Despite the unprecedented humanitarian crisis in Syria, Syrian students sought to develop their research skills by attending numerous in-house and online workshops conducted through Syrian efforts or provided by international organizations. This study was novel in providing a broad overview of the characteristics and effectiveness of all these interventions used during the first ten years of the Syrian armed conflict. We first proved that attending more of these workshops was associated with higher research knowledge, attitudes, and productivity. Then, we showed that self-reported research knowledge had particularly the strongest correlation with the number of attended workshops and was also the strongest predictor of the number of conducted and published research projects. Additionally, we could, using participants’ evaluations, show that these extracurricular interventions were more effective than curricular training and as valuable as practical peer support during ongoing research projects. Finally, we presented a scheme summarizing all the modifiable personal factors that play a role in improving or hindering research productivity in our limited resources settings (Fig 6).

Even in countries where research training is deeply rooted as a part of the curriculum, research workshops seemed to be the most effective way of training (22). These workshops are also widely recognized as an effective tool for promoting medical research in low- and middle-income countries (LMICs) (23–25). In Syrian, they were suggested as an attainable alternative to address the shortcomings of the research curriculum (10,16). Previous reports assessing individual interventions that targeted research skills including EBM and academic writing in Syria highlighted the knowledge-enhancing effects of their workshops (11,13,14,26), or at least improvement limited to attendees’ confidence (27), or perceived skills (15). Additionally, a recent cross-sectional study on Syrian residents suggested that attending more trainings on medical research correlates with better practices of EBM (28). We similarly proved that attending more research workshops has a significant positive impact on research-related knowledge. Although this finding comes in line with previous reports, it uniquely generalizes their findings employing a novel comprehensive assessment that pooled all eligible interventions in the study period and recruited a large sample size from several universities and academic levels.

Our findings also confirmed that participants who attended more workshops reported higher attitudes towards research, which was described as a major outcome of one workshop targeting EBM.(26) Notably, attitudes towards research were less strongly correlated with workshops attendance compared to knowledge. We can attribute that to the fact that medical personnel in Syria, even those who have never conducted any research project, generally reported high attitudes towards research (10,16), and this does not apply to the poor research-related knowledge repetitively reported (21,28,29). The weak impact of workshops on attitudes can also be due to the limited effectiveness of workshops in addressing certain research barriers, such as language, internet connection, and time availability (10,11,16,29), thus, hindering attitudes strengthening towards medical research.

Despite that, when it comes to studying the improvement in research productivity, trainings on research skills can achieve it in several pathways (Fig 6). Our previous article established that self-reported knowledge explains much of the variability in the number of conducted and published scientific papers (21). The current study also proves that attending research-related workshops as an independent factor has a positive additional value on research conduction. This can be attributed to the development of leadership and time management skills through extracurricular activities (30) and the possibility to engage more effectively in the research community during such trainings (31). The extracurricular workshops in Syria were also suggested to help in establishing research networks that foster research knowledge and participation, in addition to enhancing students’ understanding of research materials (10,20). The higher research productivity we found among participants who attended longer workshops supports this logic, as the time by itself may offer a higher probability to the establishment of the aforementioned research networks. Although, the literature suggests that shorter courses can be of higher feasibility and effectiveness (12,32), they might not offer further mentorship after the training (33), possibly suggesting a lower impact on research productivity, which meets our findings.

Although MOOCs and traditional learning showed similar effectiveness in medical education by means of a meta-analysis (34), MOOCs remain a valuable, and sometimes the only, asset in LMICs to acquire the needed knowledge and skills to conduct research projects (35). In line with that, our study found that participants who attended MOOCs reported higher knowledge and research productivity than those who attended other workshops. This can be explained by the findings of Li et al, which highlighted that MOOCs attendees tend to have higher motivation to learn (36). The open-structure of MOOCs also allows students to design their individual learning objectives depending on their needs (37). Therefore, we can speculate that participants who had running projects preferably attended MOOCs to address the specific knowledge gaps they faced during the progress of their projects, which could be the reason behind the higher knowledge and research conduction we found among MOOCs attendees. A similar pattern was evident in an academic writing workshop, where participants who practiced research skills through writing assignments gained higher objective knowledge than those who did not achieve these assignments (13).

Although the investigated workshops were in general effective in improving research knowledge, attitudes, and productivity, it is difficult to believe that Syrian healthcare personnel leveraged from the full capacities of these interventions. It was quite evident that these interventions lacked a consistent pattern across the different cities and varied in terms of content, delivery, and targeted group(s). This lack of organization can be attributed to the fact that they were in most cases driven by the needs in their proximity, which suggests a significant room for improvement if they become tailored based on up-to-date representative assessments of the needs and barriers towards research (10,13,16,21). On the other hand, we assume that the lack of institutional collaborations constrained the amplitude of benefit, especially from in-house workshops, to specific groups and locations. Therefore, it is important to emphasize the role of the concerned faculties and ministries in organizing research training efforts. This is particularly relevant in developing countries, where personnel with decision-making capacities are less involved in the scientific progress (38).

Nevertheless, this study emphasized the role of peers in pushing the wheel of research training in Syria (9). The vast majority of in-house trainings, as well as some online workshops, in our analysis relied heavily or completely on under- or postgraduate peer trainers with wider research experiences and higher research-related knowledge and attitudes. This role of peers was particularly underlined in countries grappling with significant training gaps and depletion of professionals, as reported in the Syrian case (10,11,13,16). The reliance on peers in such settings is both justified and indispensable, as peer-led training presents a practical and affordable solution that alleviates the burden on professors and faculty members (39,40). Superiority of peer training might also be argued, as one study also reported negative experiences (e.g., uncomfortable interaction) in extracurricular activities delivered by faculty members (30). Notably, the support from peers extended beyond extracurricular trainings to personalized peer-to-peer assistance during ongoing research projects (9,16). Our study further underscored that these two forms of peer-support are of comparable value in the gained knowledge, attitudes, and practice. Interestingly, both of these methods were significantly more valuable to beneficiaries than the previously deemed substandard curricular research training (10,11,16), suggesting them as an established solution for the dearth of expertise in Syria (13).