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 Table of Contents  
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 45-50

Implementing foundation course for the first time-qualitative analysis of medical students' feedback and lessons learned

1 Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
2 Department of Microbiology, Christian Medical College, Ludhiana, Punjab, India
3 Department of Surgery, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India

Date of Submission02-Sep-2020
Date of Decision27-Nov-2020
Date of Acceptance27-Aug-2021
Date of Web Publication18-Oct-2022

Correspondence Address:
Kavita Bhatnagar
Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cjhr.cjhr_127_20

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Introduction: Medical education aims at training an individual with respect to the knowledge, clinical skills, communication skills, and soft skills and building the highest standards of morale. While majority of training programs offer considerable technical skills only a few incorporate the remaining assets. Methods: A curriculum innovation project “Foundation Course” aiming to achieve the above goals, designed for the students entering a medical college was conducted for 74 students joining M. B. B. S. course in a Government Medical College in Port Blair in the year 2015. The feedback from students and teachers was collected at the end of entire activity in the form of a specially designed structured questionnaire with open as well as close-ended questions. Qualitative analysis was performed for students' and teachers' feedback on the open-ended questions. Results: The response rate was 100%. Students perceived foundation course as an excellent opportunity to acquire basic knowledge, attitude, and skills required for subsequent phases in MBBS course. The students opined that teachers who were friendly and approachable enhanced their learning. The attitude of teachers, the methodology of teaching, and the cooperation of peers all played a significant role in enhancing the learning. This course was helpful and increased their orientation to the curriculum and eased out the apprehension to cope up with the challenges. Conclusion: This foundation course enhanced their orientation to the curriculum and campus, boosted confidence to cope up with the challenging syllabus, helped them develop time and stress management skills, and sensitized them to achieve the highest standards of morale required to ensure ethical practice. Students' feedback revealed that how the faculty taught and interacted with the students had more impact than the content.

Keywords: Communication skills, foundation course curriculum innovation, medical education, medical ethics, students' reflections

How to cite this article:
Bhatnagar K, Oberoi A, Ketkar M. Implementing foundation course for the first time-qualitative analysis of medical students' feedback and lessons learned. CHRISMED J Health Res 2022;9:45-50

How to cite this URL:
Bhatnagar K, Oberoi A, Ketkar M. Implementing foundation course for the first time-qualitative analysis of medical students' feedback and lessons learned. CHRISMED J Health Res [serial online] 2022 [cited 2022 Dec 8];9:45-50. Available from: https://www.cjhr.org/text.asp?2022/9/1/45/358810

  Introduction Top

Medical education in the modern era aims at training an individual with respect to the knowledge, clinical skills, communication skills, and soft skills and building the highest standards of morale. The current system of medical education is based on the Flexner Report, which formulated a structure- and process-based systems.[1]The changing trends in the global scenario with the recent technical advances, the overwhelming additions to the existing information, and the untoward incidents of physical violence demand a paradigm shift in training from the traditional model to the competency-based medical education.[2] This is of utmost importance to meet the increased expectations of patients and greater accountability in the modern era.[2] Many students fall prey to the overwhelming pressures of the vast curriculum and lack of time and stress management.[3] Foundation course for the students enrolled in this course is the appropriate channel to enhance their orientation to the curriculum and boost confidence to cope up with the forthcoming challenges. This study analyzes the effectiveness of foundation course in terms of feedback by the students to a specially designed questionnaire and their reflections.


Foundation course was conducted for the fresh students admitted to MBBS course at Andaman and Nicobar Islands Institute of Medical Sciences Port Blair, India, in 2015 from 1st August to 30th September. The entire foundation course was divided into 3 parts: Part 1, it was dedicated to orientation program and few skills labs from August 1, 2015, to August 7, 2015, between 8 am and 6 pm; Part 2, it was dedicated to subject specific orientation sessions in basic sciences, that is, anatomy, physiology, biochemistry, and community medicine (CMFM) starting from 8th to 10th August; and Part 3, the remaining sessions not included in part 1 and 2 were distributed in regular timetable of physiology on every Friday for 1 h and community medicine every Saturday for 1 h for the total duration of foundation course. Yoga sessions and sports were arranged after working hours and on holidays. The sessions included in the foundation course are listed as follows.

  1. Group dynamics
  2. Overview of the MBBS course/curriculum
  3. Medical profession and physician's role in society
  4. Health needs of the country: policies and organization
  5. History of medicine with reference to the evolution of medical knowledge
  6. Learning clinical skills
  7. Learning clinical skills and skills of first aid and basic life support
  8. Learning skills including self-directed learning
  9. Teaching learning methods
  10. Communication skills and interpersonal skills
  11. Cadavers as teachers
  12. Medical ethics and professionalism
  13. What is unprofessional and unethical behavior
  14. Relevance of humanities in medical education
  15. Environmental issues and community orientation
  16. Health economics
  17. Computer learning
  18. Sociology and demographics
  19. Biohazard safety
  20. Time/stress management
  21. Research and STS projects
  22. Library use and E learning
  23. Learning styles
  24. Tips to be successful in medical studies
  25. National and local health scenarios in A and N Island.

Approval was obtained from the institutional ethics committee and the study adhered to the tenets of the Declaration of Helsinki.

Sensitization sessions were undertaken for the participating faculty. The specially designed Foundation course began with the inaugural ceremony, formal introduction of the faculty and the students. It was attended by the students parents. This was followed by the session on group dynamics, with the outdoor group activity and the ice-breaking and interactive sessions. The interventions that followed were small group sessions, roleplays by the faculty as well as students, hands-on training on mannequins, peer physical examination, cadaver and other tissue handling, and group tasks in groups of 7–8 students. Visits to the hospital, library, and community health centers were undertaken in small groups of 16–17 students. Apart from the orientation lectures concerning the information about the curriculum and the preclinical subjects, a wide variety of activities that were undertaken were English-language classes, basic computer training, yoga session, sports sessions, the ramp walk, and the student picnic. The intervention also incorporated the skills lab, sessions to enhance the communication skills, the training of basic life support, the White-coat ceremony, the sensitization to ethics and humanity, the incorporation of the idea “Cadavers as teachers.” The foundation course emphasized on the use of interactive sessions; group activities; inclusion of videos, movie clips, and mannequins; and hands-on training in small groups with avoidance of didactic lectures and jargons.

At the end of the day, all students and participating teachers were given a specially designed questionnaire to assess the feedback in terms of the teacher-related factors, the peer-related factors, the impact of teaching methodology, the impact of the foundation course, and the suggestions. Validation of all questionnaires was done through peer review during our listserve discussions of FAIMER CMCL FRI and modifications were done accordingly. The students were also allowed to present their reflections in the form of poetry, story, essays, and PowerPoint presentations with pictures and videos. The qualitative analysis of the data was done for the open-ended questions. The following problems were posed by the researchers for all students to answer to assess their perception of educational quality of the foundation course.

  1. Which behaviors or characteristics of teacher facilitated/or hindered learning?
  2. Which behaviors or characteristics of your peers facilitated/or hindered learning?
  3. Which teaching–learning methods facilitated/hindered learning?
  4. How will this foundation course help you to cope with challenging medical course?
  5. What would have been done better? Your suggestion please.

A similar questionnaire was designed for teachers as well. The following questions are posed:

  1. How do you think these sessions were beneficial for the students?
  2. Which methodology of teaching was adapted?
  3. How would you grade your experience with this methodology of teaching in a scale of 0–5 with respect to students enthusiasm and learning?
  4. Overall experience being a part of this project?
  5. Any suggestions?

  Results Top

The response rate was 100%. The interpretation from the responses of students revealed that the behavior characteristics of teachers like friendly and humble nature had the maximum impact on their learning. This was followed by the attitude of concern, the dedication, knowledge about the subject, and the ability to encourage an interactive session. Such qualities not only enhanced the learning ability but also created a role model for the students. The methodology of teaching also impacted the quality of the session. The most favored one was the interactive session. This was followed by the session with video demonstration and PowerPoint presentations.

The students opined that if the teachers were biased towards a particular group of students, it hindered learning. Too lengthy sessions without break caused reduced concentration.Friendly peers with a helpful attitude enhanced learning. while distracting, disturbing, dominating and over-participating attitude of peers were detrimental to learning.

All the students were positive about the nature of the program and stated that this program gave them a confidence to cope up with a challenging medical course. The analysis of feedback revealed that this program helped students acclimatize to the campus environment, provided them with the orientation of medical course and curriculum, and helped them develop team spirit. The students also imbibed time and stress management skills, learning skills, and communication skills. Organization of extracurricular activities provided them with a platform to showcase their talents.

This program trained them in basic life support and sensitized them to medical ethics and codes of conduct, created awareness about the responsibilities and accountability of a doctor, and invoked a sense of commitment to life-long learning.

Areas of improvement suggested were more time for relaxation, more emphasis on community-based education, and inclusion of student seminars.

[Figure 1], [Figure 2], [Figure 3] describe the quantitative analysis of qualitative data. Student responses to open text-type questions on educational quality and utility of the course were entered into MS-word. Code or label words were found in the transcript (open coding) and then themes were created by grouping these codes or labels given to words or phrases (axial coding). A separate master list of all the codes was prepared for all open-ended questions and percentage (number) of comments was calculated for each code which was then presented in tabular form.
Figure 1: Quantitative analysis of qualitative data describing the qualities of teachers which enhanced learning

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Figure 2: Quantitative analysis of qualitative data describing the impact of methodology of teaching on learning

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Figure 3: Quantitative analysis of qualitative data describing the factors detrimental to learning

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One hundred percent (25/25) of the teachers had a positive feedback about all the sessions included in the foundation course. All the teachers were of the opinion that the session conducted by them were beneficial. Ninety-two percent (23/25) teachers were of opinion that the interactive teaching had a better response from the students. The methodologies with the highest grades were those with interactive sessions such as skit plays (average 4.24/5), field trips (average 4/5), and debate (average 3.7/5). Six teachers suggested that although the project appeared to be extremely beneficial for the students, the time required for conduction of the same was utilized from the already tightly packed schedule of 1st year. This suggestion to include this curriculum before admission was also put forth by a couple of them.

  Discussion Top

Imparting students with sound medical knowledge and skills and developing behavioral and attitudinal skills to transform them into a dedicated health worker is one of the major responsibilities vested in a faculty of a medical college.[4] Reforms in the existing curriculum are necessary to enable them to achieve these goals.[2] The essence of this course project was to provide a fertile ground for imparting the knowledge and skills required for completion of the course. This interactive curriculum innovation program introduced with the objective of laying a foundation stone for transformation of the directionless enthusiastic young minds into a chef-d'oeuvre in the form of a dedicated medical practitioners of high morale was applauded by those benefitting from this program. This is very well reflected from the following excerpt taken from a students' reflection.

Within us, a directionless force

Here attending the foundation course

We've joined this course knowing knought

This course gave us all we've got.

All info about this course

Making us a directioned force.

Day one taught group dynamics

Where students shew their crazy tricks

To create the longest chain

and students covered the entire lane.

Day two taught us evolution

Of pills, it's creator and institution

Which was a peep to medical history

Revealing us the entire mystery.

Ethics was taught on day three

Revealing responsibilities to me

What should i do as a student

And when I'm doctor, not to be prudent.

Day four taught me humanity

A doctor's role in community

And another thing was made clear

Please respect the cadaver.

Day five helped us counter stress

And told us to live tensionless.

Day six was the day to thank

And we all being very frank

“This course was a STEPPING STONE

For the WHITE COAT we're gonna don!!!

First Year Medical Student

The session began with the formal inaugural ceremony, which was followed by the ice-breaking session. Ice-breaking session was an interactive one which helped the students interact with each other and showcase their personality.

  1. Ice-breaking session: The ice-breaking session was very interactive giving each and every student a platform to express themselves, which was quite extravagant and humorous as well

  2. The qualitative analysis of the data revealed that certain personality traits of teacher, behavior of teachers, as well as teaching methodology play a significant role in learning process. This can be elicited from the following reflections of the students.

  3. Exposure to phenomenal learning methods quite different from those being followed by us till now (an excellent help)
  4. Teachers were highly knowledgeable, motivational and encouraging……Best part…encouraged to ask questions and given enough time to answer…

The reflections very well correlate with the characteristics of a good teacher mention by Baier F et al.[5]

Methodology of teaching also plays a critical role in invoking interest in students, increasing attentiveness, effective delivery of the intricate knowledge, and the ultimate learning experience for students. From the classic age-old methods of didactic teaching to newer and more interactive methods including group discussions, video-based demonstrations, debates, skits, seminars and symposiums by the students, the methodology of teaching has witnessed a drastic transformation. Even simple maneuvers such as asking the students to state the take-home message at the end of the session are conducive to active participation in learning. The recent modules not only aspire to enhance students' concentration but also target their learning ability. The various interactive sessions were very well appreciated by the students. The effectiveness of interactive teaching has also been demonstrated in previous studies.[6]

Similarly, the personality traits of the peer, the group dynamics, and the ability to work in harmony with the peer also have an impact on learning. They mentioned the following referring to the characteristics of the peer that hindered learning.

  1. “Meaningless/negative comments on teachers/other students”
  2. “Some were dominating, over-participatory creating unhealthy competition…”

Some of the interventions were specially appreciated by the students, who believed that these interventions created a significant impact on their young minds.

Some of these are as follows:

  1. “I still remember the rule of 5D's mentioned by Director i.e. DEVOTION DEDICATION DETERMINATION DIGNITY DISCIPLINE and I have promised myself that I will follow this till my last breath”
  2. ”The much awaited moment in my life took place that day, which was when we all took the Hippocratic Oath wearing our white coats. After taking oath I personally felt that yes now the time has come. my responsibilities are waiting for me.”
  3. ”Knowing how we have evolved is much important especially when it comes to medical profession– a session on HISTORY OF MEDICINE and EVOLUTION OF MEDICAL KNOWLEDGE. (Believe me! It was keenly interesting and informative)”
  4. ”Awesome ways of managing time and stress by meditating, exercising, avoiding procrastination, working in small intervals, habit to make to do– list, prioritizing the tasks and numerous other ways were taught”
  5. ”The post lunch session had an interesting and relevant debate on the topic “Technology is killing the art of learning” which was followed by few questions from the audience. The debate really enabled us to ponder our thoughts upon the use of technology in our medical studies.”

Knowledge about medical ethics and professionalism is a foundation stone in the formative process of a dedicated medical practitioner with high standards of morale. In the past teaching, medical ethics was limited to a couple of chapters in certain textbooks.[7] Knowledge and information that was gained was only through enthusiastic reading and observing the seniors.[7] What retained was usually the legal ethics with a negligible role of clinical and research ethics.[7] There was no uniformity in the code of conduct. Many a times, the role models of such students were unable to stand by their words. This leads to a wide disparity in what was preached and practice.[8] Training of undergraduate students in medical ethics is one of the most desired changes in the reformation of curriculum. The sessions such as cadavers as teachers were directed toward sensitizing the students the importance of these human resources of learning.[9]

The evolving trends of modern era demand a high standard of professional attitude in addition to the sound knowledge of the subject for the effective delivery of the health care.[10],[11] These values of professionalism should be inculcated right from the beginning of their journey.[12] These values can be inculcated at the formative stage to nip in the bud of any developing unprofessional attitude. Various methods have been described to teach professionalism.[13],[14],[15] In this foundation course curriculum innovation project, a special session was dedicated to the orientation of ethics and professionalism which was savored by them.

  1. This was a pretty much important day since it withheld something that cements a Doctor to his profession that is “Medical ethics and Professionalism.” The true foundation laying for us, new sprouting doctors was laid down. We were introduced to the life like situation and work out a possible solution to the adverse circumstance: without degrading the medical ethics and without disgracing true professionalism
  2. ”Trees do not deny their shades even to the people, who come to cut it down, HOSPITALITY and KINDNESS shown even to the enemies is the true charity.” This session was all about how to become a good doctor. Doctor should also have the personality of a “TREE”.

    Time and stress management sessions are extremely important in helping the medical students to cope up with the overwhelming pressures of medical studies. These students who may otherwise fall prey to these stressors.[3] These sessions were cherished by many of them.
  3. ”Awesome ways of managing time and stress by meditating, exercising, avoiding procrastination, working in small intervals, habit to make to do– list, prioritizing the tasks and numerous other ways were taught.”

The students also suggested certain changes that can be included to increase the effectiveness of the program. Some of these were more time for relaxation, more emphasis on community-based education, and inclusion of student seminars.

The teachers also had a positive feedback about the project with a unanimous agreement on the beneficial impact of this project on the overall development of the students as a doctor. Teachers perceived this as a platform to create a responsible and disciplined medical practitioner.

Documented feedback to be will be incorporated in future sessions.

The overall success of this program can be evaluated from the impact that this project had on these young minds.

  1. “A journey of thousands miles start from a single step only”. We also had taken the first step for the long journey of 5 1\2 years in our life, through the very informational foundation course
  2. “By the sea I find my focus…, Here is the space to be myself…, Commune with surf and sand and sky”
  3. ”All birds find shelter during the rain, but the eagle flies through above clouds. its not the “problem” but the “attitude” which makes a difference!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!”.

  Conclusion Top

This foundation course was successful in creating an impact on these young minds and preparing them to tackle the challenges ahead. Student's feedback and reflections revealed that how the faculty taught and interacted with the students had more impact than the content. In the students' words,


A journey so never-ending,

A journey so bestowed upon,

A journey I have always cherished, to enter in the world of MBBS course.

Laid before me were various roads, that diverged in different directions.

I knew that the first step to my course of foundation, would ridden me of all my pre-occupied perceptions.

The courses were rough, but I fluttered among the woods, to get a glimpse of humane quality,

like unity in groups.

Ethics and professionalism turned over the stones, “CADAVERS AS TEACHERS” did send a shiver through my bones.

Being self-reliant and self-independent were of prime importance' Or else stress and improper time management could have killed us at any instance.

Striding deeper into the woods, came bunches of surprises, with importance of library and E-Learning,

that did give mind mapping an adequate thinking.

Learning the right methods of CPR and SQ3R, did send a wave of questions – that what kind of humans we are?a journey so memorable, will always be adorable.

I wish I could traverse it's every moment, till my last breath could torment.”

- First year medical student


This project was successful in sufficing the objective of providing the opportunity to the students to understand the deeper perspective of this curriculum. The foundation course has now become an integral part of training of undergraduate students.

  Acknowledgments Top

My heartfelt gratitude and sincere thanks to Dr. Prof Tejinder Singh and Dr. Prof Dinesh Badiyal, Director and Co-Director of FAIMER Regional Institute, CMC, Ludhiana, for their valuable guidance for this project.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Flexner A. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. New York: Carnegie Foundation for the Advancement of Teaching; 1910.  Back to cited text no. 1
Ferguson PC, Caverzagie KJ, Nousiainen MT, Snell L; ICBME Collaborators. Changing the culture of medical training: An important step toward the implementation of competency-based medical education. Med Teach 2017;39:599-602.  Back to cited text no. 2
Puthran R, Zhang MW, Tam WW, Ho RC. Prevalence of depression amongst medical students: A meta-analysis. Med Educ 2016;50:456-68.  Back to cited text no. 3
Mittal R, Mahajan R, Mittal N. Foundation programme: A student's perspective. Int J Appl Basic Med Res 2013;3:52-4.  Back to cited text no. 4
Baier F, Decker AT, Voss T, Kleickmann T, Klusmann U, Kunter M. What makes a good teacher? The relative importance of mathematics teachers' cognitive ability, personality, knowledge, beliefs, and motivation for instructional quality. Br J Educ Psychol 2019;89:767-86.  Back to cited text no. 5
Groth M, Barthe KG, Riemer M, Ernst M, Herrmann J, Fiehler J, et al. Critical analysis of an e-learning and interactive teaching module with respect to the interpretation of emergency computed tomography of the brain. Rofo 2018;190:334-40.  Back to cited text no. 6
Anshu. Inclusion of ethics matters in the undergraduate medical curriculum. Indian J Med Ethics 2011;8:135-8. DOI: https://doi.org/10.20529/IJME.2011.057.  Back to cited text no. 7
Pandya SK. Clinical ethics: A practical approach. Natl Med J India 2006;19:340-1.  Back to cited text no. 8
Winkelmann A, Güldner FH. Cadavers as teachers: The dissecting room experience in Thailand. BMJ 2004;329:1455-7.  Back to cited text no. 9
Pawlina W, Hromanik MJ, Milanese TR, Dierkhising R, Viggiano TR, Carmichael SW. Leadership and professionalism curriculum in the Gross Anatomy course. Ann Acad Med Singap 2006;35:609-14.  Back to cited text no. 10
Feili A, Kojuri J, Bazrafcan L. A dramatic way to teach clinical reasoning and professionalism. Med Educ 2018;52:1186-7.  Back to cited text no. 11
Shrivastava SR, Shrivastava PS. Teaching professionalism and leadership skills to an Indian medical graduate. CHRISMED J Health Res 2019;6:112-3.  Back to cited text no. 12
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Schulz K, Puscas L, Tucci D, Woodard C, Witsell D, Esclamado RM, et al. Surgical Training and Education in Promoting Professionalism: A comparative assessment of virtue-based leadership development in otolaryngology-head and neck surgery residents. Med Educ Online 2013;18:22440.  Back to cited text no. 13
Dhaliwal U, Singh S, Singh N. Reflective student narratives: Honing professionalism and empathy. Indian J Med Ethics 2018;3:9-15.  Back to cited text no. 14
Mahajan R, Aruldhas BW, Sharma M, Badyal DK, Singh T. Professionalism and ethics: A proposed curriculum for undergraduates. Int J Appl Basic Med Res 2016;6:157-63.  Back to cited text no. 15


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