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Responsible research and innovation, or RRI, is a concept that aims to bring together society and science for a better future. There are six key elements of RRI: public engagement, gender equality, science education, open access, ethics and governance. Higher Education Institutions and Responsible Research and Innovation (HEIRRI) project aimed to bring the concept of RRI into the educational system. Using state-of-the-art review of good practices, HEIRRI team developed 10 training programs on RRI for different higher education institution educational levels, including a summer school and a massive open online course (MOOC). We conducted pilot of the trainings and evaluated participants’ experiences. Satisfaction with HEIRRI training programs on responsible research and innovation was high, both for participants and for the trainers, and trainings raised awareness of RRI. Participants’ feedback was used to identify areas that need improvement and provided for recommendations for final versions of the HEIRRI training programs. In order to equip researchers with skills to recognize and apply RRI values, RRI should be included in their education. HEIRRI training is suitable for a range of different disciplines, including forensic science, and is free to use and adjust for specific contexts (available from: https://rri-tools.eu/heirri-training-programmes). KEY POINTSRRI aims to make research inclusive, responsible, reflexive and to foster integrity of researchersHEIRRI project developed a toolbox of engaging activities for introduction of RRI concepts in higher educationHEIRRI training can be used to introduce RRI at all levels of higher education and members of the publicHEIRRI training is suitable for a range of different disciplines, including forensic science, and is free to use and adapt

Background Lack of knowledge about systematic reviews (SRs) could prevent individual healthcare workers (HCWs) from using SRs as a source of information in their clinical practice or discourage them from participating in such research. In this study, we aimed to explore in-depth the opinion of a sample of HCWs about the newly created online educational intervention designed to improve knowledge about SRs. Methods We created a brief online educational intervention on SRs, consisting of 11 textual modules. We evaluated it among practicing HCWs who graduated from a university-level health sciences program using a mixed-methods pilot study that consisted of pre- and post-intervention questionnaires and qualitative evaluation via semi-structured interviews. We assessed participants’ knowledge about SR methodology before and after the intervention, and compared the responses. We sought their opinions about the characteristics of SRs. Also, the participants were presented with four scientific abstracts, where they were asked to distinguish whether those abstracts presented summaries of a systematic or a non-systematic review. Results Twelve participants took part in the study. In the pilot study, the participants’ knowledge about SRs was improved after the intervention compared to the baseline. Participants provided positive feedback regarding the educational intervention. Suggestions to improve the educational intervention were to provide more details about the forest plot, add more digital content or images, provide more details about the methodological steps of an SR, add descriptions about practical applications of SRs and provide links to additional educational materials. The participants suggested that HCWs could be motivated to take part in such an education if it is offered as continuing medical education (CME) course or credit for academic/career advancement. Conclusion HCWs provided positive feedback about the newly designed online educational intervention on SRs; they considered it an appropriate tool for learning about SRs and resulted in increased knowledge about SRs. In addition, participants gave suggestions for improving education, which can be used to tailor the education for end-users. In future studies, it would be useful to examine the effectiveness of the modified educational intervention on increasing knowledge in a larger sample and in the form of a randomized controlled trial.

Background Knowledge assessment in evidence-based medicine (EBM) is usually performed by the measurement of memorised facts, understanding of EBM concepts and application of learned knowledge in familiar situations, all of which are considered lower-level educational objectives. The aim of this study was to assess EBM knowledge both on higher and lower cognitive levels across EBM topics. Methods In order to assess knowledge on different EBM topics across learning levels, we created a knowledge test (Six Progressive Levels in Testing – SPLIT instrument), which consists of 36 multiple choice items and measures knowledge in EBM at six cognitive levels (Remembering, Understanding, Applying, Analysing, Evaluating and Creating) and addresses six EBM topics (Evidence-based practice, Internal validity, Clinical importance, Study design, Sources of evidence, Diagnostic studies). Three independent assessors defined the minimum passing score (MPS) for the overall test, based on the first-year course content and educational objectives. The instrument was assessed in a sample of first- (n = 119) and third-year medical students (n = 70) and EBM experts (n = 14). Results The MPS was 16 correct answers out of total 36 questions, and was achieved by 21 out of 119 first-year students, 14 out of 70 third-year students and 9 out of 14 EBM experts (χ2 = 13.3; P Study design and Sources of evidence (P = 0.002 and 0.004, respectively, Kruskal-Wallis test). First- and third-year students performed better on specific course topics taught in that study year (Diagnostic studies and Clinical relevance, respectively). Conclusion EBM knowledge of students and experts differ according to the specificities of their education/expertise, but neither group had excellent knowledge in all areas. It may be difficult to develop a knowledge test that includes different EBM topics at different cognitive levels to follow the development of specific and general aspects of EBM knowledge.

Education is important for fostering research integrity (RI). Although RI training is increasingly provided, there is little knowledge on how research stakeholders view institutional RI education and training policies. Following a constructivist approach, we present insights about research stakeholders’ views and experiences regarding how research institutions can develop and implement RI education and training policies. We conducted thirty focus groups, engaging 147 participants in eight European countries. Using a mixed deductive-inductive thematic analysis, we identified five themes: (1) RI education should be available to all; (2) education and training approaches and goals should be tailored; (3) motivating trainees is essential; (4) both formal and informal educational formats are necessary; and (5) institutions should take into account various individual, institutional, and system-of-science factors when implementing RI education. Our findings suggest that institutions should make RI education attractive for all and tailor training to disciplinary-specific contexts.

Aim: The evidence about factors predicting the desire of medical graduates for pursuing research careers are inconsistent. Identification of factors which influence decision for pursuing research career would be important information to medical schools to improve research environment for students. For that reason, we performed an international survey of medical students to analyze the factors predicting research careers in medicine. Methods: An international online survey of undergraduate and graduate medical students was performed, using the using the data from Res Medica student journal database, about their research activities, future interests and plans and desire to pursue research careers. Results: In total, 486 students took the survey. Logistic regression revealed a single significant factor influencing medical students’ desire to pursue a research degree: in-creased motivation for participation in research in future (R2=0.33). Conclusion: In order to encourage students and training doctors to more readily engage in research, exposure to re-search and research participation could have an incremental value to existing research education in medical schools.

Background Lack of knowledge of systematic reviews (SRs) could prevent individual health care professionals from using SRs as a source of information in their clinical practice or discourage them from participating in such research. Objective In this randomized controlled trial, we evaluated the effect of a short web-based educational intervention on short-term knowledge of SRs. Methods Eligible participants were 871 Master’s students of university health sciences studies in Croatia; 589 (67.6%) students who agreed to participate in the trial were randomized using a computer program into 2 groups. Intervention group A (294/589, 49.9%) received a short web-based educational intervention about SR methodology, and intervention group B (295/589, 50.1%) was presented with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. The participants’ knowledge of SRs was assessed before and after the intervention. The participants could not be blinded because of the nature of the intervention. The primary outcome was the difference in the percentage of correct answers about SR methodology per participant between the groups after the intervention, expressed as relative risk and 95% CI. Results Results from 162 and 165 participants in the educational intervention and PRISMA checklist groups, respectively, were available for analysis. Most of them (educational intervention group: 130/162, 80.2%; PRISMA checklist group: 131/165, 79.4%) were employed as health care professionals in addition to being health sciences students. After the intervention, the educational intervention group had 23% (relative risk percentage) more correct answers in the postintervention questionnaire than the PRISMA checklist group (relative risk=1.23, 95% CI 1.17-1.29). Conclusions A short web-based educational intervention about SRs is an effective tool for short-term improvement of knowledge of SRs among health care studies students, most of whom were also employed as health care professionals. Further studies are needed to explore the long-term effects of the tested education. Trial Registration OSF Registries 10.17605/OSF.IO/RYMVC; https://osf.io/rymvc

We assessed students’ and employees’ perception of ethical climate at a university school of medicine compared to that of social sciences and humanities, as well as temporal changes in the employees’ perception of ethical climate. We also explored potential predictors of ethical climate, including moral foundations. This cross-sectional questionnaire study was conducted at the University of Split School of Medicine and the Faculty of Humanities and Social Sciences, in Croatia, from April to September 2019. We used 36- item Ethical Climate Questionnaire and 22-item Moral Foundation Questionnaire to survey employees, senior and doctoral students. We collected responses using ballot boxes as well as online survey. We collected 449 complete responses (response rate 36.8%). The dominant ethical climates at two schools were “Company rules and procedures” and “Laws and professional codes”. We compared our results with a study conducted in 2012 and found that the perception of ethical climate had not changed dramatically in last 8 years. Ethical climate, or shared social and work- related behaviours, does not seem to change in these institutions even when students and staff are included with faculty in surveys. We provide further discussion of why this seems to be the case.

Aims: To evaluate the effect of biomedical students' ongoing education, we assessed their knowledge and attitudes toward antimicrobial use. Study Design: A cross-sectional study was carried out among the students of four study programs: Medicine in Croatian, Medicine in English, Dental medicine, and Pharmacy. The anonymous questionnaire was distributed to students who attended classes from April to May 2018. Results: A total of 947 (86%) out of 1, 107 students enrolled at the University of Split School of Medicine participated in this study. A third of dental students (51/159) and a quarter of medical (113/458) and pharmacy students (32/130) believed that paracetamol was an antibiotic that reduces pain. However, the percentage significantly decreased from the first to the final years. Only 31% of the final year dental medicine students (5/16) named a correct guideline for the usage of antimicrobial drugs, 23% of medical students (18/78), and none in the English program. Pharmacy students were the most informed, since 76% of the final year students (16/21) named Intersectoral Coordination Mechanism for the Control of Antimicrobial Resistance (ISKRA) guidelines. Conclusion: The students showed poor knowledge on the use of guidelines for antibiotic use, highlighting the need for changes in the existing curricula, including a more effective course on antimicrobial prescribing.

Background Although numeracy, defined as understanding and handling numbers, is an important skill for the medical profession, it is not clear whether it changes during graduate medical education and whether it can be improved by specific interventions. The objective of this study was to assess objective and subjective numeracy levels at different stages of medical education and explore whether a research methodology/statistics course improves numeracy levels in a longer period. Methods We performed cross-sectional and controlled before-and-after studies. First-year sociology students and first- to sixth-year medical students from the in the cross sectional study and two groups of first-year medical students in a controlled before-and-after study. The intervention was a course on biostatistics and research methodology using blended approach. Numeracy was measured using Subjective Numeracy Scale (Cronbach α = 0.70) and Numeracy Understanding in Medicine instrument (Cronbach α = 0.75). Results Whereas first-year medical students did not differ from first-year sociology students in objective numeracy, medicine students had higher results on subjective numeracy. Students from higher years of medical school had generally higher subjective and objective numeracy scores. In the controlled before-and-after study, the intervention group improved more in subjective numeracy (median difference on a 0–8 scale = 0.5, 95% CI 0.3 to 0.7 vs − 0.4, 95% CI − 0.4 to − 0.1, P Conclusions Although the numeracy levels at the beginning of the medical school are within the range of non-medical population, both objective and subjective numeracy improve during the higher years of medical school. Curriculum during medical school may help in numeracy increase, while research methodology training may help to increase subjective but not objective numeracy skills.

Use of patient clinical photographs requires specific attention to confidentiality and privacy. Although there are policies and procedures for publishing clinical images, there is little systematic evidence about what patients and health professionals actually think about consent for publishing clinical images. We investigated the opinions of three stakeholder groups (patients, students and doctors) at 3 academic healthcare institutions and 37 private practices in Croatia (total 791 participants: 292 patients, 281 medical and dental students and 281 doctors of medicine or dental medicine). The questionnaire contained patient photographs with different levels of anonymization. All three respondent groups considered that more stringent forms of permission for were needed identifiable photographs than for those with higher levels of anonymization. When the entire face was presented in a photo only 33% of patients considered that written permission was required, compared with 88% of the students and 89% of the doctors. Opinions about publishing patient photographs differed among the three respondent samples: almost half of the patients thought no permission was necessary compared with one-third of students and doctors. These results show poor awareness of Croatian patients regarding the importance of written informed consent as well as unsatisfactory knowledge of health professionals about policies on the publication of patients' data in general. In conclusion, there is a need for increasing awareness of all stakeholders to achieve better protection of patient privacy rights in research and publication.

Assessing the success and performance of researchers is a difficult task, as their grant output is influenced by a series of factors, including seniority, gender and geographical location of their host institution. In order to assess the effects of these factors, we analysed the publication and citation outputs, using Scopus and Web of Science, and the collaboration networks of European Research Council (ERC) starting (junior) and advanced (senior) grantees. For this study, we used a cohort of 355 grantees from the Life Sciences domain of years 2007-09. While senior grantees had overall greater publication output, junior grantees had a significantly greater pre-post grant award increase in their overall number of publications and in those on which they had last authorship. The collaboration networks size and the number of sub-communities increased for all grantees, although more pronounced for juniors, as they departed from smaller and more compact pre-award co- authorship networks. Both junior and senior grantees increased the size of the community within which they were collaborating in the post-award period. Pre-post grant award performance of grantees was not related to gender, although male junior grantees had more publications than female grantees before and after the grant award. Junior grantees located in lower research-performing countries published less and had less diverse collaboration networks than their peers located in higher research-performing countries. Our study suggests that research environment has greater influence on post-grant award publications than gender especially for junior grantees. Also, collaboration networks may be a useful complement to publication and citation outputs for assessing post-grant research performance, especially for grantees who already have a high publication output and who get highly competitive grants such as those from ERC.

Plagiarism is one of the most severe academic integrity issues. This study examined students’ knowledge of and attitudes towards plagiarism, tested their ability to recognize plagiarism, and explored the association of study levels and attendance in courses dealing with referencing rules and plagiarism with students’ attitudes and knowledge. A cross-sectional online survey was conducted at the University of Split, comprising the students of all schools and study levels (n = 388). Overall, results indicate the students were not very familiar with referencing rules and did not perform well on either theoretical questions or practical examples. However, they demonstrated positive attitudes towards plagiarism avoidance as well as towards compliance with academic integrity with respect to the correct use of research publications. Students’ self-reported attendance in courses dealing with referencing rules and plagiarism avoidance was not associated with their knowledge of and attitudes toward plagiarism. These findings are important for a general understanding of students’ attitudes, and the relation of practical and theoretical knowledge of plagiarism. Furthermore, the academic community addresses plagiarism not only as an ethical and regulatory violation but also as a direct consequence of a lack of knowledge, and of academic illiteracy. Study programs should be adjusted and long-term policies developed at all academic levels to promote a positive climate among students towards responsible academic writing.

Background: We assessed the ethics review of proposals selected for funding under the Marie Skłodowska-Curie Actions (MSCA) and the European Research Council (ERC) in Horizon 2020, EU’s framework programme for research and innovation, 2014-2020. Methods: We analysed anonymized datasets for 3,054 MSCA individual fellowships (IF), 417 MSCA Innovative Training Networks (ITN), and 1,465 ERC main-listed proposals with ethics conditional clearance, over four years (2016 to 2019). The datasets included the information on ethics issues identified by applicants in their proposal and ethics issues and requirements identified by ethics experts during the ethics review. Results: 42% of proposals received ethical clearance. For proposals with conditional ethics clearance (n=3546), most of the identified ethics issues by both applicants and ethics experts were in the ethics categories related to humans; protection of personal data; environment, health and safety; and non-EU countries. Ethics experts identified twice as many ethics issues compared to applicants across funding schemes, years, and from high- and low-research performing countries. ERC grants had the highest number of ethics requirements per proposal (median (Md)=8, interquartile range (IQR=4-14), compared to ITN (Md=6, IQR=3-13) and IF grants (Md=3, IQR=2-6). The majority of requirements had to be fulfilled after grant agreement: 99.4% for IF, 99.5% for ITN, and 26.0% for ERC. For 9% of the proposals, the requirements included the appointment of an independent ethics advisor and 1% of the proposals had to appoint an ethics advisory board. Conclusions: Many applicants for highly competitive H2020 funding schemes lack awareness of ethics issues raised by their proposed research. There is a need for better training of researchers at all career stages about ethics issues in research, more support to researchers from research organizations to follow the funding agencies requirements, as well as further development and harmonization of the ethics appraisal process during grant assessment.

Background There are a few studies of alignment between different knowledge-indices for evidence-based medicine (EBM). The aim of this study was to investigate whether the type of test used to assess knowledge of EBM affects the estimation of this knowledge in medical students. Methods Medical students enrolled in 1-week EBM course were tested with the Fresno, Berlin, and ACE tests at the beginning and the end of the course. We evaluated the ability of these tests to detect a change in the acquired level of EBM knowledge and compared the estimates of change with those of the Control group that was tested with the ACE and Berlin tests before and after an unrelated non-EBM course. The distributions of test scores and average item difficulty indices were compared among the tests and the groups. Results Test scores improved on all three tests when compared with their pre-test results and the control. Students had on average a “good” performance on the ACE test, “sufficient” performance on the Berlin test, and “insufficient” performance or have “not passed” on the Fresno test. The post-test improvements in performance on the Fresno test (median 31% increase in percent scores, 95% confidence interval (CI) 25–42%) outperformed those on the ACE (13, 95% CI 13–20%) and Berlin tests (13, 95% CI 7–20%). Post-test score distributions demonstrated that the ACE test had less potential to discriminate between levels of EBM knowledge than other tests. Conclusion The use of different EBM tests resulted in different assessment of general EBM knowledge in a sample of graduate medical students, with lowest results on the Fresno and highest on the ACE test. In the light of these findings, EBM knowledge assessment should be based on the course’s content and learning objectives. Electronic supplementary material The online version of this article (10.1186/s12909-018-1391-z) contains supplementary material, which is available to authorized users.

Objectives The aim of this study was to test the usefulness of an infographic in the translation of knowledge about health information from a Cochrane systematic review to lay and professional populations in comparison to a plain language summary (PLS) and scientific abstract (SA). Study Design and Setting We conducted three parallel randomized trials with university students ( n = 171), consumers ( n = 99), and doctors ( n = 64), to examine the effect of different summary formats of a Cochrane systematic review on the knowledge about health information presented in the review, reading experience, and perceived user-friendliness. In the trials involving students and doctors, an infographic was compared to a PLS and a SA, while in those with consumers, an infographic was compared to a PLS. Results We found no difference in knowledge between the infographic and the text-based PLS in any of the trials or in the whole participant sample. All three participant groups preferred the infographic and gave it higher ratings for reading experience (d = 0.48 in the overall sample) and user-friendliness (d = 0.46 in the overall sample). Conclusion Although the infographic format was perceived as more enjoyable for reading, it was not better than a traditional, text-based PLS in the translation of knowledge about findings from a Cochrane systematic review.

The paper describes the testing of the retrieval method as the new way of learning evidence.based medicine (EBM) concepts. The retrieval was the successful method for the short term learning of concepts, but not for the long term.