|Year : 2021 | Volume
| Issue : 2 | Page : 101-105
Impact of foundation course on students: Part of a newly introduced competency-based medical curriculum for undergraduates in India
Kumar Siddharth1, Sunita1, Manish Kumar1, Rekha Kumari2
1 Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
2 Department of Biochemistry, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
|Date of Submission||31-Aug-2021|
|Date of Acceptance||01-Oct-2021|
|Date of Web Publication||6-Dec-2021|
Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna - 800 014, Bihar
Source of Support: None, Conflict of Interest: None
Introduction: A new competency-based curriculum was rolled out across medical schools in India from the year 2019. It aims at transforming the way an Indian medical graduate is taught and assessed. This study was aimed at assessing the impact of a month-long foundation course, a new element of the curriculum, at the beginning of the 1st year. The foundation course aims to bring students from different socio-economic and educational backgrounds on an equal footing for their way ahead.
Materials and Methods: The study was designed as quasi-experimental. Freshly admitted undergraduate students were included in the study. Students with an attendance of <60% during the foundation course were excluded from the study. A questionnaire (having 2 sections) was used, one to assess computer knowledge (10 questions) and a 17-item 5-point Likert scale to assess opinion on various domains as envisaged in the foundation course. They also rated their overall impression of the foundation course. The students attempted the questionnaire before and then again after the completion of the foundation course. Data from 91 paired subjects (66 males, 25 females) were analyzed using t-test, Wilcoxon signed-rank test, etc.
Results: There was a statistically significant (P < 0.05) change in mean computer scores after 1 month. A few statements on the scale, such as the importance of handwashing, indicated the previous knowledge of the students. A statistically significant change in opinion was observed in some statements on ethics, professionalism, etc.
Conclusions: Foundation course will help students become more professional in their approach to modern medicine. It makes them realize the importance of ethics, communication, and gender sensitization.
Keywords: Foundation course, new curriculum, quasi-experimental
|How to cite this article:|
Siddharth K, Sunita, Kumar M, Kumari R. Impact of foundation course on students: Part of a newly introduced competency-based medical curriculum for undergraduates in India. J Indira Gandhi Inst Med Sci 2021;7:101-5
|How to cite this URL:|
Siddharth K, Sunita, Kumar M, Kumari R. Impact of foundation course on students: Part of a newly introduced competency-based medical curriculum for undergraduates in India. J Indira Gandhi Inst Med Sci [serial online] 2021 [cited 2022 May 26];7:101-5. Available from: http://www.jigims.co.in/text.asp?2021/7/2/101/331754
| Introduction|| |
The field of healthcare in both clinical care and training doctors is rapidly changing. These advances have also increased ethical concerns with regards to treatment and research. At the same time, there are also increasing incidence of violence against healthcare workers. These, among other reasons led The Medical Council of India (MCI) to review the Bachelor of Medicine and Bachelor of Surgery (MBBS) curriculum.,,, This review of the curriculum was also done considering the changes in the demography, socio-economic changes, perceptions and values of the people, emerging diseases, and impact of advances in the field of science and technology. The now-dissolved MCI, therefore, developed a competency-based curriculum for the Indian Medical Graduate and introduced it in August 2019.
India is unique because of its diversity. Students joining the undergraduate medical curriculum come from all parts of the country. They are from different geographical, educational, socio-economic language, and cultural backgrounds. The MBBS course is a highly challenging course that demands discipline, motivation, ethics, hard work, lifelong learning, communication and social skills, and knowledge. The increasing omnipresence of technology and computers in the last two decades and their role in every aspect of life including health care also needs to be addressed.
Thus, to achieve a smooth transition and to orient the students for the challenges of the course, a new 1-month duration of foundation course has been added to the curriculum for fresh undergraduates. Its components include six areas, namely orientation, skills module, field visits, professional development including ethics, sports/extracurricular activities, language, and computer skills.
Although the guidelines for the foundation course are there, institutions were independent for the development and implementation of the course accordingly.
In this study, an attempt was made to evaluate the existing ideation and any change therein after the completion of an 1-month foundation course on the students. This study could give us an insight into areas where more effort needs to be put in by the institution so that it can be better tailored and suited. The foundation course consists of the following modules.
- Skills (35 h)
- Orientation (30 h)
- Community health center visit (8 h)
- Professional development and ethics (40 h)
- Sports and extracurricular activities (22 h)
- Enhancement of language and computer skills (40 h).
| Materials and Methods|| |
The study was designed as a quasi-experimental, cross-sectional study. Foundation course for MBBS students was conducted by (Institution, City) as a month-long program according to curriculum guidelines. A questionnaire (having 2 sections) was used, one to assess computer knowledge (10 questions) and a 17-item 5-point Likert scale to assess the opinion or information of students on various domains of the foundation course. These questions were interlinking in a way that answers to one question were justified by the response to other questions in the same domain.
Assessment for enhancement of language and computer skills was done using multiple-choice questions with the single best answer and with no negative marking. Each question in this section was of one mark each.
The students were asked to attempt the questionnaire before starting and again after the completion of the foundation course. After the foundation course, the students were asked to rate the overall perception of the foundation course on a scale of 1–5 (one being the lowest and 5 the highest). Approval from the institutional ethical committee was obtained. Written consent was obtained in the beginning and students' responses were anonymized.
All the students getting admitted in the 1st year of the MBBS program for session 2019 were eligible to be included in the study. Students with attendance of <60% in the foundation course were excluded from the study. There were 120 students in all. Twenty-nine students who either refused consent, did not submit the questionnaire back, or did not have requisite attendance, were not included. A total of 91 paired responses were obtained, out of which 66 were male and 25 were female. The data were entered into an Excel sheet and were analyzed through SPSS Statistics for Windows, Version 17.0. (Chicago: SPSS Inc.). The computer section of the questionnaire was scored and paired t-test was used to analyze it. Wilcoxon signed-rank test was used to score the scaled items in the other part of the questionnaire.
| Results|| |
On their overall impression of the foundation course, the mean score was 3.92. In the prefoundation course test, the mean computer score for the students was 7.92 ± 1.462 and the postfoundation course score was 8.41 ± 1.468. The value of P was 0.003 and the difference was statistically significant [Table 1].
The 5-point Likert scale had 17 items which the students could rate from strongly agree, agree, don't know, disagree, or strongly disagree. Out of the 17 items, there were three which indicated the previous knowledge of the students, and hence, pre–post results were similar. They were statements about handwashing, communication skills, and sports. Most of the students answered appropriately in the prefoundation course attempt and their answers were the same in the postfoundation course attempt.
There were four items in which a statistically significant change in responses was seen after the foundation course. They were statements about ethics, confidentiality, professionalism, and gender sensitization. The rest of the statements had some changes in the response of students but were not statistically significant. The scores are given in [Table 2] and [Table 3].
They were statements on collaborative and group learning, learning methodologies, impact, and role of doctors in society. The rest of the statements did not show any significant changes in students' responses after the foundation course.
| Discussion|| |
The last revision to the undergraduate medical curriculum in India had taken place about 20 years ago. With a fast-changing world, encompassing advances in all fields of life, an overhaul of the curriculum was long back due and necessary. Furthermore, changes in the society around us also necessitated this change.
One of the objectives of the foundation course was to point all students in the common direction. Although there are common guidelines for all the colleges to implement the foundation course, there might be individual differences among them.
Detailed guidelines for implementation of foundation course and what should be covered are given in the curriculum documents provided by MCI, yet the individual institutions have the final say.
| Discussion on Responses to the Questionnaire|| |
A 17-item, 5-point Likert scale, a questionnaire, was used as a tool to assess the perception of students on various modules of the foundation course. These questions were interlinking in a way that answers to one question were justified by the response to other questions in the same domain.
Questions 1, 2, 3, 4, and 12 were framed for probing knowledge and attitude of freshly admitted students toward professional development and ethics. The change observed is statistically significant and obviously due to gaining knowledge of medicolegal issues associated with the medical profession.
For the questions looking to gauge the affective domain of skill, i.e. communication skill, the responses were almost equivocal in pre- and postfoundation course sessions.
Orientation module questions were framed with intensive focus to find the viewpoint of freshly admitted students on lifestyle in a medical college, both interpersonal relations and academics. Sexual harassment and gender sensitization are important areas for an Indian medical graduate to understand and questions number 10 and 11 dealt with it. On scrutiny of the responses to question numbers 10 and 11, the change in the attitude was highly explicit and postsession response was unanimous for not sharing an obscene joke about a colleague on social media or chat group or commenting on the physical attributes of a colleague. For other like question numbers 9, 16, and 17, changes were observed but not as stark as concerning the question numbers 10 and 11.
Most of the students agreed that cheating in an examination is not appropriate. Although familiar to the students from their previous learning, this pertinent topic must not be ignored and should be re-emphasized in the foundation course.,,
In many of the statements in the scaled section, there was a change in opinion about the topic or certain ideas were reinforced. There were statements in which the responses of the students varied greatly even after the foundation course.
The results also show that some knowledge of computers is already there among the students. Most of the higher secondary certification boards in India now have an introductory computer course as an optional subject. The foundation course led to an increased score of the students. The prescore mean was 7.92 ± 1.462 and the postscore was 8.41 ± 1.468. These mean scores were out of 10. The foundation course should guide the student on how to use online resources and the computer as a tool for better learning. Different studies have also demonstrated similar results among perceptions.,,,,
| Conclusions|| |
Foundation course is a positive addition to the undergraduate medical curriculum in India. It helps students become better learners and more professional in their approach to modern medicine. It makes them realize the importance of ethics, communication, and gender sensitization, being inquisitive and overall orients them for lifelong learning.
The impact of the foundation course on students was seen in areas such as ethics, professionalism, and gender sensitization. Institutions should iron out the initial hiccups in the perfect implementation of the foundation course.
The results of our study demonstrate that students attested to the need for the foundation course. The Likert questionnaire gives us some insight into what the students already know and how the foundation course can be better tailored for them.
Limitations and future research
The quasi-experimental design and recall bias are important limitations of the study. Being an independently designed questionnaire, evaluated at only one institution, once, its validity requires to be assessed. Thus, it could be improved for accurate evaluation in a standardized manner throughout the country.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wu D, Wang Y, Lam KF, Hesketh T. Health system reforms, violence against doctors and job satisfaction in the medical profession: A cross-sectional survey in Zhejiang Province, Eastern China. BMJ Open 2014;4:e006431.
Ranjan R, Meenakshi, Singh M, Pal R, Das JK, Gupta S. Epidemiology of violence against medical practitioners in a developing country (2006-2017). J Health Res Rev 2018;5:153-60. [Full text]
Anand T, Grover S, Kumar R, Kumar M, Ingle GK. Workplace violence against resident doctors in a tertiary care hospital in Delhi. Natl Med J India 2016;29:344-8.
] [Full text]
Reddy IR, Ukrani J, Indla V, Ukrani V. Violence against doctors: A viral epidemic? Indian J Psychiatry 2019;61:S782-5.
Medical Council of India (IN). Competency based Undergraduate curriculum for the Indian Medical Graduate. Vol. 1. New Delhi: Medical Council of India, 2018. p. 3-12.
Medical Council of India (IN). Competency based Undergraduate curriculum for the Indian Medical Graduate. Vol. 1. New Delhi: Medical Council of India, 2018. p. 17-20.
Medical Council of India (IN). Foundation Course for the Undergraduate Medical Education Program, New Delhi: Medical Council of India, 2019. p. 1-16.
Ray SK, Amarchand R, Srikanth J, Majumdar KK. A study on prevalence of bacteria in the hands of children and their perception on hand washing in two schools of Bangalore and Kolkata. Indian J Public Health 2011;55:293-7.
] [Full text]
Tanwani R, Chandki R, Joshi A, Arora VK, Nyati P, Sutay S. Perception and Attitude of Medical Students towards Communication Skills Lab and Teaching Module. J Clin Diagn Res 2017;11:C12-4.
Pratinidhi SS, Haribhakta SV, Ambike DA, Bhole O, Kankariya B. Study of knowledge and practices related to handwashing in school going children of a rural community. Int J Contemp Pediatr 2020;7:24-9.
Mittal R, Mahajan R, Mittal N. Foundation programme: A student's perspective. Int J Appl Basic Med Res 2013;3:52-4.
Singh S, Ghosh S, Pandya H. Foundation program for MBBS students at entry level: Experience at an Indian medical school. South East Asian J Med Educ 2007;1:330-7.
Patel J, Akhani P. A study of perception of first-year MBBS students toward orientation program and foundation course at entry level. Natl J Physiol Pharm Pharmacol 2017;7:920-3.
James T, Ajith TA, Joson D, Thomas B. Analysis of feedback from first-year undergraduate medical students who attended foundation course at a teaching institution in South India. J Educ Health Promot 2021;10:8.
Das A, Rai P, Das S, Singh A, Hasija S. Evaluation of newly introduced structured foundation course in MBBS curriculum at entry level in India: Students' perspective. Asian J Med Sci 2021;12:51-8.
Sobti S, Gupta M, Gupta V, Gupta A, Parihar S, Singh V. Assessment of newly introduced foundation course for medical undergraduates: Students' vs. faculty's perspective. J Family Med Prim Care 2020;9:3042-7. [Full text]
Velou MS, Ahila E. Foundation course for first year MBBS students in India – Disparity between its intentions and implementations. IAIM 2020;7:91-6.
[Table 1], [Table 2], [Table 3]