Evaluating Institutional Electives - Insights from stakeholders

Evaluating Institutional Electives - Insights from stakeholders | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluating Institutional Electives - Insights from stakeholders Ketaki Poorey, Abid Manzoor, Sachendra Mittal, Mukesh Tiwari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4794441/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Elective courses offer students the opportunity to pursue specialized interests beyond the standard curriculum. India adopted electives formally from MBBS 2019 batch, aligning with Competency-Based Medical Education (CBME). Challenges in organizing, teaching, and assessing electives persist, with disparities in execution and student perceptions. This project aims to assess the Electives program's effectiveness, gathering data on stakeholders' experiences and identifying challenges and recommendations to serve students' educational objectives and enhance their learning experience. Aim To Evaluate Institutional Electives in Undergraduate Medical Curriculum. Objectives : 1. To analyze the students' & faculty perceptions for the elective program. 2. To identify the challenges faced by the students & faculty during electives. 3. To formulate recommendations based on the insights gathered from focus group discussions (FGDs) and survey responses. Methodology : Observational Qualitative Study, which will include volunteers from the MBBS 3rd year part 1, admission batch 2020 students and all the faculty and administrators involved in the Electives Program. Their perception on the effectiveness and overall impact of the Electives program would be collected in the form of questionnaires and Focused group discussions would be conducted to know in detail the challenges, best practices and recommendations from faculty and students to improve the Electives program. Results: The study found high satisfaction with the Electives program among both students and faculty. They emphasized that the time duration of direct engagement, teaching methodologies and assessment criteria had a significant impact on their choices and satisfaction. Participants provided suggestions for revising the electives to be more structured, clinical-oriented and the addition of sports/general electives to the pool. Conclusions: Gathering the stakeholder perceptions, challenges, and recommendations regarding the Electives program it is clear that Electives have immense potential to make an effective educational impact. Electives Experiential Learning Teaching methods MBBS Students Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 What this study adds This study adds clarity to what learners wish to imbibe from the Electives Program. It adds to our knowledge of appreciated and effective teaching learning methods used during the Electives program. It identifies the challenges and also how they were/will be overcome by our learners and the teachers to make the learning effective during the program. Background Elective courses, as their name suggests, are essentially opted by choice of the learner. They're provided to students to enable them to explore diverse and specialized learning opportunities within their areas of interest, apart from the predetermined curriculum. With the publication of the Flexner Report in 1910, medical teaching and curriculum progressed towards standardization. (1) Since then, a change in the paradigm led to the implementation of alternative curricular pathways in addition to the core curriculum, including shortened preclinical curricula, dedicated research time and early clinical experiences. These alternative curricular pathways were designated as “electives”. Elective rotations in UK medical education were introduced as part of the curriculum reforms in the early 1970s. These reforms aimed to provide medical students with opportunities for self-directed learning, exposure to different medical specialties, and exploration of areas of particular interest. Electives have been a part of the American medical education curriculum for many decades, but they became more formalized in the early to mid-20th century. Medical schools began to incorporate elective periods into their curriculum to provide students with opportunities for specialized clinical experiences and to explore areas of interest beyond the core curriculum. Elective courses for the undergraduates in medical education were introduced relatively late in India. Historically, medical education in India followed a more traditional curriculum structure with limited flexibility. In recent years, India has also been transitioning towards Competency-Based Medical Education (CBME) to align with global standards and enhance the effectiveness of medical training. Electives serve as valuable learning experiences, allowing learners to delve into different career paths, fields of study, or research endeavors. (2) Electives were introduced in the MBBS admission batch 2019. NMC (National Medical Council) gave us the guidelines of implementing the electives. (3) Given that it's a novel program within the Indian context, there were numerous disparities in its organization, teaching methods, assessment, and evaluation. The students' perception of electives remains uncertain and varied. Faculty and students encountered several challenges during the implementation of electives. Various approaches were adopted for learning and assessing in electives. Despite the framework introduced by the NMC, there was considerable confusion regarding the execution of electives and their effectiveness post-implementation. In order to ensure the success of this program in achieving its educational objectives and to better understand the needs of both learners and faculty, this project aims to gather data on stakeholders' perceptions, needs, challenges faced and recommendations. This data will be utilized to evaluate the program and implement improvements where necessary for the next year Electives program. Methodology Study design : Qualitative & Quantitative observational study Participants : MBBS Batch 2020, 3rd year part 1 students and Faculty involved in electives Sample size: All volunteers from MBBS 2020 batch and Faculty involved in electives Program. Students: 133 participated in questionnaire based surveys (Each of BLOCK 1 and 2). 48 students participated in FGDs conducted Faculty: 43 faculty ( 19-BLOCK 1+24-BLOCK 2) in questionnaire based surveys 26 faculty ( 14-BLOCK 1+12-BLOCK 2) participated in FGDs conducted Sampling : Convenient sampling Description of Intervention: It was an observational study Study tools : Questionnaire based perception survey for the students. Questionnaire based perception survey for the faculty. FGD with Students FGD with faculty Content validation of the study tools were done by Medical Education experts at the institute (CC members, Academic coordinator), regional center and Nodal center resource faculty and FAIMER Fellows actively involved in Electives program in their institute. This was followed by pilot testing on a small group of students to improve clarity and understanding followed by finalization . Flow of events: The flowchart is available in the Supplementary Files section. Data collection process: Once research objectives were framed and the data collection tools decided. Questionnaires containing Likert scale based questions and open - ended questions were framed and validated for students and the faculty/ preceptors /administrators, separately. Focus group discussion guides were prepared & validated informed consent was obtained from the participants. Students answered separate questionnaire via google forms for BLOCK 1 and BLOCK 2 Faculty responded to a single questionnaire Students & Faculty who volunteered participated in Separate FGD each having a homogenous group of 6-8 students/ faculty. Data was video recorded for the purpose of not missing any point and a simultaneous organogram was prepared to ensure participation of all the faculty. Minimum duration of FGD was 25 minutes while maximum lasted for 50 minutes. Data was analyzed as below. Data analysis : Data collected from the participants on a 5 point Likert scale in the questionnaire was analyzed and presented using tables, charts, and narrative descriptions to communicate key findings and conclusions. Qualitative data in form of open ended questions and FGD response transcript was analyzed by thematic analysis and to understand how they provide meaning to the construct and make sense of their experiences, narrative analysis was used. Results This study was conducted on the Students who had just finished with the 3rd year part 1 exam. Students were given a questionnaire based survey form where they answered 11 questions about the effectiveness, learning environment and overall impact of the electives on them separately for both the BLOCKs. The results are shown in Figure 1 & 2 respectively for Block 1 & 2. Table 1 :- Agreement Level of Students perceptions regarding BLOCK 1 electives S.No. Perception Level of Agreement Strongly Disagree Disagree Neutral Agree Strongly Agree 1 Electives provided me with a comprehensive understanding of the chosen topic. 0.0 0.8 2.3 20.3 76.7 2 Learning objectives of the electives were clearly defined in the beginning. 0.0 0.8 1.5 22.6 75.2 3 Learning objectives of the electives were achieved at the end of the electives. 1.5 0.8 2.3 24.1 71.4 4 Elective rotations were well structured and organized. 1.5 0.8 2.3 19.5 75.9 5 Appropriate learning resources were provided during the electives. 1.5 0.8 2.3 26.3 69.2 6 Appropriate mentorship, and supervision was received during the electives. 1.5 0.8 2.3 18.0 77.4 7 Adequate opportunities were given for active participation and direct engagement in the elective experiences. 1.5 0.8 1.5 19.5 76.7 8 The assessment conducted at the end of the elective program was appropriate. 0.0 0.8 3.8 15.8 79.7 9 The Elective Program helped me clarify for future career path. 0.0 0.8 5.3 15.0 78.9 10 Elective program helped me build up research acumen. 0.0 0.8 4.5 27.8 66.9 11 Elective program helped me improve comprehension for clinical application/ my clinical skills in the elected area. 0.0 0.8 3.8 22.6 72.9 #Values in Cells are expressed as % with total no. 133 Table 2 :- Agreement Level of Students perceptions regarding BLOCK 2 Electives S.No. Perception Level of Agreement Strongly Disagree Disagree Neutral Agree Strongly Agree 1 Electives provided me with a comprehensive understanding of the chosen topic. 0.0 0.8 6.0 15.8 77.4 2 Learning objectives of the electives were clearly defined in the beginning. 0.0 0.8 3.0 17.3 78.9 3 Learning objectives of the electives were achieved at the end of the electives. 0.8 0.8 8.3 15.0 74.4 4 Elective rotations were well structured and organized. 0.0 1.5 5.3 15.8 77.4 5 Appropriate learning resources were provided during the electives. 0.0 1.5 3.8 21.8 72.9 6 Appropriate mentorship, and supervision was received during the electives. 0.0 1.5 5.3 18.8 74.4 7 Adequate opportunities were given for active participation and direct engagement in the elective experiences. 0.0 1.5 4.5 18.8 75.2 8 The assessment conducted at the end of the elective program was appropriate. 1.5 0.8 4.5 15.8 78.2 9 The Elective Program helped me clarify my future career path. 0.0 0.8 3.8 16.5 78.9 10 Elective program helped me build up research acumen. 0.0 0.8 4.5 19.5 75.2 11 Elective program helped me improve comprehension for clinical application/ my clinical skills in the elected area. 0.0 0.8 5.3 19.5 74.4 #Values in Cells are expressed as % with total no. 133 Over all 95.7% and 94% of students were in agreement that the electives provided an effective learning experience and a conducive learning environment during BLOCK 1 and BLOCK 2 Electives respectively. Further analyzing, about 2% students felt that the elective rotations were not well structured and organized, Learning resources were not adequately shared. They also found inadequate engagement and mentoring during BLOCK 1 & BLOCK 2. While 2% students also reported a disagreement for the assessment methods conducted during BLOCK 2. Although the number was quite low. When students were asked about challenges they faced during the electives, most of them said that they had no challenges as such and the faculty were quite supportive to help them throughout. Duration of Electives as per the students was appropriate where 62 & 69% students said that 2 weeks was adequate while23 & 32 % students felt that 4 weeks would have been better respectively for BLOCK 1 & BLOCK 2 as shown in Figure 4 & 5. As per students’ perspective: On repeatedly reading and analyzing answers to the open ended questions and the responses during the FGD following were the highlighted phrases : Challenges faced by the students: Most of the students reported that there were no difficulties or challenges as such. Following were a few relevant responses given by the students. BLOCK 1 No challenges Difficulty in recalling the basics initially Collaboration with colleagues during tasks/ projects assigned. Preparing for seminars and presentation BLOCK 2 Adjusting to a new environment and way of teaching. Interaction with the patients Distance for the RHTC elective. Common Challenges: Mandatory attendance Reduced one to one interaction with preceptor on some days due to overloaded faculty. Daily time duration was too long. 2. What went well: Learning in a clinical setting. In depth knowledge of the topic selected. Revisiting the basics. Clinical correlation of basic sciences. Operation theater visits, hands on activities. Direct interaction with the preceptors. Deep understanding of the topic selected. Learning by making projects and presenting seminars. 3. Suggestions for more elective course to be added in the curriculum: Oncology and other super specialty departments. Emergency medicine. Sports/ extracurricular activities. More electives in Radiology & Psychiatry. Forensic medicine. 4. When asked for suggestions to improve, most of them found the electives good as such and said that they had learnt a lot during the duration. Most of the students appreciated the clinical exposure & clinical correlation they received during this period, but also demanded more one to one interaction with the preceptor. A few students also requested broader topics where they could have rotations in different sub- sections rather than an in -depth knowledge in a single one. For any other suggestions and comments students mentioned that “I know that I have to work hard to get my dream branch in future”, “Adrenaline rush in the critical care was the best”, “Interaction with the patients was the most challenging and best part”, “Case presentation and seminar presentation helped building confidence”. A few students suggested more research oriented topics and a few also reported that they were unable to connect with the preceptors and found the electives just like their ward postings. Faculty were also given a questionnaire based survey after completion of their respective electives and 19 and 24 faculty responded to the questionnaire based survey for BLOCK 1 and BLOCK 2, respectively. The perceptions and faculty’s agreement level on a 5 point likert scale have been presented in Table 3 and 4. Table 3 :- Agreement Level of Faculty perceptions regarding BLOCK 1 electives: S.No. Perception Level of Agreement Strongly Disagree Disagree Neutral Agree Strongly Agree 1 Topics chosen for Electives in your department are appropriate for the students to give an effective learning experience. 0 0 5.3 26.3 68.4 2 Learning objectives of the electives were achieved by the students successfully at the end of the electives. 0 0 0.0 52.6 47.4 3 Students were actively involved and engaged during the teaching learning activities of Electives. 0 0 15.8 31.6 52.6 4 The Elective Program plays an important role in helping the students choose their future career path. 0 0 5.3 52.6 42.1 5 The Elective program could give the students enough opportunities to help them build up research acumen. 0 0 5.3 52.6 42.1 6 The Elective program could give the students enough opportunities to help them improve clinical skills/ comprehension to clinical application in the chosen topic. 0 0 0.0 31.6 68.4 7 The Elective Program can foster and enhance students' critical thinking skills. 0 0 5.3 47.4 47.4 #Values in Cells are expressed as % with total no. 19 Table 4 :- Agreement Level of Faculty perceptions regarding BLOCK 2 Electives S.No. Perception Level of Agreement Strongly Disagree Disagree Neutral Agree Strongly Agree 1 Topics chosen for Electives in your department are appropriate for the students to give an effective learning experience. 0.0 0.0 12.5 20.8 66.7 2 Learning objectives of the electives were achieved by the students successfully at the end of the electives. 0.0 0.0 8.3 50.0 41.7 3 Students were actively involved and engaged during the teaching learning activities of Electives. 0.0 12.5 16.7 37.5 33.3 4 The Elective Program plays an important role in helping the students choose their future career path. 4.2 12.5 0.0 29.2 54.2 5 The Elective program could give the students enough opportunities to help them build up research acumen. 4.2 8.3 8.3 45.8 33.3 6 The Elective program could give the students enough opportunities to help them improve clinical skills/ comprehension to clinical application in the chosen topic. 0.0 0.0 8.3 45.8 45.8 7 The Elective Program can foster and enhance students' critical thinking skills. 0.0 0.0 4.2 41.7 54.2 #Values in Cells are expressed as % with total no. of 24 faculty Almost all the BLOCK 1 faculty were in agreement with the effectiveness, good learning environment and positive overall impact of the Electives program on the students. 12.5% faculty in the BLOCK 2 felt that the involvement of the students was low. 16.7% faculty didn't perceive electives to play any part in students' selection of future pathways. 12.5% felt that electives were not able to give any research acumen to the students. Both BLOCK 1 and BLOCK 2 faculty were satisfied with the topics selected, effectiveness, and the students’ ability to develop critical thinking and clinical acumen during the Electives. Responses of the BLOCK 2 faculty were a little varied in regards to the student participation and effectiveness of the program as compared to the BLOCK 1 Faculty. although even during FGDs most of the students were quite satisfied with the clinical exposure they had received. On repeatedly reading and analyzing answers of the Faculty to the open-ended questions and the responses during the FGD following were the highlighted phrases under the topics referred to: Most of the faculty reported that the program was better managed this year as compared to the previous year as the level of clarity was more. What went well? Students enthusiasm to learn Students participation in various tasks assigned during the electives. Project work was very well done by most of the students. Seminars were presented very well. Teaching Learning Strategies or innovative approaches used for better learning experience during the electives: Assignment to report Adverse drug reaction of the admitted patients. Prescription auditing. Seminar presentation. Project. Hands on practice of skills. Case presentation. Attending ward rounds. Bedside teaching. Demonstration of related Anatomy in Operation theater. Poster presentation. Assessment and evaluation methods used during electives: MCQ tests Viva-voce Project/ Poster Presentation. Logbook assessment. Assignment submission. Case presentation. Challenges Faced by faculty during electives: Keep up active involvement of all students during the program. Poor attendance. Devoting time for electives along with the routine work, MBBS & PG teaching schedule. Duration was too less to give in depth knowledge of the topic. Many faculty were not aware of the program and its intention, and so their contribution was less. Recommendations for next year to overcome the challenges and improve students learning experience Less of formal didactic teaching and more of task based and assignment based activities. Cases to be allotted for longitudinal reporting of progress of a case even in para clinical laboratory based electives for retrospective analysis and clinical correlation. Simulation based training on mannequins. Short Research projects to be included. Mandatory preceptor training for all faculty before next electives. More ‘Students Choice’ topics to be added to the pool of electives. Some broad topics to be added where students can be rotated in different sections during the program. Shift from formal teaching to observation based and experiential learning. Strict action on students who are not completing the required 75% of attendance. Discussion Elective courses for undergraduate medical students encourage self-directed learning by allowing students to choose based on their interests. This student-centered approach shifts the teaching-learning dynamic, empowering learners to take responsibility for their education. (4) As per the responses received from the students and the faculty the Electives hold significant promise within medical education, rendering training more engaging, fostering the acquisition of diverse skills, and contributing to the holistic professional growth of students beyond conventional curricular confines. (5) With accumulated experience and ongoing exploration, it is expected that a greater variety of elective offerings will be developed in the coming years. This evolution promises to further enrich the educational landscape, empowering students to tailor their learning experiences and equipping them with the multifaceted competencies essential for success in their future medical careers. When compared with the other data published related to electives in other countries, they have gone a long way to international and outside the institute electives evaluation. These studies mainly focus on the attitude and behavior of learners to choose a particular topic and their safety. (6) While in our stage we are still budding to implement the curricular electives in a satisfactory way to make it have a satisfactory developmental impact on our students. Not much research has been done on electives. So the published data is scarce. (7) A cross-sectional study was conducted through a written evaluation survey concerning the electives available in the academic year 2015–2016 in the Faculty of Medicine of University of Porto. Although there system is a lot different than ours, in their study also students' satisfaction was mainly based on Agreement with teaching and learning methodologies, followed by Agreement with assessment methodologies employed. Electives with too much workload were last to be opted for and the last year ranking (can be compared to peer review in our case) was the basis of elective selection. (8) Our students also reported a similar strategy while electing electives. In addition to these the preceptor also had a major influence on the elective selection rather than the topic. International electives are not an option for our students still to explore as a future aspect- A qualitative analysis of 14 semi-structured interviews with elective hosts at seven elective sites in sub-Saharan countries was done as a part of international electives evaluation as a lot of students from the UK opt for these electives. The main reason being more clinical exposure. Although the challenges quoted by the elective hosts were the priority of teaching the local students and the requirement of more student preparation before electives. (9) A recent cross-sectional study conducted in a Medical college at Delhi over 87 students concluded that Electives is a welcome addition to the medical curriculum. The students their suggested more patient oriented electives and a few found the program not an appropriate one for the final year students. They demanded limited seats for each elective (which we had already followed). Inclusion of electives is perceived to be beneficial by most of the students of this study which is in line with our study too. (10) Implication of study: Based on the comprehensive data collected from both students and faculty, several recommendations can be proposed to enhance the Electives program: Protocol recommended for implementation of Electives as per our experience and recommendations from stakeholders: At the end of 2nd Prof the students can be surveyed for their choice of topics which can be added for the electives. After checking for feasibility and consensus of faculty topics, course contents and structure can be revised. At the beginning of the 3rd part 1 students can be given a brief overview of available electives for them through short presentations by the preceptors/concerned faculty. Students can be offered the electives based on the 1st and 2nd Prof Exam results. Feedback collected from students and faculty after completion can be reviewed for further improvement in the program by dropping electives where students were not satisfied or the faculty felt that the students did not have satisfactory learning. Implementing standardized protocols for Electives, protocols for resource sharing, and mentor engagement across all departments will improve the organization and implementation further. Preceptor and faculty training separately for electives should be mandatory. A half a day workshop, with training on effective teaching methodologies, mentorship skills, and time management to ensure optimal student engagement and learning outcomes so that the faculty are updated and prepared for the upcoming electives. Encourage the use of effective teaching methods such as bedside teaching, case presentations, and small group discussions, projects, which have been identified by both students and faculty as beneficial for learning. Students can be allowed to attend the ward and OT even after the college timings during the BLOCK 2 electives to allow for deeper immersion in the chosen topics and ample time for students to engage in meaningful learning activities. Facilitate more one-on-one interactions between students and preceptors to enhance personalized learning experiences and provide targeted mentorship. Introduction of more research-oriented electives and incorporation of small projects within elective rotations to foster research acumen and expose students to the research process. A few broader topics with rotations in the subdivisions to have a more broader view of the subject can be introduced to gain exposure to various facets of a discipline. Introduction of Electives Courses from Super-specialty subjects and Emergency medicine can be added. Optimization of Assessment methods to ensure comprehensive evaluation of students' knowledge and skills acquired during elective rotations. Faculty Engagement can be improved by raising awareness about the Electives program, providing incentives/ appreciation/certificate for participation, and offering support for balancing elective responsibilities with routine work. By implementing these recommendations, the Electives program can be improved further to provide students with enriching learning experiences, enhance faculty satisfaction and engagement, and prepare our students to become entrusted professionals. Conclusion As per the responses received from the students and the faculty the Electives hold significant promise within Indian medical education, rendering training more engaging, fostering the acquisition of diverse skills, and contributing to the holistic professional growth of students beyond conventional curricular confines. With accumulated experience and ongoing exploration, it is expected that Electives Program will definitely become a program of high impact on the students, helping them to cater to their interests, enrich the educational landscape, empowering students to tailor their learning experiences and equipping them with the multifaceted competencies essential for success in their future medical careers. Abbreviations CBME: Competency-Based Medical Education CC: Curriculum Committee FGD: Focused Group Discussion MBBS: Bachelor of Medicine, Bachelor of Surgery NMC: National Medical Council Declarations Ethics approval and consent to participate: Institutional Ethics Committee, NIMS University, Jaipur (Rajasthan) approved the research protocol for the above study (Ref. No. NIMSUR/IEC/2024/872) Consent for publication: Not applicable Availability of data and materials: The data generated and analyzed during the current study is available with the corresponding author but cannot be shared publicly, to protect study participants privacy. Competing interests: The authors declare that they have no competing interests. Funding: The authors declare that no funding was received for this research project. Authors' contributions: KP conceptualized the research design. KP, AM, SM and MT worked together for the data collection and analysis. Manuscript was written by KP, AM, SM. The manuscript was reviewed and edited by MT. All authors read and approved the final manuscript. Acknowledgements: This research project was done as a part of Fellowship, FAIMER Batch 2023. I would like to acknowledge the constant support and guidance from Dr. Waseem F. Ansari as a project Mentor, CMCL- FRI Faculty, Seniors & Fellows for their unwavering support & direction and also Students & Faculty NIMS&R, Jaipur for their enthusiastic participation. Authors' information: KP is presently the Coordinator of Medical Education Unit at her Institute. Author is pursuing FAIMER Fellowship at CMCL, Ludhiana. She completed her Advanced course in Medical Education in 2019. References Beck AH. The Flexner report and the standardization of American medical education. Jama. 2004;291(17):2139–40. Mihalynuk T, Leung G, Fraser J, Bates J, Snadden D. Free choice and career choice: clerkship electives in medical education. Med Educ. 2006;40(11):1065–71. Medical Council of India. Electives for the Undergraduate Medical Education Training Program, 2020: p 1- 30. Lumb A, Murdoch-Eaton D. Electives in undergraduate medical education: AMEE Guide No. 88 Med Teach. 2014;36:557–72 Tolsgaard MG. Clinical skills training in undergraduate medical education using a student-centered approach. Dan Med J. 2013 Aug;60(8):B4690. C Wiskin et al, compiled on behalf of the MSC UK Electives Committee. Recommendations for undergraduate medical electives: a UK consensus statement, Med Educ. 52, Issue 1(2018) Jolly B. A missed opportunity. Med Educ. 2009;43:104–5. Ramalho, A.R., Vieira-Marques, P.M., Magalhães-Alves, C. et al. Electives in the medical curriculum – an opportunity to achieve students’ satisfaction?. BMC Med Educ 20, 449 (2020). Kumwenda B, Dowell J, Daniels K, Merrylees N. Medical electives in sub-Saharan Africa: a host perspective. Med Educ. 2015 Jun;49(6):623-33. doi: 10.1111/medu.12727. Kaur G, Kritika, Arora P. Electives in Medical Curriculum- An Insight of Medical Students. Indian J Comm Health. 2023;35(4):485-493 Additional Declarations No competing interests reported. Supplementary Files floatimage1.png Flow of events Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4794441","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":335060229,"identity":"454ff7f5-6e61-42cc-938b-8784c0412d39","order_by":0,"name":"Ketaki 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10:09:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4794441/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4794441/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":63914648,"identity":"910631d5-da40-4e33-9038-01674442029e","added_by":"auto","created_at":"2024-09-03 17:11:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26644,"visible":true,"origin":"","legend":"\u003cp\u003eOverall impact of Block 1 Electives as per the perception of the students:\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4794441/v1/17b4c5fb0a2416b8e3c9cb47.png"},{"id":63913832,"identity":"9b0e154c-cc7d-4475-9177-92ceae23a99b","added_by":"auto","created_at":"2024-09-03 17:03:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30927,"visible":true,"origin":"","legend":"\u003cp\u003eOverall impact of BLOCK 2 Electives as per the perception of the students:\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4794441/v1/333362a6e14e4f3343cc9f10.png"},{"id":63914649,"identity":"449f8488-a0b6-4e9b-9bf1-43c38bfdb51a","added_by":"auto","created_at":"2024-09-03 17:11:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":175968,"visible":true,"origin":"","legend":"\u003cp\u003eFig. 4 Appropriate duration of BLOCK 2\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4794441/v1/ddf6ab63d5a4d7d8dc6aea3a.png"},{"id":63913840,"identity":"fb11f427-e90c-42ec-bb79-3aa53199c915","added_by":"auto","created_at":"2024-09-03 17:03:59","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":154460,"visible":true,"origin":"","legend":"\u003cp\u003eFig. 5 Appropriate duration of BLOCK 2\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-4794441/v1/54b993b6d056805bddfdd4ef.png"},{"id":63913839,"identity":"1dfdc49b-a877-4536-9faf-d2627ac8f654","added_by":"auto","created_at":"2024-09-03 17:03:59","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":47964,"visible":true,"origin":"","legend":"\u003cp\u003eFig. 6: As per the BLOCK 2 faculty agreement to the active involvement of faculty during T/L activities in Electives.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-4794441/v1/eef9a3b415e1a1502bcc15c8.png"},{"id":63913836,"identity":"c8cfdbab-87e8-4e72-9d5b-e8fafba8109f","added_by":"auto","created_at":"2024-09-03 17:03:59","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":24950,"visible":true,"origin":"","legend":"\u003cp\u003eFig. 7: As per the BLOCK 2 faculty agreement to the opportunity for students to build up research acumen.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-4794441/v1/1f4516d5a84af7e3e6ea9d13.png"},{"id":63914650,"identity":"31863c88-261a-4fc4-b0ff-5a74a472e2cf","added_by":"auto","created_at":"2024-09-03 17:11:59","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":69682,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 8: Faculty perception: BLOCK 1 Electives\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-4794441/v1/48f6246697df738a0b2b5a8e.png"},{"id":63913841,"identity":"bbf9c93f-1830-4a5f-a1ba-a268969afa7b","added_by":"auto","created_at":"2024-09-03 17:04:00","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":1125189,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 9: Faculty perception: BLOCK 2 Electives\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-4794441/v1/9683a886a2c1d71dcb05ad4d.png"},{"id":68516439,"identity":"d2ca6036-3c87-4b45-b0f7-2ebc32dc72d2","added_by":"auto","created_at":"2024-11-08 06:54:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2145112,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4794441/v1/44271d7c-6cba-4e62-9526-6d6fe02ad874.pdf"},{"id":63913835,"identity":"437f1015-08be-4edb-99f9-0f6d76da590b","added_by":"auto","created_at":"2024-09-03 17:03:59","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":387456,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow of events\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4794441/v1/e90a3dd82f2c81b6321d39da.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEvaluating Institutional Electives - Insights from stakeholders\u003c/p\u003e","fulltext":[{"header":"What this study adds","content":"\u003col\u003e\n \u003cli\u003eThis study adds clarity to what learners wish to imbibe from the Electives Program.\u003c/li\u003e\n \u003cli\u003eIt adds to our knowledge of appreciated and effective teaching learning methods used during the Electives program.\u003c/li\u003e\n \u003cli\u003eIt identifies the challenges and also how they were/will be overcome by our learners and the teachers to make the learning effective during the program.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Background","content":"\u003cp\u003eElective courses, as their name suggests, are essentially opted by choice of the learner. They\u0026apos;re provided to students to enable them to explore diverse and specialized learning opportunities within their areas of interest, apart from the predetermined curriculum.\u0026nbsp;With the publication of the Flexner Report in 1910, medical teaching and curriculum progressed towards standardization.\u003cstrong\u003e\u0026nbsp;(1)\u003c/strong\u003e Since then, a change in the paradigm led to the implementation of alternative curricular pathways in addition to the core curriculum, including shortened preclinical curricula, dedicated research time and early clinical experiences. These alternative curricular pathways were designated as \u0026ldquo;electives\u0026rdquo;. Elective rotations in UK medical education were introduced as part of the curriculum reforms in the early 1970s. These reforms aimed to provide medical students with opportunities for self-directed learning, exposure to different medical specialties, and exploration of areas of particular interest. Electives have been a part of the American medical education curriculum for many decades, but they became more formalized in the early to mid-20th century. Medical schools began to incorporate elective periods into their curriculum to provide students with opportunities for specialized clinical experiences and to explore areas of interest beyond the core curriculum.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eElective courses for the undergraduates in medical education were introduced relatively late in India. Historically, medical education in India followed a more traditional curriculum structure with limited flexibility. In recent years, India has also been transitioning towards Competency-Based Medical Education (CBME) to align with global standards and enhance the effectiveness of medical training. Electives serve as valuable learning experiences, allowing learners to delve into different career paths, fields of study, or research endeavors. \u003cstrong\u003e(2)\u003c/strong\u003e Electives were introduced in the MBBS admission batch 2019. NMC (National Medical Council) gave us the guidelines of implementing the electives. \u003cstrong\u003e(3)\u003c/strong\u003e Given that it\u0026apos;s a novel program within the Indian context, there were numerous disparities in its organization, teaching methods, assessment, and evaluation. The students\u0026apos; perception of electives remains uncertain and varied. Faculty and students encountered several challenges during the implementation of electives. Various approaches were adopted for learning and assessing in electives. Despite the framework introduced by the NMC, there was considerable confusion regarding the execution of electives and their effectiveness post-implementation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn order to ensure the success of this program in achieving its educational objectives and to better understand the needs of both learners and faculty, this project aims to gather data on stakeholders\u0026apos; perceptions, needs, challenges faced and recommendations. This data will be utilized to evaluate the program and implement improvements where necessary for the next year Electives program.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eStudy\u0026nbsp;design\u003c/strong\u003e:\u0026nbsp;Qualitative \u0026amp; Quantitative observational study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e: MBBS Batch 2020, 3rd year part 1 students and Faculty involved in electives\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll volunteers from MBBS 2020 batch and Faculty involved in electives Program.\u003c/p\u003e\n\u003cp\u003eStudents: 133 participated in questionnaire based surveys (Each of BLOCK 1 and 2).\u003c/p\u003e\n\u003cp\u003e48 students participated in FGDs conducted \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFaculty: 43 faculty ( 19-BLOCK 1+24-BLOCK 2) \u0026nbsp;in questionnaire based surveys\u003c/p\u003e\n\u003cp\u003e26 faculty ( 14-BLOCK 1+12-BLOCK 2) participated in FGDs conducted\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling\u003c/strong\u003e: Convenient sampling\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescription of Intervention:\u0026nbsp;\u003c/strong\u003eIt was an observational study\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy tools\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eQuestionnaire based perception survey for the students.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eQuestionnaire based perception survey for the faculty. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFGD with Students\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFGD with faculty\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eContent validation\u003c/em\u003e\u003c/strong\u003e of the study tools were done by Medical Education experts at the institute (CC members, Academic coordinator), regional center and Nodal center resource faculty and FAIMER Fellows actively involved in Electives program in their institute. This was followed by \u003cstrong\u003e\u003cem\u003epilot testing\u003c/em\u003e\u003c/strong\u003e on a small group of students to improve clarity and understanding followed by \u003cstrong\u003e\u003cem\u003efinalization\u003c/em\u003e\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFlow of events:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe flowchart is available in the Supplementary Files section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection process:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eOnce research objectives were framed and the data collection tools decided.\u003c/li\u003e\n \u003cli\u003eQuestionnaires containing Likert scale based questions and open - ended questions were framed and validated for students and the faculty/ preceptors /administrators, separately.\u003c/li\u003e\n \u003cli\u003eFocus group discussion guides were prepared \u0026amp; validated\u003c/li\u003e\n \u003cli\u003einformed consent was obtained from the participants.\u003c/li\u003e\n \u003cli\u003eStudents answered separate questionnaire via google forms for BLOCK 1 and BLOCK 2\u003c/li\u003e\n \u003cli\u003eFaculty responded to a single questionnaire\u003c/li\u003e\n \u003cli\u003eStudents \u0026amp; Faculty who volunteered participated in Separate FGD each having a homogenous group of 6-8 students/ faculty.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eData was video recorded for the purpose of not missing any point and a simultaneous organogram was prepared to ensure participation of all the faculty.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMinimum duration of FGD was 25 minutes while maximum lasted for 50 minutes.\u003c/li\u003e\n \u003cli\u003eData was analyzed as below.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData analysis\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eData collected from the participants on a 5 point Likert scale in the questionnaire was analyzed and presented using tables, charts, and narrative descriptions to communicate key findings and conclusions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQualitative data in form of open ended questions and FGD response transcript was analyzed by thematic analysis and to understand how they provide meaning to the construct and make sense of their experiences, narrative analysis was used.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study was conducted on the Students who had just finished with the 3rd year part 1 exam. Students were given a questionnaire based survey form where they answered 11 questions about the effectiveness, learning environment and overall impact of the electives on them separately for both the BLOCKs. The results are shown in Figure 1 \u0026amp; 2 respectively for Block 1 \u0026amp; 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 1\u003c/u\u003e\u003c/strong\u003e\u003cu\u003e:- Agreement Level of Students perceptions regarding BLOCK 1 electives\u003c/u\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.507246376811594%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eS.No.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.927536231884055%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePerception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.56521739130435%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eLevel of Agreement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eStrongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eElectives provided me with a comprehensive understanding of the chosen topic.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e76.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eLearning objectives of the electives were clearly defined in the beginning.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e75.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eLearning objectives of the electives were achieved at the end of the electives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eElective rotations were well structured and organized.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e75.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eAppropriate learning resources were provided during the electives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e69.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eAppropriate mentorship, and supervision was received during the electives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e77.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eAdequate opportunities were given for active participation and direct engagement in the elective experiences.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e76.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eThe assessment conducted at the end of the elective program was appropriate.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e79.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eThe Elective Program helped me clarify for future career path. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e78.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eElective program helped me build up research acumen.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e66.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eElective program helped me improve comprehension for clinical application/ my clinical skills in the elected area.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\" valign=\"bottom\"\u003e\n \u003cp\u003e72.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003e#Values in Cells are expressed as % with total no. 133\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 2\u003c/u\u003e\u003c/strong\u003e\u003cu\u003e:- Agreement Level of Students perceptions regarding BLOCK 2 Electives\u003c/u\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.507246376811594%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eS.No.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.927536231884055%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePerception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.56521739130435%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eLevel of Agreement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eStrongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eElectives provided me with a comprehensive understanding of the chosen topic.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e77.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eLearning objectives of the electives were clearly defined in the beginning.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e78.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eLearning objectives of the electives were achieved at the end of the electives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e74.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eElective rotations were well structured and organized.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e77.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eAppropriate learning resources were provided during the electives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e72.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eAppropriate mentorship, and supervision was received during the electives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e74.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eAdequate opportunities were given for active participation and direct engagement in the elective experiences.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e75.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eThe assessment conducted at the end of the elective program was appropriate.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e78.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eThe Elective Program helped me clarify my future career path. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e78.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eElective program helped me build up research acumen.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e75.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eElective program helped me improve comprehension for clinical application/ my clinical skills in the elected area.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e74.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003e#Values in Cells are expressed as % with total no. 133\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOver all 95.7% and 94% of students were in agreement that the electives provided an effective learning experience and a conducive learning environment during BLOCK 1 and BLOCK 2 Electives respectively. Further analyzing, about 2% students felt that the elective rotations were not well structured and organized, Learning resources were not adequately shared. They also found inadequate engagement and mentoring during BLOCK 1 \u0026amp; BLOCK 2. While 2% students also reported a disagreement for the assessment methods conducted during BLOCK 2. Although the number was quite low. When students were asked about challenges they faced during the electives, most of them said that they had no challenges as such and the faculty were quite supportive to help them throughout.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDuration of Electives as per the students was appropriate where 62 \u0026amp; 69% students said that 2 weeks was adequate while23 \u0026amp; 32 % students felt that 4 weeks would have been better respectively for BLOCK 1 \u0026amp; BLOCK 2 as shown in Figure 4 \u0026amp; 5.\u003c/p\u003e\n\u003cp\u003eAs per students\u0026rsquo; perspective:\u003c/p\u003e\n\u003cp\u003eOn repeatedly reading and analyzing answers to the open ended questions and the responses during the FGD following were the highlighted phrases :\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eChallenges faced by the students:\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eMost of the students reported that there were no difficulties or challenges as such. Following were a few relevant responses given by the students.\u003c/p\u003e\n\u003cp\u003eBLOCK 1\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eNo challenges\u003c/li\u003e\n \u003cli\u003eDifficulty in recalling the basics initially\u003c/li\u003e\n \u003cli\u003eCollaboration with colleagues during tasks/ projects assigned.\u003c/li\u003e\n \u003cli\u003ePreparing for seminars and presentation\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eBLOCK 2\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAdjusting to a new environment and way of teaching.\u003c/li\u003e\n \u003cli\u003eInteraction with the patients\u003c/li\u003e\n \u003cli\u003eDistance for the RHTC elective.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eCommon Challenges:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eMandatory attendance\u003c/li\u003e\n \u003cli\u003eReduced one to one interaction with preceptor on some days due to overloaded faculty.\u003c/li\u003e\n \u003cli\u003eDaily time duration was too long.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e2. What went well:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eLearning in a clinical setting.\u003c/li\u003e\n \u003cli\u003eIn depth knowledge of the topic selected.\u003c/li\u003e\n \u003cli\u003eRevisiting the basics.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eClinical correlation of basic sciences.\u003c/li\u003e\n \u003cli\u003eOperation theater visits, hands on activities.\u003c/li\u003e\n \u003cli\u003eDirect interaction with the preceptors.\u003c/li\u003e\n \u003cli\u003eDeep understanding of the topic selected.\u003c/li\u003e\n \u003cli\u003eLearning by making projects and presenting seminars.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e3. Suggestions for more elective course to be added in the curriculum:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eOncology and other super specialty departments.\u003c/li\u003e\n \u003cli\u003eEmergency medicine.\u003c/li\u003e\n \u003cli\u003eSports/ extracurricular activities.\u003c/li\u003e\n \u003cli\u003eMore electives in Radiology \u0026amp; Psychiatry.\u003c/li\u003e\n \u003cli\u003eForensic medicine.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e4. When asked for suggestions to improve, most of them found the electives good as such and said that they had learnt a lot during the duration. Most of the students appreciated the clinical exposure \u0026amp; clinical correlation they received during this period, but also demanded more one to one interaction with the preceptor. A few students also requested broader topics where they could have rotations in different sub- sections rather than an in -depth knowledge in a single one.\u003c/p\u003e\n\u003cp\u003eFor any other suggestions and comments students mentioned that \u0026ldquo;I know that I have to work hard to get my dream branch in future\u0026rdquo;, \u0026ldquo;Adrenaline rush in the critical care was the best\u0026rdquo;, \u0026ldquo;Interaction with the patients was the most challenging and best part\u0026rdquo;, \u0026ldquo;Case presentation and seminar presentation helped building confidence\u0026rdquo;. A few students suggested more research oriented topics and a few also reported that they were unable to connect with the preceptors and found the electives just like their ward postings.\u003c/p\u003e\n\u003cp\u003eFaculty were also given a questionnaire based survey after completion of their respective electives and 19 and 24 faculty responded to the questionnaire based survey for BLOCK 1 and BLOCK 2, respectively. The perceptions and faculty\u0026rsquo;s agreement level on a 5 point likert scale have been presented in Table 3 and 4.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 3\u003c/u\u003e\u003c/strong\u003e\u003cu\u003e:- Agreement Level of Faculty perceptions regarding BLOCK 1 electives:\u003c/u\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.507246376811594%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eS.No.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.927536231884055%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePerception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.56521739130435%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eLevel of Agreement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eStrongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eTopics chosen for Electives in your department are appropriate for the students to give an effective learning experience.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e68.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eLearning objectives of the electives were achieved by the students successfully at the end of the electives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e52.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e47.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eStudents were actively involved and engaged during the teaching learning activities of Electives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e52.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eThe Elective Program plays an important role in helping the students choose their future career path.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e52.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eThe Elective program could give the students enough opportunities to help them build up research acumen.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e52.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eThe Elective program could give the students enough opportunities to help them improve clinical skills/ comprehension to clinical application in the chosen topic.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e68.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eThe Elective Program can foster and enhance students\u0026apos; critical thinking skills.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e47.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e47.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003e#Values in Cells are expressed as % with total no. 19\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 4\u003c/u\u003e\u003c/strong\u003e\u003cu\u003e:- Agreement Level of Faculty perceptions regarding BLOCK 2 Electives\u003c/u\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.507246376811594%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eS.No.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.927536231884055%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePerception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.56521739130435%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eLevel of Agreement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eStrongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eTopics chosen for Electives in your department are appropriate for the students to give an effective learning experience.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eLearning objectives of the electives were achieved by the students successfully at the end of the electives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eStudents were actively involved and engaged during the teaching learning activities of Electives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eThe Elective Program plays an important role in helping the students choose their future career path.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e29.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e54.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eThe Elective program could give the students enough opportunities to help them build up research acumen.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eThe Elective program could give the students enough opportunities to help them improve clinical skills/ comprehension to clinical application in the chosen topic.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.523255813953488%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.05813953488372%\" valign=\"bottom\"\u003e\n \u003cp\u003eThe Elective Program can foster and enhance students\u0026apos; critical thinking skills.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.883720930232558%\"\u003e\n \u003cp\u003e54.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003e#Values in Cells are expressed as % with total no. of 24 faculty\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAlmost all the BLOCK 1 faculty were in agreement with the effectiveness, good learning environment and positive overall impact of the Electives program on the students. 12.5% faculty in the BLOCK 2 felt that the involvement of the students was low. 16.7% faculty didn\u0026apos;t perceive electives to play any part in students\u0026apos; selection of future pathways. 12.5% felt that electives were not able to give any research acumen to the students.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBoth BLOCK 1 and BLOCK 2 faculty were satisfied with the topics selected, effectiveness, and the students\u0026rsquo; ability to develop critical thinking and clinical acumen during the Electives.\u003c/p\u003e\n\u003cp\u003eResponses of the BLOCK 2 faculty were a little varied in regards to the student participation and effectiveness of the program as compared to the BLOCK 1 Faculty. although even during FGDs most of the students were quite satisfied with the clinical exposure they had received.\u003c/p\u003e\n\u003cp\u003eOn repeatedly reading and analyzing answers of the Faculty to the open-ended questions and the responses during the FGD following were the highlighted phrases under the topics referred to:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eMost of the faculty reported that the program was better managed this year as compared to the previous year as the level of clarity was more.\u003c/li\u003e\n \u003cli\u003eWhat went well?\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eStudents enthusiasm to learn\u003c/li\u003e\n \u003cli\u003eStudents participation in various tasks assigned during the electives.\u003c/li\u003e\n \u003cli\u003eProject work was very well done by most of the students.\u003c/li\u003e\n \u003cli\u003eSeminars were presented very well.\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"3\" type=\"1\"\u003e\n \u003cli\u003eTeaching Learning Strategies or innovative approaches used for better learning experience during the electives:\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eAssignment to report Adverse drug reaction of the admitted patients.\u003c/li\u003e\n \u003cli\u003ePrescription auditing.\u003c/li\u003e\n \u003cli\u003eSeminar presentation.\u003c/li\u003e\n \u003cli\u003eProject.\u003c/li\u003e\n \u003cli\u003eHands on practice of skills.\u003c/li\u003e\n \u003cli\u003eCase presentation.\u003c/li\u003e\n \u003cli\u003eAttending ward rounds.\u003c/li\u003e\n \u003cli\u003eBedside teaching.\u003c/li\u003e\n \u003cli\u003eDemonstration of related Anatomy in Operation theater.\u003c/li\u003e\n \u003cli\u003ePoster presentation.\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"4\" type=\"1\"\u003e\n \u003cli\u003eAssessment and evaluation methods used during electives:\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eMCQ tests\u003c/li\u003e\n \u003cli\u003eViva-voce\u003c/li\u003e\n \u003cli\u003eProject/ Poster Presentation.\u003c/li\u003e\n \u003cli\u003eLogbook assessment.\u003c/li\u003e\n \u003cli\u003eAssignment submission.\u003c/li\u003e\n \u003cli\u003eCase presentation.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003col start=\"5\" type=\"1\"\u003e\n \u003cli\u003eChallenges Faced by faculty during electives:\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eKeep up active involvement of all students during the program.\u003c/li\u003e\n \u003cli\u003ePoor attendance.\u003c/li\u003e\n \u003cli\u003eDevoting time for electives along with the routine work, MBBS \u0026amp; PG teaching schedule.\u003c/li\u003e\n \u003cli\u003eDuration was too less to give in depth knowledge of the topic.\u003c/li\u003e\n \u003cli\u003eMany faculty were not aware of the program and its intention, and so their contribution was less.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003col start=\"6\" type=\"1\"\u003e\n \u003cli\u003eRecommendations for next year to overcome the challenges and improve students learning experience\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eLess of formal didactic teaching and more of task based and assignment based activities.\u003c/li\u003e\n \u003cli\u003eCases to be allotted for longitudinal reporting of progress of a case even in para clinical laboratory based electives for retrospective analysis and clinical correlation.\u003c/li\u003e\n \u003cli\u003eSimulation based training on mannequins.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eShort Research projects to be included.\u003c/li\u003e\n \u003cli\u003eMandatory preceptor training for all faculty before next electives.\u003c/li\u003e\n \u003cli\u003eMore \u0026lsquo;Students Choice\u0026rsquo; topics to be added to the pool of electives.\u003c/li\u003e\n \u003cli\u003eSome broad topics to be added where students can be rotated in different sections during the program.\u003c/li\u003e\n \u003cli\u003eShift from formal teaching to observation based and experiential learning.\u003c/li\u003e\n \u003cli\u003eStrict action on students who are not completing the required 75% of attendance.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Discussion","content":"\u003cp\u003eElective courses for undergraduate medical students encourage self-directed learning by allowing students to choose based on their interests. This student-centered approach shifts the teaching-learning dynamic, empowering learners to take responsibility for their education. \u003cstrong\u003e(4)\u003c/strong\u003e As per the responses received from the students and the faculty the Electives hold significant promise within medical education, rendering training more engaging, fostering the acquisition of diverse skills, and contributing to the holistic professional growth of students beyond conventional curricular confines.\u003cstrong\u003e\u0026nbsp;(5)\u003c/strong\u003e With accumulated experience and ongoing exploration, it is expected that a greater variety of elective offerings will be developed in the coming years. This evolution promises to further enrich the educational landscape, empowering students to tailor their learning experiences and equipping them with the multifaceted competencies essential for success in their future medical careers.\u003c/p\u003e\n\u003cp\u003eWhen compared with the other data published related to electives in other countries, they have gone a long way to international and outside the institute electives evaluation. These studies mainly focus on the attitude and behavior of learners to choose a particular topic and their safety.\u003cstrong\u003e\u0026nbsp;(6)\u003c/strong\u003e While in our stage we are still budding to implement the curricular electives in a satisfactory way to make it have a satisfactory developmental impact on our students. Not much research has been done on electives. So the published data is scarce.\u003cstrong\u003e\u0026nbsp;(7)\u003c/strong\u003e A cross-sectional study was conducted through a written evaluation survey concerning the electives available in the academic year 2015\u0026ndash;2016\u0026nbsp;in the Faculty of Medicine of University of Porto. Although there system is a lot different than ours, in their study also students\u0026apos; satisfaction was mainly based on Agreement\u0026nbsp;with teaching and learning methodologies, followed by Agreement with assessment methodologies employed. Electives with too much workload were last to be opted for and the last year ranking (can be compared to peer review in our case) was the basis of elective selection.\u003cstrong\u003e\u0026nbsp;(8)\u003c/strong\u003e Our students also reported a similar strategy while electing electives. In addition to these the preceptor also had a major influence on the elective selection rather than the topic.\u0026nbsp;International electives are not an option for our students still to explore as a future aspect- A qualitative analysis of 14 semi-structured interviews with elective hosts at seven elective sites in sub-Saharan countries was done as a part of international electives evaluation as a lot of students from the UK opt for these electives. The main reason being more clinical exposure. Although the challenges quoted by the elective hosts were the priority of teaching the local students and the requirement of more student preparation before electives.\u003cstrong\u003e\u0026nbsp;(9)\u003c/strong\u003e A recent cross-sectional study conducted in a Medical college at Delhi over 87 students concluded that\u0026nbsp;Electives is a welcome addition to the medical curriculum. The students their suggested more patient oriented electives and a few found the program not an appropriate one for the final year students. They demanded limited seats for each elective (which we had already followed). Inclusion of electives is perceived to be beneficial by most of the students of this study which is in line with our study too. (10)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplication of study:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the comprehensive data collected from both students and faculty, several recommendations can be proposed to enhance the Electives program:\u0026nbsp;\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eProtocol recommended for implementation of Electives as per our experience and recommendations from stakeholders:\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eAt the end of 2nd Prof the students can be surveyed for their choice of topics which can be added for the electives.\u003c/li\u003e\n \u003cli\u003eAfter checking for feasibility and consensus of faculty topics, course contents and structure can be revised.\u003c/li\u003e\n \u003cli\u003eAt the beginning of the 3rd part 1 students can be given a brief overview of available electives for them through short presentations by the preceptors/concerned faculty.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Students can be offered the electives based on the 1st and 2nd Prof Exam results.\u003c/li\u003e\n \u003cli\u003eFeedback collected from students and faculty after completion can be reviewed for further improvement in the program by dropping electives where students were not satisfied or the faculty felt that the students did not have satisfactory learning.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eImplementing standardized protocols for Electives, protocols for resource sharing, and mentor engagement across all departments will improve the organization and implementation further.\u003c/p\u003e\n\u003col start=\"2\" type=\"1\"\u003e\n \u003cli\u003ePreceptor and faculty training separately for electives should be mandatory. A half a day workshop, with training on effective teaching methodologies, mentorship skills, and time management to ensure optimal student engagement and learning outcomes so that the faculty are updated and prepared for the upcoming electives.\u003c/li\u003e\n \u003cli\u003eEncourage the use of effective teaching methods such as bedside teaching, case presentations, and small group discussions, projects, which have been identified by both students and faculty as beneficial for learning.\u003c/li\u003e\n \u003cli\u003eStudents can be allowed to attend the ward and OT even after the college timings during the BLOCK 2 electives to allow for deeper immersion in the chosen topics and ample time for students to engage in meaningful learning activities.\u003c/li\u003e\n \u003cli\u003eFacilitate more one-on-one interactions between students and preceptors to enhance personalized learning experiences and provide targeted mentorship.\u003c/li\u003e\n \u003cli\u003eIntroduction of more research-oriented electives and incorporation of small projects within elective rotations to foster research acumen and expose students to the research process.\u003c/li\u003e\n \u003cli\u003eA few broader topics with rotations in the subdivisions to have a more broader view of the subject can be introduced to gain exposure to various facets of a discipline.\u003c/li\u003e\n \u003cli\u003eIntroduction of Electives Courses from Super-specialty subjects and Emergency medicine can be added.\u003c/li\u003e\n \u003cli\u003eOptimization of Assessment methods to ensure comprehensive evaluation of students\u0026apos; knowledge and skills acquired during elective rotations.\u003c/li\u003e\n \u003cli\u003eFaculty Engagement can be improved by raising awareness about the Electives program, providing incentives/ appreciation/certificate for participation, and offering support for balancing elective responsibilities with routine work.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eBy implementing these recommendations, the Electives program can be improved further to provide students with enriching learning experiences, enhance faculty satisfaction and engagement, and prepare our students to become entrusted professionals.\u003c/p\u003e\n"},{"header":"Conclusion","content":"\u003cp\u003eAs per the responses received from the students and the faculty the Electives hold significant promise within Indian medical education, rendering training more engaging, fostering the acquisition of diverse skills, and contributing to the holistic professional growth of students beyond conventional curricular confines. With accumulated experience and ongoing exploration, it is expected that Electives Program will definitely become a program of high impact on the students, helping them to cater to their interests, enrich the educational landscape, empowering students to tailor their learning experiences and equipping them with the multifaceted competencies essential for success in their future medical careers.\u003c/p\u003e\n"},{"header":"Abbreviations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eCBME: Competency-Based Medical Education\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCC: Curriculum Committee\u003c/li\u003e\n \u003cli\u003eFGD: Focused Group Discussion\u003c/li\u003e\n \u003cli\u003eMBBS: Bachelor of Medicine, Bachelor of Surgery\u003c/li\u003e\n \u003cli\u003eNMC: National Medical Council\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eInstitutional Ethics Committee, NIMS University, Jaipur (Rajasthan) approved the research protocol for the above study (Ref. No.\u0026nbsp;NIMSUR/IEC/2024/872)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eNot applicable\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe data generated and analyzed during the current study is available with the corresponding author but\u0026nbsp;cannot be shared publicly, to protect study participants privacy.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eThe authors declare that they have no competing interests.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eThe authors declare that no funding was received for this research project.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eKP conceptualized the research design. KP, AM, SM and MT worked together for the data collection and analysis. Manuscript was written by KP, AM, SM. The manuscript was reviewed and edited by MT. All authors read and approved the final manuscript.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eThis research project was done as a part of Fellowship, FAIMER Batch 2023. I would like to acknowledge the constant support and guidance from Dr. Waseem F. Ansari as a project Mentor, CMCL- FRI Faculty, Seniors \u0026amp; Fellows for their unwavering support \u0026amp; direction and also Students \u0026amp; Faculty NIMS\u0026amp;R, Jaipur for their enthusiastic participation.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors\u0026apos; information:\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eKP is presently the Coordinator of Medical Education Unit at her Institute. Author is pursuing FAIMER Fellowship at CMCL, Ludhiana. She completed her Advanced course in Medical Education in 2019.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBeck AH. The Flexner report and the standardization of American medical education. Jama. 2004;291(17):2139\u0026ndash;40.\u003c/li\u003e\n \u003cli\u003eMihalynuk T, Leung G, Fraser J, Bates J, Snadden D. Free choice and career choice: clerkship electives in medical education. Med Educ. 2006;40(11):1065\u0026ndash;71.\u003c/li\u003e\n \u003cli\u003eMedical Council of India. Electives for the Undergraduate Medical Education Training Program, 2020: p 1- 30.\u003c/li\u003e\n \u003cli\u003eLumb A, Murdoch-Eaton D. Electives in undergraduate medical education: AMEE Guide No. 88 Med Teach. 2014;36:557\u0026ndash;72\u003c/li\u003e\n \u003cli\u003eTolsgaard MG. Clinical skills training in undergraduate medical education using a student-centered approach. Dan Med J. 2013 Aug;60(8):B4690.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eC Wiskin et al, compiled on behalf of the MSC UK Electives Committee. Recommendations for undergraduate medical electives: a UK consensus statement, Med Educ. 52, Issue 1(2018)\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJolly B. A missed opportunity. Med Educ. 2009;43:104\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eRamalho, A.R., Vieira-Marques, P.M., Magalh\u0026atilde;es-Alves, C. \u003cem\u003eet al.\u003c/em\u003e Electives in the medical curriculum \u0026ndash; an opportunity to achieve students\u0026rsquo; satisfaction?. \u003cem\u003eBMC Med Educ\u003c/em\u003e 20, 449 (2020).\u003c/li\u003e\n \u003cli\u003eKumwenda B, Dowell J, Daniels K, Merrylees N. Medical electives in sub-Saharan Africa: a host perspective. Med Educ. 2015 Jun;49(6):623-33. doi: 10.1111/medu.12727.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKaur G, Kritika, Arora P. Electives in Medical Curriculum- An Insight of Medical Students. Indian J Comm Health. 2023;35(4):485-493\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Electives, Experiential Learning, Teaching methods, MBBS Students","lastPublishedDoi":"10.21203/rs.3.rs-4794441/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4794441/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eElective courses offer students the opportunity to pursue specialized interests beyond the standard curriculum. India adopted electives formally from MBBS 2019 batch, aligning with Competency-Based Medical Education (CBME). Challenges in organizing, teaching, and assessing electives persist, with disparities in execution and student perceptions. This project aims to assess the Electives program's effectiveness, gathering data on stakeholders' experiences and identifying challenges and recommendations to serve students' educational objectives and enhance their learning experience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo Evaluate Institutional Electives in Undergraduate Medical Curriculum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp;\u0026nbsp;\u0026nbsp; To analyze the students' \u0026amp; faculty perceptions for the elective program.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp;\u0026nbsp;\u0026nbsp; To identify the challenges faced by the students \u0026amp; faculty during electives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003eTo formulate recommendations based on the insights gathered from focus group discussions (FGDs) and survey responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eObservational Qualitative Study, which will include volunteers from the MBBS 3rd year part 1, admission batch 2020 students and all the faculty and administrators involved in the Electives Program. Their perception on the effectiveness and overall impact of the Electives program would be collected in the form of questionnaires and Focused group discussions would be conducted to know in detail the challenges, best practices and recommendations from faculty and students to improve the Electives program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study found high satisfaction with the Electives program among both students and faculty. They emphasized that the time duration of direct engagement, teaching methodologies and assessment criteria had a significant impact on their choices and satisfaction. Participants provided suggestions for revising the electives to be more structured, clinical-oriented and the addition of sports/general electives to the pool.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGathering the stakeholder perceptions, challenges, and recommendations regarding the Electives program it is clear that Electives have immense potential to make an effective educational impact.\u003c/p\u003e","manuscriptTitle":"Evaluating Institutional Electives - Insights from stakeholders","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-03 17:03:54","doi":"10.21203/rs.3.rs-4794441/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c645a5a7-d834-4137-884f-cbe340333788","owner":[],"postedDate":"September 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-08T06:53:42+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-03 17:03:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4794441","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4794441","identity":"rs-4794441","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}