Are students kidding with health research ethics?

HIV Clinic in Cameroon

This 2012 paper Are students kidding with health research ethics? The case of HIV/AIDS research in Cameroon by Munung et al raises an important issue of student projects on sensitive health issues – and ethics approval to cover their work.

The researchers describe tracing back student projects on HIV to see if ethical issues were addressed and if ethics approval was required and sought.

Although focusing on HIV research in Cameroon, many of the issues around teaching, support and training about health research ethics are relevant worldwide. Indeed I’d argue that for student projects at masters level taught on social and health degrees in the West understanding ethics and robust screening by ethics committees could be better.

I do wonder whether the focus on the student is perhaps slightly unfair and other structural issues (including at tutor, institutional and healthcare organisation level) need just as much attention. I also wonder about the pressures put upon students, particularly if they are doing their projects while also working for charities, NGOs or health agencies, might encourage them to cut corners.

The researchers make some recommendations around health research and ethics (see below) – what do you think of these suggestions? Could you implement them? What do we need to do to improve ethics teaching for students in the health and social sciences?

“The main reasons for this situation could be that i) there is no systematic training in research ethics in Cameroon universities and ii) supervisors/senior researchers do not appreciate or are not aware of the importance of research ethics and, consequently, fail to mentor their students or trainees appropriately about it or they simply push it to the background. It is therefore essential that training in HRE be incorporated in the curriculum of universities in Cameroon in order to bring up the next generation of scientists equipped with a thorough knowledge and practice of HRE. Also, guide- lines for writing student theses should include at least a statement requiring students to show proof of ethics ap- proval in their theses, if the research involves human participants. This, we believe, would be one way of fighting the occurrence of research scandals, many of which probably result from negligence and ignorance rather than from deliberate intention. Equally recommendable is the introduction of standardized continuous education and refresher courses in research ethics for both junior and senior researchers in Cameroon.”

3 responses to Are students kidding with health research ethics?

  1. Clare

    I think that these are all very important contributory factors but being in the current position of fighting the bureaucracy of getting national ethics approval in East Africa I can add on a few more to this list!! Firstly the timeframe – my application (supposed to be issued in 4 weeks) is in its sixth week now (it has been approved but one of the signatories is on holiday so am still waiting) and has taken me going in twice a week to try and push things along. For many students this timeframe is far too long. Secondly the cost – the fee for national students is $200 and on top of this 5 copies of applications (often 50-80 pages) have to be printed and bound (with printing of each page costing $0.5) and then after reviewers comments another 4 copies of the revised application have to be printed and bound. Thirdly there is unfortunately still an incredible biomedical focus in all research to do with HIV and there is a shortage of reviewers who can comment on the sensitive ethical aspects of more qualitative research. For instance in my application I justify purposive sampling but a reviewer told me that even so “there needs to be some randomization” and also that “you need to give information on growing procedures”. I am confident in my knowledge and skills and so refuted these two nonsensical comments referencing literature to back me up however I doubt that students would be able to do this in the still very hierarchical “don’t question superiors” nature of academia here. I think that universities need to establish their own ethics committee that are endorsed by the national institution (that can still advise on more complex projects when necessary) so that costs, timeframes, and relevancy of reviewer advice can correlate with university expectations of their students. Not one of the numerous students that I have talked to here (in social science studies and often whose projects focus on sensitive social issues) obtained ethics approval. One even asked me why I was bothering with it!

    • Ceri

      Thanks for your blog Petra. A subject that we come back to time and time again with students undertaking projects both in the UK and internationally. Clare has also given us a great synopsis of how it all really works on the ground.

      Ethical concerns remain a central concern to me of any student undertaking research in any setting. I am currently in the process of examining some MSc dissertations based on simple research projects which were by and large educational ‘audits’ or evaluations in the UK. Despite the availability of extensive resources on research ethics, students on this particular programme often see ‘ethical concerns’ as meaning ‘I’ve completed an ethics form and they’ve said it’s exempt therefore there are no ethical issues’. Or ‘I’ve been granted ethical approval so I’m covered by ethics’. NO NO NO!!! Research ethics is such a fundamental issue at the heart of all research and yet it is not taught very well at M level. In this instance this is an unacceptable structural problem. At best students will go on a course about how to complete an ethics application, at worst someone will throw it in to a introductory session on research methods. However, it doesn’t get them thinking about the ethical implications of their research, how they need to minimise any potential risks for participants and how they need to act as responsible researchers (and in my current examining) as doctors registered with the General Medical Council which brings which it a whole host of responsibilities and obligations!!

      Moving aside from my current frustrations (it’s that time of year!) getting ethical approval when working in countries that are familiar with big pharmas coming in and doing drug trials can be challenging for students. There is almost exclusively a biomedical slant with qualitative research mis-understood and an assumption that all research is funded (for unfunded student projects!). Equally, there is a big emphasis on increasing the number of publications in learned journals. As a result we have experienced ethics committees asking our international students to increase their sample size some 4-5 times above what we had agreed was acceptable for an M level project in order to get approval.

      I completely agree with Clare in terms of the establishment of additional ethics committees at University level. We have found that our liaison with national research committees is not taken favourably, particularly when we are trying to assure them of the nature of the research (M level, unfunded, short timescale etc) but this sits within their own hierarchical approach which local students will not challenge.

      As M level course designers we have an obligation to ensure that students are well equipped with all of the tools (from understanding how to formulate a research question through to knowing which techniques are most appropriate to the ethical considerations) to become better researchers in their field. For those courses we don’t design but merely teach on I believe we also have a responsibility to bang the ethics drum loudly to ensure that other institutions are up to speed.

      • Petra

        I spotted on Twitter via @Neuro_Skeptic an additional post by @DoctorZen tackling how for many Western institutions ‘ethics training’ is now embedded in the syllabus but that lapses in conduct continue (I’ll not spoil why, the piece will tell you that) http://neurodojo.blogspot.co.uk/2014/08/education-and-scientific-misconduct.html

        I wonder if this goes back to your points above about issues around structures and systems. But also that assuming because things are on the syllabus doesn’t mean they’re taught or understood well. Nor taught in ways that transfer to ‘real life’ research.

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