - nine months after project com-
mencement) were assisted to rescope or amend their
project to ensure that it could be completed within the
available time.
e majority of project supervisors have a clinical or
research background. ere were no specified mini-
mum supervisor criteria, each research hub had an MD
Research Coordinator who both vetted and advised
potential supervisors and provided support as needed
once projects were underway. Typically, a supervisor
has 2–5 students, although some have only one student.
Supervisors guide students during all phases from topic
selection to writing up the final report. Within their aca-
demic timetable in the first two years of their MD degree,
students receive additional teaching on research meth-
ods and ethics, and sessions with librarians supporting
basic literature searching. ese sessions give students
grounding in both qualitative and quantitative research
methodologies. Progressive and final summative assess-
ment of research projects is achieved through a series of
milestone assessment tasks and the completion of a final
written report, synthesising the results in a 3000 word
publication format. Students have an opportunity to
share their research findings through oral and poster pre-
sentations at a research symposium. During the period of
this study, projects required a minimum of 320h work
over two and a half years, carried out in addition to of
the overall MD program without any dedicated research
time. e teaching elements of the program (e.g. lectures,
workshops) and the milestone meetings are run outside
of the direct research time.
Methods
Participants
A total of 1375 students from five cohorts who completed
the medical program between 2017 and 2021 were sent
the participant information sheet and link to the online
survey by email after completion of their MD research
project. e survey was undertaken using the Lime Sur-
vey tool (www.limesurvey.org) from 2017 to 2019 and
QualtricsXM (https://www.qualtrics.com/au/ ) from 2020.
Conclusions The majority of students reported positive outcomes from the mandatory research project. Student
satisfaction can be improved by ensuring supportive research environments and high-quality supervision, and
inclusion of dedicated research time in the medical curriculum.
Keywords Medical students, Research projects, Research skills, Student satisfaction
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Kaur et al. BMC Medical Education (2023) 23:502
Participation was voluntary, and consent was implied if
the completed survey was returned. Data collection was
anonymous. e study was approved by e University
of Sydney Human Research Ethics Committee, (Approval
#2017/748).
Survey instrument
A survey instrument with 52 questions was developed
based on extensive research of previous student evalua-
tion literature. Content validity of the survey was deter-
mined by faculty based experts in medical education. e
original draft instrument underwent pilot evaluation with
students and academics/clinicians who were involved in
the medical program. e reliability of the questionnaire
was assessed by Cronbach’s alpha [11]. e estimated
time for students to complete the survey was 30min. A
combination of questions with Likert-type responses,
multiple choice answers and free text comments were
used. Project-specific information was collected through
seven items; information related to research skills devel-
opment was collected through three items; and ten items
collected information about research methods teaching.
e role of research supervisors was assessed through
thirteen items, and eleven items collected information
about project milestones, presentations and final report
writing. A final set of seven questions asked about stu-
dents’ overall assessment of the project plus barriers and
enablers in completing the project. Student satisfaction
with the project, reported on a 10-point scale ranging
from 1 for least satisfied to 10 for most satisfied, was con-
sidered the main outcome measure.
Outcomes
Although research is frequently intended for publication,
the primary aim of the MD research project is to develop
important skills, such as evaluating scientific literature
and understanding and experiencing the research pro-
cess. e outcomes of this study were therefore measured
through student self-reported research skills develop-
ment, research output and overall student satisfaction
with the research experience.
Data analysis
e Cronbach’s α was found to be 0.781. Descriptive data
for survey variables are presented as mean ± standard
deviation of variable scores. Continuous variables were
compared by independent samples t-test for two groups
and analysis of variance (ANOVA) test if more than two
groups were included. Categorical data were compared
using Pearson’s Chi square test. A linear regression model
was constructed to measure effect of various factors on
student satisfaction. Variance of inflation factor to assess
collinearity, standardised residuals to detect and evaluate
outliers and Cook’s distance to identify influential cases
were used for this model. e significance level for all
tests was set at P < 0.05. Analyses were performed using
IBM SPSS Statistics for Windows, Version 26.0. (IBM
SPSS Statistics,Armonk, MY). Manifest content analysis,
which involves describing the text instead of developing
themes, [12, 13] was used to analyse textual data from
open ended questions. A systematic approach known as
framework analysis [14] was utilised to organise and anal-
yse the qualitative data. e data were initially reviewed
and patterns were identified, resulting in a set of codes
based on the key concepts that emerged from the analy-
sis. ese codes were then applied to the data and sum-
marised to identify any patterns or relationships between
the codes. Conclusions were drawn from this analysis.
Results
Of 1375 students invited, 577 students completed the
survey, corresponding to a response rate of 42% which
ranged from 40 to 43% across all five cohorts. After
exclusion of incomplete surveys, a final sample of 513
was included in the analysis. Supplementary Table dis-
plays the main codes that were derived from the content
analysis supported with examples quotes. ese quotes
are alos used in the main text of results to reinforce the
relevant findings.
Characteristics of MD research project
Most projects (n = 292, 57%) were based on clinical data,
while projects based on information technology (n = 15,
3%) and medical education (n = 15, 3%) were least com-
monly undertaken. Almost one third (148/513, 29%) of
students completed an extended rural placement either
during the third or fourth year of their medical degree
which meant they were remote from their project loca-
tion for the final stages of the project.
Main barriers and enablers to completing the research
project
Student perceptions of the main enablers to completing
their research were support/expertise of the research
tutor (400/513, 78%), flexibility to undertake a project
they could do from different locations (364/513, 71%),
and the process of writing up the final report (359/513,
70%) (See Fig.1).
e main barriers perceived by students to complet-
ing their research project were competing academic
demands of the overall medical program (379/513, 74%)
and lack of dedicated time in the curriculum for the con-
duct of research (318/513, 62%).
Research skills development
Only 37% (189/513) of students thought they had the
necessary research skills at the beginning of their proj-
ect to complete a research project. A significantly higher
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Kaur et al. BMC Medical Education (2023) 23:502
number of students (431/513, 84%, χ2 = 8.99, P = 0.02)
reported having acquired the necessary research skills
as a result of completing the project. Literature search-
ing and data analysis were reported as the research skills
gained by the majority of students (379/513, 74% and
426/513, 83% respectively). Responses to open ended
questions overwhelmingly supported the benefits of hav-
ing gained research skills, as reflected in the following
quote:
“e opportunity to independently carry out and
undertake a project that improved my analyti-
cal, creative and logical skills. e project had also
helped me improve my communication and critical
thinking skills.” (Student from 2021 cohort).
Some students did not feel they had acquired any new
skills while a few thought it was difficult to acquire new
skills, as reflected in the student quote below:
“ I found it dicult to balance developing these skills
with the other demands of the project.” (Student from
2021 cohort).
A few students felt encouraged to undertake research in
the future, as expressed in the quotes below:
“e research project is valuable as it has given me
the condence to seek future research opportunities.
Going from literally zero to a complete research proj-
ect. Learning how to search the literature, develop a
research question, devise methodology, collect data,
analyse data, and write up a paper. A stepping stone
towards what a real-life situation would be once
fully graduated and furthering a career.” (Student
from 2020 cohort).
“It was a good experience to go through the process
of doing research and I learned about the challenges
I will face in the future if I choose to undertake
research.” (Student from 2020 cohort).
Prior research experience
More than half of the students (n = 297, 58%) reported
that they had worked on a research project during their
undergraduate or postgraduate studies prior to medi-
cal school. 38% (114/297) of these students had done
an Honours project and 14% (43/297) reported having
a doctoral degree, while others reported having gained
research experience through a summer research proj-
ect, Masters’ degree, or through a research assistant role.
Most (n = 190, 64%) of these students found their prior
research experience to be helpful in completing their
research project.
Utility of research skills training activities
Only 44% (225/513) of students considered research
methods teaching as helpful in relation to their capacity
Fig. 1 Main barriers and enablers to completing the research project. Note: Multiple responses were allowed.
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Kaur et al. BMC Medical Education (2023) 23:502
to complete their MD research project. Research skills
teaching methods and their perceived utility are shown
in Fig.2. Library workshops, critical appraisal workshops
and research methodology lectures were considered most
beneficial by students.
Role of supervisor
e majority of students considered their supervisors
as supportive (353/513, 83%), good in communicating
expectations (379/513,74%), and highly experienced in
research (430/513,84%). Only 31% (159/513) reported
meeting their supervisors regularly in addition to man-
dated milestone meetings, with the remaining students
meeting their supervisors either infrequently or only at
milestones.
e majority of students who provided feedback in
open ended responses about their supervisors character-
ised them as exceptional, remarkable, impressive, or as a
valuable asset to their research experience. An expression
of positive supervisor experience was reflected in the fol-
lowing quote:
“My supervisor was very enthusiastic, knowledge-
able, supportive and provided an excellent learning
environment and pushed me to grow in areas I was
unfamiliar with.” (Student from 2020 cohort).
Many students credited their ability to publish to their
supervisors:
“My supervisors were fantastic and made the entire
MD project experience a positive one. I am grateful
to have had the opportunity to work with them and
to produce a piece of research which has been pub-
lished-good for my CV.” (Student from 2019 cohort).
ose who were not satisfied with their supervisor felt
that either their supervsior was too busy or was inexpe-
rienced, as suggested by the following student comments:
“ Whilst my supervisors were very nice and support-
ive people, they were exceptionally busy clinicians
who do not have the time to fully instruct me on the
steps required to conduct a research project.” (Stu-
dent from 2021 cohort).
“My supervisor was clear in what he wanted, but did
not have experience in the eld so left it to other peo-
ple to provide assistance. Often they were hard to to
reach or provided limited assistance.” (Student from
2019 cohort).
Fig. 2 Rating of usefulness of research methods teaching in completing the research project
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Kaur et al. BMC Medical Education (2023) 23:502
Research output
21% (107/513) of students reported having submitted
a manuscript based on their project to a peer reviewed
journal. A further 13% (67/513) reported currently work-
ing on a manuscript for journal submission. In addition,
18% of students presented or were intending to present
their findings at a local or international conference.
Dedicated time
e need for dedicated time for completion of the
research project was identified in students’ comments:
“Having a dedicated time for it e.g., 8 weeks, rather
than having to do it in between everything else over
3 years. It was nice to get into a nice ow for a few
weeks then take time o due to academic demands
then jump back in” (Student from 2019 cohort).
“A more dedicated time period for MD project com-
pletion as I found one of the most dicult parts was
tting in my MD project around my academic time-
table.” (Student from 2017 cohort).
Student satisfaction
Overall mean satisfaction score for the MD research
project was 5.0 (± 2.5) out of a total score of 10, with 59%
students reporting their satisfaction above this mean
score. e mean satisfaction scores ranged from 4.7 to
5.1 across five cohorts. Median score was 6 (IQR-3-7).
e number of students in a project group had no asso-
ciation with overall student satisfaction. Similarly, type of
research project, project location and whether the stu-
dent had prior research experience were not associated
with student satisfaction. On univariate analysis signifi-
cant associations were seen between student satisfaction
and factors related to supervisors, perceived usefulness
of research and ethics teaching, research skills develop-
ment and research outputs. Mean satisfaction scores cor-
responding to these factors are shown in Fig.3.
e results from linear regression model are shown
in Table 1. Overall, students who reported having
acquired new skills indicated a higher satisfaction score
(mean = 5.5 ± 2.2) compared to those reported acquiring
no new skills (mean = 2.1 ± 1.6, β = 2.937 (95% CI = 2.178–
3.695; P < 0.001). ose students who considered that
research methods skills and ethics teaching were help-
ful in gaining research skills were more satisfied (mean
Fig. 3 Univariate analysis of factors associated with student satisfaction. Note: P values were significant for scores comparing those who said yes from
those who said no for all statements shown in the figure.
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Kaur et al. BMC Medical Education (2023) 23:502
score = 5.6 ± 2.2) than those who did not find these to be
helpful (mean score 3.9 ± 2.3, β = 1.436 (95% CI = 0.809–
2.064); P < 0.001). ose who felt supported by their
supervisors reportedhigher satisfaction (mean score
5.1 ± 2.3) than those who did not feel supported (mean
score: 4.6 ± 2.1, β = 0.257 (95% CI=-0.119-0.633; P = 0.012).
Having a research output in the form of a publication or
a conference presentation led to higher mean satisfac-
tion scores (mean score: 6.1+/-2.4) compared to not hav-
ing such outputs (mean score = 4.4 ± 2.0, β = 1.014 (95%
CI = 0.185–3.752;P < 0.001) (See Table1).
Discussion
Our findings suggest that medical students considered
their research experience undertaken as a mandatory
research project as positive overall. eir satisfaction
with the research project was mainly driven by factors
such as supportive supervisors, research skills training,
achieving research outputs and development of research
skills.
ere is a shortage of physician researchers in Austra-
lia [15]. To address this issue, it has been suggested that
efforts to increase student interest in medical research
should be made during the medical degree [6]. One
approach to achieve this may be through an increased
emphasis on research skill development during medical
studies. Research projects are instructive in the principles
of EBM and its relevance to clinical practice, thus helping
students to understand the rationale behind their clinical
decision making. A previous review established this as
the main motivator in participating in research [6]. It was
encouraging to find that 84% of respondents in this study
reported having gained research skills.
Prior research experience has been recognised as an
important motivator to undertake and complete research
projects during a medical degree [16]. Similar to findings
from past research [9, 16, 17] more than 50% of our stu-
dents reported having research experience prior to medi-
cal school. It is expected that those with prior research
experience have better knowledge, skills and confidence
in conducting research than those without this experi-
ence. However, there have been mixed responses in the
literature about whether students are better engaged
in a research project if they have prior research experi-
ence [9]. In fact, it has been reported that medical stu-
dents may not see any value in a research project to
their career progression when they have a prior research
based degree such as a doctorate. Our findings indicate
that students who had prior research experience found it
helpful to complete the research project, although their
overall satisfaction scores were not different from those
who did not have any prior research experience. It would
be important to explore in future studies if students
planned to continue research activities after medical
school, and whether prior research experienced influ-
enced this sentiment.
e role of supervisors in completing research proj-
ects and developing student appreciation of the value of
research cannot be overemphasised. Supportive supervi-
sors with relevant research experience, clear communi-
cation of expectations, and availability to meet regularly
with their students were identified as the key factors con-
tributing to higher levels of student satisfaction. It is well
recognised that the success of student research initiatives
rely on suitably qualified and experienced supervisors
[18–20]. Our findings indicate that a supportive super-
visor led to higher satisfaction with research activities.
e qualitative comments in our study were overwhelm-
ingly appreciative of supervisors. Students reported that
their supervisors were knowledgeable and also guided
them to develop essential research skills and, for some,
to publish their work. On the other hand, poor mentor-
ship and poor role models are among the key factors that
prevent medical students from engaging in research [9,
16, 19]. Our previous research arising from the Sydney
Medical Program has reported that the barriers identi-
fied by academic and clinician supervisors also include
having limited research experience, and time and other
resource constraints within their roles [21]. Reasons for
inadequate supervision are therefore multifactorial, and
our findings concur with other studies regarding the
importance of the supervisor role in enabling a successful
student research experience.
Our findings from this study indicate that those stu-
dents who reported having published their research were
more satisfied with the research project than those who
did not publish. Research outputs mainly in the form of
peer-reviewed publications are valued by medical stu-
dents, as these are helpful in career progression and
for competing and applying for future specialist train-
ing [22]. Arguably they are also considered indicators of
successful research. An important skill many students
learn from completing the research project is preparing
their work for publication. Publishing as first author is a
Table 1 Results from linear regression model showing factors significantly associated with student satisfaction
Factors aecting student satisfaction β (95% CI) P value
The research methods ethics teaching was useful in preparing me for conducting my research. 1.436 (0.809–2.064) < 0.001
I felt supported by my supervisor 0.257 (-0.119-0.633) 0.012
I acquired new skills as a result of working on the research project 2.937 (2.178–3.695) < 0.001
My project resulted in a peer reviewed paper submitted for publication 1.014 (0.185–3.752 < 0.001
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Kaur et al. BMC Medical Education (2023) 23:502
valuable addition to a professional curriculum vitae and
may therefore be a contributor to future career success.
However, the quality of the publication, its relevance and
other factors are also likely to influence the significance of
such publications. Supervisors can engage their students
with research dissemination by facilitating opportuni-
ties for them to publish their research and present their
findings at local and international conferences. ese
outcomes have the potential to foster students’ interest
in research by involving them in the wider research com-
munity [23, 24].
It has also been argued that medical students should
recognise the value of research for the practice of EBM
and not only for gaining a competitive edge in academia
and funding [25]. At the same time, research outputs are
useful rewards for their accomplishments and can work
as encouragements to develop their interest in research.
In addition, other options to encourage medical students
to undertake research should be explored, such as inte-
grated MD/PhD degrees or sponsoring research in col-
laboration with other countries and universities.
Program changes based on survey results
Addressing some of the barriers identified in current and
past research may facilitate better student engagement
with research. Alongside poor supervision, the main bar-
rier identified in our study was lack of dedicated time
in the timetable to do research. is barrier has been
reported in other studies [9, 16, 20]. Based on evaluation
feedback, commencing in 2022 e University of Syd-
ney MD program has incorporated substantial changes
to the research project, chiefly that it is now carried out
in a dedicated block of 14 weeks in the third year of the
program. Recognising that not all research projects can
be finished within a 14-week time slot, students are given
an opportunity to undertake an extended stream project
over one year. Under this option students are given the
choice to continue through to completion their research
project alongside their other studies in addition to the
dedicated 14 weeks block. e option to do an extended
stream project is based on the premise that students who
chose these projects may be more likely to engage in
research and thus would gain higher satisfaction. Further
studies could elucidate how these formats of the research
project impact student satisfaction and engagement with
research.
Important limitations of our study include that it is
based on the experience of students at a single institution
and the response rate is low. Moreover, recall bias may
impact the validity of the findings. ose students who
completed the survey may have been more motivated
to do so because of a strongly positive or negative MD
research project experience. Due to anonymity it was not
possible to link survey responses to course performance
as measured by summative assessment nor to assess
whether the respondents were representative of the
overall MD cohort during the survey period. However,
the data have been collected across five cohorts and the
findings are consistent across all five cohorts. An impor-
tant future step would be to examine if medical students
engage in further research activities beyond their degree
requirements. eir involvement in research could be
ascertained by examining how many of them author pub-
lications, pursue a PhD degree or apply for competitive
grants and research fellowships. Our immediate next
step focuses on verifying publications by screening and
matching journal papers with student records. Matching
this information with self-reported publication data and
prior research experience would assist in confirming the
robustness of findings.
In summary, our findings demonstrate that manda-
tory research projects during a medical degree are per-
ceived by students as useful in developing research skills
and therefore important in preparing the next genera-
tion of physician researchers to be competent adopters of
evidence-based medicine. Important structural changes
to the program have been made based on these study
results, and further improvements will include strength-
ening the supportive environments for students.
Supplementary Information
The online version contains supplementary material available at https://doi.
org/10.1186/s12909-023-04475-y.
Supplementary Material 1
Supplementary Material 2
Acknowledgements
The authors would like to thank the medical students from the five cohorts
for completing the surveys. The authors also acknowledge Professor Michael
Frommer and Professor David Tiller who were instrumental in the design,
development, and implementation of the MD research project program.
Administrative management for the MD Project team was provided by
Clara Spencer, Anna Forte, Hannah Bath, Craig Purcell, Paniani Patu and Sally
Middleton. The substantial support of research supervisors and coordinators
of both the research project program and this survey is also acknowledged.
Authors’ contributions
Jonathan Hakim, Rebekah Jenkin, Eszter Kalman, Rajneesh Kaur, Joanne Hart
and David Bowen contributed to the study conception and design. Data
collection was performed by Jonathan Hakim and Joanne Hart. Data analyses
were performed by Rajneesh Kaur. The first draft of the manuscript was
written by Rajneesh Kaur and all authors commented on subsequent versions
of the manuscript. All authors read and approved the final manuscript.
Funding
No funding was received for this work.
Data Availability
The datasets generated and/or analysed during the current study are not
publicly available, as per conditions of Ethics Committee approval, but are
available from the corresponding author on reasonable request.
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Kaur et al. BMC Medical Education (2023) 23:502
Declarations
Competing interests
The authors declare that they have no competing interests.
Ethics approval and consent to participate
This research project was approved by the University of Sydney Human
Research Ethics Committee, #2017/748. All methods were carried out in
accordance with relevant guidelines and regulations. Informed consent was
obtained from all participants.
Consent for publication
Not applicable.
Author details
1School of Medicine, Faculty of Medicine and Health, University of
Sydney, Sydney 2006, Australia
2School of Health Sciences, Faculty of Medicine and Health, University of
Sydney, Sydney 2006, Australia
3Office of the Deputy Vice Chancellor (Education), Educational Innovation
Team, DVC(E) Portfolio, University of Sydney, Sydney 2006, Australia
4School of Medical Sciences, Faculty of Medicine and Health, University of
Sydney, Sydney 2006, Australia
Received: 5 December 2022 / Accepted: 24 June 2023
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