Mentors and Minds: Exploring Feedback of Students and Teachers on Elective Postings under Competency-based Medical Education Curriculum

Abstract

Background:

In 2019, India shifted to competency-based medical education (CBME). This reform allows MBBS students to select electives in basic sciences, clinical programs, and research domains under the Graduate Medical Education Regulations 2019. Electives deepen learning through communicative and instrumental phases, contrasting with mandatory core courses.

Aim and Objectives:

To identify the perceptions of students and teachers regarding the newly introduced electives under the CBME curriculum.

Methodology:

This cross-sectional study was conducted for a 2-month duration among MBBS medical students following the CBME curriculum, particularly the 2019–2020 batch and teachers assigned for different electives in JSS Medical College and Hospital, Mysuru. A total of 197 students underwent elective posting for 1 month. Data were collected using a structured digital self-administered questionnaire designed separately for the students and the coordinators.

Results:

Out of 197 students and 36 teachers, 65.4% (129) in Block 1 and 57.3% (113) in Block 2 felt the duration of elective postings was sufficient. The majority of the students expressed that one more month should have been extended for elective postings. Among the teachers, 38.8% in Block 1 and 33.3% (12) in Block 2 felt the duration of elective postings was sufficient. Regarding the effectiveness of elective postings in evoking students’ interest in the subject, the majority, i.e., 49.4% agreed, whereas 19.4% expressed neutral opinion.

Conclusions:

In the present study, the majority of the students and faculty expressed positive responses about the selection process, implementation, utility, and effectiveness of the electives in the MBBS program.

INTRODUCTION

In 2019, India undertook a landmark reform in medical education by transitioning from its traditional, teacher-centered curriculum to the competency-based medical education (CBME) framework. This shift aimed to elevate the quality of medical training to meet global standards by adopting a more systematic, outcome-oriented, and student-centric approach. The overarching goal of CBME is to produce a competent Indian medical graduate capable of serving as a physician of first contact. Although initially met with resistance due to inadequate faculty training and the complexity of the guidelines, the CBME curriculum was eventually implemented with the support of faculty development initiatives and the Curriculum Implementation Support Program.[1]

One of the most notable reforms introduced under CBME was the inclusion of electives in the undergraduate medical curriculum. According to the Graduate Medical Education Regulations 2019, Part II, these electives allow MBBS students to engage with diverse disciplines through structured postings in basic sciences, clinical specialties, and research.[2]

Electives offer students valuable opportunities to gain firsthand exposure to specific fields of study, potential career paths, or research domains. These early experiences – whether in clinical, laboratory, community, or team-based settings – can have a profound and lasting impact on a student’s professional development. Beyond preparing students for future careers, electives encourage innovative thinking, broaden perspectives beyond routine examinations, and help align personal interests with real-world practice.[2]

Moreover, electives promote transformative learning by fostering deeper engagement through both communicative and instrumental learning processes. Unlike mandatory core courses, electives are optional components of the curriculum that students are nonetheless required to complete, thereby offering flexibility while maintaining essential educational rigor.[3]

Given the recent introduction of electives into the CBME curriculum, it is important to assess how these modules are being perceived by both students and faculty. Understanding the challenges encountered and gathering suggestions for improvement are critical for enhancing the effectiveness of this initiative. In this context, the present study was conducted to explore the feedback of students and faculty members regarding the implementation and impact of electives under the CBME curriculum.

METHODOLOGY

A cross-sectional study was conducted over 2 months among 3^rd-year MBBS students (Phase III, Part I) enrolled under the CBME curriculum, as well as faculty members assigned as coordinators for various electives across different departments at JSS Medical College, a constituent college of JSS Academy of Higher Education and Research (Deemed-to-be University), Mysuru, Karnataka.

The study protocol was approved by the Institutional Ethics Committee (Ref: JSS/MC/IEC/Acad 075/2022-23). Informed consent was obtained from all participants after explaining the purpose and procedures of the study.

A total of 197 students participated in the elective postings, which spanned 1 month and commenced after the successful completion of their Phase III, Part I examinations. A list of available electives, submitted by various departments, was circulated via a Google Form. Students were asked to rank their preferences on a priority scale from 1 (highest preference) to 5 (lowest). In cases where student preference exceeded departmental intake capacity, subsequent choices were considered for allocation. Each student was introduced to the respective subject-level coordinator and was posted in two elective blocks, each lasting 15 days.

Data were collected using pretested, structured, self-administered digital questionnaires – developed separately for students and faculty coordinators. The content validity of the questionnaires was ensured through review by ten experts in medical education.

Section 1 of both questionnaires included an overview of the study, investigator details, assurances of data confidentiality, and an informed consent statement.

Section 2 of the student questionnaire covered sociodemographic details and items related to the elective experience – such as the type of elective chosen, selection process, adequacy of duration, scheduling, faculty involvement, session regularity, skill-based opportunities, attendance maintenance, use of logbooks, and suggestions for improvement.

The faculty coordinator questionnaire contained similar items, along with additional questions on student punctuality, the perceived need for assessment methods, attendance tracking, and student engagement during the elective period.

Participants were given instructions for completing the questionnaire and received the survey links via email and social media platforms. A response window of 10 days was provided; students who failed to respond within this period were excluded from the analysis.

Data were entered in Microsoft Excel and analyzed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including frequencies and percentages, were used to summarize categorical variables.

RESULTS

A total of 197 medical students and 36 teachers participated in the current study. Regarding the best method for selection of electives among students, majority responded that 58 (29.4%) previous academic performance should be the yardstick followed by 48 (24.3%) should be based on first come first serve basis, whereas among teachers, majority, i.e. 10 (27.7%) felt that the pretest examination is the best way to allocate the students for the electives followed by 7 (9.4%) felt that the first come first serve basis.

Among the students, 129 (65.4%) in Block 1 and 113 (57.3%) in Block 2 felt the duration of elective postings was sufficient. The majority of the students expressed that one more month should have been extended for elective postings. Among the teachers, 14 (38.8%) in Block 1 and 12 (33.3%) in Block 2 felt the duration of elective postings was sufficient. Among the teachers who expressed that the duration was not sufficient, the majority thought one more month should have been extended for elective posting [Table 1].

Table 1.

Perception of the duration of elective postings (n=197)

Duration of electives	Students, n (%)	Teachers, n (%)
Block 1
Sufficient	129 (65.4)	14 (38.8)
Not sufficient	68 (34.6)	3 (8.3)
Block 2
Sufficient	113 (57.3)	12 (33.3)
Not sufficient	84 (42.7)	7 (19.4)

Among the students, 138 (70.1%) in Block 1 and 149 (75.6%) in Block 2 responded that a scheduled timetable was put up by the respective department, and among them, 135 (68.5%) in Block 1 and Block 2 mentioned that the schedule was appropriate according to the duration. Furthermore, 145 (73.6%) and 148 (75.1%) in Block 1 and Block 2 felt the staff were adherent to the schedule [Table 2].

Table 2.

Details of students’ responses regarding planning and implementation of electives

Questions	Block 1, n (%)	Block 2, n (%)
Schedule/timetable put up for electives in the respective department	138 (70.1)	149 (75.6)
Staff were adherent to the schedule/timetable	145 (73.6)	148 (75.1)
Schedule was appropriate according to the duration	135 (68.5)	135 (68.5)
Sessions were conducted regularly and effectively	150 (76.1)	167 (84.8)
Adequate opportunities were provided to the students to explore the subject	151 (76.6)	169 (85.8)
Attendance was maintained by the departments	191 (96.9)	191 (96.9)

Among the students, 150 (76.1%) in Block 1 and 167 (84.8%) in Block 2 mentioned that the sessions were conducted regularly and effectively. 151 (76.6%) in Block 1 and 169 (85.8%) in Block 2 expressed that adequate opportunities were provided to the students to explore the subjects. 96.9% of students mentioned that attendance was maintained by the departments in both the blocks [Table 2].

In the study participants, 175 (88.8%) students recommended electives for future batches and 71 (36.51%) thought that there should be an assessment at the end of electives, and 150 (76.1%) in Block 1 and 159 (80.7%) in Block 2 mentioned that there should be an opportunity for them to give feedback on electives.

Among teachers, 33 (91.6%) recommended electives for future batches and 28 (77.8%) expressed that there should be an assessment at the end of electives, and 27.8% (10) in Block 1 and 38.9% (14) in Block 2 mentioned that there should be an opportunity for them to give feedback on electives [Table 3].

Table 3.

Feedback on common elements at the end of elective postings by teachers and students

Questions	Students, n (%)	Teachers, n (%)
There should be an assessment at the end of the electives (Block 1 and 2)	71 (36.1)	28 (77.8)
Opportunity should be given to provide feedback on electives	159 (80.7)	24 (72.7)
Recommend elective postings for future batches (Block 1 and 2)	175 (88.8)	33 (91.6)

Among the study participants, 76.1% (150) students and 32.4% (12) teachers felt that regular clinical postings should not be continued along with the electives and 86.8% (171) students in Block 1 and 91.3% (180) students in Block 2 felt they were provided with extra information in the electives other than the regular postings, and as a whole, 80% students felt no difficulties during the electives, and among the rest, timing was the major issue during electives.

Among the teachers, 52.8% felt the electives affected their regular schedule, and 77.8% were given a choice to conduct classes for electives. 72.2% of teachers felt there should be a specialized module for teachers before conducting electives, and 88.8% felt the students were adherent and punctual to the schedule posted [Table 4].

Table 4.

Feedback regarding elective postings by teachers

Item	n (%)
Elective postings affected the regular teaching schedule	19 (52.8)
Given a choice to conduct classes for electives	28 (77.8)
Teachers should have a specialized training module before conducting electives	26 (72.2)
Students were adherent and punctual to the schedule posted	32 (88.8)

When asked a question if elective postings really help in evoking interest in the subject among students, 29.1% of students strongly agreed, 49.4% agreed, 7.4% disagreed, 3.4% strongly disagreed, and the rest, i.e. 19.4% were neutral in their opinion [Figure 1a].

Figure 1.

Opinion of students and teachers on whether elective postings helped students to evoke their interest in a specific subject. (a) Opinion of students, (b) opinion of teachers

When asked a question if elective postings really help in evoking interest in students for the subject, 13.8% of teachers strongly agreed, 44.4% agreed, and 41.8% were neutral, whereas none of the teachers disagreed about it [Figure 1b].

DISCUSSION

In our present study, around 197 medical students and 36 teachers participated in the current study. Among the students, 183 (92.8%) in Block 1 and 189 (95.9%) in Block 2 were provided with an opportunity to select their electives.

Based on the article by Sidhu and Mahajan,[4] the challenges faced include teacher’s support, and mentoring was needed by the students, not only for the training in the electives per se but also for choosing a good and required elective. Our study supports that the majority, i.e. 29.4% felt previous academic performance was the best method for selection of electives among students, whereas among teachers, 27.7% felt pretest examination was the best method for selection of electives.

In the study by Ramalho et al.,[5] around 3.3% felt that subjective evaluation was adequate, but 27.5% felt that this method was inadequate, whereas in our study, 36.1% of students and 77.8% of teachers felt that there should be an assessment at the end of electives. In the same study, 3.3% thought that the organization of the elective was adequate; however, in our study, around 76.1% in Block 1 and 84.8% in Block 2 felt that the sessions were conducted regularly and effectively.

In the study by Vidja et al.,[6] 49% agree and 6% disagree that time duration was appropriate for the electives and 6% felt they had an opportunity to develop deeper understanding of the subject, whereas in our study, 68.5% from both Block 1 and 2 felt that the duration was appropriate and 76.6% and 85.8% in Block 1 and 2, respectively, acquired adequate opportunities to explore the subject.

The effectiveness of the elective course was measured across many universities in the USA, Canada, the Netherlands, Saudi Arabia, the UK, and other countries, which showed significant benefits. In our current study, around 29.1% students strongly agreed that their interest was evoked, and 49.4% also agreed to it. This is in accordance with the study conducted by Al-Taher et al.[7] which shows that around 33.5% strongly agreed that electives provided active learning. In the study by Ramalho et al.,[5] 27.5% evoked interest in electives, whereas in the study conducted by Vidja et al.,[6] around 11% perceived there was an opportunity to develop interest in a subject.

CONCLUSIONS

In the present study, the majority of the students and faculty expressed positive responses about the selection process, implementation, utility, and effectiveness of the electives in the MBBS program. However, electives being the newer initiative in undergraduate medical education, finer details of implementation, challenges faced by the institutions, faculty, and students need to be worked out, and the necessary measures should be taken. Increasing elective diversity will help to cater to diverse student interests and career aspirations, and offering flexible scheduling options, including online and hybrid formats, will enhance accessibility. Implementing regular student feedback mechanisms will continuously improve elective quality and provide faculty development opportunities to ensure high-quality instruction and mentorship.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.