Perception analysis of first year MBBS students after attending the first one-month Foundation Course in a North Indian medical college

Introduction: The Competency Based Medical Education (CBME) Curriculum for undergraduate medical education was introduced in India from the 2019 academic session onwards. A new element of the curriculum is the one-month Foundation Course.
Aim: To collect and analyse feedback from first year MBBS students regarding their experience with the one-month Foundation Course.
Methodology: This study was conducted at LLRM Medical College, Meerut. The Foundation Course timetable was designed as per the guidelines given by the Medical Council of India (MCI). The sessions were attended by newly joined first year MBBS students of 2019 batch. A feedback form designed on Google Forms was used to obtain feedback from the students at the conclusion of the Foundation Course.
Results: Out of the total 100 students, 66 responded to the feedback form. Respondents were overall satisfied with the sessions covered under the 6 sections. A majority of 24 respondents were of the opinion that the Field Visit sessions were the best conducted sessions. When asked for suggestions for further improvements in future foundation courses the two major themes generated were ‘Good experience’ and ‘More topics/sessions to be included’.
Conclusion: The strength of the first foundation course conducted in this institution lies in its meticulous planning and implementation as well as the enthusiastic participation and positive reception by students. The feedback received from the students will be helpful in further refinement of the course for future implementation.

Keywords: Education Medical Undergraduate, Feedback, Curriculum, Learning.


Introduction
The Competency Based Medical Education (CBME) Curriculum for undergraduate medical education was introduced in India from the 2019 academic session onwards. 1 The CBME curriculum has introduced many new and innovative teaching-learning elements including the one-month Foundation Course which is to be conducted in the month of August when the new batch of first year students join medical college. 2 students and faculty alike. Feedback was collected from the students at the conclusion of the course. The feedback form included a separate section in which students were asked to give suggestions for further improvement in the Foundation Course for future batches. An analysis of the feedback received is presented in this study.

Aim
To collect and analyse feedback from first year MBBS students regarding their experience with the one-month Foundation Course.

Methodology
This study was conducted at the Lala Lajpat Rai Memorial Medical College, Meerut. The Foundation Course timetable was designed as per the guidelines given by the Medical Council of India (MCI). The 175 hours were divided into sessions covering all the topics mentioned in the guidelines. The sessions were attended by newly joined first year MBBS students of 2019 batch.
A feedback form was designed on Google Forms to obtain feedback from the students at the conclusion of the Foundation Course. The feedback form was validated by taking the opinion of experts from the field of medical education. The link to the form was shared with the students on the last day of the course. Students were informed that submission of feedback was voluntary and anonymous and their feedback would be helpful in future improvements to the Foundation Course; therefore, they were requested to provide honest and unbiased feedback.

Data analysis
Quantitative Data -The feedback form consisted of 6 questions/statements based on a 5 point Likert scale. The numbers and percentages were calculated automatically by Google Forms and the linked Google Sheets. This data is presented as bar diagrams. For the Likert type questions, median and mode were also calculated.
Qualitative Data -The feedback form also consisted of 1 open ended question. Thematic Analysis was conducted for the qualitative data (replies to the open ended question).

Results
Out of the total 100 students, 66 responded to the feedback form.
A. Questions 1-6 were to be answered using a 5point Likert Scale (with 1=Highly Unsatisfactory; 5=Highly Satisfactory) 1. In question 1 the respondents were asked to rate the sessions conducted under the section 'Orientation'. Respondents were overall satisfied with the sessions; median=4, mode=4. 23 respondents (34.8%) rated the sessions as highly satisfactory and 25 (37.9%) rated the sessions as satisfactory ( Figure 1). 2. In question 2 the respondents were asked to rate the sessions conducted under the section 'Skills Module'. Respondents were highly satisfied with the sessions; median=4, mode=5. 29 respondents (43.9%) rated the sessions as highly satisfactory and 28 (42.4%) rated the sessions as satisfactory ( Figure 2). 3. In question 3 the respondents were asked to rate the sessions conducted under the section 'Field Visits'. Respondents were highly satisfied with the sessions; median=5, mode=5. 47 respondents (71.2%) rated the sessions as highly satisfactory and 14 (21.2%) rated the sessions as satisfactory ( Figure 3). 4. In question 4 the respondents were asked to rate the sessions conducted under the section 'Professional Development and AETCOM'. Respondents were highly satisfied with the sessions; median=4, mode=5. 31 respondents (47%) rated the sessions as highly satisfactory and 21 (31.8%) rated the sessions as satisfactory ( Figure 4). 5. In question 5 the respondents were asked to rate the sessions conducted under the section 'Language and Computer Skills'. Respondents were divided in their opinion but still a majority of 42.4% respondents expressed satisfaction regarding the sessions; median=3, mode=3. 12 respondents (18.2%) rated the sessions as highly satisfactory and 16 (24.2%) rated the sessions as satisfactory ( Figure 5). 6. In question 6 the respondents were asked to rate the sessions conducted under the section 'Sports and Extracurricular Activities'. Respondents were satisfied with the sessions; median=3, mode=3, 5. 16 respondents (24.2%) rated the sessions as highly satisfactory and 15 (22.7%) rated the sessions as satisfactory ( Figure 6).
B. In question 7 the respondents were asked that in their opinion which was the best conducted session/group of sessions. A majority of 24 respondents were of the opinion that the Field Visit sessions were the best conducted sessions during the Foundation Course while 19 respondents voted for the sessions conducted under 'Skills Module'. Sessions on professional development received 10 votes while 5,4 and 4 respondents voted for sessions under 'Orientation', 'Language and Computer Skills' and 'Sports and Extracurricular Activities' respectively.
C. Finally, in question 8 the respondents were asked to give suggestions for further improvements in the sessions conducted during the one-month Foundation Course. Thematic analysis was conducted for the responses received from the students. (Table 1) The foundation course was good" Sub-themes -"Overall everything was very nice our faculty members gave their best" a). Course/sessions well conducted "All the topics of all the sessions were interesting" b). Appreciation of faculty members "All the sessions were done very nicely" "All the teachers did their best to make this foundation course, which is included for the first time, an informative one "Very good and foundation does not require any improvement. it was awesome" "The efforts of teachers to make the session interesting were appreciable" 2.
More topics/sessions to be included 14 "Should enhance field visit time" Sub-themesa). More field visits "Skills modules should be more" b.) More skills module sessions "More Extracurricular activities" c). More sessions of extracurricular activities "Better if other sport also considered" d). More sports sessions "Please include basketball game" e). More types of sports to be included 3.
Reduce the duration of Foundation Course 5 "Duration of foundation course should be less" "It would be better if the foundation course is a little bit of shorter duration than 30 days" 4.
More interactive sessions 2 "With more role play and interactive sessions"

5.
Course to begin after all rounds of counselling are completed 2 "May be if it is implemented after completion of counselling student will not miss their sessions, I missed some due to late allotment of seat" "I suggest extend the days in Foundation course as many students due to counselling purposes take late admission and they miss many days" 6.
Reduce repetition of topics 1 "At times session with same objective were repeated may times under different headings" 7.
Weather conditions to be considered for outdoor sessions 1 "Weather conditions should be kept in mind so that outdoor sessions are not missed owing to drastic weather, preferably October is the best time for this course"

Discussion
Orientation programmes ranging from one day to one week have been traditionally conducted for newly joining first year MBBS students across many colleges in the country. [3][4][5] The basic purpose of these programmes has been to orient the students to the environment of a medical college. Such programmes aim to ease the transition of students from pedagogical to andragogical learning and familiarize them with the teaching programme and curricula of various subjects. Similar programmes have also been conducted for second year MBBS students to orient them to clinical medicine (under the previous curriculum the students were exposed to clinical subjects for the first time in the second professional); 6 and for interns, to allow for easy transition of the students to clinical work by improving clinical and communication skills. 7 However, this was the first time that a structured one-month Foundation Course was conducted for students joining first professional MBBS in all medical colleges as per the guidelines issued by the Medical Council of India.
In this study we analysed the feedback received from the students who attended the Foundation Course in the institution in 2019. Overall, there was a high level of satisfaction with the sessions conducted under all six sections of the course. When asked for feedback and suggestions for improvement, the most common theme was the appreciation of the well conducted sessions and the hard work of the faculty members involved in planning and execution of the course. This is similar to the findings of Khilnani AK et al. who reported that students had a positive overall experience after attending the Foundation Course and appreciated the faculty members involved in the implementation of the same. 8 Dixit R et al. also reported a high level of satisfaction of students with the course with an overall rating of 4.19 on a 5 point Likert Scale. 9 In our study the highest satisfaction was reported for the 'Field Visits' followed by the 'Skills Modules'. This was corroborated when students were asked for their opinion regarding the best conducted session/sessions. In fact, students wanted more skills training sessions as well as more field visits to be included in future Foundation Course timetables. Previous studies have reported high level of appreciation for and satisfaction with the skills module sessions conducted during the Foundation Course. 8,10 Similarly, sessions on community orientation and field visits were perceived very positively by the students in a study conducted by Vyas S. et al. 11 Few respondents recommended increasing the number of sessions on extracurricular activities and sports while two respondents felt that more types of sports should be included in the Foundation Course. Only 5 respondents (7.57%) felt that the duration of the Foundation Course should be reduced while 1 respondent pointed out the need to reduce repetition of topics between various sessions taken by different faculty members. Three previous studies have reported similar feedback from the students but the feedback has not been quantified in two of the studies. 10,12 In one of the studies however, 49% students felt the need to reduce the duration of the Foundation Course 8 which is in sharp contrast with only 7.57% respondents giving this feedback in our study.
Students also opined that sessions should be made more interactive e.g. by including role plays. This may not be possible for all topics but is nonetheless an important feedback for improvement in future foundation courses. 2 respondents reported that they had missed few sessions due to late joining and opined that the foundation course should begin only after all rounds of counselling were over and all the students had joined. In an evaluation of the orientation programme for fresh MBBS entrants conducted by Mahajan R. et al. one of the major suggestions given by both students and faculty was that the programme should be conducted only after the final counselling when all students have joined. 3 While the dates of the foundation course are fixed, some flexibility may be allowed to the colleges either to begin the sessions after all students have joined or to conduct extra sessions for the students who join late so that they can catch-up with the rest of the batch. One of the respondents gave the feedback that weather conditions must be kept in mind before planning sports and/or outdoor sessions. Considering that the month of August is the peak of the monsoon season (interspersed with high temperatures on clear days) in most parts of the country, this feedback should be definitely kept in mind to avoid either cancellation of outdoor sessions due to heavy rainfall or incidences of dehydration or heat stroke among the students due to exposure to high daytime temperatures.

Conclusion
The one-month Foundation Course is an excellent way of introducing newly joined MBBS students to the world of medicine and medical education. The strength of the first foundation course conducted in this institution lies in its meticulous planning and implementation as well as the enthusiastic participation and positive reception by students. While the institution and all resource faculty members did their best to plan and implement the course as per the guidelines, there is always scope for further improvement. The feedback received from the students will be helpful in further refinement of the course for future implementation with subsequent batches.

Source of Funding
None.

Conflict of Interest
The authors declare no conflict of interest.