Abstract Title
Six Years in Development: Trends and Growth in Undergraduate Medical Electives at the College of Medicine, King Saud University, Riyadh, KSA

Authors

Elizabeth Feeley
Mona Soliman

Theme

Best Practice in Curriculum Planning, Development, Implementation, and Evaluation

INSTITUTION

Department of Medical Education
College of Medicine
King Saud University, Riyadh

Background

Worldwide, elective programs form a significant part in undergraduate medical education. This elective program was designed to provide students with a structured opportunity to investigate personal interests, develop professionalism, and facilitate both horizontal and vertical integration, as they make the transition from classroom observers to healthcare professionals. This study examines the development, implementation and progression of the undergraduate mandatory medical electives at King Saud University, College of Medicine. The program was initiated in 2012-2013 with 247 fourth year students, as part of the new curriculum.  In 2013-2014 (500 students) the program included all fourth and fifth year students. These students did an elective as the final four weeks of their respective years, instead of opting for groups doing the electives at different times throughout the year, as is done in internship. This allowed for more uniform preparation. By utilizing different forms of action research, issues have been identified and changes implemented.

In the initial year, all 247 students were offered fifteen minute interviews to assess student experience level, expectations, perspectives and interests. They were asked about previous elective experience, research experience (they have a research project in third year), involvement in the medical community at-large and non-medical extracurricular activities. Formal interviews were not done in the following years.

The data from the interviews were used to fine-tune an online application, using jotform.com, which students submitted about one month after the interviews. In subsequent years, students have submitted their forms earlier in the year to facilitate applications to other institutions both nationally and abroad.

After scoring the online forms, students were allocated to the respective departments within the KSUMC hospitals. Students who requested to do their electives at other institutions were given letters of support and followed separately. Selected students were invited to participate in interviews for sponsored international electives.

In addition to student input, the electives unit had an advisory committee comprised of faculty members in assessment, curriculum development, research and teaching. Evaluation forms for both students and physicians were developed, evaluated by the committee, and further validated.

Due to the diversity of the elective options and locations, students were given a pass/fail grade. If a student failed, they were required to repeat the elective in the department where they had failed. This allowed them to receive the remedial attention they needed. No student failed twice.

Summary of Work

Over 90% of the students came for their scheduled interviews, demonstrating keen interest from the beginning.  In spite of challenges, all students (100%) received electives at the end of each year, many in their initial first choice of discipline (about 70%). The failure rate has been less than 1% over the last five years. International electives have grown. In the first year, only two sites had contracts. This year we have five college sponsored international sites. In addition, many students have selected to self-fund international electives. This has resulted in our students attending accredited institutions in over twelve different countries and multiple disciplines. All international electives have been completed successfully and many with recommendations.

The program is now well-supported by faculty from different departments.

Summary of Results

Each year, the unit has worked closely with students to develop individual plans and address areas of concern. With the result that students are placed more often in disciplines of their interests and abilities than they would have been if they had just been placed arbitrarily. With each year, students are not only evaluated, but have been given the opportunity to give feedback and discuss improvements for the program. Challenges, such as preparation to work in a different language and culture have been addresses for those pursuing international electives, whereas those in local programs have sought how to best strengthen their preparations for residency programs. 

Below is the current year’s plan.

 

Conclusion

Including undergraduate electives earlier in the program allows students to better assess their strengths, weaknesses and preferences. It also allows practical issues to be addressed at an earlier stage, leading to less harm for students and patients,  as they transition from the classroom to becoming clinicians.

Take-home Messages
  1. More research is needed to better understand the process that students use to select their electives and improve the basic selection process.
  2. Professional trends studies and projections on where physicians will most be needed in the next ten to twenty-five years would benefit students as they make career plans.
  3. Incorporating students into health care teams, as active members, facilitates learning more effectively than allowing them to just be observers.
  4. National and international elective programs have grown substantially, but much work still needs to be done on developing global health electives.
  5. The use of online forms allowed for greater uniformity during the application period and during the evaluation of the forms during the selection process.
  6. Communication skills present an ongoing challenge especially when students are working in cross-cultural situations.
  7. Professionalism, time management, and integration with the respective teams continue to challenge students. More practical training in these area may be helpful.

 

Acknowledgement

The authors would like to express their gratitude to Ms. Zhan Reyes, Mr. Philip Feeley, Prof. Samy Azer, Prof. Hamza Abdulghani, Dr. Nehal Khamis, Dr. Mahmoud Salah Khalil, Dr. Sami Al-Nasser and Dr. Nervana Bayoumy for their ongoing wisdom, insights and encouragement in the development and growth of the electives unit.  

Background
Summary of Work
Summary of Results
Conclusion
Take-home Messages
Acknowledgement
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