Abstract
Background
A one-month long foundation course has been introduced at the entry-level for first-year MBBS (Bachelor of Medicine and Bachelor of Surgery) students in the medical institutions across India from 2019. Therefore, the present study is aimed at describing the experience of implementing a one-month long foundation course conducted for the Competency-based Undergraduate Medical Curriculum (CBUC) of Indian Medical Graduate as per the guidelines from the National Medical Commission (NMC) (erstwhile Medical Council of India, MCI). We have evaluated the student and faculty perceptions towards the effectiveness of the program.
Methods
The foundation course had six modules Orientation, Skills, Field visit to Community Health Centre, Professional Development including Ethics, Sports and Extracurricular activities, Computer Skills, and Language enhancement program. Regular feedback wascollected from students (N = 250) and teachers (N = 26) involved in the Foundation course using a semi-structured questionnaire. The program's overall feedback was also obtained at the end of the course, using a validated questionnaire. The quantitative findings were expressed in frequency and percentage. The qualitative observations (reflections of students and faculty) were subjected to thematic.
Results
The students and faculty appreciated the one-month long foundation course. The course's defined objectives were met as indicated by most students (98.4%) and faculty (75%). The course seemed to be useful for students to embark on a formal MBBS curriculum. It also exposed them to new knowledge and practices, as indicated by the feedback. Thematic analysis of the students' and faculty's reflections was carried out and two themes were identified, i.e., ‘strengths’ and ‘challenges.’ The Foundation Course Committee will work out appropriate remedial measures to overcome the challenges in the future sessions for subsequent batches.
Conclusions
The one-month-long foundation course was found to be beneficial for newly joined students to get introduced and adjusted to higher education systems' demands. Also, the challenges faced during the program needs to be addressed with suitable remedial measures while implementing for subsequent batches. This effort will ensure a smooth conduct of the foundation course for the future batches of medical undergraduates and make the program more effective.
Keywords: Foundation course, Undergraduate medical students, Teaching-learning, Competency-based undergraduate medical curriculum (CBUC), Educational module
Introduction
The selection of students to Indian medical colleges depends on the candidate's merit at the qualifying examination or a competitive entrance examination.1 The selection criteria do not address the non-scholastic abilities of the students. The students who followed rote learning in their pre-medical schooling may find it challenging to cope with medical colleges' altered educational environment. Furthermore, students from different cultural backgrounds may find it challenging to adapt to the new environment.2
The regulatory body governing medical education in the country, National Medical Commission (NMC) erstwhile Medical Council of India (MCI), has rolled out the Competency-Based Undergraduate Medical Curriculum (CBUC) of Indian Medical Graduate from the batch of 2019 for the Bachelor of Medicine and Bachelor of Surgery program (MBBS). The one-month long foundation course (FC) is one of the essential elements and is introduced at the entry-level for first-year MBBS students. The FC aims to sensitize the learners with the required knowledge and skills for starting a challenging professional course. In turn, it would lay a strong foundation for their pursuit of learning throughout the MBBS course and later on a career in medicine.3 The course also emphasizes the various essential roles of the “Indian Medical Graduate” (IMG).4
Foundation course (FC) under competency-based Undergraduate Medical Curriculum (CBUC)
The FC is of a one-month duration after admission to prepare a student to study medicine effectively. It intends to orient students towards the institutional infrastructure and facilities, skills such as first aid, ‘basic life support,’ biohazard safety, environmental issues, learning skills and communication, community orientation, professional development including ethics, language enhancement, and computer skills, sports and extracurricular activities. It also provides an overview of the entire medical curriculum.5
Previous studies on the effectiveness of having a FC for the MBBS students have gained a positive response from the student community.2,6, 7, 8 However, these programs were of a shorter duration of two to ten days. The usefulness of a one-month long FC is less explored. A one-week brief orientation program was also being conducted in our institution every year for the newly joined undergraduate students. It included introducing the course structure, learning methods, technology usage, and peer interactions, facilitating their smooth transition from high school to medical college.2,3 However, a structured FCof four weeks' duration implemented by NMC (erstwhile MCI) in 2019was the first experience for us, just like any other medical college in India.
The new CBUC related FC, unlike the regular one, was spanning one month, and faculty were skeptical about how students would perceive it. As this was the first program and the FC document is very dynamic based on infrastructure and faculty availability, the NMC (erstwhile MCI) had given the flexibility to individual colleges under a broad framework. The success of this program hence primarily reflects on the creativity of faculty and institutional support. Therefore, the faculty and management were keen to reflect on the course conducted as there is enormous scope for improvement and designing.
Therefore, the present study aims to showcase our experience of implementing a one-month long FC prescribed by NMC (erstwhile MCI). It also intends to evaluate the student and faculty perspectives on the effectiveness of the program.
Material and methods
Study population
The study involved 250 newly admitted first-year medical undergraduate students of the 2019 batch.
The study also incorporated the feedback of the 26 faculty (8 males and 18 females) engaged in organizing and implementing the FC. These faculty coordinators were involved in co-ordinating the logistics of various sessions and they observed the various session to provide the feedback.
The participation of the students and teachers was voluntary. The study was approved by the Institutional Ethics Committee (IEC 365/2020).
Implementation of the foundation course
In association with the preclinical departments, the Department of Medical Education implemented the one-month long FCas per the directives of NMC (erstwhile MCI). A Foundation Course Committee (FCC) was constituted to enable effective implementation and smooth functioning.
Formation of the Foundation Course Committee (FCC)
FCC was constituted by the Institution head (Dean) as the Chairperson and a faculty from the Department of Medical Education as the master lead. The members included heads of departments from preclinical departments and other faculty from the Department of Medical Education. The FC encompassed six modules, and six faculty were identified as leads for these modules to permit smooth execution.
The FCC and the Curriculum Committee organized meetings (N = 15) to extensively plan, implement, monitor, and assess the FC's functioning.
The committee was responsible for allocating the resources and design the timetable for the FC. The FCC was also capable of coordinating with the administration and resource persons for various sessions.
The faculty leads were entrusted with conducting their respective modules, collecting feedback, preparing, and providing the summarized report to the FCC. The consolidated report was then submitted to the concerned regulatory authorities by the Dean.
Foundation course-design
The FC had six sections: Orientation, skill module, field visit to community health centre, professional development including ethics (P&E), sports and extracurricular activities, computer skills, and language enhancement program.3 The faculty from preclinical and para-clinical departments coordinated the program efficiently. A total of 180 h was utilized for the conduction of the FC.
A timetable designed incorporated all the modules. The resource persons identified were from different disciplines such as medicine, nursing, allied health sciences, Yoga, library sciences, physical education, humanities, engineering, and humanities. The students were divided into smaller groups to facilitate active learning to fit into the designed time frame. The teaching-learning (T/L) activities used were: small group teaching, field visits, interactive lectures using handouts, video clips, discussions, question and answer (Q&A) sessions. Think-pair-share, demonstrations, role plays, flip charts, reflections, quizzing, games were the other T/L activities considered (Fig. 1). Further, the students were encouraged to write their reflections in a logbook to document the FC experiences.
Fig. 1.
Representative images of excerpts from the foundation course.
The following modules were involved insensitizing the newly joined MBBS students towards medical education as a part of the FC:
Module I–orientation
The orientation module was designed for 30 h.
The FC began with the dawn of an inaugural event- ‘Medorient 2019’. The newly joined students, along with their parents, were invited to attend the program. The students and parents were acquainted and oriented to the course, hospital and campus facilities, infrastructure, student support center, sports facility, and library services. A white coat ceremony was held for the students. Students were thrilled to wear their white coats as a symbol of their entry into the medical fraternity. They also took the Hippocratic Oath.
A session on ‘Meet the Mentor’ followed in the afternoon. In this program, students, along with parents, interacted with the teachers designated to be mentors. Each mentor was allotted a maximum of 8–10 students. The mentors would function as local guardians of the students and help them in their overall personal and professional development. They would also serve as an official first point of contact for parents.
The orientation module also included the following aspects:Introduction to Institution/campus/facilities; role of doctors in the society; history of medicine and alternate systems; roles of an IMG; overview of the MBBS curriculum and various career pathways; principles of family practice.
Module II–skill module
The skill module designed for 35 h covered the following:
First aid: It aimed to develop an understanding and acquire knowledge about common medical ailments, provide first aid for the victims in an emergency, and develop skills and attitude in delivering first aid competently.
Basic Life Support (BLS): The session aimed to equip students with skills required to perform single and two-rescuer cardiopulmonary resuscitation in an adult victim of cardiorespiratory arrest. It also included the skills needed to operate an automated external defibrillator (AED).
Universal precautions, waste Management, immunization,and documentation were the other topics discussed.
The resource persons conducting the sessions were from medicine, nursing, and allied health sciences.
Module III–community orientation module
The community orientation module was of 10 h duration. The following were the sections dealt with:National health goals and policies/health care systems/community health; interactions with patients and families, exposure to primary and secondary health care levels. The resource persons conducting the sessions were from the departments of Community Medicine and Public health.
Module IV–professional development including ethics (P&E)
The P&E module, was designed for 40 h, and the following were the subsections of the module:
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Concept of professionalism and ethics among health care professionals
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Clinical shadowing
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Professional and altruistic behavior
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Working in a health care team
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Outline the concepts of disability, impairment, and handicap
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Cultural competence
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Stress management andTime Management
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Interpersonal relationships
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Group learning, group dynamics, self-directed and collaborative learning
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Principles of family practice,doctor–patient Relationship, healthcare system, and its delivery
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Awareness about reproductive health and common issues related to it (3D: Dreams, Desires, and destiny)
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Foundation of communication
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What can the student expect and expectations from a student, study skills
The other sections dealt with were:
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Innovations in medicine: The need to innovate and the ecosystems provided by the university such as mentoring, monetary support, and bio incubator facilities
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‘What kind of learner are you?’ - In this session, the learner's type was determined using the VARK (Visual, Auditory, Reading, Kinesthetic) questionnaire.9
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AETCOM (Attitude, Ethics, and Communication) module: “Cadaver as First Teacher” was the session that focused on the importance of cadaver in medical education.10 Legal and Ethical Aspects in handing the cadaver and biosafety and biohazard waste management were also discussed.
The resource persons conducting the module sessions were from Medical Education, Centre for Bioethics, Humanities, Psychology, Clinical psychology, and psychiatry.
Module V–enhancement of language and computer skills
The module designed for 40 h included the following subsections:
Enhancement of Language skills: The session included the essential elements of communication skills. It demonstrated the use of local language in interactions with the patients and peers and explained the importance of excellent communication skills in medicine. It also aided in recognizing the common barriers to communication.
The faculty conducting the session on enhancement of language skills were well versed in training the students in local language, i.e. Kannada.
Enhancement of computer skills: The session demonstrated the necessary computer skills and ways of accessing online resources. The students were also acquainted with the‘E-learning platform’, ‘Student Information System’, ‘Impartus’- the institutional lecture capture systems in classrooms, and ‘E-pad’- the paperless examination systems.
The faculty conducting the session on enhancement of computer Skills were from the School of Information Sciences.
Module VI–sports and extracurricular activities
The sports and extracurricular activities module was for 22 h. The session was designed to demonstrate the importance of work-life balance in a demanding profession and allow students to have compulsory physical activity and showcase their talents.
The module sessions were coordinated by the faculty from the institution's physical education department and various student clubs.
Study instruments
The feedback from the students and faculty regarding the functioning of the FC was obtained using a questionnaire. It included two sections.
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Overall program feedback: The program's overall feedback was obtained at the end of the one-month long FC using a validated questionnaire. The questionnaire describing the usefulness of the session included ten questions. The students and faculty used the same five-point Likert scale questionnaire to give their feedback. The responses ranged from ‘strongly disagree’ to ‘strongly agree.’
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Module wise observations: The students and teachers provided regular feedback at the end of each module. The rating included five options: ‘excellent,’ ‘very good,’ ‘good,’ ‘fair’, and ‘poor’. The same questions was administered to the students and faculty.
The questionnaire also had a section in the end that included open-ended questions that enabled the students and faculty to reflect on their teaching-learning experience and provide their views regarding each module's effectiveness.
Statistical analysis
Quantitative Analysis:The quantitative data were recorded and analyzed using SPSS version 16 (SPSS Inc., Chicago, IL), and the results were expressed in frequency and percentages.
Qualitative Analysis:The observations penned by the students and faculty regarding the effectiveness of each module were subjected to thematic analysis.11 The authors read and re-read the student and faculty reflections and coded the information. The codes were studied to identify the pattern, and the themes and sub themes were identified.
Results
Two hundred fifty newly admitted first-year medical undergraduate students who had undergone the one-month FC participated in the study. Out of 250, 249 (117 males and 132 females) students voluntarily answered the questionnaire. Twenty-six faculty (8 males and 18 females) with teaching experience ranging from 5 to 28 years involved in implementing the course also expressed their opinions.
Overall program feedback
Majority of the students provided a positive feedback regarding the overall program. When asked whether the defined objectives of the one-month long FC were met, 244 (98.4%) students agreed, whereas four (1.6%) denied. Among the faculty, 18 (75%) agreed, and six (25%) disagreed. Fig. 2 shows the student (Fig. 2A) and faculty (Fig. 2B) responses regarding the entire FC. The feedback provided by students and faculty regarding the effectiveness of the FC is represented in Table 1, Table 2.
Fig. 2.
Showing the student (Fig. 2A) and faculty (Fig. 2B) responses summated regarding the entire foundation course.
Table 1.
The feedback provided by the students (N = 249) regarding the effectiveness of the foundation course.
| Strongly disagree | Disagree | Neutral | Agree | Strongly agree | ||
|---|---|---|---|---|---|---|
| 1 | The objectives of the course were clear to me | 3(1.2%) | 2 (0.8%) | 16(6.4%) | 117(47%) | 111(44.6%) |
| 2 | The lecture and workshops were well planned and easy to understand | 1 (0.4%) | 1 (0.4%) | 8(3.2%) | 92(36.9%) | 147 (60%) |
| 3 | The contents were illustrated with adequate examples | 2(0.8%) | 3(1.2%) | 21(8.4%) | 90(36.1%) | 133(53.4%) |
| 4 | The level of the course was satisfactory | 1(0.4%) | 2(0.8%) | 23(9.2%) | 96(38.6%) | 127(51%) |
| 5 | The course exposed me to new knowledge and practices | 2(0.8%) | 1(0.4%) | 13(5.2%) | 114(45.8%) | 119(47.8%) |
| 6 | I feel confident to embark into formal MBBS curriculum | 1(0.4%) | – | 25((10.1%) | 100(40.3%) | 122(49.2%) |
| 7 | The lectures were clear and easy to understand | 2(0.8%) | 1(0.4%) | 11(4.4%) | 117(47%) | 118 (47.4%) |
| 8 | The teaching aids were effectively used | 2(0.8%) | 1(0.4%) | 14(5.6%) | 82(32.9%) | 150 (60.2%) |
| 9 | The course material handed out was adequate | 2(0.8%) | 5(2%) | 23(9.3%) | 105(42.3%) | 113(45.6%) |
| 10 | The instructors encouraged interaction and were helpful | 1(0.4%) | 1(0.4%) | 6(2.4%) | 84(33.7%) | 157(63%) |
The values are expressed in frequency and percentage.
Table 2.
The feedback provided by the faculty (N = 26) regarding the effectiveness of the foundation course.
| Strongly disagree | Disagree | Neutral | Agree | Strongly agree | ||
|---|---|---|---|---|---|---|
| 1 | The objectives of the course were clear to me | – | – | – | 18 (69.2%) | 8 (30.7%) |
| 2 | The course contents met with my expectations | 1 (4%) | – | 3 (12%) | 16 (64%) | 5 (20%) |
| 3 | The lecture and workshops were well planned | – | – | 2(7.7%) | 14 (53.8%) | 10 (38.5%) |
| 4 | The contents were illustrated with adequate examples | – | – | 5 (20%) | 12(48%) | 8 (32%) |
| 5 | The level of the course was satisfactory | – | – | 2 (8.3%) | 15(62.5%) | 7(29.2%) |
| 6 | The course was useful for students to embark into formal MBBS curriculum | – | – | 5(20%) | 14(56%) | 6(24%) |
| 7 | The lectures were clear and easy to understand | – | – | 3(11.5%) | 17 (65.4%) | 6 (23.1%) |
| 8 | The teaching aids were effectively used | – | – | 3(12%) | 11(44%) | 11(44%) |
| 9 | The course material handed out was adequate | – | – | 6(25%) | 12(50%) | 6 (25%) |
| 10 | The instructors encouraged interaction and were helpful | – | – | 1(4%) | 12(48%) | 12(48%) |
The values are expressed in frequency and percentage.
Module wise observations
The students' and faculty feedback for every module is tabulated (Tables 3 and 4).
Every module was rated ‘excellent’ to fair by the students and faculty alike. Among all the modules, the skill module received highest rating by the students marking it as ‘excellent’ (57.7%). The ‘excellent’ rating for the other modules were in the following order: language enhancement (47.2%), P&E (42.7%), orientation (40.7%), community orientation (39.5%), sports and extracurricular activities (34.1%) and computer skills (16.9%). A few modules received the rating as ‘poor’ by the students. The modules that received the ‘poor’ rating were community orientation (0.8%), language enhancement (1.6%), computer skills (12.9%), and sports and extracurricular activities (3.7%).
Module wise feedback from the faculty showed highest rating for the orientation module with 47.8% of faculty marking this module as ‘very good.’ The ‘very good’ rating for the other modules were in the following order: skill (33.3%), P&E (30.4%), language enhancement, sports and extracurricular activities (28%), community orientation and computer skills (20%).
The students' and faculty's reflections regarding the effectiveness of each module were segregated into two themes: ‘Strengths’ and ‘Challenges’. Three sub themes were identified for each theme.
Theme 1: strengths
Under this theme, the following sub themes were identified. ‘Impact on students', ‘Student Learning’,'Student Involvement’.
Impact on students
The one-monthlong FC and its six modules had a significant impact on the students, as indicated by their reflections. Most of the concepts discussed in the modules were new to the students. The introduction to the ‘doctor–patient relationship’ under clinical shadowing was deeply appreciated by the students. The modules in FC enlightened them to involve and explore further actively during sessions. Students were also familiarized with the various cultural diversities that exist amidst them and to learn to interact with each other. The video presentations used as a T/L activity in most of the modules significantly impacted student learning.
“It was a sight to behold! The students taking the Oath beamed with pride and gratitude. The memorable event also witnessed the parents ardently photocapturing their children taking the Oath. There was happiness filled in their hearts.”(As told by a faculty on the ‘Hippocratic Oath’ taking ceremony).
“We got an opportunity to observe the doctor-patient interaction. It was an exciting experience!” (Female student on ‘clinical shadowing’ section of P&E module).
“Videos made a significant impact. It was easy to engage the students. The topic discussed was to the point and crisp.” (Faculty speaks on ‘disability competencies’ section of P&E module).
Student learning
The students found the planned sessions in the FC to be highly informative. The faculty further backed these observations. The sessions evoked the students' interests in learning and seeking more information and knowledge. The critical aspects of healthcare systems were efficiently introduced as indicated by the feedback. The sessions on interpersonal relationships, communication, and learning skills were also ardently followed by the students.
“Students were eager to understand the working of the health care system.” (Faculty speaks on ‘national health goals and policies/health care systems/community health’ section of the community orientation module).
“Highly informative sessions and laid a basis for students to explore more facilities in the healthcare systems.” (Male student on ‘healthcare system and its delivery’ under the P&E module).
“Conducting similar sessions frequently to reinforce the importance of communication is a must throughout the students' learning period.” (Faculty on ‘foundation of communication’ under the P&E module).
“The students familiarized themselves with various aspects of interpersonal relationships.” (Faculty on ‘interpersonal relationships’ under the P&E module).
“Students understood the various skills included in the process of learning.”(Faculty on ‘learning skills’ under the P&E module).
Student Involvement
Students were very interactive during the sessions and were eager and enthusiastic to learn from sessions in the FC. The sessions were exciting, engaging and involved active participation from students. The activities were well planned and executed, as mentioned by the students.
“We, students, were very interactive during the sessions and were eager and enthusiastic to learn more. Sessions involved active participation and were very informative.”(Male student on first-aid and BLS).
“The students were enthusiastic about learning the various ways of documentation and its importance in their profession.” (Faculty speaks on documentation section of the Skills module).
“We were actively involved in the activities. Think, pair, and share the activity we liked the most.” (Female student on ‘working in a health care team’ under the P&E module).
“An exciting session where all the students actively participated. The activities were well planned and executed.” (Female student on ‘stress management’ under the P&E module).
“The students were highly co-operative and eager to learn and participate in the activities conducted.” (Faculty on ‘time management’ under the P&E module).
“Students were eager to learn language skills and their importance in day to day life. The students were excited to learn a new language, i.e., Kannada (local language).”(Faculty on enhancement of language and computer skills module).
“Not only were the sports activities fun-filled, but they also served as means of personality development for young students just entering the medical profession. As there was no competition, we could play without rivalry or the fear of being judged. We could try our hands on any event. It was also an excellent opportunity to break the ice and get to know our batch mates and seniors better since the events were interactive and involved group participation.”(Male student on sports and extracurricular activities module).
“The talented students mesmerized the audience and judges alike during the talent show. Events such as ‘Mad Ads,’ ‘Picture Perfect,’ and ‘Clap’ brightened an otherwise dreary, rainy day.”(Faculty on sports and extracurricular activities module).
Theme 2: challenges
The subthemes identified were- ‘Student Management’, ‘Course Content’, ‘Student Behaviour’.
Student Management
Managing a vast crowd of students was challenging in some of the sessions (modules on skills, community orientation, P&E module, computer enhancement skills). The faculty opined that having too many students in a group made it difficult to interact and explain the concepts in detail. Constraints of space and acoustics were the other challenges faced.
“Conducting the sessions for four long days to teach all 250 students in smaller groups was a hassle.” (Faculty speaks on ‘first-aid’ under the skills module).
“The student group of 60 per session was quite large. It was time-consuming to get every student to have hands-on training on the mannequin for all components of CPR.” (Faculty on ‘BLS’ under the skills module).
“Too many students in a group during discussions, field trips, visit to PHCs made it difficult to follow.” (Female student on P&E and community orientation modules).
“All the students did not get a complete hands-on exposure while learning computer skills.” (Male student on enhancement of computer skills under module V).
Course Content
Student and faculty reflections revealed that the exposure to some of the complicated systems, i.e., National health goals and policies/health care systems/community health, etc., was too early. The students expressed that it was difficult to appreciate these topics at the beginning of the course. Some students and faculty also opined in their reflections that the one-monthlong FC was too long.
The introduction of newer systems at an early stage was hard to understand in community orientation.” (Female student on community orientation module).
“One-month long foundation course was very long and exhausting!” (Male student on overall program feedback).
Student behaviour
Some of the students were hesitant to come forward and interact, as indicated by their reflections. It was also opined that some students found it challenging to learn an entirely new language. Also, the students who were not interested in sports and extracurricular activities were only asked to sit and watch the others play/perform. Other alternate activities were not planned to engage them.
“Finding it difficult to learn/follow an entirely new language (local language) in a short duration.” (Female student on enhancement of language skills under module V).
“Many students who were not interested in sports and extracurricular activities were made just to sit and watch”. (Female student on sports and extracurricular activities module).
Further reflections by the students and faculty regarding the effectiveness of each module are depicted in Annexure 1.
Discussion
The purpose of having a one-month long FC was to sensitize newly joined medical students with the required knowledge and skills that would assist them inacclimatizing to the new professional environment. The first professional year in medicine involves study in Anatomy, Physiology, and Biochemistry. Humanities and community medicine are also introduced in first year of the course. Therefore, the FC would greatly help the students embarking on an intense preclinical curriculum.3
Previous studies on the effectiveness of having a FC for the MBBS students have also benefited the student community.2,6−8The FC helped the students to get oriented with the campus and learning environment. It also helped them acquire confidence to face the challenges in the medical curriculum.2 However, these programs were of a shorter duration of two to ten days.2,6, 7, 8 The functioning of a one-month long FC is relatively new, and its usefulness is less explored.
The one-month long FC was implemented and student and faculty perceptions regarding one-month long FC is presented in this study.
The FC was well appreciated by the students, as indicated by the feedback. 98.4% students and 75% of faculty expressed that the desired objectives from the course were addressed during various sessions. The denial by a small percentage of the population, i.e., four students (1.6%) and six faculty (25%), maybe due to the challenges faced during the conduct of the FC. The challenges have been duly noted and would be suitably addressed in the future sessions of the FC for the subsequent batches.
Modules of the foundation course
Module I- Orientation
The module focused on orienting new students to place (learning environment and facility),teaching schedules and timetables, processes (rules, regulations, policies, and procedures), personnel (faculty, staff, and mentors), and the hospital.5 Higher educational institutions conduct orientation programs for their newly admitted students all over the world. It is to acclimatize them to the resources and infrastructure and acquaint them with teaching programs and academic challenges.12
The student orientation program builds the foundations for developing a community of learning, as indicated by various studies in different disciplines. These studies involved undergraduate students from multiple disciplines, i.e., schools of pharmacy, business, medical sciences, biological sciences, physical sciences, agriculture, faculty of arts, social sciences, and education.13, 14, 15
The orientation module was rated from ‘excellent’ to ‘good’ by the students (94.7%) and faculty (80.8%) in the present study (Table 3, Table 4). None of them felt that the sessions were ‘poor’ or ‘unsatisfactory.’ The sessions were highly informative and interactive as added by the students.
Table 3.
The feedback received from the students (N = 248) at the end of every module of the foundation course.
| Module | Excellent | Very Good | Good | Fair | Poor |
|---|---|---|---|---|---|
| I. Orientation | 101(40.7%) | 89(35.9%) | 45(18.1%) | 13(5.3%) | – |
| II. Skill | 143(57.7%) | 80(32.3%) | 17(6.9%) | 8(3.2%) | – |
| III. Community Orientation | 98(39.5%) | 96(38.7%) | 40(16.1%) | 12(4.8%) | 2(0.8%) |
| IV. Professional Development and Ethics | 106(42.7%) | 85(34.3%) | 48(19.4%) | 9(3.6%) | – |
| VA. Language enhancement | 117(47.2%) | 77(31%) | 39(15.7%) | 11(4.4%) | 4(1.6%) |
| VB. Computer Skills | 42(16.9%) | 42(16.9%) | 63(25.4%) | 69(27.8%) | 32 (12.9%) |
| VI. Sports and Extracurricular Activities | 84(34.1%) | 75(30.5%) | 58(23.6%) | 20(8.1%) | 9(3.7%) |
The values are expressed in frequency and percentage.
Table 4.
The feedback received from the faculty (N = 26) at the end of every module of the foundation course.
| Module | Excellent | Very Good | Good | Fair |
|---|---|---|---|---|
| I. Orientation | 3(13%) | 11(47.8%) | 6(20%) | 3(13%) |
| II. Skill | 4(16.7%) | 8(33.3%) | 9(37.5%) | 3(12.5%) |
| III. Community Orientation | 4(16%) | 5(20%) | 14(56%) | 2(8%) |
| IV. Professional Development and Ethics | 4(17.4%) | 7(30.4%) | 10(43.5%) | 2(8.7%) |
| VA. Language enhancement | 7(28%) | 7(28%) | 10(40%) | 1(4%) |
| VB. Computer Skills | 4(16%) | 5(20%) | 13(52%) | 3(12%) |
| VI. Sports and Extracurricular Activities | 4(16%) | 7(28%) | 11(44%) | 3(12%) |
The values are expressed in frequency and percentage.
Module II- Skills
This module focused on the necessary skills that are considered essential for all health care personnel who deal with patients. Therefore, the students are required to be trained in these skills before entering areas of patient care.5 An earlier study had indicated that the FC would support students coming from diverse learning environments to cope with the knowledge and skills required in the dynamic and rapidly changing healthcare system.2 Skills such as BLS and first aid were hugely acclaimed by the students, as indicated by previous studies.2,7 As expressed from student and faculty feedback (Table 3, Table 4), the findings from our study accords with results from previous studies where skills module received high rating and appreciation.2,7 The students were very interactive during the sessions and were eager and enthusiastic to learn more (subtheme 1.3). However, conducting the sessions for four long days to teach all 250 students in smaller groups was challenging as mentioned by the faculty (subtheme 2.1). Suitable redressal measures need to be taken into consideration to overcome this challenge.
Module III- Community Orientation
The module included field visits to the community and primary health centers (PHCs). These visits provide orientation to the care delivery through community and PHCs and include interaction with health care workers, patients, and their families.5
Community orientation is an essential dimension of primary care. It allows medical practitioners to recognize and address the social and environmental determinants of health through the community.16
Including this module in FC is a good initiative, as indicated by the current study's observations of students' (94.3%) and faculty (92%) perceptions. The students were eager to understand the working of the health care system. They were even happy for the opportunity to visit and observe the functioning of urban and rural health training centers, as indicated by their reflections (subtheme 1.2). However, it was observed that the exposure to some of the complicated systems, i.e., National health goals and policies/health care systems/community health was too early. The students may find it difficult to appreciate the same at the beginning of the course (subtheme 2.2). The same could be gradually introduced at an appropriate time in their undergraduate curriculum.
Module IV- Professionalism and ethics
Professionalism defines a set of values and behavior that build the trust that a patient has in his/her doctor. Ethics are principles that govern the conduct of doctors.5
Professionalism and ethics were previously diffused passively to the students through “the hidden curriculum,” leaving a lot to chance. However, over time, it has been advocated that graduates need to be formally trained in professionalism and ethics concepts.17 Introducing the same at the beginning of the course would help teach a medical student essential virtues at a tender age.
The present study indicated that both students (96.4%) and faculty (91.3%) appreciated the P&E module and its components (Table 3, Table 4). The students were excited to witness the doctor-patient interaction under ‘clinical shadowing. A previous study on the medical students' perception of doctor–patient relationship revealed that the exposure to the psychological aspects of the doctor–patient relationship helps students to comprehend their experiences and should be introduced gradually from the early stages of learning.18 The incorporation of ‘doctor-patient’ relationship in the FC was greatly appreciated by the students as observed in the present study. It could be probably because they could make a close association with medical practice during the early days of their journey to become doctors (subtheme 1.1).
Effective communications and interactions among peers, teachers, patients and other medical staff builds a relationship of trust and boosts the performance at work, i.e., patient-care.19 Introduction to interpersonal relationships and communication skills in the FC was therefore a welcome sign and the students familiarized themselves with its various aspects (subtheme 1.2).
Studies in the past have advocated the application and importance of study skills in learning. Group learning, group dynamics, self-directed and collaborative learning and its usefulness are also highlighted.20 Acquainting the students with these skills at an early stage, i.e., during the FC would be beneficial for better learning. The attempt was useful as indicated by the reflections and the students understood the considerable skills included in the process of learning (subtheme 1.2). The sessions on stress management, time management etc were also highly interactive and involved active student participation (subtheme 1.3). Mentoring by senior students, along with the resource faculty, was an added benefit. However, accommodating a large group of participants and space constraints and acoustics were the challenges faced during the sessions (subtheme 2.1). Therefore, the sessions need to be redesigned to accommodate a smaller number of participants to make them more interactive.
Module V- Language and Computer Skills enhancement
This module focused on the skills needed to enable students from diverse backgrounds (including different Boards, the language of instruction, culture, and varying degrees of technological exposure) to appreciate and accommodate the similarities and differences in medical practice and to feel at par with each other.5 Our students from varied backgrounds enjoyed the sessions on local language (Kannada) and basic computer enhancement programs as a part of the FC (subtheme 1.3). However, a small percentage of the students were unhappy with the conduct of the module (1.6% for language and 12.9% for computer skills enhancement respectively) They demanded further smaller group involvement for better learning (subtheme 2.1). It was because the methods used were hard to be followed by them at one go and needed repeated exposure and hands-on experience. Also, the local language cannot be learned in a short duration, i.e., one month. It requires continued exposure and voluntary efforts (subtheme 2.3).
Module VI- Sports and extracurricular activities
‘All work and no play makes Jack a dull boy!’ is a saying that is most popular and applicable to the traditional curriculum. Participation in sports and extracurricular activities have resulted in better educational outcomes.21,22 Therefore, the module was included to demonstrate the importance of work-life balance in a demanding profession and provide an opportunity for students to have compulsory physical activity and showcase their talents.5 Majority of the students liked this module, as observed in the present study (subtheme 1.3). However, the students who were not interested in sports and extracurricular activities (music, dance, and drama) were only asked to sit and watch the others play/perform. Other alternate activities were not planned to engage them. The students disliked this act (subtheme 2.3). Therefore appropriate measures need to be taken considering the students' interests. Various other activities such as painting, clay modeling, poetry, etc. can also be introduced to engage more students.
The faculty involved in conducting the FC found it challenging to keep a few students engaged in the T/L activities conducted as a part of the FC. Some students were hesitant in expressing their views/opinions when provoked (subtheme 2.3).
Some students and faculty also conveyed that the one-monthlong FC was too long (subtheme 2.2). There is a necessity to relook into the challenges and identify the shortcomings. Further, the program should be redesigned to meet the expectations of all students'.
The FCC is striving to address the challenges and make the FC a pleasurable experience for medical undergraduates' subsequent batches.
Limitations of the study
The study involved the feedback from the students who participated in the FC and the faculty coordinators involved in its logistics and implementation. The resource faculty being from different streams, could not be reached out to receive their feedback. Therefore the view-point of the resource faculty conducting the various sessions were not considered in the present study. Future studies can incorporate feedback from the resource faculty and students with in-depth interviews and focused group discussions to understand their perceptions.
Conclusion
The FC is useful in laying a strong foundation for transforming a young and novice medical undergraduate student towards becoming a competent IMG.
A one-month long FC for the newly admitted medical undergraduate students was implemented with all sessions given by the guidelines from NMC (erstwhile MCI) for newly rolled out CBUC for IMG. The FC created an opportunity for the students' to get oriented to the new campus, program, facility, peers, and faculty. It provided them ample time and opportunities to adjust themselves in a new environment, improve peer interactions, and harness the essential knowledge, skills, and attitude necessary for effective learning during their CBUC training.
Also, the challenges faced during the program needs to be addressed with suitable remedial measures while implementing for subsequent batches. This effort will ensure a smooth conduct of the FC for the future batches of medical undergraduates and make the program more effective.
Ethical approval
Provided by the Institutional Ethics Committee.
Disclosure of competing interest
The authors have none to declare.
Acknowledgements
Heartfelt thanks to all the faculty of the Departments of Anatomy, Physiology, Biochemistry, and Medical Education for helping in executing this one-month long foundation course. Special thanks to our former Pro-Vice-Chancellor, Dr. Poornima Baliga, former Dean, Dr. Pragna Rao, and the present Dean, Dr. Sharath K. Rao, for their guidance and encouragement. The authors are also indebted to Dr. Muralidhar M Kulkarni, Associate Professor of Community Medicine for his support carrying out the thematic analysis.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.mjafi.2021.01.002.
Appendix A. Supplementary data
The following are the supplementary data to this article:
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