Exploring the Benefits of Early Clinical Exposure in Undergraduate Medical Students

INTRODUCTION

Medical education, conventionally characterised by lecture-based studies, particularly in the initial years of study, led to a disconnect between theoretical knowledge and practical clinical application. To address this disconnect, the National Medical Commission has mandated the practice of early clinical exposure (ECE) in the new competency-based medical education curriculum introduced in 2019 in India.^1,2

ECE is a learning strategy that encourages exposure of medical students to the clinical environment as early as the 1^st year of medical college. The learning experiences imparted in the preclinical phase provide a strong foundation for learning clinical subjects.¹ ECE implementation has reported a conspicuous enhancement in students’ clinical skills, communication abilities and professional attitudes, along with their academic performance and confidence levels. Students also reported an increased interest in learning when a clinical context was provided.³ ECE focuses on integrating the gap between preclinical and clinical subjects, which is essential as preclinical students face difficulty in understanding the relevance of learning basic science concepts, and are also less motivated to learn basic science concepts.⁴ It is necessary to promote active learning, heighten attention and motivation among the students towards a better understanding of basic science concepts.

The method of teaching basic sciences based on clinical concepts will facilitate better understanding of the concept, acquisition of clinical examination skills, critical thinking and self-directed learning, which will help to train the students for professional practice in a rapidly changing health care environment.⁵ Teaching basic science concepts, integrating with clinical disciplines, will create interest in learning basic science concepts with relevance and provide better comprehension of basic science knowledge.⁶ It will also enable learning and remembering of basic science in a better way, and would be effective in bridging the gap between theoretical knowledge and practical patient-oriented care,⁷ which would prepare students for the impending implementation of the national exit test to obtain their medical license.⁸ Moreover, it provides an opportunity to teach the doctor–patient relationship and communication effectively.⁹ ECE also allows scientific inquiry and facilitates further learning, so we aimed to assess student perception towards ECE in hospital and classroom settings.¹⁰ This study aims to evaluate the impact of ECE on the clinical skills and learning ability of undergraduate medical students.

MATERIAL AND METHODS

This cross-sectional study was conducted among Phase I undergraduate medical students in hospital and classroom settings. Students who gave written consent to participate in the study were included in the study. We selected facial nerve as a topic, as preclinical students find it difficult to understand the anatomy and physiology of the facial nerve due to the complexity in its course and functions. A structured teaching module was developed by the team of faculty members who agreed to participate in the exercise, and consists of a lesson plan, specific learning objectives, students’ and facilitators’ guides, open-ended and closed-ended feedback questionnaires for students. The questionnaire was then validated by subject matter experts who were not a part of the team, to ensure validity and reduce the risk of bias. The faculty (physiology and neurology) and students involved in the teaching process were given an orientation about the teaching methodology.

In the classroom setting, following a brief lecture and with help of paper-based case scenarios faculty members facilitated the discussions in small groups in demonstration rooms whereas in the hospital setting, following an anchoring lecture, students were taken to inpatient wards, where faculty from neurology department demonstrated the signs of facial nerve palsy along with social implications. Students’ perceptions were collected from the students after ECE in classroom and hospital settings by administering a feedback questionnaire.

RESULTS

A total of 232 students participated in this study, of which 40% were male and 60% were female within the age group of 18–23 years. Student perceptions collected after the ECE sessions in the classroom as well as in hospital settings revealed that a majority of students in both the groups (90% in the classroom setting, 95% in the hospital setting) found it easy to follow the contents of the modules provided. Students in both groups felt that the various parts of the modules were aligned and that the modules helped them to brush up on and apply basic sciences knowledge in health and disease effectively. They also strongly felt that the encouragement of the facilitators towards active discussions, along with the comprehensive modules, helped them to develop critical reasoning and interactive skills, and to become active learners.

While no significant difference in student perspectives regarding ECE learning in the classroom versus hospital setting was observed through quantitative analysis, their feedback and comments provide deeper insight, as depicted in Table 1. For instance, while the classroom setting helped strengthen the basics of the subject and was beneficial from an examination perspective, students felt that exposure to live cases in a hospital setting made it easy to remember the clinical manifestations of the conditions. Some students felt that the classroom setting was a good way to encourage active learning, and that the group discussions made the topic more interesting and cleared a lot of doubts, which would not have been possible in the limited time constraints of lecture hours as depicted by the students’ comments in Figure 1. The hospital setting, however, gave the students a chance to develop their conceptual understanding, and they felt that the practical knowledge imparted by doctors made things a lot clearer than mere classroom lectures [Figure 2].

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Figure 1:

Students’ perspectives on early clinical exposure in classroom setting.

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Figure 2:

Students’ perspectives on early clinical exposure in hospital setting.

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DISCUSSION

Results of the various studies conducted globally in various settings stated that ECE enables medical students to perceive real-life medical scenarios with greater empathy and to obtain a better and deeper understanding of medical theory and practice through the application of their knowledge in such situations.¹¹ In our present study, also majority of students strongly agreed that this teaching module helped them to apply the basic sciences knowledge in health and disease. In another study, authors opined that early clinical experience highlighted the importance of basic sciences and increased the students’ interest in studying said basic sciences.¹² Students who participated in our study also felt that ECE in both hospital and clinical settings motivated them to become active learners. Moreover, in another study, ECE serves as a platform to orient students toward the social context of clinical practice and provides an opportunity to strengthen students’ affective and cognitive learning.¹³ In another study, authors observed that ECE also played an integral role in interconnecting the various dimensions of medical profession such as scientific, ethical, interpersonal, professional, and social implications, to the new members of the medical field in addition to enhancing their motivation to learn.¹⁴ Results of our present study also revealed that students learned the skill of critical reasoning and effective communication.

In addition, ECE conducted in some special situations, like exposure of students to patients on their deathbeds, revealed and strengthened the emotional component of the profession, and taught them to care more effectively for the patients.¹⁵

CONCLUSION

ECE in hospital and classroom settings facilitated better understanding of course content, enhanced problem-solving and communication skills among the students. A majority of the 232 participants found the content of the modules easy to follow, and that active discussions helped them to better engage with the study material and improved their critical thinking skills. They reported that, while classroom-based ECE provided conceptual clarity, clinical settings provided exposure to real-life medical scenarios. Introducing ECE in the regular curriculum will increase their interest in the subjects and ensure all-around development of the future medical professionals.