SYSTEMATIC REVIEW

BALANCING RESEARCH AND ACADEMIC DEMANDS IN MEDICAL EDUCATION: A

QUALITATIVE META-SYNTHESIS

Ayesha Jamil¹, Shaikh Fahad Falah², Naveed Afzal Khan³, Bela Inayat⁴, Naheed Mahsood⁵,

Ayesha Junaid⁶, Junaid Sarfaraz Khan⁷

How to cite this article

ABSTRACT

OBJECTIVES

Jamil A, Falah SF, Khan NA, Inayat

B, Masood N, Junaid A, et al.

Balancing Research and Academic

Demands in Medical Education: A

Qualitative Meta-Synthesis. J

Gandhara Med Dent Sci.2026;13(2):

116-126

This qualitative meta-synthesis examined how undergraduate medical

students explain and make sense of their experiences balancing research with

academic requirements.

METHODOLOGY

A qualitative meta-synthesis was conducted in line with PRISMA guidelines.

Systematic searches were performed in PubMed and Google Scholar using

predened keywords related to undergraduate medical students, research

engagement, and academic demands. Qualitative and mixed-method studies

with identiable qualitative ndings were included. A total of 12 studies

conducted across multiple countries (including LMICs and HICs) were

selected after screening titles, abstracts, and full texts. Data were analysed

using an inductive thematic synthesis approach to generate higher-order

themes.

https://doi.org/10.37762/jgmds.13-2.871

Date of Submission: 25-02-2026

Date Revised:

Date Acceptance:

05-03-2026

30-03-2026

¹Associate Professor, Department of

Pharmacology, Khyber Girls Medical

College, Peshawar

²Assistant Professor, Department of

Pharmacology, Khyber Girls Medical

College, Peshawar

RESULTS

Four higher-order themes were identied: (i) negotiation of academic and

research identities, (ii) research as both enrichment and burden, (iii)

structural and relational determinants of balance, and (iv) adaptive coping

strategies. Research was both viewed positively and as challenging across

contexts. In LMIC contexts, there were fewer resources and an examination-

based system that added a heavy workload, unlike in high-income settings,

where a system of systematic support and integration into the curriculum

enabled engagement to be more sustainable. Factors that determined balance

were mentorship, institutional support, and curriculum design.

CONCLUSION

⁴Assistant Professor, Department of

Biochemistry, Khyber Girls Medical

College, Peshawar

⁵Associate Professor, Department of

Medical Education and Research,

Khyber Girls Medical College,

Peshawar

⁶Assistant Professor,Centre for Language

Development, Forman Christian College

University, Lahore

⁷Dean, School of Health Professionals’

Education, Research and

Research-academic balance is an institutional rather than a personal

process. Curricular integration, mentoring designed with safeguards and

moderated time, as well as institutional countermeasures, are necessary to

facilitate fruitful and sustainable research engagements in both LMIC and

high-income contexts.

KEYWORDS: Undergraduate Medical Students, Research Engagement,

Academic Workload.

Entrepreneurship, Health Services

Academy, Islamabad

Correspondence

³Naveed Afzal Khan, Assistant Professor,

Department of Medical Education and

Research, Khyber Girls Medical

College, Peshawar

+92-334-9085561

dr.naveed@live.com

academically intensive. Students are required to

manage theoretical learning, frequent assessments, and

INTRODUCTION

clinical responsibilities simultaneously.⁹In many

settings, research engagement is introduced as an

additional requirement rather than being structurally

integrated into the curriculum, creating competition for

time and cognitive resources.^10,11,12The benets of

Over the past few decades, undergraduate medical

education has undergone a signicant transformation,

with an increasing emphasis on early exposure to

research and scholarly activities.^1,2Engagement in

research as part of medical training contributes to

critical thinking, analytical thinking, and lifelong

learning, which are critical to evidence-based

practice.^3,4Therefore, as a component of continuing

education, undergraduate research participation is

increasingly encouraged or required at many medical

schools worldwide.^5,6,7,8Despite these educational

benefits, undergraduate medical training remains

undergraduate

research

have

been

repeatedly

documented in the empirical literature, including

increased academic condence, greater understanding

of scientific inquiry, and greater interest in academic

medicine.^3,4,13,14Existing literature has extensively

documented both the advantages of undergraduate

research and the barriers to participation, including time

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Balancing Research and Academic Demands in Medical

constraints, workload pressure, limited mentorship, and

education, where culture, mentorship, and curricula

inuence learning processes.^36,37Qualitative meta-

synthesis overcomes the limitations of studies of

individual sites by increasing the transferability of the

interpretation.³⁸Although they cannot be generalized

statistically, similarities and dierences highlight

dierences between contexts, leading to the informing

of educational practice and policy. This review

enhances insight into the roles of research within

insucient institutional support.^{2,8,15,16,17,18}However,

much of this evidence is derived from quantitative

studies focusing on attitudes and perceived barriers.

While informative, such approaches provide limited

insight into how students actually experience and

interpret the process of balancing research with

academic demands.^19,20Conversely, qualitative research

oers deeper insight into it as researchers delve into

students’ views, meanings, and the realities of their

situations.^4,21Qualitative research oers a deeper

understanding by exploring students' lived experiences,

meanings, and contextual realities. However, qualitative

studies in this eld remain dispersed across dierent

students’

academic

needs

across

diverse

contexts.^{30,33,36,39,40}

METHODOLOGY

institutions,

cultures,

and

educational

systems.

The present research used a qualitative meta-synthesis

to synthesize the results of qualitative studies

Individual studies are often context-specic and limited

in transferability when considered in isolation.²¹This

gap is particularly relevant in low- and middle-income

countries (LMICs), including Pakistan, where structural

constraints, examination-driven curricula, and limited

institutional resources shape students’ experiences

dierently from those in high-income settings.^22,23,24

Pakistan-based studies have noted the presence of

extensive academic stress, insucient time allocation,

and irregular and unstructured mentorship as chronic

issues in the undergraduate medical education

investigating

undergraduate

medical

students’

experiences balancing their research involvement with

academic expectations.^30,33,35,41The synthesis allowed

combining the research rather than merely combining

the studies. Following Leary, Walker, Sandelowski, and

Barroso, the qualitative data (ndings) were considered

data and analysed to produce higher-order abstraction

concepts.^38,40

thematic synthesis methodology

(Thomas and Harden, 2008) was utilized, as it

facilitates systematic coding and clear analytical

development of themes in the analysis of heterogeneous

qualitative and mixed-method investigations, which is

more appropriate than meta-ethnography in this review.

The study was guided by an interpretivist epistemology,

operationalised through inductive coding, iterative

system.^16,25,26Qualitative meta-synthesis oers

rigorous methodological framework for synthesizing

results from various qualitative studies to develop

higher-order interpretations and theories.²⁷In contrast to

narrative reviews, meta-synthesis does not consider

qualitative ndings as evidence but as data to be

directly compared, translated, and reinterpreted.^28,29

This approach allows the development of new

understandings of concepts that extend beyond the

conclusions of individual studies and is increasingly

valued within health professions education research.^30,31

The question to be answered by this meta-synthesis is

the following: how do medical students in their

undergraduate level make sense of their lived

experiences of how to balance their research interests

and academic demands? Synthesizing qualitative

comparison

meanings

across

studies,

and

development of higher-order themes reecting context-

dependent student experiences.⁴⁰There was no

intention to generate universal conclusions; rather, the

aim was to develop context-sensitive interpretations of

recurring patterns across studies.⁴²This review was

conducted in line with PRISMA guidelines and

informed by ENTREQ recommendations to ensure

transparency in qualitative synthesis. The question that

informed the qualitative meta-synthesis is: How do

undergraduate medical students describe and interpret

their lived experiences of balancing research

engagement with academic demands? It is based on

phenomenological inquiry, which means it is concerned

with lived experiences, feelings, diculties, and coping

mechanisms rather than quantiable outcomes. In line

with Colaizzi’s strategy, it aims to capture students’

concomitant interpretation and reection, in alignment

with the management of concurrent research and

curricular pressures across institutional and cultural

contexts.^43,44,45

evidence, it examines how students negotiate dual roles

and determines the conditions under which research is

perceived as enriching or burdensome across a variety

of settings, including medical education in Pakistan.^21,32

qualitative meta-synthesis focuses on lived

experiences and the meanings of the research question.

This interpretive approach is subjective and reects

complexities and contextual nuance, unlike quantitative

meta-analysis, which estimates eects.^33,34According to

Leary and Walker (2018), a qualitative meta-synthesis

allows the induction of patterns and the development of

theories across.³⁵Combining the results brings forth

higher-level themes that are useful in medical

Search Strategy

A systematic literature search was conducted across

several electronic databases to identify qualitative

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Balancing Research and Academic Demands in Medical

process.^52,53A summary of the quality appraisal of

included studies is presented in Table 2.

studies. The databases to be searched were PubMed and

Google Scholar, which are in line with best practices in

health

professions

education

reviews.^30,46,47

Data Extraction

Comprehensive coverage of biomedical literature is

available in PubMed, and broader retrieval of reading

across interdisciplinary and grey literature is possible

with Google Scholar. The search strategy combined

keywords and Boolean operators: undergraduate

The results sections of the chosen studies provided most

of the information. The primary data for analysis

consisted of the researchers’ explanations, the primary

themes identied in each study, and direct quotes from

students. To make the results simple to decipher,

medical students, research engagement, academic information on the study’s setting and participants was

also recorded.^33,38,54,55Data were analysed using

demands, and qualitative research. Search query

(PubMed):AND ("medical students" OR undergraduate

medical students) (research OR research engagement)

AND (academic workload) or (academic demands) or

(balance) and (qualitative OR interviews OR focus

groups).^46,47,48,49In December 2025, the nal search

was done. The search was limited to English-language

studies published since 2005 and was not restricted to

any geographical area, to reect the varied learning

settings over the period, as interest in undergraduate

inductive thematic synthesis (Thomas & Harden,

2008).⁵⁶

1. Line-by-line coding of qualitative data

2. Development of descriptive themes

3. Generation of higher-order analytical themes

Coding was conducted iteratively, with constant

comparison across studies.^40,57,58A coding framework

was developed and rened throughout the analysis

process. Reexivity was upheld in the process by

research has grown.^46,50,51Despite there being only two considering the fact that the academic and disciplinary

databases, attempts were made to be comprehensive by

using general search terms and manually screening

references. Qualitative studies or mixed-method studies

with clear qualitative results, Undergraduate medical

students, Research/academic balance, and sufcient

perspectives of the researchers aected the process of

interpretation.⁵⁹

Results of the Qualitative Meta-synthesis

Overview of Included Studies

total of 12 studies were included following

methodological description were included. Entirely systematic screening. Study selection followed

quantitative research and Editorials, commentaries, and

opinion papers were excluded. Studies were screened in

three stages: Title screening, Abstract screening, and

Full-text review. Study selection followed PRISMA

guidelines, and the process is illustrated in Figure 1.

The qualitative checklist provided to determine

methodological quality of the included studies was the

Critical Appraisal Skills Programme (CASP). This

instrument was chosen to allow a systematic review of

qualitative research regarding rigor, credibility, and

PRISMA guidelines and is illustrated in Fig 1.

The included studies were conducted across multiple

regions, including Pakistan, South Asia, East Asia, the

Middle East, Europe, North America, and multi-country

settings. Data collection methods included interviews,

focus groups, and narrative reections. Study designs

included qualitative, mixed-method, and review studies;

however, only extractable qualitative ndings were

included

the

synthesis.

Participants

were

undergraduate medical students engaged in research

relevance. It was appraised across several major areas, through curricular and extracurricular pathways. Across

including clarity of research aims, suitability of the

qualitative methodology, suciency of data collection

procedures, transparency of data analysis, sensitivity of

researcher-participant relations, ethics, and consistency

between results and conclusions. The studies were not

studies,

key areas explored

included

identity

negotiation, mentorship, workload, and institutional

context. The characteristics of the included studies are

presented in Table 1, and the methodological quality

appraisal is summarised in Table 2. Fig. 1 shows that 40

excluded solely based on quality assessment; it served records were found after the database search. Six

as a tool to inform the conclusions and to ensure they

were grounded in the methodology’s strengths and

limitations. Moreover, the inclusion of mixed-method

and review studies was restricted to cases in which it

was clear that some qualitative data was available.

Potential methodological variability arising from the

duplicate records were removed, leaving 34 studies to

be screened by title and abstract. After screening, 20

full-text articles were evaluated for eligibility. Eight

studies were ltered out based on a lack of qualitative

depth, inadequate focus on research-academic balance,

or inadequate methodology. In the end, 12 articles

inclusion of such studies was also recognised, and the fulfilled all the inclusion criteria and were added to the

findings were taken with care in the synthesis final qualitative meta-synthesis (Fig.1)

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Balancing Research and Academic Demands in Medical

Lee et al. South

(2023) Korea

(East

Qualitative Learner -

Driven

Relational mentors

hip, institutional

Research

facilitation, structu

Asia)

Experiences ed involvement.⁶³

(HIC)

Burgoyn

e et al.

Ireland Qualitative Undergradu Identity stress,

(Europe)

(2010) (HIC)

ate Medical motivation, and

Research:

Student

perceived

academic-research

Perspective stress.⁶⁴

Sellbe Sweden Qualitative Balancing

rg et al. (Europe)

(2022) (HIC)

Identity negotiation,

Acting and adaptation to

Adapting

Qualitative Medical

Students’

increasing needs.⁶⁵

Motivation vs

Cusch

Malta

(Europe)

workload stress,

ieri et al.

(2021) (HIC)

Perceptions academic

on Research positioning.⁶⁶

Bierer

USA

Literature

Impact of

Institutional

(North Review:

Americ Program

Scholarly

integration,

Concentrati recognition systems,

Chen

(2010) a) (HIC) Evaluation ons

and structural

Focus

support.⁶⁷

Amga

Multi - Integrated Medical

d et al. country Mixed-

(2015) (Global) Methods

Global obstacles

and facilitators,

system-level

Student

Research

Systematic Review

Review

determinants.⁶⁸

(HIC)

Figure 1: Flow Diagram of Study Selection for Qualitative

Meta-Synthesis

Wilso

Saudi

Qualitative Female

Medical

Gender barriers,

mentorship, cultural

and structural

n et al. Arabia

(2023) (Middle

East)

Students

Inductive thematic synthesis generated four higher-

order analytical themes describing how undergraduate

medical students experience balancing research

engagement with academic demands.

Research

tensions.⁶⁹

Experiences

(HIC)

Murdoc United Qualitative Understand Understanding of

h-Eaton Kingdo

ing

research, identity

m (Eur

et al.

(2010)

Research & development, and

ope)

Research

Skills

curricular

exposure.

RESULTS

(HIC)

The twelve studies (Tab. 1) produced four higher-order

analysis themes that describe how undergraduate

medical students experience and cope with the

balancing act between research and academic

requirements in dierent contexts.

Table 2: Quality Appraisal of Included Studies (CASP Summary)

Author/

year

Clear

aims

Method Data

Analysis Overall

ology

collection rigorous quality

approp on

riate

Mahmood

et al. (2025)

Ahmed et

al. (2023)

Yes

Moderate Good

Table 1: Characteristics of Included Studies in the Meta-

Synthesis

Moderate Moderate Moderate

Author Region Study

(year) design

Title

Major concept

Bobhate et Yes

al. (2024)

Yes

Moderate Good

(Shortened) relevant to the

synthesis

Abdolalipou Yes

r et al.(2024)

Yes

Good

Mahmo Pakistan Qualitative Barriers to

od et al (LMIC) (Interviews) Research

(2025)

Time limitations,

unstructured

Lee et al.

(2023)

Burgoyne

et al. (2010)

Yes

Engagement mentorship, and

structural barriers¹⁶

Yes

Moderate Moderate Moderate

Yes Yes Good

Ahmed Pakistan Qualitative Confronting Institutional

(LMIC) (Inductive Challenges: barriers, coping

et al.

(2023)

Sellberg et Yes

al. (2022)

solutions, and

thematic

research culture

analysis)

Cuschieri

et al. (2021)

Bierer &

Yes

Moderate Moderate Moderate

gaps.⁶⁰

Bobhate India

Mixed

Barriers and Academic stress,

Enablers of motivators, and

Moderate Moderate Moderate Moderate

et al.

(South Methods

Chen (2010)

Amgad et

al. (2015)

Wilson et

al. (2023)

Murdoch-

Eaton et al.

(2010)

(2024) Asia)

(Qualitative Research

structural enablers.⁶¹

(LMIC) Component) Uptake

Iran

Qualitative Factors

Academic stress,

coping techniques,

and performance

Abdola

Yes

Moderate Good

lipour (South (Content

Aecting

Academic

et al.

(2024)

Asia)

(LMIC)

analysis)

Moderate Moderate Moderate

Achievement burden.⁶²

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Balancing Research and Academic Demands in Medical

Theme 1: Negotiating Dual Academic and Research

environments, the absence of protected time, inadequate

research infrastructure, and an enormous faculty

workload prevented meaningful participation.^16,60,68On

the contrary, organized school programs and student

research projects in North America and East Asia

showed how institutional acquiescence justies

Identities

As presented in the Table. 1. There was a continuous

tension between students‘ identities as learners and as

new researchers across studies in Pakistan, South Asia,

Europe, East Asia, and North America. Examinations

and clinical duties were considered a priority in

Pakistan and South Asia and were not negotiable.

Research was commonly seen as an added burden that

demanded personal sacrice.^16,60,61,62European studies

likewise highlighted identity negotiation, with research

viewed as valuable yet secondary to core academic

requirements.^64,65,66,70Conversely, environments in

which research was incorporated into curricular

structures had a more coherent identity. This cross-

context is summarized in Table 3. South Korean and

research

engagement.^63,67

European

literature

demonstrated that research incorporated into the

curriculum reduces role conict and enhances

equilibrium

between

academic

and

research

practice.^65,66Collectively, the synthesis positions

balance as primarily shaped by structural and relational

conditions rather than individual capacity alone. These

institutional comparisons across LMICs and high-

income countries are depicted in the Table. 3.

Theme 4: Adaptive Coping and Self-Regulation

North American studies revealed that formal scholarly Strategies

As indicated across contexts in Table 1, students

programs and research models led by learners promoted

their integration of research into their professional self-

concept.^63,67The synthesis as a whole indicates that

identity integration is eectively mediated by the

institutional research framework within undergraduate

medical curricula (Table 1).

employed adaptive coping strategies to manage

competing academic and research responsibilities.

These included time management, prioritization,

reducing research scope during examination periods,

and compartmentalizing tasks.^62,64,65Self-regulatory

strategies were more evident in structured environments

where research expectations were clearly dened.

Students described aligning research with long-term

Theme 2: Research Engagement as Enrichment

Versus Burden

All of the studies suggest a major dichotomy, as shown

in the Table. 1: Research was seen as both practically

challenging and stimulating to the mind. Beyond the

demanding academic duties, students perceived it to be

engaging and academically useful.^63,64,66,68Although

research was also mostly experienced as an additional

goals,

planning

proactively,

and

monitoring

progress.^63,67However, in settings characterized by

rigid curricula and limited mentorship, coping strategies

were often insucient to oset structural constraints

fully. This institutional comparison is reected in the

Table 3.^16,60,61,69Thus, while individual regulation

supports short-term adaptation, sustainable equilibrium

appears to depend on institutional alignment, as

demonstrated across the studies summarized in the

Table 1. Taken together, the 12 studies in Tab. 1

demonstrate that balancing research engagement with

academic demands is a dynamic, context-dependent

process. Identity negotiation, uctuating perceptions of

benet and burden, mentorship quality, institutional

design, and adaptive strategies interact to shape lived

burden

along

with

the

demands

the

curriculum.^16,60,61,62Pakistani and Indian studies

emphasized time limitations, academic load, and stress

as persistent obstacles.^16,60,61Iranian and European

studies also reported the same nature of workload

stress.^62,65In the context of Middle Eastern studies,

additional social and structural barriers further

complicated engagement in research.⁶⁹These ndings

indicate that institutional support, mentorship, and

workload co-exist and vary in terms of burden and

benet in various settings (Table.3).

experiences

across

geographical

regions.^{16,60,61,62,63,64,65,66,67,68,69,70}Despite overall trends

worldwide, variations across well-organized, high-

income environments and resource-constrained contexts

strongly inuence how research can be easily

incorporated or perceived as an extra burden. To clarify

cross-contextual variations, a comparative construct of

HICICs and high-income countries (HICs) institutional

trends is presented in the Table. 3.

Theme 3: Structural and Relational Determinants of

Balance

As Table. 1 shows that structural and relational

variables played a signicant role in determining

students' ability to balance research and academic

activities, with supportive mentorship reducing stress

and

weak

supervision

amplifying

it.^{16,60,61,63,69}

Engagement sustainability was also aected by

institutional

design.

resource-constrained

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Balancing Research and Academic Demands in Medical

Table 3: Research & Academic Balance Across Institutions of

and Chen (2010) that structured research programmes

in high-income settings help facilitate research

engagement by increasing student understanding,

academic output, and interest in research careers,

though issues regarding balancing between research and

clinical training persist.⁶⁷Combined, these results

suggest that, in LMIC contexts, even identity

negotiation processes are highly fragmented, and

research is on the outside of academic agendas.

Located, however, in the realm of high-income

environments, despite the existing problems, more

curricular integration and institutional support are used

to achieve a more articulated formation of dual

academic and research identities. Research involvement

was presented as an intellectually stimulating, time-

consuming experience, but the experience depended on

the situation. In high-income environments, a South

Korean and Maltese study by Cuschieri et al. (2021)

and Lee et al. (2023) found that research participation

empowered, built condence, and contributed to

professional growth when oered within the framework

of structured or learner-oriented approaches.^63,66Such

results suggest that the positive experience of research

can be taught through institutional support and

curricular integration. By contrast, LMIC-based studies

point to workload overload as the primary factor.

According to Abdolalipour et al. (2024) in Iran,

signicant participation in research was limited due to

academic pressures, and Mahmood et al. (2025) and

Ahmed et al. (2023) in Pakistan reported that research

was done in conjunction with the preparation of

LMICs and HICs

HIC ICs (Pakistan,

Dimension

HICs (Europe, North

America, East Asia)

Current but restrained

by institutional

India, Sudan)

Stronger learner-

Identity

Negotiation researcher role^16,60,61,62

assistance^65,66,69,70

Workload

Stress

Exam-centered, with

emphasis on limited

time^16,60,61,62

Systematic program

lessen burden^63,66,67

Mentorship

Quality

Decient supervision,

unstructured

Well-designed

mentorship

guidance^16,60,70

program^63,67,70

Curricular

Integration

Research tends to be

voluntary or

Institutional scholarly

programs and integrated

research programs^63,67,70

extracurricular^16,60,61

Institutional Resource scarcity and

Institutional support,

recognition, and time

security^67,68

determinant

social

challenges^{16,60,61,62,69}

Gender based

Gender

considerati

ons

Key

interpretive

Managed by designated

bodies^67,68

institutional and

cultural barriers⁶⁹

Balancing stressfully,

institutionally

Institutionally research

validated, balance

facilitated^63,67,70

conclusion

constrained^{16,60,61,62,69}

DISCUSSION

This qualitative

meta-synthesis

examined

how

undergraduate medical students balance academic

workload with research engagement across diverse

contexts. The ndings (Tab.1) indicate that this balance

is not solely an individual responsibility but is largely

shaped by institutional structures, mentorship, and

curricular design. In the literature, a tension emerged

between students’ roles as learners and as new

researchers, though to varying degrees depending on

the situation. Mahmood et al. (2025) and Ahmed et al.

(2023) in Pakistan (LMIC) reported that research was

frequently viewed as an added burden, competing

directly with examination preparation and academic

performance.^16,60Likewise, Bobhate et al. (2024) in

India (LMIC) characterized role strain due to academic

performance-based settings, in which academic

research involvement was challenging to maintain with

academic requirements.⁶¹Conversely, the results from

high-income environments oer a more dierentiated

picture. European authors Murdoch-Eaton et al. (2010)

found that students were uncertain about their

competence in research, indicating the diculty in

building a research identity.⁷⁰High-income settings.

Burgoyne et al. (2010) observed that although students

examinations,

which

resulted

fatigue

and

overwork.^16,60,62Such results indicate that research can

be seen as an extra burden and not a value-adding

exercise in resource-deprived and examination-focused

settings. The dimension of burden also prevails in some

conditions, even in high-income contexts. Wilson et al.

(2023) found that female Saudi students perceived a

greater burden of research engagement due to

institutional and gender-based barriers.⁶⁹In line with it,

Amgad et al. (2015) emphasized the fact that

institutional infrastructure and balance between

workloads are fundamental to the experience of

research as a benecial or burdensome process.⁶⁸All

these results can be interpreted to mean that research

engagement is a continuum between enrichment and

overload. The institutional support and academic

pressure in LMIC settings hinge on this balance and

burden, making it harder. In high-income settings,

academic programmes make the experience more

valued research highly and appreciated its role in pleasant and fullling, but they still face contextual

medical practice, their awareness of institutional challenges that might persist. The emergence of

research opportunities and the sense that research was structural and relational factors proved pivotal drivers

unrelated

clinical

practice

aected

their of sustainable research-academic balance, but their

participation.⁶⁴Moreover, it was evidenced by Bierer roles diered depending on the context. Mahmood et al.

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Balancing Research and Academic Demands in Medical

(2025) and Ahmed et al. (2023) reported that weak adaptive self-regulatory strategies both in the LMIC

supervision, unclear expectations, and inadequate and high-income environments, their eectiveness is

institutional support were the greatest barriers to largely dependent on alignment in institutions.

effective research engagement in LMIC settings, Structural constraints in LMIC contexts limit coping,

especially in Pakistan.^16,60In high-income countries, whereas in high-income settings, supportive systems

studies reveal the benecial eect of instituted make personal approaches more eective and allow a

mentorship and institutional support. According to Lee more sustainable balance. The relationship between

et al. (2023), relational trust and the overall continuity research and academia is shown in the Table. 1 is a

of faculty mentorship led to condence and continuity relative balance mainly inuenced by institutional

in research activities.⁶³On the same note, Sellberg et al. settings, mentoring, and workload. In LMIC contexts,

(2022) also emphasized that structured supervision research is often cumbersome due to limited resources

promotes adaptation to competing academic demands.⁶⁵and a focus on examination systems, unlike in high-

Bierer and Chen (2010) have also shown that income settings, where curricular integration and

institutionalised

systematic platform that justies student involvement variations make the dierence between experiencing

and promotes long-term involvement, whereas research as an enrichment or a strain, and it is important

research

programmes

oer

support can make research more sustainable. These

Murdoch-Eaton et al. (2010) identied the relevance of to note that curriculum design, mentorship, and

well-stated research competencies in undergraduate protected time should be aligned. The meta-synthesis

programmes.^67,70As a whole, all these ndings point to shows that research engagement in undergraduate

the fact that research-academic balance is mostly medical education cannot be considered an appendix

mediated

structurally.

There

are

fragmented but, rather, should be planned and organized as an

lack of inseparable part of academic needs. When research is

engagements in LMICs caused by

infrastructure and unorganised mentoring, whereas seen as extracurricular, there is role conict and strain

smooth engagements in high-income settings are of workloads. Examination driven study settings in

enabled by organised supervision, safeguarded time, studies indicated that research is considered

and curriculum alignment to enable sustained contacts secondary consideration to regular academics, but that

in research activities. Students in dierent settings used when structured programs have integrated into the

adaptive coping and self-regulatory strategies to curriculum, the legitimacy and sustainability are

balance competing academic and research demands, yet presented. The ndings imply that research ought to be

did not manage these demands equally across settings. institutionalized instead of being an optional

In LMIC settings, it was common that individual activity.^{16,60,61,62,66}

Longitudinal,

curriculum-based

strategies could not overcome structural constraints. research pathways need to be implemented at medical

Mahmood et al. (2025) and Bobhate et al. (2024) also schools because Murdoch-Eaton et al. (2010) stated that

reported that Pakistani and Indian students used time well-dened

research

competencies

minimize

ambiguity and enhance identity coherence.⁷⁰Workload

compression emerged as a consistent determinant of

management

and

prioritisation

but

remained

constrained by inexible curricula and exam

pressures.⁶¹Equally, Abdolalipour et al. (2024) in Iran overload across contexts. Abdolalipour et al. (2024) and

Bobhate et al. (2024) demonstrated that students

frequently conduct research during the evenings or

examination periods, which contributes to fatigue and

diminished well-being. Similarly, Mahmood et al.

(2025) identied time scarcity as a major structural

highlighted the importance of attention to planning and

time organisation as one of the strategies to sustain

academic performance, but these factors did not allow

complete participation in the research.⁶²Conversely,

existing research in high-income backgrounds suggests

that coping mechanisms are better when organizational barrier.^16,60,61,62Institutions should therefore consider

introducing

protected

research

time,

exible

frameworks reinforce them. Sellberg et al. (2022)

showed that adaptive role negotiation in dealing with

scheduling, or credit-bearing research modules. Lee et

al. (2023) illustrated that learner-driven research

programs, when structurally supported, enhance

competing

demands

occurs

through

structured

supervision.⁶⁵But even in these settings, there are still

shortcomings; Wilson et al. (2023) found that

institutional and gender-based constraints in Saudi

Arabia minimized the eectiveness of individual

coping behaviors.⁶⁹The ndings are also consistent

with Amgad et al. (2015), who stressed that institutional

facilitators, not personal resilience, are determining

factors of long-term research engagement.⁶⁸On the

whole, these data imply that although students used

engagement

without

compromising

academic

performance.⁶³Without temporal alignment between

research and academic expectations, promotion of

research may intensify stress rather than enrich

learning.^16,60,61,63Across studies, mentorship quality

consistently dierentiated enriching from stressful

research experiences. Mahmood et al. (2025) and

Ahmed et al. (2023) identied supervision gaps as

April - June 2026

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122

Balancing Research and Academic Demands in Medical

significant barriers, whereas Lee et al. (2023) a liability, but an important part of medical education,

especially in various LMIC and high-income settings.

emphasized relational trust as foundational to sustained

engagement. Burgoyne et al. (2010) similarly

highlighted the motivational role of supportive faculty

CONFLICT OF INTEREST: None

relationships.^16,60,63,64

Investment

structured

mentorship systems, faculty development, and clear

FUNDING SOURCES: None

supervisory expectations

therefore

essential.

Sustainable research engagement appears to depend as

much on relational scaolding as on curricular

design.^16,60,63,65Institutional signaling strongly shapes

student priorities. Bierer and Chen (2010) demonstrated

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Shaikh Fahad Salah- Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript; Final

Approval

Naveed Afzal Khan - Concept & Design; Data Acquisition;

Drafting Manuscript; Critical Revision; Final Approval

Bela Inayat - Concept & Design; Data Acquisition; Drafting

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Naheed Mahsood - Concept & Design; Data Acquisition; Data

Analysis/Interpretation;

Revision; Final Approval

Drafting

Manuscript;

Critical

Ayesha Junaid - Concept & Design; Data Acquisition; Data

Analysis/Interpretation;

Revision; Final Approval

Drafting

Manuscript;

Critical

Junaid Sarfaraz - Concept & Design; Data Acquisition; Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Supervision; Final Approval

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

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