90 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 4, NO.2

Research in Indian medical institutes

K. SUDHAKAR REDDY, P. SAHNI, G. K. PANDE, S. NUNDY

ABSTRACTBackground and methods. The research output of medical

institutions in India is thought to vary considerably, althoughno studies have been done since 1965. We consulted theCorporate Index of the Science Citation Index to countthe number of publications included from each of the 128medical institutions in India between 1981 and 1988. We alsocompared these results to the number of publications from lead-ing international institutions in 1988.

Results. Only 6 (4.7%) institutions had over 50 articles peryear included, 33 (26%) had 5 to 50 articles included, 43 (38%)had 1 to 5 articles and 41 (32%) had less than one articleincluded. Seven medical colleges had none. Only the AllIndia Institute of Medical Sciences, New Delhi and the Post-graduate Institute of Medical Education and Research,Chandigarh could be compared with the world leaders.

Conclusions. The quality of research from Indian medicalcolleges is low. To improve it we suggest teaching institutionsshould forbid their faculty to undertake private practice.research grants should be disbursed more evenly andresearch achievement should be considered an importantcriterion for selection and promotion.

INTRODUCTIONThere have been very few attempts to compare researchfrom different medical institutions and colleges in India'although there is an impression that hath its quality andquantity vary considerably.

One way to evaluate research output would he to com-pare the total number of papers published in prestigiousmedical journals." These data are now available in theScience Citation Index (SCI), a monthly publication fromPhiladelphia. USA. which covers high quality journalsand provides information on how many times a particulararticle by an author is cited in another. Each year the SCIpublishes a Corporate Index which lists the papers itcarries according to their institution of origin. Using thiswe have assessed the research output of Indian medicalcolleges over nine years (1980-8).

METHODSFrom the Corporate Index we counted the total numberof publications (including original articles, reviews, shortcommunications, case reports and reports of conferencesand symposia) listed under each Indian medical institution.If the medical college was not listed in 1980, we calculatedthe mean annual number of publications in the years sinceits name first appeared in the Corporate Index.

All India Institute of Medical Sciences. New Delhi 110029. IndiaK. SUDHAKAR REDDY. P. SAHNI. G. K. PANDE. S. NUNDY

Department of Gastrointestinal Surgery

Correspondence to S. NUNDY

© The National Medical Journal of India 1991

We compared these results with the output of ten otherwell known medical institutions elsewhere.

RESULTS

Research output between 1980 and 1988 (Table I)Of the 128 Indian medical colleges existing in 1988, 121were listed in the Corporate Index during 1980 to 1988.

Only 6 (4.7%) published more than 50 articles a year inSCI covered journals. These were the All India Instituteof Medical Sciences, New Delhi; the Postgraduate Instituteof Medical Education and Research, Chandigarh; theInstitute of Medical Sciences in Varanasi; the TataMemorial Hospital and Cancer Research Institute inBombay; the Christian Medical College in Vellore and theKing George Medical College in Lucknow. Thirty-three(26%) institutions produced between 5 and 50 articles peryear, 45 (38%) produced between 1 and 5 publications ayear and 41 (32%) less than one publication a year. Sevenmedical colleges had not produced any articles in SeIcovered journals over this nine year period. The annualoutput was fairly constant and this is reflected by the smallstandard deviations about the mean.

The top six institutions contributed 56% of the totalnumber of publications while the remaining 122 contributed44%. (The All India Institute of Medical Sciences, NewDelhi and the Postgraduate Institute of Medical Educationand Research, Chandigarh contributed 35% ofthe total.)

Foreign medical institutesIn Table III we list the number of papers in the 1988Corporate Index from ten well known foreign medicalinstitutions. This varies between 371 from Med HSCH.Hanover, Fed Rep Ger and 2610 from Mayo Foundation,Rochester, Minnesota, USA.

DISCUSSIONOur study indicates that there is a wide variation in thenumber of 'quality' publications from different Indian

.medical institutions. Only six managed to produce over50 papers a year in SCI covered journals and these 'elite'institutions contributed over half the total number ofpapers. Indeed the total number of papers included in theSCI from all the medical institutions in Calcutta (45) wasless than a fifth of the annual output of the All India Instituteof Medical Sciences. Moreover, apparently only twomedical institutes, the All India Institute of MedicalSciences, New Delhi and the Postgraduate Institute ofMedical Education and Research, Chandigarh can becompared with well known institutes abroad but eventheir research output is less than that of the world leaders.

TABLE 1. Indian medical institutes ranked by the number of publications in SCI covered journals

Medical institute City Average S.D. Rank Medical institute City Average S.D. Ranknumber numberof pub li- ofpuhli-cations cations

(1980-8) ( I980--ll)

All India Institute of Medical Sciences New Delhi 237.56 37.3 Government Medical College Jammu 2.44 2.7 56Postgraduate Institute of Medical Madurai Medical College and

Education and Research Chandigarh 218.67 41.0 2 Government Rajaji Hospital Madurai 2.44 1.7 56Institute of Medical Sciences, Banaras Government Medical College Patiala 2.44 1.6 56

Hindu University Varanasi 77.67 23.4 M.S. Ramaiah Medical College Bangalore 2.22 2.8 61Tata Memorial Hospital and Cancer L.L.R.M. Medical College Meerut 2.22 1.3 61

Research Institute Bombay 69.11 12.2 4 B.R.D. Medical College Gorakhpur 2.11 1.9 63Christian Medical College Vellore 64.11 12.8 5 Gandhi Medical College Bhopal z.oo 2.8 64King George Medical College Lucknow 60.89 19.0 6 S.C.B. Medical College Cuttack 1.78 2.5 65Seth G.S. Medical College and K.E.M. National Medical College Calcutta 1.7S 2.0 65

Hospital Bombay 39.78 14.4 7 Burdwan Medical College Burdwan 1.78 1.9 65Maulana Azad Medical College and Kurnool Medical College Kurnool 1.67 2.2 68

L.N.J.P. Hospital New Delhi 37.56 6.4 8 Government Medical College Aurangabad 1.67 1.9 68Jawaharlallnstitute of Postgraduate Medical College Calcutta 1.67 I.R 6S

Medical Education and Research Pondicherry 35.56 5.0 9 M.G.M. Medical College Indore 1.67 1.7 68Kasturba Medical College Manipal 25.56 10.4 10 Gaja Raja Medical College Gwalior 1.67 1.1 68Jawaharlal Nehru Medical College Aligarh 24.44 8.8 II Government Medical College Nagpur 1.44 1.4 73National Institute of Mental Health Andhra Medical College Vishakhapatnam 1.44 1.4 73

and Neurosciences Bangalore 20.33 6.0 12 Medical College and Hospital Kottayarn 1.44 1.2 73Sree Chitra Tirunallnstitute of Medical VS.S. Medical College Burla 1.33 2.0 76

Sciences and Technology Trivandrum 20.00 7.9 13 Gandhi Medical College Hyderahad 1.33 0.9 76G.B. Pant Hospital New Delhi 19.78 7.7 14 Government Medical College Jabalpur 1.33 0.7 76Grant Medical College and J.J. Group Rajendra Medical College Ranchi 1.22 1.6 79

of Hospitals Bombay 17.33 4.4 IS Kidwai Memorial Institute of Oncology Bangalore 1.22 1.6 79National Institute of Virology Pune 17.22 5.9 16 Regional Medical College Imphal 1.11 1.7 81Medical College and Hospital Rohtak 15.89 5.8 17 Kilpauk Medical College Madras 1.11 1.4 81Chittaranjan National Cancer Research Kasturba Medical College Mangalore I. I I 0.9 81

Centre Calcutta 14.56 6.3 18 Dayanand Medical College Ludhiana 1.0() 2.1 84Safdarjung Hospital New Delhi 14.56 4.9 18 Coirnbatore Medical College Coimhatore 1.00 1.0 84Lady Hardinge Medical College New Delhi 13.44 6.9 20 M. R. Medical College Gulbarga 1.00 0.7 84Rabindranath Tagore Medical College Udaipur 12.56 6.3 21 J.N. Medical College Belgaum 1.00 0.7 84St John's Medical College Bangalore 11.33 3.9 22 Medical College Calicut 0.89 1.4 88LokmanyaTilakMunicipal Medical College Bombay 10.78 6.6 23 Medical College Amritsar 0.89 1.2 88Madras Medical College and Government Bangalore Medical College Bangalorc 0.89 0.9 88

General Hospital Madras 10.67 4.7 24 M.K.C.G. Medical College Berhampur 0.89 0.8 88Osmania Medical College Hyderabad \0.00 5.4 25 T.D. Medical College Alleppey 0.67 1.0 92S. M.S. Medical College Jaipur 9.89 2.4 26 M.P. Shah Medical College Jamnagar 0.67 1.0 92Haffkine Institute Bombay 9.33 3.8 27 S.K. Medical College Muzaffarpur 0.67 0.9 92Institute of Postgraduate Medical Vivekananda Institute of Medical Sciences Calcutta 0.67 0.1 92

Education and Research Calcutta 9.22 10.0 28 R.G. Kar Medical College Calcutta 0.56 J.3 96Calcutta School of Tropical Medicine Calcutta 8.67 3.3 29 Gauhati Medical College Gauhati 0.56 1.0 96University College of Medical Sciences New Delhi 8.44 4.9 30 Rangaraya Medical College Kakinada 0.56 0.7 96S. N. Medical College Agra 8.44 4.2 30 Kakatiya Medical College Warangal 0.56 0.7 96Topiwala National Medical College and J.J.M. Medical College Davangare 0.56 0.7 96

B.Y.L. Nair Hospital Bombay 7.89 3.8 32 Darbhanga Medical College Laheriasarai 0.44 1.0 101M.L.N. Medical College Allahabad 7.89 2.9 32 Assam Medical College Dibrugarh 0.44 0.9 101Mahatma Gandhi Institute of Medical Tirunelveli Medical College Tirunelveli 0.44 0.7 101

Sciences Wardha 7.44 2.4 34 Karnataka Medical College Hubli 0.44 0.7 101Medical College and Hospital Trivandrum 7.22 5.0 35 Himachal Pradesh Medical College Simla 0.44 0.7 101Central Jalma Institute of Leprosy Agra 6.22 2.3 36 Government Medical College Guntur 0.44 0.7 101M. L. B. Medical College Jhansi 5.78 3.5 37 Dr Ambedkar Medical College Bangalore 0.44 0.7 101J. L. N. Medical College Ajmer 5.78 2.3 37 Indira Gandhi Medical College Nagpur 0.33 1.0 108All India Institute of Hygiene and J. L. N. Medical College Raipur 0.33 0.7 \08

Public Health Calcutta 5.56 4.1 39 N .H. L. Municipal Medical College Ahmedabad 0.33 0.5 \08Medical College Baroda 4.89 4.5 40 Nalanda Medical College Patna 0.22 0.7 111Government Medical College Surat 4.89 2.8 40 Maulana Azad Medical College Bhopal 0.22 0.4 111Sardar Patel Medical College Bikaner 4.78 2.9 42 S. V. Medical College Tirupati 0.22 0.4 111Bombay Hospital and Medical Research Pataliputra Medical College Dhanbad 0.22 0.4 III

Centre Bombay 4.67 3.2 43 Bhagalpur Medical College Bhagalpur 0.11 0.3 115Armed Forces Medical College Pune 4.56 1.5 44 A. N. Magadh Medical College Gaya 0.11 0.3 115P. G. Institute of Basic Medical Sciences Madras 4.33 3.6 45 Swami RamanandTeerth Rural MedicalG.S.V.M. Medical College Kanpur 4.33 2.7 45 College Ambajogai 0.11 0.3 115B.]. Medical College Ahmedabad 3.56 2.9 47 S.S. Medical College Rewa 0.11 0.3 115B.]. Medical College Pune 3.44 2.5 48 North Bengal Medical College Siliguri 0.11 0.3 115Dr V.M. Medical College Solapur 3.33 2.4 49 Bankura Sanmilani Medical College Bankura 0.11 0.3 115Dr Sampurnanda Medical College Jodhpur 3.33 1.9 49 Shyam Sunder Medical College Chandausi 0.11 0.3 115Nilratan Sircar Medical College Calcutta 3.00 2.2 51 Chingleput Medical College Chingleput 0.00 0.0 122Tanjavur Medical College Tanjavur 2.78 2.9 52 Silchar Medical College Silchar 0.00 0.0 122Stanley Medical College Madras 2.67 1.8 53 M.G.M. Medical College Jamshedpur 0.00 0.0 122Nizam's Institute of Medical Sciences Hyderabad 2.56 4.4 54 Krishna Institute of Medical Sciences Karad 0.00 0.0 122Patna Medical College Patna 2.56 1.7 54 Guru Gobind Singh Medical COllege Faridkot 0.00 0.0 122Christian Medical College Ludhiana 2.44 3.0 56 Government Medical College Mysore 0.00 0.0 122Medical College Srinagar 2.44 2.9 56 Government Medical College Bellary 0.00 0.0 122

92

TABLE II. Publicationsfrom10wellknownmedicalinstitutionsin the World (1988)

Institution Country No. ofpublications

Mayo Foundation, Rochester, Minnesota USA 2610Karolinska Institute, Stockholm Sweden 2233Hammersmith Hospital & RoyalPostgraduate Medical School, London England 847

Hospital for Sick Children, Toronto Canada 724School of Medicine, Osaka University Japan 689Hadassah University Hospital, Jerusalem Israel 556Acad Med CfR, University ofAmsterdam Netherlands 528

Hospital St Louis, Paris France 506Royal Melbourne Hospital, Parkville Australia 384Med HSCH, Hanover Germany 371

A major criticism of using inclusion in SCI as a yardstickof research quality is that the publication lists mainlyWestern journals and very few of those published in India.However, Indian scientists tend to send their best papersabroad- and a research study on the quality of Indianmedical journals found that journals not listed in the SCIwere generally of poor quality (unpublished data). Wehave also used the total number of times an author isincluded in the SCI as an index of quality because thenumber of articles an author produces is generally relatedto their quality."

Why is research in Indian medical colleges so poor? Ofthe six 'elite' medical institutes, 5 are staffed by full timefaculty who are not permitted to practise privately. Webelieve private practice to be the major reason for thepoor quality of research in most Indian medical colleges.The amount of time and effort needed to do good medicalresearch does not allow for the dissipation of energies innon-academic fields such as private practice. Anotherreason is that very little credit is given to research achieve-ment during job selection or promotion interviews.

THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 4, NO.2

Proximity to politicians and bureaucrats, or even worseinfluences, are usually much more important.

Finally, governments and research agencies are ofteneither unhelpful or unfair in disbursing their funds. 4 Largesums of money are spent on a few elite institutions incapital cities while others are starved of research, or evenmaintenance grants.

What is to be done? First and foremost medicalresearch must be recognized to be very important for acountry's progress. Many medical problems are peculiarto India but there have been no major advances towardstheir solution. Indeed eminent American scientists haveobserved that research into tropical diseases is best donein the West as scientists in the third world have neither theability nor the facilities to solve the problems theyencounter every day. 5

Secondly, being on the faculty of a medical collegeshould be a full time appointment. This would involverestructuring of the number of personnel and their pay butas it has been done successfully in some medical institu-tions it must be possible in others.

Finally the selection and promotion of personnel andthe disbursement of research grants must be based strictlyon merit. Perhaps, this is the most difficult solution,especially under our present circumstances.

REFERENCESRangarao BV. Scientific research in India: An analysis of publications.J Scient Ind Res 1967;26:166-76.

2 Vollmer HM. Evaluating two aspects of quality in research programeffectiveness. In: Yovits MC (ed). Research program effectiveness.147--{)7.

3 Krishnan CN, Visvanathan B. The performance of modern scienceand technology in India: The case of scientific and technologicaljournals. Patriotic and People Oriented Science and TechnologyBulletin 1987;11:1-19.

4 Bhattacharyya AK. Calcutta School of Tropical Medicine. Natl MedJ India 1989;2:39-42.

5 Goffman W, Warren KS. Scientific information systems and theprinciple of selectivity. New York: Praeger, 1976:119-147.