Perceptions of stakeholders regarding the foundation course

INTRODUCTION

Medical education has metamorphosed into a new field of research, in which various innovative methods are being experimented and added.^[1] In India, medical education involves a great deal of selfless training with varied human interactions and interpersonal relationships in different grades of hospital settings.^[2] In India, students are selected in medical colleges through selection criteria which do not take into consideration their non-scholastic abilities.^[3] Moreover, these students directly enter the medical colleges from schools with a tender age of around 17 years and need to adapt to the challenging atmosphere of these medical colleges.^[2]

Hence, a methodically planned foundation course of 1 month was introduced to undergraduate MBBS students in most of the medical colleges of India from the batch 2019 to 2020 onwards. This foundation course includes insight into the course layout, national health scenario, demographics, medical ethics, attitudes and communication, sensitisation to different learning methods, time management and motivational skills, the role of doctors and Indian Medical Graduate (IMG) in society, interpersonal relationships and working in a health-care team, biohazard safety, peer and faculty interaction, computer and information technology, national and regional languages, sports and Yoga and meditation with an overview of basic sciences subjects to be taught in Phase I MBBS.^[4] This orientation and sensitisation of students to these assortments of topics were to be done during the whole 1^st month at the beginning of the MBBS course.^[2] These topics will be covered longitudinally in a more focused and elaborate way during the rest of the undergraduate course to have an IMG with all the required knowledge and skills.^[2]

No study had been attempted in India regarding the perceptions of stakeholders that is, students, faculty and the administrators involved in foundation course teaching, as this was for the 1^st time, it was introduced. Although, few studies in India have been attempted to find out the students’ feedback about the foundation course all the stakeholders involved in the foundation course were not considered.^[3-6] The present study was planned to find the perceptions of stakeholders regarding the foundation course teaching and to study the outcomes of this course on all of them.

MATERIALS AND METHODS

The study was conducted at Government Medical College (GMC), Kathua (J&K). Ethical clearance from the Institutional Ethical Committee of the GMC, Kathua, was taken. The study was conducted between January and February 2020. The study sample included all the stakeholders involved in the foundation course: 90 Phase I MBBS students of batch 2019–2020, 38 faculty and 15 administrators involved in the foundation course teaching. The purpose of feedback was clearly explained to all the stakeholders and informed verbal consent was also taken. Open-ended anonymous questionnaires were developed separately for students, faculty and administrators which included questions related to all the topics taught during the foundation course. To validate the questionnaire, pilot studies were done separately for all the stakeholders. A team of medical education experts from the GMC, Kathua (J&K), and GMC, Jammu (J&K), developed a questionnaire of 35 questions based on a 5-point Likert scale for students and it was pilot tested for validation on 10 Phase I MBBS students who were not part of the study sample. Similarly, a questionnaire for faculty of 30 questions and administrators of 25 questions, all based on a 5-point Likert scale was developed and pilot tested for validation on 5 faculty and on 4 administrators who were not part of the study sample.

The same team of experts analysed the responses obtained and made the necessary changes and selected three sets of questionnaires each for students, faculty and administrators containing 28, 23 and 20 questions, respectively. Closed-ended questions were grouped in three categories; one concerned with the general perceptions about the foundation course; the second one with perceptions about the orientation programmes in the foundation course (orientation of students); and the third concerned with perceptions about skill development, professionalism and ethics (improvement in students).

A set of four questions, one open-ended and three closed-ended were added to the each questionnaire. The foundation course was already conducted in the GMC, Kathua, during August 2019 as per MCI guidelines. Questionnaires were distributed to all the stakeholders. The data obtained from the open-ended questions helped to get a qualitative assessment from the students. The collected data were entered into MS excel and the answers to the questionnaire based on the 5-point Likert scale were converted to percentages and analysed separately for all the stakeholders. The last 4 questions which were common to all the stakeholders were also analysed. The results are presented in tables and bar diagrams.

RESULTS

About 48.89%, 52.22%, 41.11%, 44.44% and 48.89% of students agreed that the foundation course was a memorable experience, satisfying, boosted their confidence, lessened their anxiety and helped them develop a positive attitude towards the medical profession, respectively [Table 1]. When asked about the duration of course, 34.44% strongly disagreed to increase and 43.33% strongly agreed to decrease the course duration. Students agreed that the foundation course has helped them in orientation to the mission of the institute (36.67%), different departments (52.22%), course and examinations (34.44%), BLS and first aid (41.11%), biomedical waste management (56.67%), working as a team (48.89%) and responsibilities as a doctor (43.33%). Perceptions of students were that they agree about the foundation course helping them in skill development, professionalism and ethics such as communication skills (34.44%), time management (30%), stress handling (34.4%), language command (37.78%), acquaintance with faculty (51.11%) and positive interaction with staff (34.44%). About 45.56% and 41.11% of students favoured foundation course in their learning of learning methodologies and making their learning helpful [Table 1].

When asked about foundation experience, 52.63% faculty and 46.67% of administrators strongly agreed it to be a memorable experience and 52.63% faculty and 46.67% of administrators agreed it to be satisfying. About 47.37% and 39.47% of faculty members agreed and 60% and 53.33% of administrators strongly agreed that the course has boosted confidence in students and made them less anxious, respectively. Both faculty (26.32%) and administrators (66.67%) disagreed that the course had made the students more disciplined. About 47.37% of faculty agreed that teaching foundation course topics were interesting, while 47.37% of administrators agreed that arranging for the course was a challenging task. Faculty (36.84%) and administrators (40%) strongly disagreed that course duration should be increased, but 47.37% (faculty) and 33.33% administrators strongly agreed that duration should rather be decreased. About 42.11% (faculty) strongly disagreed that students have not benefitted by foundation course while 53.33% (administrators) disagreed. Faculty (36.84%) strongly agreed and administrators (53.33%) agreed that the course has indeed played a positive role in the academic performance of students. Faculty and administrators mostly agreed and somewhere strongly agreed that orientation programmes in the course had increased the orientation of students to varied health and institute related topics. Faculty agreed that the course has improved students’ communication skills and time management (47.37%), while administrators strongly agreed regarding communication skills (46.67%), but for time management were not clear. Administrators agreed strongly (40%) that the foundation has helped students handle stress effectively, while faculty only agreed (26.32%) to it. Faculty and administrators agreed that the course helped the students’ language command to improve and also had a positive influence on their interaction with staff and faculty. About 50% of faculty agreed but about 46.67% of administrators were uncertain about course helping students improve their computer skills [Tables 2 and 3].

In the open-ended questionnaire [Table 4] when asked about the strength of the course from the stakeholders, the students mentioned the clinical visits and yoga and meditation, orientation to different departments, MBBS course, BLS and first aid and interaction with the faculty which made them confident and reinforced their choice of becoming a doctor, the faculty mentioned cooperation among different departments, students becoming aware of so many topics, more communicative and interactive students, who were more oriented to the MBBS course, campus, departments and faculty, while the administrators said that for them it was a course being conducted as per MCI guidelines making the students more confident. As far as weaknesses of the course was concerned students claimed that maintaining the logbooks, poor sports infrastructure and fewer computer classes, faculty claimed that it was their lack of prior exposure to Faculty Development Programmes, some students urging them for studying basic sciences, and some topics such as the history of medicine and the administrators said that it was arranging for lots of resources in a short time and complaint by some parents regarding lack of proper studies. When asked for any suggestions, all the stakeholders wanted the course duration to be decreased and to be spread over the whole of Phase 1 with a few hours every week, students also wanted the freedom from maintaining logbooks and the administrators wanted parents’ involvement in the course [Table 4].

The overall rating given to the foundation course by majority stakeholders from administrators (66.67%) and faculty (47.37%) was between 80% and 90%, while that from students (33.33%) was between 70% and 80% [Figure 1].

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Figure 1:

The overall rating to the foundation course by the stakeholders.

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DISCUSSION

All over the world, when the students shift from schools to undergraduate courses, the need for excellence makes the colleges and universities expose them, to specially developed orientation programmes, to acquaint them with different teaching programmes, make them comfortable in a new campus environment and help them handle the impending academic challenges.^[2,7,8] Similarly, to sensitise the medical students, MCI introduced a 1 month long foundation course during August from batch 2019 to 2020 in all medical colleges in India under its domain.^[2-6,8-11]

The foundation course was also introduced in GMC, Kathua, for Phase I MBBS students of batch 2019–2020, as part of the new CBME undergraduate curriculum.^[2] Earlier, very few studies have been attempted to find the perceptions of stakeholders regarding the foundation course. In most such studies, the foundation/orientation course was short term, on an experimental basis, did not include all the topics which were covered in the foundation course and analysed mainly the perceptions of students rather than those of all the stakeholders involved. This study was designed to determine the perceptions of all stakeholders regarding foundation course teaching and to study the outcomes of this course on all of them.

In the current study, the majority of stakeholders found the foundation course a memorable experience and about two-thirds of them rated it as satisfying, these results are in agreement with those reported by Patel and Akhani on the orientation and foundation courses.^[10] About one-third of students in the present study reported an improvement in their communication skills (34.44%) after the foundation course and also improvement in language command (37.78%) [Tables 1-3]. These results were similar to those reported by Gara and Neelima where communication skills improved in 42.8%.^[6] In a few of the studies related to communication skills in students, most of the students were in favour of teaching communication skills to them.^[12-15] Important features of doctors’ training are good and effective communication with the patient, as it improves compliance of patients, boosts their confidence in doctors, with better health care, and fewer legal issues.^[13]

When asked to rate the foundation course in the present study, about two-third of administrators and half of the faculty rated it between 80% and 90%, while one-third of students between 70% and 80% [Figure 1]. In a few short orientation studies, 80–90%, 72% and 88.10% of the students found the foundation course to be useful.^[15-17] Singh et al. in their experimental foundation course also found the students to have benefitted from it.^[3] In a study where feedback was taken both before and after the completion of the foundation course from students, they rated it 4.19 ± 0.61.^[18]

It was an interesting finding that although, majority of the stakeholders favoured that the duration of the foundation course should be decreased yet they also agreed that the foundation course has had a positive impact on the interaction of students with staff and faculty. In some of the studies on previous batches of medical students, students were found hesitant to interact with the faculty, so one of the objectives of the foundation course to improve student-faculty interaction appears to have been achieved^[2,19,20] [Tables 1-3].

As per MCI, earlier there was a deficiency in the quality of medical education which required improvement after a careful and critical analysis.^[21] Irrespective of the selection criteria, the curriculum and the faculty have a positive influence on the MBBS students’ performance.^[22] The good health of any nation is the backbone for its prosperity and to maintain it, the medical education needs to be the best. Implementation of CBME undergraduate curriculum is a step forward with the foundation course being its integral part.^[2,18,23] The aim is to make the IMG competent enough to face the challenges encountered while working in the Indian health-care system.

Evaluation of any programme is to assess if the expected outcome of that planned programme has been achieved or not and if there is any scope for further improvement after critical self-assessment.^[24] In our study, evaluation of the foundation course in the form of analysing the perceptions of stakeholders, we observed that most of the objectives of the foundation have been achieved in the form of short-term outcomes such as satisfied, confident students, interested in studying medicine, aware of their responsibility as a doctor, more tech-savvy, managing time skilfully, knowledgeable about different learning methodologies, adopting healthy lifestyles, handling stress, oriented to skills like BLS, first aid and biomedical waste management, improved interaction with faculty and satisfied faculty and administrators with the foundation course. Major views in open-ended questions found were that the students wanted no logbooks, all the stakeholders wanted course duration to be decreased, students and faculty wanted the foundation to be spread over 1 year with few hours every week rather than during the 1^st month and administrators wanted the involvement of parents.

As far as, achievement of the intermediate outcomes such as improved understanding of clinical subjects by students, improved subsequent sessions of the foundation course, improved confidence of faculty and administrators in conducting foundation course, better interaction of students with patients, their families and communities and improved teaching by faculty is concerned and also the long-term outcome that is, better health care by IMG is concerned we have to wait and watch.

CONCLUSION

The objectives of the foundation course, like medical graduates being aware of their responsibilities as doctors, of doctor-patient communication and interaction with faculty, were all met. The impact of the foundation course on IMG training has a long way to go, the beginning seems to be promising in the form of achievement of short-term outcomes indicated in this study, it appears that soon the intermediate and long-term outcomes will also be achieved, leading to a better health-care system.