Satisfaction survey of early clinical exposure in medical students: a cross-sectional study

Satisfaction survey of early clinical exposure in medical students: a cross-sectional study | 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 Satisfaction survey of early clinical exposure in medical students: a cross-sectional study Maryam Kachuei, Mohammad Rezazadeh, Mohammad Hoseinzadeh, Akram Hashemi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5677524/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 Introduction: Early clinical exposure (ECE), one type of vertical integration model between preclinical and clinical subjects, is a teaching-learning technique that improves early medical students' professionalism. Conventional medical training delays clinical exposure until later years, potentially diminishing students' motivation and confidence. This study aims to evaluate the satisfaction and perception of third-year medical students from the ECE program. Method: A cross-sectional survey was conducted involving a convenience sample of 93 third-year medical students participating in an ECE program from December to March 2023 in the emergency ward. Data were collected using a validated semi-structured questionnaire, administered immediately after the program and three months later, after the students officially entered the clinical setting. Quantitative and qualitative analyses were conducted to assess students' satisfaction and perceptions. Results: Out of 93 participants, 80 completed the questionnaire. Most of the students found ECE to be an effective program with a satisfaction rate of over 90% in terms of benefits for the clinical years, helping to adapt to the clinical environment, giving confidence to communicate with supervisors and patients, and taking medical history and physical examination individually or in groups of two or more people. However, results show a significant decrease in the attitude towards the ECE program after entering the hospital (P value = 0.001). Qualitative feedback highlighted the effectiveness of ECE in helping students adapt to the clinical environment, the need for prolonged interaction with supervisors, and the integration of ECE across all courses. Discussion: The ECE program significantly improved students' initial confidence and adaptability to clinical environments. However, the observed decline in long-term satisfaction suggests a gap between the structured ECE experience and the complexities of real clinical practice. Continuous adaptation and integration of ECE throughout medical training are essential to sustain students' motivation and confidence as they transition to clinical roles. Figures Figure 1 1. Introduction The early years of medical school play a crucial role in shaping medical students' attitudes about medicine, future practice, and how the medical courses relate to societal demands ( 1 ). Medical students' clinical exposure is delayed until their third or fourth year of study in the conventional method of medical education, which is employed in Iran, Europe, and America. This is due to preclinical and clinical courses being separated, and the emphasis is on theoretical knowledge in labs and classrooms ( 2 ). As a result, medical students were isolated from the actual professional workplace, which diminished their confidence and motivation. One teaching-learning strategy that improves preclinical and clinical subjects' exposure to medical patients during their early years of medical college is early clinical exposure (ECE) ( 3 , 4 ). Although it has changed throughout time, the concept of ECE has its origins in the late 19th century, when modern medical education first emerged ( 5 ). Today, ECE is an integral part of medical education in many countries around the world, and students follow four roles in the ECE program: 1. passive observer; 2. active observer; 3. actor in rehearsal; 4. and actor in performance ( 6 ). ECE programs come in many different forms, including shadowing programs, clinical immersion programs, and community-based clinical experiences ( 7 ). The goal for which we wish to employ ECE will determine which of the three settings should be used. A brief ECE program could improve medical students' attitudes toward medical school, improve their confidence that they can succeed in the medical field, and give them a sense of social, emotional, and professional fulfillment, even though there is no one optimal approach to ECE ( 8 ). There are several key benefits of ECE for medical students. Firstly, it allows students to develop a deeper understanding of the clinical relevance of their studies. By witnessing the application of theoretical concepts in real-life patient care situations, students can better appreciate the importance of their academic learning and how it translates into clinical practice. This can help to motivate students and foster a greater sense of relevance and purpose in their studies ( 9 ). Additionally, ECE provides students with the opportunity to observe and learn from experienced healthcare professionals. By shadowing doctors, nurses, and other healthcare providers, students can gain valuable insights into the day-to-day responsibilities of healthcare professionals and the interpersonal skills required to work effectively with patients ( 10 ). This exposure can help students develop a better understanding of the healthcare team dynamic and the importance of effective communication and collaboration in delivering high-quality patient care. Furthermore, ECE allows students to develop essential clinical skills and competencies from an early stage in their training ( 9 ). By interacting with patients, taking medical histories, and participating in clinical examinations, students can begin to hone their diagnostic and problem-solving abilities, as well as develop their communication and interpersonal skills ( 11 ). This hands-on experience is invaluable in helping students develop confidence and cultivate a sense of medical professionalism. According to studies, ECE may greatly inspire medical students in a number of ways, enhancing their academic performance, clinical expertise, communication abilities, and self-assurance ( 12 ). However, further research is needed to fully understand the long-term effects of ECE on students' clinical competence and patient outcomes. This study is designed to measure the satisfaction and evaluation of the ECE program from the point of view of third-year medical students in Iran. 2. Methods This study was conducted as a cross-sectional survey and was approved by the Ethics Committee of Iran University of Medical Sciences (IR.IUMS.REC.1403.360). The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for observational studies. The Faculty of Medicine of Iran University of Medical Sciences has a 7-year undergraduate medical course. In the first 3 and a half years of this educational curriculum, students only learn the theory of medical sciences and do not have any training or contact with the clinical environment. Since the exact definition of ECE is controversial ( 13 ), in this study, the ECE program was implemented in a hospital-based setting, and appropriate resources such as logbook, textbooks, notes, instruments, learning material, case record sheets, and computers were used. 2.1. Study design: The ECE program of Iran University of Medical Sciences is performed from December to March 2023 at the emergency ward. The ECE program focused on skills such as history taking, physical examination, and effective communication with the patient and other medical staff, individually or in a group. The program is designed for 6 hours (from 9 am to 3 pm) in such a way that students in groups of 5 people are under the supervision of a professor during this time. One week before the program, each group of students was informed about the rules and objectives of participation in the program by the program coordinator. The ECE program involved multiple events, including a brief description of a medical student’s responsibilities towards the patients, an introduction to hospital wards and staff duties, familiarity with the regulations of the emergency ward, basic principles of history taking, clinical reasoning, and physical examination for patients, communication with patients and their companions, and participation in the case-based learning sessions. The case-based learning approach was conducted in each session; clinical cases were presented in a step-by-step manner to challenge the reasoning of learners. Students were also asked some basic science questions related to the cases to stimulate them to apply their basic science knowledge in solving the patient’s problems. At the end of the session, medical students visited a number of patients individually, with a partner, and in groups under the supervision of the professor. 2.2. Data collection and sampling: This cross-sectional survey involved both quantitative and qualitative data collection methods to obtain comprehensive insights into the perceptions of medical students. The convenience sample included 93 third-year medical students who participated in the ECE program. Participation was anonymous and voluntary, with no incentives. 2.3. questionnaire All data were collected through a validated semi-structured questionnaire, with an acceptable Cronbach’s alpha coefficient value of 0.67 ( 14 ). The questionnaire consisted of 8 items with a five-point Likert scale (5 = strongly agree, 4 = agree, 3 = uncertain, 2 = disagree, and 1 = strongly disagree) and one voluntarily open-ended question, which had an acceptable test-retest correlation, internal consistency, and construct validity. This questionnaire was translated directly from English to Persian. Then, the questionnaire was piloted among 20 members of the educational development center of Iran University of Medical Sciences and subsequently refined by cultural adaptation testing and feedback. In the first phase, the questionnaire was distributed to all students immediately after the implementation of the ECE program, and in the second phase, 3 months after the students entered the clinical setting. In this way, the long-term effect of the ECE program was investigated, and students had a more appropriate judgment of ECE when they officially entered the clinical setting. The questionnaire included questions about the student's satisfaction with the ECE program and its benefits in the areas of preparation for clinical years, adaptation to the clinical environment, and increasing confidence to perform clinical skills and interaction with patients and healthcare staff individually or in a group. The qualitative data were collected using an open question, in which the content analysis method was used. 2.4. Qualitative analyses For the qualitative analysis, two analytical strategies ( 15 ) were applied: a. In cases where the responses were succinct, word or theme frequency was employed. b. A thematic analysis technique was applied in cases when the responses were more extensive. Whole responses served as the study's unit of analysis, and they were interpreted without regard to any preconceived framework for analysis. Manual coding was done on the data. Following that, sessions aimed at reaching a consensus were used to identify, define, and agree upon emerging topics. 2.5. Quantitative analyses Descriptive quantitative analyses were done using SPSS version 27. Categorical variables were described with percentages, and continuous variables with mean and median (IQR). The Mann-Whitney U test was used to compare the students' satisfaction scores between the first and second phases of the program, and the significance level of 0.05 was considered. 3. Results Out of a total of 93 participants, a total of 80 medical students completed the questionnaire anonymously, which makes the response rate 86%. The median (IQR) age of students was 21.8 (21.3–22.5) years, of which 53.7% were male. Students’ satisfaction with the benefits of early clinical exposure was assessed in terms of eight main concepts that are shown in Table 1 (first phase) and Table 2 (second phase). Based on the quantitative data, a total of 78 students (97.5%) indicated that they agreed or strongly agreed that the ECE module was helpful for third-year students. Further, 76 students (95.0%) believed that the ECE background was a useful foundation for their clinical years. Also, 79 students (98.8%) state that ECE helped in their adjustment to the clinical learning setting. There were no students who disagreed with the first three items of the questionnaire. Three months after entering into the hospital, the percentage of respondents who agreed or strongly agreed to the first three dropped to 88.7%, 76.2%, and 91.2%, respectively. A total of 74 students (92.5%) believed that ECE provided them with the confidence to approach their clinical supervisors, which helped them prepare for their clinical years. Only 2 participants (2.4%) strongly disagreed or disagreed with this concept, which increased to 15 (18.8%) three months after entering the clinical setting. Furthermore, 76 students (95.0%) state that ECE provided them with the confidence to approach the patients, which dropped to 65 students (81.2%) in the second phase. Most of the students stated that ECE provided them with the confidence to take a history and physical examination individually (92.6%), with a partner (93.8%), and in a group (91.3%), which dropped to 66.2%, 78.7%, and 70% in the second phase, respectively. Table 1 Results of questionnaire immediately after participating in ECE program. Strongly disagree (Score = 1) Disagree (Score = 2) Uncertain (Score = 3) Agree (Score = 4) Strongly agree (Score = 5) Mean score Usefulness of ECE for third-year medical students 0 0 2 (2.5%) 23 (28.7%) 55 (68.8%) 4.66 Contribution of ECE for a useful foundation for the clinical years 0 0 4 (5%) 24 (30%) 52 (65%) 4.60 Help in adapting to the clinical environment 0 0 1 (1.2%) 26 (32.5%) 53 (66.3%) 4.65 Providing confidence to approach clinical supervisors 1 (1.2%) 1 (1.2%) 4 (5%) 20 (25%) 54 (67.5%) 4.56 Providing confidence to approach patients 1 (1.2%) 0 3 (3.7%) 25 (31.3%) 51 (63.7%) 4.56 Providing confidence to perform history taking and examination alone 1 (1.2%) 1 (1.2%) 4 (5%) 29 (36.3%) 45 (56.3%) 4.45 Providing confidence to perform history taking and examination in a group 1 (1.2%) 1 (1.2%) 5 (6.3%) 30 (37.5%) 43 (53.8%) 4.41 Providing confidence to perform history taking and examination with a partner 0 2 (2.5%) 3 (3.7%) 28 (35%) 47 (58.8%) 4.50 Table 2 Results of questionnaire 3 months after entering the hospital. Strongly disagree (Score = 1) Disagree (Score = 2) Uncertain (Score = 3) Agree (Score = 4) Strongly agree (Score = 5) Mean score Usefulness of ECE for third-year medical students 2 (2.5%) 2 (2.5%) 5 (6.3%) 28 (35%) 43 (53.7%) 4.35 Contribution of ECE for a useful foundation for the clinical years 1 (1.2%) 8 (10%) 10 (12.5%) 23 (28.7%) 38 (47.5%) 4.11 Help in adapting to the clinical environment 1 (1.2%) 6 (7.5%) 0 32 (40%) 41 (51.2%) 4.32 Providing confidence to approach clinical supervisors 1 (1.2%) 9 (11.3%) 5 (6.3%) 31 (38.7%) 34 (42.5%) 4.10 Providing confidence to approach patients 2 (2.5%) 4 (5%) 9 (11.3%) 31 (38.7%) 34 (42.5%) 4.13 Providing confidence to perform history taking and examination alone 1 (1.2%) 10 (12.5%) 16 (20%) 24 (30%) 29 (36.2%) 3.87 Providing confidence to perform history taking and examination in a group 1 (1.2%) 6 (7.5%) 17 (21.2%) 22 (27.5%) 34 (42.5%) 4.02 Providing confidence to perform history taking and examination with a partner 1 (1.2%) 7 (8.7%) 9 (11.3%) 34 (42.5%) 29 (36.2%) 4.03 In this study, the total points reported for 8 questions by each participant are considered the satisfaction score, which ranges from 8 to 40 based on the Likert scale (5 = strongly agree, 4 = agree, 3 = uncertain, 2 = disagree, and 1 = strongly disagree). Responses were categorized as low (less than 20), moderate (between 20 and 30), or high (greater than 30) satisfaction based on their total scores. In the first phase of the questionnaire, the satisfaction score of 1.3 percent of the respondents was low, 7.5 percent was moderate, and 91.3 percent was high. In the second phase of the questionnaire, the satisfaction score of 5% of the respondents was low, 25% was moderate, and 70% was high. The average satisfaction score in the first phase of the questionnaire was 36.5 (median = 38.5, IQR = 32.3–40), and in the second phase, it was 33.1 (M = 33, IQR = 30–40), which shows a significant difference in reducing the attitude towards the ECE program after entering the hospital (P = 0.001) (Fig. 1 ). For the open-ended question, 29 students in the first phase and 25 students in the second phase who completed the questionnaire gave comments about the ECE program and suggestions on how to improve it. After coding the sentences and extracting the concepts, the output of the open question can be summarized in 5 concepts (some sentences from the participants are given as examples): I. The most shared concept with 24 comments is that the ECE program helped students to adapt to the hospital environment. (It was a unique experience, getting to know the hospital environment was one of the positive points of this program.) II. The next concept with 11 comments suggests that professors spend more time teaching students. (It is suggested that the professors allocate more time to teach us.) III. The third concept, with 10 comments, considered the ECE program more useful than theoretical sciences. (Learning does not happen outside the hospital, please implement this program in other wards as well.) IV. The next concept with 5 comments suggested increasing the duration of the case-based learning sessions. (The duration of the case-based learning session was short.) V. The last concept with 2 comments considers ECE completely useless. (There was no need for this program; I learned everything after I officially entered the hospital.) 4. Discussion The results of this study provide valuable insights into the perceptions of third-year medical students regarding ECE and its impact on their professional development. Overall, the majority of students reported high levels of satisfaction with the ECE program and perceived it as a useful module for preparing them for their clinical years. Specifically, students believed that ECE helped them adapt to the clinical learning environment, gain confidence in approaching clinical supervisors and patients, and develop essential clinical skills such as history-taking and examination. Previous studies have focused on existing types of clinical exposure or student satisfaction only immediately after the implementation of the program ( 13 ); therefore, the distinction of this study was to evaluate the long-term attitudes and perceptions of medical students and compare them with short-term values. However, findings are consistent with previous studies that have demonstrated the positive impact of ECE on students' motivation and confidence, communication and scientific skills, and familiarity with the hospital setting ( 16 , 17 ). The EURACT Basic Medical Education Committee shows that ECE was used in 65 of the medical schools in 30 European countries in 2021 ( 18 ). The study by Ewnte et al. (2023) found that ECE positively impacts students' professional knowledge, problem-solving skills, and motivation ( 19 ). Also, Menyhart et al. (2024) performed a cross-sectional study to evaluate medical students’ attitudes towards ECE in Iran. Most students stated that ECE familiarized them with the role of basic sciences knowledge (80.1%) and increased their interest in medicine and encouraged them to read more (84.5%) ( 20 ). According to these findings, ECE assisted students in communicating the value of basic science knowledge to their future practice and in appreciating how it may be applied to clinical problem-solving. Another Iranian study with a quasi-experimental study with a pretest-posttest design shows that the attitude of most students from the learning-in-hospital settings group was positive before and after the exposure. This study also states that the motivation of students in the video-based education group was higher than that of students in the learning-in-hospital settings group, but this difference was not statistically significant (P = 0.6) ( 21 ). In our study, the highest percentage of satisfaction was related to help in adaptation to the clinical environment. A similar report in the study of AkbariRad M et al. revealed that ECE could familiarize (81.2%) the students with the role of basic sciences knowledge in clinical settings ( 22 ). However, it is important to note that the results of this study also revealed a decline in students' satisfaction with the ECE program over time. Specifically, the highest percentage of decrease in satisfaction was related to providing confidence to perform history taking and examination alone. This suggests that the initial positive perceptions of the ECE program may diminish as students face the challenges of real-world clinical practice. One possible explanation for this decline in satisfaction could be the differences between the controlled setting of the ECE program and the unpredictable nature of clinical practice. In the structured environment of the ECE program, students may feel more supported and confident in their abilities, whereas, in the hospital setting, they may encounter more complex scenarios that challenge their skills and confidence. This discrepancy between expectations and reality could lead to a decrease in satisfaction and confidence over time. Moreover, the qualitative analysis of the open-ended question revealed some interesting insights into students' experiences with the ECE program. The most commonly cited benefit of the program was gaining practical experience and interaction with the hospital environment, which suggests that hands-on learning is highly valued by students. Additionally, students expressed a desire for more time with supervisors, specific training opportunities, and the integration of ECE into all theory courses, indicating a need for more comprehensive and immersive clinical experiences. Previous studies confirm the concepts derived from the qualitative analysis of our study by Farajpour A et al. that indicate that medical students can be motivated by ECE to develop the foundation for the development of essential skills, such as problem-solving, clinical reasoning, communication, personal development, and the formation of a professional identity and professionalism ( 23 ). Another qualitative study shows that ECE increases concepts related to professionalism, including interpersonal skill with patients, teamwork, duty toward public health, and protection of patients' rights ( 24 ). Nevertheless, it is important to acknowledge the limitations of this study, which may impact the generalizability of the findings. Firstly, the study sample was relatively small, with only 80 medical students completing the questionnaire, which may limit the representativeness of the results. Additionally, the study was conducted at a single institution in Iran, which may not completely reflect the experiences of medical students in other cultural or educational settings. Furthermore, the study design relied on self-reported data from students, which may be subject to response bias and reliability issues. Future research could benefit from incorporating objective measures of students' clinical skills and competencies to provide a more comprehensive assessment of the impact of ECE on professional development. 5. Conclusion In conclusion, ECE is a valuable component of medical education that offers numerous benefits for students, healthcare providers, and the healthcare system. By providing students with the opportunity to gain firsthand experience in clinical settings from the early years of their training, medical schools can help to prepare future healthcare professionals who are well-rounded, competent, and compassionate. As medical education continues to evolve, ECE will undoubtedly play a crucial role in shaping the next generation of healthcare professionals. Declarations Ethics approval and consent to participate: Ethical approval for this study (Ethical code: IR.IUMS.REC.1403.360) was provided by the Research Ethics Committee of Iran university of medical sciences, Tehran, Iran on 2024-11-11. Consent for publication: Not Applicable Ethics approval and consent to participate: This study is approved by the Iran University of Medical Sciences research committee with the ethics code: IR.IUMS.REC.1403.360. It is hereby announced that informed consent has been obtained from all the participants to conduct the study and the personal information of the participants will not be disclosed in any way. Competing interests: The authors declare no conflict of interest in the creation and publication of this article. Our aim is to provide accurate and unbiased information, adhering to strict ethical standards. This work is based on thorough research and analysis, and any potential sources of influence have been fully disclosed. We are committed to maintaining transparency and integrity in all our endeavors, fostering the trust and confidence of our readers. Funding: This study was not financially supported. Author’s contributions: All authors have made significant contributions to this study. M.R designed the work, collected some data, performed the statistical analyses, and prepared the final manuscript. M.K supervised the implementation of the plan and edited the main manuscript text. M.H designed the work, supervised the implementation of the plan. A.H designed the work, supervised the implementation of the plan. A.S.M supervised the implementation of the plan. A.H (Amirhossein Heidari) collected some data Acknowledgments: We extend our sincere appreciation to Firoozabadi Hospital and their dedicated staff for their invaluable support and collaboration throughout this study. 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Sharifi A, Shohani M, Gheshlaghi LA, Shafiei E. Comparing the Effects of Early Clinical Exposure on the Attitude and Motivation of First-year Medical Students from Ilam University of Medical Sciences Based on Video-based Education and Learning-in-hospital Settings Methods. Shiraz E-Medical Journal. 2022;23(11). AkbariRad M, Khadem-Rezaiyan M, Ravanshad S, Rafiee M, Firoozi A, Zolfaghari SA, et al. Early clinical exposure as a highly interesting educational program for undergraduate medical students: an interventional study. BMC Medical Education. 2023;23(1):292. Farajpour A, Salehi A, Mashoufi R, Bakhshi Bejestani A. Medical students’ reflection on early clinical exposure experience: a qualitative research. Strides in Development of Medical Education. 2024;21(1):113-20. Liu C-i, Tang K-P, Wang Y-C, Chiu C-H. Impacts of early clinical exposure on undergraduate student professionalism—a qualitative study. BMC Medical Education. 2022;22(1):435. 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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-5677524","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":392997198,"identity":"4a774f20-de36-4a92-aa9f-427244297bba","order_by":0,"name":"Maryam Kachuei","email":"","orcid":"","institution":"Iran University of Medical Sciences (IUMS)","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Kachuei","suffix":""},{"id":392997199,"identity":"3477380e-abfe-4764-925b-7a1f4af62ea5","order_by":1,"name":"Mohammad Rezazadeh","email":"data:image/png;base64,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","orcid":"","institution":"Iran University of Medical Sciences (IUMS)","correspondingAuthor":true,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Rezazadeh","suffix":""},{"id":392997200,"identity":"c2ffbb69-af9f-4e05-8638-c8916979813b","order_by":2,"name":"Mohammad Hoseinzadeh","email":"","orcid":"","institution":"Iran University of Medical Sciences (IUMS)","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Hoseinzadeh","suffix":""},{"id":392997201,"identity":"e77f6722-5eb0-490d-9b35-9d8fca313c55","order_by":3,"name":"Akram Hashemi","email":"","orcid":"","institution":"Iran University of Medical Sciences (IUMS)","correspondingAuthor":false,"prefix":"","firstName":"Akram","middleName":"","lastName":"Hashemi","suffix":""},{"id":392997202,"identity":"69141a13-f340-4935-a66a-5fd57974b75d","order_by":4,"name":"Ashraf Sadat Mousavi","email":"","orcid":"","institution":"Iran University of Medical Sciences (IUMS)","correspondingAuthor":false,"prefix":"","firstName":"Ashraf","middleName":"Sadat","lastName":"Mousavi","suffix":""},{"id":392997203,"identity":"8ca22372-6ab0-4092-b01c-6e1578150f40","order_by":5,"name":"Amirhossein Heidari","email":"","orcid":"","institution":"Iran University of Medical Sciences (IUMS)","correspondingAuthor":false,"prefix":"","firstName":"Amirhossein","middleName":"","lastName":"Heidari","suffix":""}],"badges":[],"createdAt":"2024-12-19 14:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5677524/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5677524/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72363697,"identity":"cb744d99-0e83-4601-81e8-2f1be3ff19f7","added_by":"auto","created_at":"2024-12-26 06:18:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32431,"visible":true,"origin":"","legend":"\u003cp\u003eResults Categorize results by score: Low (less than 20), moderate (between 20 and 30), or high (greater than 30). Students’ satisfaction score in the first phase (a). Students’ satisfaction score in the second phase (b). The difference in satisfaction score between the first and second phases (c).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5677524/v1/a7b96021b8fdca2e7669b3ea.png"},{"id":81426937,"identity":"6bc7cf81-e05d-4d14-929a-a8d54afd3cbc","added_by":"auto","created_at":"2025-04-26 07:46:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":614111,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5677524/v1/b59f2aa7-3b4e-402a-93de-c80180bac369.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Satisfaction survey of early clinical exposure in medical students: a cross-sectional study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe early years of medical school play a crucial role in shaping medical students' attitudes about medicine, future practice, and how the medical courses relate to societal demands (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Medical students' clinical exposure is delayed until their third or fourth year of study in the conventional method of medical education, which is employed in Iran, Europe, and America. This is due to preclinical and clinical courses being separated, and the emphasis is on theoretical knowledge in labs and classrooms (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). As a result, medical students were isolated from the actual professional workplace, which diminished their confidence and motivation.\u003c/p\u003e \u003cp\u003eOne teaching-learning strategy that improves preclinical and clinical subjects' exposure to medical patients during their early years of medical college is early clinical exposure (ECE) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Although it has changed throughout time, the concept of ECE has its origins in the late 19th century, when modern medical education first emerged (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eToday, ECE is an integral part of medical education in many countries around the world, and students follow four roles in the ECE program: 1. passive observer; 2. active observer; 3. actor in rehearsal; 4. and actor in performance (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). ECE programs come in many different forms, including shadowing programs, clinical immersion programs, and community-based clinical experiences (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The goal for which we wish to employ ECE will determine which of the three settings should be used. A brief ECE program could improve medical students' attitudes toward medical school, improve their confidence that they can succeed in the medical field, and give them a sense of social, emotional, and professional fulfillment, even though there is no one optimal approach to ECE (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are several key benefits of ECE for medical students. Firstly, it allows students to develop a deeper understanding of the clinical relevance of their studies. By witnessing the application of theoretical concepts in real-life patient care situations, students can better appreciate the importance of their academic learning and how it translates into clinical practice. This can help to motivate students and foster a greater sense of relevance and purpose in their studies (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, ECE provides students with the opportunity to observe and learn from experienced healthcare professionals. By shadowing doctors, nurses, and other healthcare providers, students can gain valuable insights into the day-to-day responsibilities of healthcare professionals and the interpersonal skills required to work effectively with patients (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). This exposure can help students develop a better understanding of the healthcare team dynamic and the importance of effective communication and collaboration in delivering high-quality patient care.\u003c/p\u003e \u003cp\u003eFurthermore, ECE allows students to develop essential clinical skills and competencies from an early stage in their training (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). By interacting with patients, taking medical histories, and participating in clinical examinations, students can begin to hone their diagnostic and problem-solving abilities, as well as develop their communication and interpersonal skills (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). This hands-on experience is invaluable in helping students develop confidence and cultivate a sense of medical professionalism.\u003c/p\u003e \u003cp\u003eAccording to studies, ECE may greatly inspire medical students in a number of ways, enhancing their academic performance, clinical expertise, communication abilities, and self-assurance (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, further research is needed to fully understand the long-term effects of ECE on students' clinical competence and patient outcomes. This study is designed to measure the satisfaction and evaluation of the ECE program from the point of view of third-year medical students in Iran.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThis study was conducted as a cross-sectional survey and was approved by the Ethics Committee of Iran University of Medical Sciences (IR.IUMS.REC.1403.360). The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for observational studies.\u003c/p\u003e\n\u003cp\u003eThe Faculty of Medicine of Iran University of Medical Sciences has a 7-year undergraduate medical course. In the first 3 and a half years of this educational curriculum, students only learn the theory of medical sciences and do not have any training or contact with the clinical environment. Since the exact definition of ECE is controversial (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e), in this study, the ECE program was implemented in a hospital-based setting, and appropriate resources such as logbook, textbooks, notes, instruments, learning material, case record sheets, and computers were used.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1. Study design:\u003c/h2\u003e\n \u003cp\u003eThe ECE program of Iran University of Medical Sciences is performed from December to March 2023 at the emergency ward. The ECE program focused on skills such as history taking, physical examination, and effective communication with the patient and other medical staff, individually or in a group. The program is designed for 6 hours (from 9 am to 3 pm) in such a way that students in groups of 5 people are under the supervision of a professor during this time. One week before the program, each group of students was informed about the rules and objectives of participation in the program by the program coordinator.\u003c/p\u003e\n \u003cp\u003eThe ECE program involved multiple events, including a brief description of a medical student\u0026rsquo;s responsibilities towards the patients, an introduction to hospital wards and staff duties, familiarity with the regulations of the emergency ward, basic principles of history taking, clinical reasoning, and physical examination for patients, communication with patients and their companions, and participation in the case-based learning sessions.\u003c/p\u003e\n \u003cp\u003eThe case-based learning approach was conducted in each session; clinical cases were presented in a step-by-step manner to challenge the reasoning of learners. Students were also asked some basic science questions related to the cases to stimulate them to apply their basic science knowledge in solving the patient\u0026rsquo;s problems. At the end of the session, medical students visited a number of patients individually, with a partner, and in groups under the supervision of the professor.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2. Data collection and sampling:\u003c/h2\u003e\n \u003cp\u003eThis cross-sectional survey involved both quantitative and qualitative data collection methods to obtain comprehensive insights into the perceptions of medical students. The convenience sample included 93 third-year medical students who participated in the ECE program. Participation was anonymous and voluntary, with no incentives.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3. questionnaire\u003c/h2\u003e\n \u003cp\u003eAll data were collected through a validated semi-structured questionnaire, with an acceptable Cronbach\u0026rsquo;s alpha coefficient value of 0.67 (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e). The questionnaire consisted of 8 items with a five-point Likert scale (5\u0026thinsp;=\u0026thinsp;strongly agree, 4\u0026thinsp;=\u0026thinsp;agree, 3\u0026thinsp;=\u0026thinsp;uncertain, 2\u0026thinsp;=\u0026thinsp;disagree, and 1\u0026thinsp;=\u0026thinsp;strongly disagree) and one voluntarily open-ended question, which had an acceptable test-retest correlation, internal consistency, and construct validity. This questionnaire was translated directly from English to Persian. Then, the questionnaire was piloted among 20 members of the educational development center of Iran University of Medical Sciences and subsequently refined by cultural adaptation testing and feedback.\u003c/p\u003e\n \u003cp\u003eIn the first phase, the questionnaire was distributed to all students immediately after the implementation of the ECE program, and in the second phase, 3 months after the students entered the clinical setting. In this way, the long-term effect of the ECE program was investigated, and students had a more appropriate judgment of ECE when they officially entered the clinical setting.\u003c/p\u003e\n \u003cp\u003eThe questionnaire included questions about the student\u0026apos;s satisfaction with the ECE program and its benefits in the areas of preparation for clinical years, adaptation to the clinical environment, and increasing confidence to perform clinical skills and interaction with patients and healthcare staff individually or in a group. The qualitative data were collected using an open question, in which the content analysis method was used.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4. Qualitative analyses\u003c/h2\u003e\n \u003cp\u003eFor the qualitative analysis, two analytical strategies (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e) were applied:\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003ea. In cases where the responses were succinct, word or theme frequency was employed.\u003c/p\u003e\n \u003c/span\u003e \u003cspan\u003e\n \u003cp\u003eb. A thematic analysis technique was applied in cases when the responses were more extensive. Whole responses served as the study\u0026apos;s unit of analysis, and they were interpreted without regard to any preconceived framework for analysis. Manual coding was done on the data. Following that, sessions aimed at reaching a consensus were used to identify, define, and agree upon emerging topics.\u003c/p\u003e\n \u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e2.5. Quantitative analyses\u003c/h2\u003e\n \u003cp\u003eDescriptive quantitative analyses were done using SPSS version 27. Categorical variables were described with percentages, and continuous variables with mean and median (IQR). The Mann-Whitney U test was used to compare the students\u0026apos; satisfaction scores between the first and second phases of the program, and the significance level of 0.05 was considered.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eOut of a total of 93 participants, a total of 80 medical students completed the questionnaire anonymously, which makes the response rate 86%. The median (IQR) age of students was 21.8 (21.3\u0026ndash;22.5) years, of which 53.7% were male.\u003c/p\u003e\n\u003cp\u003eStudents\u0026rsquo; satisfaction with the benefits of early clinical exposure was assessed in terms of eight main concepts that are shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e (first phase) and Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e (second phase).\u003c/p\u003e\n\u003cp\u003eBased on the quantitative data, a total of 78 students (97.5%) indicated that they agreed or strongly agreed that the ECE module was helpful for third-year students. Further, 76 students (95.0%) believed that the ECE background was a useful foundation for their clinical years. Also, 79 students (98.8%) state that ECE helped in their adjustment to the clinical learning setting. There were no students who disagreed with the first three items of the questionnaire. Three months after entering into the hospital, the percentage of respondents who agreed or strongly agreed to the first three dropped to 88.7%, 76.2%, and 91.2%, respectively.\u003c/p\u003e\n\u003cp\u003eA total of 74 students (92.5%) believed that ECE provided them with the confidence to approach their clinical supervisors, which helped them prepare for their clinical years. Only 2 participants (2.4%) strongly disagreed or disagreed with this concept, which increased to 15 (18.8%) three months after entering the clinical setting. Furthermore, 76 students (95.0%) state that ECE provided them with the confidence to approach the patients, which dropped to 65 students (81.2%) in the second phase.\u003c/p\u003e\n\u003cp\u003eMost of the students stated that ECE provided them with the confidence to take a history and physical examination individually (92.6%), with a partner (93.8%), and in a group (91.3%), which dropped to 66.2%, 78.7%, and 70% in the second phase, respectively.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\" style=\"margin-right: calc(0%); width: 100%;\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of questionnaire immediately after participating in ECE program.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"12\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 24.5629%;\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 19.0559%;\"\u003e\n \u003cp\u003eStrongly disagree (Score\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 8.2168%;\"\u003e\n \u003cp\u003eDisagree (Score\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.0035%;\"\u003e\n \u003cp\u003eUncertain (Score\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 7.1678%;\"\u003e\n \u003cp\u003eAgree (Score\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.8776%;\"\u003e\n \u003cp\u003eStrongly agree (Score\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 5.1573%;\"\u003e\n \u003cp\u003eMean score\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.5629%;\"\u003e\n \u003cp\u003eUsefulness of ECE for third-year medical students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.7517%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 16.6084%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0035%;\"\u003e\n \u003cp\u003e2 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.1678%;\"\u003e\n \u003cp\u003e23 (28.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8776%;\"\u003e\n \u003cp\u003e55 (68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1573%;\"\u003e\n \u003cp\u003e4.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.5629%;\"\u003e\n \u003cp\u003eContribution of ECE for a useful foundation for the clinical years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.7517%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 16.6084%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0035%;\"\u003e\n \u003cp\u003e4 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.1678%;\"\u003e\n \u003cp\u003e24 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8776%;\"\u003e\n \u003cp\u003e52 (65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1573%;\"\u003e\n \u003cp\u003e4.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.5629%;\"\u003e\n \u003cp\u003eHelp in adapting to the clinical environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.7517%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 16.6084%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0035%;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.1678%;\"\u003e\n \u003cp\u003e26 (32.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8776%;\"\u003e\n \u003cp\u003e53 (66.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1573%;\"\u003e\n \u003cp\u003e4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.5629%;\"\u003e\n \u003cp\u003eProviding confidence to approach clinical supervisors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.7517%;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 16.6084%;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0035%;\"\u003e\n \u003cp\u003e4 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.1678%;\"\u003e\n \u003cp\u003e20 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8776%;\"\u003e\n \u003cp\u003e54 (67.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1573%;\"\u003e\n \u003cp\u003e4.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.5629%;\"\u003e\n \u003cp\u003eProviding confidence to approach patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.7517%;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 16.6084%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0035%;\"\u003e\n \u003cp\u003e3 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.1678%;\"\u003e\n \u003cp\u003e25 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8776%;\"\u003e\n \u003cp\u003e51 (63.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1573%;\"\u003e\n \u003cp\u003e4.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.5629%;\"\u003e\n \u003cp\u003eProviding confidence to perform history taking and examination alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.7517%;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 16.6084%;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0035%;\"\u003e\n \u003cp\u003e4 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.1678%;\"\u003e\n \u003cp\u003e29 (36.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8776%;\"\u003e\n \u003cp\u003e45 (56.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1573%;\"\u003e\n \u003cp\u003e4.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.5629%;\"\u003e\n \u003cp\u003eProviding confidence to perform history taking and examination in a group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.7517%;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 16.6084%;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0035%;\"\u003e\n \u003cp\u003e5 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.1678%;\"\u003e\n \u003cp\u003e30 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8776%;\"\u003e\n \u003cp\u003e43 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1573%;\"\u003e\n \u003cp\u003e4.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.5629%;\"\u003e\n \u003cp\u003eProviding confidence to perform history taking and examination with a partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.7517%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 16.6084%;\"\u003e\n \u003cp\u003e2 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0035%;\"\u003e\n \u003cp\u003e3 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.1678%;\"\u003e\n \u003cp\u003e28 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8776%;\"\u003e\n \u003cp\u003e47 (58.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1573%;\"\u003e\n \u003cp\u003e4.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of questionnaire 3 months after entering the hospital.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStrongly disagree (Score\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDisagree (Score\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUncertain (Score\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAgree (Score\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStrongly agree (Score\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean score\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUsefulness of ECE for third-year medical students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (53.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eContribution of ECE for a useful foundation for the clinical years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (28.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (47.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHelp in adapting to the clinical environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (51.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProviding confidence to approach clinical supervisors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (38.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (42.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProviding confidence to approach patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (38.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (42.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProviding confidence to perform history taking and examination alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (36.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProviding confidence to perform history taking and examination in a group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (42.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProviding confidence to perform history taking and examination with a partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (42.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (36.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIn this study, the total points reported for 8 questions by each participant are considered the satisfaction score, which ranges from 8 to 40 based on the Likert scale (5\u0026thinsp;=\u0026thinsp;strongly agree, 4\u0026thinsp;=\u0026thinsp;agree, 3\u0026thinsp;=\u0026thinsp;uncertain, 2\u0026thinsp;=\u0026thinsp;disagree, and 1\u0026thinsp;=\u0026thinsp;strongly disagree). Responses were categorized as low (less than 20), moderate (between 20 and 30), or high (greater than 30) satisfaction based on their total scores. In the first phase of the questionnaire, the satisfaction score of 1.3 percent of the respondents was low, 7.5 percent was moderate, and 91.3 percent was high. In the second phase of the questionnaire, the satisfaction score of 5% of the respondents was low, 25% was moderate, and 70% was high. The average satisfaction score in the first phase of the questionnaire was 36.5 (median\u0026thinsp;=\u0026thinsp;38.5, IQR\u0026thinsp;=\u0026thinsp;32.3\u0026ndash;40), and in the second phase, it was 33.1 (M\u0026thinsp;=\u0026thinsp;33, IQR\u0026thinsp;=\u0026thinsp;30\u0026ndash;40), which shows a significant difference in reducing the attitude towards the ECE program after entering the hospital (P\u0026thinsp;=\u0026thinsp;0.001) (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFor the open-ended question, 29 students in the first phase and 25 students in the second phase who completed the questionnaire gave comments about the ECE program and suggestions on how to improve it.\u003c/p\u003e\n\u003cp\u003eAfter coding the sentences and extracting the concepts, the output of the open question can be summarized in 5 concepts (some sentences from the participants are given as examples):\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eI. The most shared concept with 24 comments is that the ECE program helped students to adapt to the hospital environment. (It was a unique experience, getting to know the hospital environment was one of the positive points of this program.)\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003eII. The next concept with 11 comments suggests that professors spend more time teaching students. (It is suggested that the professors allocate more time to teach us.)\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003eIII. The third concept, with 10 comments, considered the ECE program more useful than theoretical sciences. (Learning does not happen outside the hospital, please implement this program in other wards as well.)\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003eIV. The next concept with 5 comments suggested increasing the duration of the case-based learning sessions. (The duration of the case-based learning session was short.)\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003eV. The last concept with 2 comments considers ECE completely useless. (There was no need for this program; I learned everything after I officially entered the hospital.)\u003c/p\u003e\n\u003c/span\u003e\n\u003cp\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe results of this study provide valuable insights into the perceptions of third-year medical students regarding ECE and its impact on their professional development. Overall, the majority of students reported high levels of satisfaction with the ECE program and perceived it as a useful module for preparing them for their clinical years. Specifically, students believed that ECE helped them adapt to the clinical learning environment, gain confidence in approaching clinical supervisors and patients, and develop essential clinical skills such as history-taking and examination.\u003c/p\u003e \u003cp\u003ePrevious studies have focused on existing types of clinical exposure or student satisfaction only immediately after the implementation of the program (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e); therefore, the distinction of this study was to evaluate the long-term attitudes and perceptions of medical students and compare them with short-term values. However, findings are consistent with previous studies that have demonstrated the positive impact of ECE on students' motivation and confidence, communication and scientific skills, and familiarity with the hospital setting (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe EURACT Basic Medical Education Committee shows that ECE was used in 65 of the medical schools in 30 European countries in 2021 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The study by Ewnte et al. (2023) found that ECE positively impacts students' professional knowledge, problem-solving skills, and motivation (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Also, Menyhart et al. (2024) performed a cross-sectional study to evaluate medical students\u0026rsquo; attitudes towards ECE in Iran. Most students stated that ECE familiarized them with the role of basic sciences knowledge (80.1%) and increased their interest in medicine and encouraged them to read more (84.5%) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). According to these findings, ECE assisted students in communicating the value of basic science knowledge to their future practice and in appreciating how it may be applied to clinical problem-solving.\u003c/p\u003e \u003cp\u003eAnother Iranian study with a quasi-experimental study with a pretest-posttest design shows that the attitude of most students from the learning-in-hospital settings group was positive before and after the exposure. This study also states that the motivation of students in the video-based education group was higher than that of students in the learning-in-hospital settings group, but this difference was not statistically significant (P\u0026thinsp;=\u0026thinsp;0.6) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In our study, the highest percentage of satisfaction was related to help in adaptation to the clinical environment. A similar report in the study of AkbariRad M et al. revealed that ECE could familiarize (81.2%) the students with the role of basic sciences knowledge in clinical settings (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, it is important to note that the results of this study also revealed a decline in students' satisfaction with the ECE program over time. Specifically, the highest percentage of decrease in satisfaction was related to providing confidence to perform history taking and examination alone. This suggests that the initial positive perceptions of the ECE program may diminish as students face the challenges of real-world clinical practice.\u003c/p\u003e \u003cp\u003eOne possible explanation for this decline in satisfaction could be the differences between the controlled setting of the ECE program and the unpredictable nature of clinical practice. In the structured environment of the ECE program, students may feel more supported and confident in their abilities, whereas, in the hospital setting, they may encounter more complex scenarios that challenge their skills and confidence. This discrepancy between expectations and reality could lead to a decrease in satisfaction and confidence over time.\u003c/p\u003e \u003cp\u003eMoreover, the qualitative analysis of the open-ended question revealed some interesting insights into students' experiences with the ECE program. The most commonly cited benefit of the program was gaining practical experience and interaction with the hospital environment, which suggests that hands-on learning is highly valued by students. Additionally, students expressed a desire for more time with supervisors, specific training opportunities, and the integration of ECE into all theory courses, indicating a need for more comprehensive and immersive clinical experiences. Previous studies confirm the concepts derived from the qualitative analysis of our study by Farajpour A et al. that indicate that medical students can be motivated by ECE to develop the foundation for the development of essential skills, such as problem-solving, clinical reasoning, communication, personal development, and the formation of a professional identity and professionalism (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Another qualitative study shows that ECE increases concepts related to professionalism, including interpersonal skill with patients, teamwork, duty toward public health, and protection of patients' rights (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNevertheless, it is important to acknowledge the limitations of this study, which may impact the generalizability of the findings. Firstly, the study sample was relatively small, with only 80 medical students completing the questionnaire, which may limit the representativeness of the results. Additionally, the study was conducted at a single institution in Iran, which may not completely reflect the experiences of medical students in other cultural or educational settings.\u003c/p\u003e \u003cp\u003eFurthermore, the study design relied on self-reported data from students, which may be subject to response bias and reliability issues. Future research could benefit from incorporating objective measures of students' clinical skills and competencies to provide a more comprehensive assessment of the impact of ECE on professional development.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn conclusion, ECE is a valuable component of medical education that offers numerous benefits for students, healthcare providers, and the healthcare system. By providing students with the opportunity to gain firsthand experience in clinical settings from the early years of their training, medical schools can help to prepare future healthcare professionals who are well-rounded, competent, and compassionate. As medical education continues to evolve, ECE will undoubtedly play a crucial role in shaping the next generation of healthcare professionals.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eEthical approval for this study (Ethical code: IR.IUMS.REC.1403.360) was provided by the\u003c/p\u003e\n\u003cp\u003eResearch Ethics Committee of Iran university of medical sciences, Tehran, Iran on 2024-11-11.\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eThis study is approved by the Iran University of Medical Sciences research committee with the ethics code: IR.IUMS.REC.1403.360.\u003c/p\u003e\n\u003cp\u003eIt is hereby announced that informed consent has been obtained from all the participants to conduct the study and the personal information of the participants will not be disclosed in any way.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest in the creation and publication of this article. Our aim is to provide accurate and unbiased information, adhering to strict ethical standards. This work is based on thorough research and analysis, and any potential sources of influence have been fully disclosed. We are committed to maintaining transparency and integrity in all our endeavors, fostering the trust and confidence of our readers.\u003c/p\u003e\n\u003cp\u003eFunding:\u003c/p\u003e\n\u003cp\u003eThis study was not financially supported.\u003c/p\u003e\n\u003cp\u003eAuthor’s contributions:\u003c/p\u003e\n\u003cp\u003eAll authors have made significant contributions to this study.\u003c/p\u003e\n\u003cp\u003eM.R designed the work, collected some data, performed the statistical analyses, and prepared the final manuscript.\u003c/p\u003e\n\u003cp\u003eM.K supervised the implementation of the plan and edited the main manuscript text.\u003c/p\u003e\n\u003cp\u003eM.H designed the work, supervised the implementation of the plan.\u003c/p\u003e\n\u003cp\u003eA.H designed the work, supervised the implementation of the plan.\u003c/p\u003e\n\u003cp\u003eA.S.M supervised the implementation of the plan.\u003c/p\u003e\n\u003cp\u003eA.H (Amirhossein Heidari)\u0026nbsp;collected some data\u003c/p\u003e\n\u003cp\u003eAcknowledgments:\u003c/p\u003e\n\u003cp\u003eWe extend our sincere appreciation to Firoozabadi Hospital and their dedicated staff for their invaluable support and collaboration throughout this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData availability:\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLittlewood S, Ypinazar V, Margolis SA, Scherpbier A, Spencer J, Dornan T. Early practical experience and the social responsiveness of clinical education: systematic review. Bmj. 2005;331(7513):387-91.\u003c/li\u003e\n\u003cli\u003eJafarzadeh Esfehani R, Jalal Yazdi M, Kamranian H, Jafarzadeh A, Rezaei Kalat A, Mahmudi Gharai A. Effect of early clinical exposure on learning motivation of medical students. Future of medical education journal. 2012;2(2):3-7.\u003c/li\u003e\n\u003cli\u003eVerma M. Early clinical exposure: New paradigm in Medical and Dental Education. Contemporary clinical dentistry. 2016;7(3):287-8.\u003c/li\u003e\n\u003cli\u003eShah C. Early clinical exposure-Why and how? Journal of Education Technology in Health Sciences. 2018;5(1):2-7.\u003c/li\u003e\n\u003cli\u003eIngale MH, Tayade MC, Bhamare S. Early clinical exposure: Dynamics, opportunities, and challenges in modern medical education. Journal of Education and Health Promotion. 2023;12(1):295.\u003c/li\u003e\n\u003cli\u003eTayade MC, Latti RG. Effectiveness of early clinical exposure in medical education: Settings and scientific theories\u0026ndash;Review. Journal of Education and Health Promotion. 2021;10(1):117.\u003c/li\u003e\n\u003cli\u003eTayade MC, Giri PA, Latti RG. Effectiveness of early clinical exposure in improving attitude and professional skills of medical students in current Indian medical education set up. Journal of Family Medicine and Primary Care. 2021;10(2):681-5.\u003c/li\u003e\n\u003cli\u003eSingh RA. Perception of Early Clinical Exposure (ECE) among Phase I MBBS Students in a Medical College in Northeastern India. Journal of Medical Sciences. 2024;10(2):169.\u003c/li\u003e\n\u003cli\u003eGovindarajan S, Vasanth G, Kumar PA, Priyadarshini C, Radhakrishnan SS, Kanagaraj V, et al. Impact of a comprehensive early clinical exposure program for preclinical year medical students. Health Professions Education. 2018;4(2):133-8.\u003c/li\u003e\n\u003cli\u003eBasukala A, Chaudhary K. Early Clinical Exposure in Pre-clinical Years of Medical School. JNMA: Journal of the Nepal Medical Association. 2021;59(242):1072.\u003c/li\u003e\n\u003cli\u003eVidja K, Patel J, Parmar J, Akhani P. Perception of Indian medical students regarding introduction of early clinical exposure. JPBI (Jurnal Pendidikan Biologi Indonesia). 2023;9(3):483-91.\u003c/li\u003e\n\u003cli\u003eEbrahimi S, Kojuri J, ASHKANI ES. Early clinical experience: A way for preparing students for clinical setting. 2012.\u003c/li\u003e\n\u003cli\u003eBaşak O, Yaphe J, Spiegel W, Wilm S, Carelli F, Metsemakers JF. Early clinical exposure in medical curricula across Europe: an overview. The European journal of general practice. 2009;15(1):4-10.\u003c/li\u003e\n\u003cli\u003eShuid AN, Yaman MN, Abd Kadir RA, Hussain RI, Othman SN, Nawi AM, et al. Effect of early clinical skills teaching on 3rd year medical students\u0026apos; learning: The student perspective. Journal of Taibah University Medical Sciences. 2015;10(1):26-32.\u003c/li\u003e\n\u003cli\u003eRobson C, McCartan K. Real world research (ed.). Malden, MA: Blackwell Publishing. 2002.\u003c/li\u003e\n\u003cli\u003eK U. Role of early clinical exposure for clinical training among medical undergraduate students. International Journal of Clinical Biochemistry and Research. 2023;10:184-6.\u003c/li\u003e\n\u003cli\u003eKalusopa VM, Katowa-Mukwato P, Chitundu K, Mvula M, Nzala S, Kabinga-Makukula M, et al. Experiences of early and enhanced clinical exposure for postgraduate neonatal Nursing students at the University of Zambia, school of nursing sciences: Lessons and implications for the future. Open journal of nursing. 2023;13(6):352.\u003c/li\u003e\n\u003cli\u003eSimmenroth A, Harding A, Vallersnes OM, Dowek A, Carelli F, Kiknadze N, et al. Early clinical exposure in undergraduate medical education: A questionnaire survey of 30 European countries. Medical Teacher. 2023;45(4):426-32.\u003c/li\u003e\n\u003cli\u003eEwnte B, Yigzaw T. Early clinical exposure in medical education: the experience from Debre Tabor University. BMC Medical Education. 2023;23(1):252.\u003c/li\u003e\n\u003cli\u003eMafinejad MK, Mirzazadeh A, Peiman S, Khajavirad N, Hazaveh MM, Edalatifard M, et al. Medical students\u0026rsquo; attitudes towards early clinical exposure in Iran. International journal of medical education. 2016;7:195.\u003c/li\u003e\n\u003cli\u003eSharifi A, Shohani M, Gheshlaghi LA, Shafiei E. Comparing the Effects of Early Clinical Exposure on the Attitude and Motivation of First-year Medical Students from Ilam University of Medical Sciences Based on Video-based Education and Learning-in-hospital Settings Methods. Shiraz E-Medical Journal. 2022;23(11).\u003c/li\u003e\n\u003cli\u003eAkbariRad M, Khadem-Rezaiyan M, Ravanshad S, Rafiee M, Firoozi A, Zolfaghari SA, et al. Early clinical exposure as a highly interesting educational program for undergraduate medical students: an interventional study. BMC Medical Education. 2023;23(1):292.\u003c/li\u003e\n\u003cli\u003eFarajpour A, Salehi A, Mashoufi R, Bakhshi Bejestani A. Medical students\u0026rsquo; reflection on early clinical exposure experience: a qualitative research. Strides in Development of Medical Education. 2024;21(1):113-20.\u003c/li\u003e\n\u003cli\u003eLiu C-i, Tang K-P, Wang Y-C, Chiu C-H. Impacts of early clinical exposure on undergraduate student professionalism\u0026mdash;a qualitative study. BMC Medical Education. 2022;22(1):435.\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":"","lastPublishedDoi":"10.21203/rs.3.rs-5677524/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5677524/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Early clinical exposure (ECE), one type of vertical integration model between preclinical and clinical subjects, is a teaching-learning technique that improves early medical students' professionalism. Conventional medical training delays clinical exposure until later years, potentially diminishing students' motivation and confidence. This study aims to evaluate the satisfaction and perception of third-year medical students from the ECE program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e A cross-sectional survey was conducted involving a convenience sample of 93 third-year medical students participating in an ECE program from December to March 2023 in the emergency ward. Data were collected using a validated semi-structured questionnaire, administered immediately after the program and three months later, after the students officially entered the clinical setting. Quantitative and qualitative analyses were conducted to assess students' satisfaction and perceptions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Out of 93 participants, 80 completed the questionnaire. Most of the students found ECE to be an effective program with a satisfaction rate of over 90% in terms of benefits for the clinical years, helping to adapt to the clinical environment, giving confidence to communicate with supervisors and patients, and taking medical history and physical examination individually or in groups of two or more people. However, results show a significant decrease in the attitude towards the ECE program after entering the hospital (P value = 0.001). Qualitative feedback highlighted the effectiveness of ECE in helping students adapt to the clinical environment, the need for prolonged interaction with supervisors, and the integration of ECE across all courses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e The ECE program significantly improved students' initial confidence and adaptability to clinical environments. However, the observed decline in long-term satisfaction suggests a gap between the structured ECE experience and the complexities of real clinical practice. Continuous adaptation and integration of ECE throughout medical training are essential to sustain students' motivation and confidence as they transition to clinical roles.\u003c/p\u003e","manuscriptTitle":"Satisfaction survey of early clinical exposure in medical students: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-26 06:18:49","doi":"10.21203/rs.3.rs-5677524/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":"3b0b688c-2931-4f10-9e1d-ee2ed468b2a5","owner":[],"postedDate":"December 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-26T07:38:35+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-26 06:18:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5677524","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5677524","identity":"rs-5677524","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}