Abstract
Background
Elective courses give medical students opportunities to explore interests beyond core curricula and influence career decisions. The current study aimed to assess undergraduate medical students’ satisfaction with these elective courses and gather their suggestions for improvement in curriculum design.
Methods
A cross-sectional comparative study was conducted using a validated online and self-administered questionnaire among undergraduate medical students at Al-Azhar University (Egypt) and Jazan University (Saudi Arabia). Satisfaction was measured on a 5-point Likert scale. Statistical analysis included t-tests and chi-square tests (SPSS v25), with p ≤ 0.05 considered significant.
Results
Among 1,027 students (83.1% Egyptians), the overall satisfaction score was 31.9 ± 5.8. A total of 61.1% reported a positive experience. Satisfaction was significantly higher among Saudi students (mean = 35 ± 6.2) compared to Egyptian counterparts (mean = 31.3 ± 5.5; p = 0.001) with a medium to large effect size (Cohen’s d = 0.63). Only (42.4%, 56.5%) felt they achieved course objectives, their expectations were met respectively and 33.2% indicated instructors required further training.
Conclusion
Students were moderately satisfied with elective courses, with notable differences across institutions. Curriculum reforms should consider student feedback, expand course options, and improve instructor preparedness.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12909-025-07728-0.
Keywords: Electives, Medical education, Student satisfaction, Egypt, Saudia Arabia
Background
Elective courses (ECs) have become a vital component of modern medical curricula at many institutions [1], offering students the flexibility to select subjects that align with their interests, academic objectives, and career aspirations [2]. The term “elective” indicates that the subjects are optional, and students can select them from a variety of available options within the curriculum [3]. ECs are designed to enhance student motivation, foster active learning, and offer real-world experiences beyond the traditional curriculum worldwide [2]. Recent literature emphasizes that well-structured elective programs contribute to academic success, skill acquisition, and professional identity formation [2, 4]. Moreover, ECs support learners’ autonomy and contribute to more personalized education, which is especially relevant in competency-based medical education models [5].
Despite these recognized benefits, there remains limited research on students’ satisfaction with ECs as an indicator of course quality [6]. Existing studies often lack comparative cross-cultural insights or focus narrowly on institutional evaluations. There is a pressing need to understand how elective course experiences vary across different academic contexts, particularly between institutions in Egypt and Saudi Arabia, where curricular approaches and institutional support structures may differ. Al-Azhar University, Faculty of Medicine for Girls (FMG)(Egypt) and Jazan University (Saudi Arabia) both designed EC programs integrated across academic years (from 1st till 5th year) allowing students to tailor their learning through a variety of course options to become effective physicians. However, little is known about how students perceive these offerings and whether their experiences meet educational expectations.
To the best of our knowledge, few studies have examined students’ experiences with this recently implemented elective program, particularly in Middle Eastern nations. To bridge this gap, we carried out this study to assess the satisfaction of undergraduate medical students at Al-Azhar and Jazan Universities with their elective courses and to identify their suggestions for future improvement. The findings are intended to inform the institutions and curricular revisions tailored to regional educational needs.
Methods
Study design and setting
A descriptive cross-sectional comparative study was conducted among undergraduate medical students at Al-Azhar University (FMG), Cairo, Egypt) and Jazan University (Saudi Arabia). These institutions were chosen based on geographical representation of medical education in the region, similar curricular structures, and accessibility for data collection. At Al-Azhar, electives are limited in number and scope, often tied to departmental offerings without formal student selection mechanisms. In contrast, the Saudi institution offers a structured elective program aligned with the national competency framework, giving students broader choices and more academic guidance.
This comparison allowed us to identify potential differences and similarities in elective course satisfaction between the two countries, adding depth to our findings.
Sampling methods
A minimum of 20% of students from each academic year (first through fifth) were targeted using a stratified random sample technique with proportional allocation. Since there was no prior information on student satisfaction, 50% of the total scores provided the maximum sample size, the required sample size was determined at a 95% confidence level with a 5% margin of error.
Female students from Saudi Arabia and Egypt attending Al-Azhar and Jazan Medical School in the academic year 2023–2024 were included in the survey, while students of other nationalities and those who provided incomplete answers were excluded.
Ethical considerations
All operational actions are agreed with the Declaration of Helsinki. Ethical approval was obtained from the Standing Committee for Scientific Research at Jazan University (Approval No. HAPO-10-Z-001). Feedback from students was encouraged voluntarily and their agreement has been regarded as informed consent. All responses are completely anonymous and have been kept confidential. To clarify, the data consisted exclusively of responses to the evaluation questions, presenting minimal risk in relation to what could be gained regarding students’ views and their suggestions for improvement ECs.
Measurement
Data was collected via anonymous, self-administered questionnaire distributed through universities platforms and student groups. The questionnaire was developed after reviewing relevant literature [1–3]. To evaluate its validity and clarity, a sample of 20 students participated in a pilot study. The Cronbach’s alpha for the satisfaction items was 0.86, demonstrating good internal consistency. Three specialists in medical education first examined the content validity. They were chosen because of their expertise in elective courses teaching and assessment.
The questionnaire took 6–8 min to complete, that included the following information:
I-Personal data
age, university, country, academic year and study phase (preclinical/clinical).
II-Elective course experience
Number and type of electives taken, reasons for course selection, whether courses were self-selected or assigned and students’ experiences of former elective courses.
III-Satisfaction assessment
A 5-point Likert scale (1 being strongly disagree to 5 being strongly agree) was used to score nine items. Data were reduced to three nominal levels; a neutral option and combining all ‘agree’ and all ‘disagree’ answers into two groups. Each response’s frequency was stated as a percentage of the total participants. An overall satisfaction score was produced by adding up the scores. Low satisfaction was indicated by scores below the mean, whilst high satisfaction was indicated by scores above the mean.
IV-Optional open-ended items
Students provided suggestions for improving electives and described perceived benefits that can be added to students for future career needs.
Statistical design
Data was analyzed using SPSS version 25 (SPSS Inc, Chicago, IL, USA). Descriptive statistics (mean ± standard deviation (SD), frequency, percentage) were done. Independent samples t-tests were used to compare mean satisfaction scores across universities. Chi-square tests examined associations between categorical variables. Missing data was minimal (< 2%) and handled through listwise deletion. (Cohen’s d and Phi coefficient& Cramér’s V) as measures of effect size were applied following t test and chi-square test respectively. The researchers began by thoroughly revising the transcripts of the open-ended responses. Then they identified meaningful information and condensed these into concise units and comparing these units regarding their similarities thereby categorizing the responses. A significance level of p ≤ 0.05 was used throughout.
Results
A total of 1,027 female students across the two medical schools completed the survey, with the majority being from (FMG) Al-Azhar University (n = 853/1560; 83.1%) and the remainder from Jazan University (n = 174/305; 16.9%). The overall response rate was approximately 83% for all students. Most respondents were in the preclinical phase (57.2%), with the highest participation (45.3%, 41.1%) from the 3rd-year and 1st-year respectively. The percentage of those in pre-clinical phase significantly differed by university (FMG vs. Jazan: 62.6% vs. 69.5%). Regarding elective course preferences, 50.1% of students favored both medical and non-medical electives, while 15.4% preferred non-medical only. (Table 1). As shown in Fig. 1 the primary reasons cited by students for their elective course preferences included acquiring diverse knowledge (44.6%), gaining deeper experience in the medical field (28.8%), or being interested in having knowledge of community service (14.0%) and the rest find medical courses are easier to study or their choice based upon university requirements.
Table 1.
General characteristics of medical students
| Variables | Total students N = 1027 |
Al-Azhar students, N = 853 | Jazan students, N = 174 |
p value | |||
|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | ||
| Academic phase | 0.001* | ||||||
| -Preclinical | 587 | (57.2) | 543 | (63.6) | 121 | (69.5) | |
| -Clinical | 440 | (42.8) | 310 | (36.4) | 53 | (30.5) | |
| Number of elective courses | 0.001* | ||||||
| 1 | 165 | (16.1) | 132 | (15.5) | 33 | (19.0) | |
| 2 | 236 | (23.0) | 184 | (21.6) | 52 | (29.9) | |
| ≥3 | 626 | (60.9) | 537 | (62.9) | 89 | (51.1) | |
| Preferred elective courses | 0.002* | ||||||
| -Medical | 354 | (34.5) | 294 | (34.5) | 60 | (34.5) | |
| -Non-Medical | 158 | (15.4) | 112 | (13.1) | 46 | (26.4) | |
| -Both | 515 | (50.1) | 447 | (52.4) | 68 | (39.1) | |
*p value determined using chi-square test, statistically significant at ≤ 0.05
Fig. 1.
Students’ reasons for preferring Elective courses. This figure displays the reasons mentioned by students for their elective course preferences among the total sample (N = 1,027)
Students’ previous experiences with electives varied. Approximately 55.7% reported selecting electives due to few options, and 51.4% indicated their choices were assigned by the student office. Elective courses were often chosen based on interest (58.9%) or perceived ease (54.7%). Overall, 63.1% of students felt instructors approached electives with seriousness as they did with obligatory courses, and most agreed that electives enhanced learning (59.2%) and clinical preparation (61.2%). However, 44.3% reported that students took electives less seriously because they perceived them to be easy or due to a lack of formal grading. According to university, there was a statistically significant higher means among Saudi than Egyptian students (Table 2).
Table 2.
Responses of medical students to statements on previous experiences of electives
| Statements | All responses | Al-Azhar Students, N = 853 Mean ± SD |
Jazan Students, N = 174 Mean ± SD |
P value | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Agree | Neutral | Disagree | aMean ±SD | |||||||
| n | % | n | % | n | % | |||||
| I chose electives from the available options | 572 | (55.7) | 274 | (26.7) | 181 | (16.7) | 3.7 ± 1.1 | 3.5 ± 1.1 | 3.7 ± 1.3 | 0.001* |
| I selected some electives that I interested most | 605 | (58.9) | 287 | (27.9) | 135 | (13.2) | 3.7 ± 1.1 | 3.6 ± 1.1 | 4.2 ± 1.1 | 0.001* |
| I selected electives that were easy to pass based on advice from senior students | 562 | (54.7) | 258 | (25.1) | 207 | (20.2) | 3.5 ± 1.2 | 3.5 ± 1.1 | 3.9 ± 1.3 | 0.02* |
| Some electives were assigned to me by the faculty administration | 528 | (51.4) | 253 | (24.6) | 246 | (24.0) | 3.5 ± 1.2 | 3.5 ± 1.2 | 3.8 ± 1.3 | 0.003* |
| Staff taught elective courses with a similar level of enthusiasm as the curriculum | 648 | (63.1) | 280 | (27.3) | 99 | (9.6) | 3.7 ± 0.9 | 3.7 ± 0.9 | 4 ± 1.1 | 0.004* |
| I approached electives differently because they are not graded | 455 | (44.3) | 342 | (33.3) | 230 | (22.4) | 3.3 ± 0.2 | 3.3 ± 1.1 | 3.6 ± 1.3 | 0.001* |
| The elective courses provided students with active learning methods, such as discussions / participation, similar to compulsory courses. | 608 | (59.2) | 288 | (28.0) | 131 | (12.8) | 3.6 ± 0.9 | 3.5 ± 0.9 | 4.1 ± 1 | 0.001* |
| The elective courses allowed different experiences and skills compared to compulsory courses | 633 | (61.7) | 288 | (28.0) | 106 | (10.3) | 3.7 ± 0.9 | 3.6 ± 0.9 | 4 ± 1 | 0.001* |
| The duration of elective courses provided opportunities to work on scientific research | 558 | (54.3) | 345 | (33.6) | 124 | (12.1) | 3.5 ± 0.6 | 3.6 ± 0.9 | 4.1 ± 1 | 0.002* |
| The elective courses included content relevant to future clinical practice | 629 | (61.2) | 293 | (28.5) | 105 | (10.2) | 3.7 ± 0.9 | 3.5 ± 0.9 | 3.9 ± 0.9 | 0.001* |
a Independent t.test was used for quantitative data, * p is significant
Table 3 presents student satisfaction score with electives taken to date: some responses were positive as many of the students (74.7%, 66.3%) agreed electives ran on schedule and found them well organized respectively, Consequently, half (51.1%) of students found these courses worth the cost and effort. Although 56.5% said electives met their needs, only 42.4% reported achieving set objectives. Common complaints included content complexity (48.2%) and insufficient training opportunities under supervision (35.4%). The overall students’ satisfaction was (61.1%), Saudi students reported significantly higher satisfaction (mean score = 35 ± 6.2) than Egyptian students (31.3 ± 5.5; p = 0.001), with medium to large effect size (Cohen’s d = 0.63).
Table 3.
Students’ satisfaction with their elective experience according to institutions
| Statements | All responses | Al-Azhar Students, N = 853 Mean ± SD |
Jazan Students, N = 174 Mean ± SD |
P value | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Agree | Neutral | Disagree | Mean ± SD | |||||||
| n | % | n | % | n | % | |||||
| Effective course contents and implementation | ||||||||||
| -The classes ran on schedule | 767 | (74.7) | 193 | (18.8) | 67 | (6.5) | 4 ± 0.9 | 3.8 ± 0.9 | 4.1 ± 1 | 0.001* |
| -The lectures were well organized | 681 | (66.3) | 245 | (23.9) | 101 | (9.8) | 3.8 ± 0.9 | 3.7 ± 0.9 | 4 ± 1 | 0.001* |
| -aI had adequate opportunities for training under supervision in medical elective courses | 390 | (37.9) | 274 | (26.7) | 363 | (35.4) | 3.1 ± 0.2 | 2.9 ± 0.6 | 3.7 ± 0.7 | 0.001* |
| -Some contents of the elective courses were complex and hard to understand | 495 | (48.2) | 351 | (34.2) | 181 | (17.6) | 3.4 ± 0.6 | 3.4 ± 0.5 | 3.8 ± 0.7 | 0.001* |
| -The elective courses are worth the time and effort | 525 | (51.1) | 351 | (34.2) | 151 | (14.7) | 3.5 ± 0.9 | 3.4 ± 0.5 | 3.8 ± 0.7 | 0.001* |
| Relevance of learning outcomes | ||||||||||
| -The courses met my needs (academically, clinically, and socially) | 580 | (56.5) | 327 | (31.8) | 120 | (11.7) | 3.6 ± 0.6 | 3.5 ± 0.5 | 4 ± 0.7 | 0.001* |
| -The contents of some elective courses reflect the needs of my community | 669 | (65.1) | 280 | (27.3) | 78 | (7.6) | 3.8 ± 0.9 | 3.7 ± 0.5 | 4.1 ± 0.7 | 0.001* |
| -I was able to achieve the objectives I had set for myself | 436 | (42.4) | 386 | (37.6) | 205 | (20.0) | 3.3 ± 0.1 | 3.2 ± 0.3 | 3.7 ± 0.5 | 0.001* |
| Overall experience about electives | ||||||||||
| I am satisfied with the quality of the elective courses | 590 | (57.5) | 330 | (32.1) | 107 | (10.4) | 3.6 ± 0.9 | 3.5 ± 0.3 | 3.8 ± 0.5 | 0.001* |
| Overall satisfaction | ||||||||||
|
b Mean ±SD cHigh (n,%) Low (n,%) |
31.9 ± 5.8 627 ( 61.1%) 400 (38.9%) |
31.3 ± 5.5 490 (57.4%) 363 (42.6%) |
35 ± 6.2 137 ( 78.7%) 37 (21.3%) |
0.001* 0.001* |
||||||
a(e.g., active involvement in the wards or clinics and contact with patients, etc.) b Independent t.test was used for quantitative data followed by (Cohen’s d = 0.63) to measure effect size, cchi-square was used for qualitative variables, * p is significant -
Regarding academic phase, Fig. 2. shows that most of (78.5% &79.2%) pre-clinical and clinical students respectively at Jazan university reported statistically significant higher level of satisfaction than Al -Azhar university (54.7%&62.3%) with moderate strength of the association Cramér’s V (V = 0.15).
Fig. 2.
Distribution of students’ satisfaction towards electives courses according to academic phase at Al-Azhar and Jazan Universities. This figure shows different levels of satisfaction towards electives courses among students at different universities regarding their academic phase
Suggestions for improving electives included practical training and facilitating Inter-institutional mobility (65.8%), fewer topics in greater depth (58.4%) and shifting to online delivery (41.2%). Only 33.2% cited instructors required additional training to be competent (Table 4).
Table 4.
Students’ suggestions for improving the elective curriculum
| Suggestions | Percentages (%) | Feasibility |
|---|---|---|
| Practical Training and Inter-institutional Collaboration | 65.8% |
-Enhanced Practical Experience: Elective courses should incorporate more hands-on practice opportunities within laboratories or clinical settings that are necessary for skill acquisition. -Organizing field electives outside traditional medical institutions can expose students to diverse healthcare practices. -Facilitating greater mobility among students by offering elective courses at other medical schools that promotes broader learning experiences and cultural exchange. |
| Curriculum design (fewer content and deeper structure) | 58.4% |
-Depth Over Breadth: Elective courses should focus on fewer topics but deliver deeper into each subject area. This approach enhances understanding and remembering of complex material. -There is a need for elective courses to bridge pre-clinical knowledge with clinical skills. This integration ensures that students can apply theoretical concepts in practical settings. |
| Courses Modality and Virtual Learning | 41.2% |
- Increasing the number of elective courses available through virtual platforms can enhance accessibility for students who may have geographical barriers. -Blended learning Approaches: The institutes can combine online learning with in-person sessions that provide different learning styles while maximizing resource use. |
| Staff members development to be competent | 33.2% |
-Faculty members can be engaged in ongoing training programs that focus on the latest advancements in medical education, teaching methodologies, and assessment techniques. This could involve workshops, online courses, or conferences. -Implementing structured feedback systems allows faculty to receive constructive criticism from peers and students, which can help in modifying their teaching practices. |
Finally, students perceived the educational benefits included skill acquisition, language awareness, and enhanced communication skills can be added to for their future career (Fig. 3).
Fig. 3.
Frequency of educational benefits for future market needs. This figure shows the educational benefits that can be added to students for their future career
Discussion
Elective courses can improve students’ competency as future medical professionals [4]. The significance of effective courses has been well documented in some studies [6, 7].
This study explored medical students’ satisfaction with elective courses across two institutions in Egypt and Saudi Arabia. The findings indicate moderate to high satisfaction overall, with Saudi students expressing significantly higher level of satisfaction than their Egyptian peers either in preclinical or clinical phase with medium to large effect size indicating a practical meaningful difference between two universities, also, a moderate strength of the association between academic phase and level of satisfaction. This disparity may reflect differences in course delivery, institutional resources, or faculty development programs between the two universities. Also, availability of academic and career counseling, along with up-to-date study materials at Jazan university that supports student development and satisfaction. Our results in line with those of Ramalho et al. and Çolak et al. [2, 3], who noted that well-designed elective programs contribute to student engagement and learning satisfaction. The higher satisfaction levels among Saudi students could be attributed to greater autonomy in course selection and more diversified course offerings, which were noted in previous regional studies [4, 8].
The study also highlights challenges that influence satisfaction, including limited course availability or even ascribed to them by the student office. In agreement, Agrawal et al. [9] revealed that 72.8% of students were satisfied with the structure of the electives due to some of them being unable to select the topic they preferred. These issues were similarly reported by Vidja et al. [4] who observed that restricted choice and administrative assignment of electives undermine the intended flexibility of elective programs. This suggests a greater need for elective courses that align with students’ interests and relevance to their goals. On the contrary, Stone et al. [10] stated that students in UK medical schools could choose their own elective courses. This self-directed approach enables students to select the curriculum content and defining their own learning objectives within the framework of the course.
Students valued courses that provided hands-on learning, supported professional development, and matched their interests. Also, it is crucial for them to engage in active learning experiences and have more direct contact with patients that is essential for developing higher practical skills, thereby preparing them for future clinical practice. This is in line with previous studies [4, 11]. However, content complexity and limited supervised training were common concerns, similar findings were reported by Harvey et al. [12] and Shumylo [13],.
Notably, more than half of students supported reforms such as adding field electives, online delivery, and inter-institutional mobility. These preferences reflect a growing demand for curricular adaptability and global exposure in medical education, as emphasized by Al-Taher et al. [5].
Better qualified teachers, integration of basic science with clinical cases, and discussing fewer topics in depth to make it easier were cited suggestions by students. In accordance, Ramalho et al. [3] stated that a variety of educational and administrative supports are warranted to help faculty to improve the instructors’ skills for developing and implementing learning outcomes effectively. This flexibility not only enriches students’ educational experience but also prepares them for diverse roles within the healthcare system.
Conclusion
Our findings highlight that medical students value elective courses, though satisfaction varies significantly across institutions. Factors enhancing satisfaction include a variety of course options, relevance to student interests, and opportunities for practical learning. Conversely, limited choice, inadequate supervision, and course complexity detract from the experience. To optimize the educational impact of electives, medical schools should adopt flexible selection policies allowing student autonomy. Additionally, ensuring well-organized courses with robust practical components facilitated by qualified instructors is critical. Finally, embedding student feedback into curriculum design is essential to meet evolving expectations of medical students and prepare them effectively for a dynamic healthcare environment.
Limitation
There are some limitations. For example, it depends on self-reported data, which could subject to response bias. Only female students due to institutional demographics, limiting generalizability to male medical students or institutions with mixed gender as factors influencing elective satisfaction (e.g., preferred learning styles, career interests, interaction with supervisors) may exhibit gender heterogeneity due to biological, sociocultural, or institutional factors. The cross-sectional design cannot capture how student satisfaction with electives evolves over time. Additionally, we didn’t examine the view of program faculty members towards the elective modules, which may give insightful data on overall enhancement as faculty and program administrators possess crucial perspectives on curricular goals, resource constraints, logistical challenges, and intended learning outcomes. Therefore, further studies on faculty members and a larger sample of students including male students and potentially multiple institutions are necessary.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
Thanks for expertise to revise the questionnaire and thanks for participants.
Abbreviations
- ECs
Elective courses
- FMG
Faculty of Medicine for Girls
Author contributions
F.Z. A, I. F, H.A, and S. R. A. Data collection: F.Z. A, I. F, H.A, Z.A.K and S. R. A.Data analysis and interpretation: H. A., I. F. and S. R. Manuscript writing:. F.Z. A, I. F, H.A, Z.A.K and S. R. A. Critical revision of the manuscript for important intellectual content: F.Z. A, I. F, H.A, R.H.,Z.A.K, S.K and S. R. A.
Funding
No funding was received.
Data availability
The raw material is available from the corresponding author on reasonable request.
Declarations
Competing interests
The authors declare no competing interests.
Ethics approval and informed consent to participate
Ethical approval was obtained from the Standing Committee for Scientific Research at Jazan University (Approval No. HAPO-10-Z-001). Feedback from students was encouraged voluntarily and their agreement has been regarded as informed consent.
Consent for publication
Not Applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Change history
9/18/2025
The original online version of this article was revised: The authors would like to correct the affiliations of authors 1, 2 and 4 as their names are repeated after the faculty, and it should be removed as it is not part of affiliation.
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Supplementary Materials
Data Availability Statement
The raw material is available from the corresponding author on reasonable request.