Innovative Self-directed, Problem-oriented, Lifelong learning, Integrated Clinical case Exercise (SPLICE) modules promote critical thinking skills, early clinical exposure, and contextual learning among first professional-year medical students.

Medical education is undergoing various transformations to promote a more personalized and contextual way of learning. In light of this, the innovative "Self-directed, Problem-oriented, Lifelong learning, Integrated Clinical case Exercise" (SPLICE) modules were designed, implemented, and evaluated for medical students in the first professional year as a strategy for early clinical exposure in a collaborative and self-directed way of learning. This is a mixed methods study involving first-year medical students. Students were divided randomly into the control and the intervention groups. Six SPLICE modules were administered to the intervention while the control group followed the traditional curricula. The educational outcome was compared using an end-of-module assessment. In addition, 13-item and 8-item questionnaires were administered to students to evaluate the SPLICE and plenary sessions on a 5-point Likert scale. Furthermore, students' feedback was obtained on a 10-point rating scale and in in-depth small-group interviews. The majority of students perceived that the SPLICE module improved their communication and encouraged meaningful, active learning. Students found the plenary sessions to be well organized, with sufficient interaction with professionals. Students also gave excellent scores for feedback on SPLICE modules, demonstrating the effectiveness of the innovation. In terms of test scores used in assessing learning outcomes, the intervention group outperformed the control group (P < 0.0001). The innovative SPLICE curriculum facilitated early clinical exposure and active self-directed learning. Students perceived SPLICE modules to be highly helpful in terms of promoting meaningful learning and the future application of knowledge.NEW & NOTEWORTHY The very essence of this innovative "Self-directed, Problem-oriented, Lifelong learning, Integrated Clinical case Exercise" (SPLICE) curriculum is the team-based learning of integrated pre-, para-, and clinical learning objectives right from the first professional year of study serving as an early clinical exposure. This unique way of learning creates a holistic educational environment by combining both academic and professional development thereby empowering the next generation of physician leaders to take autonomy of their own learning strategies and emerge as competent lifelong learners.

Early clinical exposure: Dynamics, opportunities, and challenges in modern medical education.

INTRODUCTION: Applications of early clinical exposure (ECE) are wide-ranging and reflect the important role that ECE plays in medical education. This review article aimed to highlight the dynamics, opportunities, and challenges of ECE in medical education. STUDY METHODOLOGY: This review article was conducted through a comprehensive search of electronic databases including PubMed, Scopus, Web of Science, and Google search engine. The keywords used for the search were "early clinical exposure," "medical education," "clinical skills," "patient contact," and "medical students. The inclusion criteria for selecting the articles were that they should be written in English, peer-reviewed, and provide insights into the dynamics, opportunities, and challenges of ECE in medical education. RESULTS: ECE allows students to gain a deeper understanding of the patient experience, and to develop empathy and a patient-centered approach to care. ECE can also help to improve recruitment and retention of medical students, by providing a more engaging and rewarding learning experience. CONCLUSION: ECE is a promising teaching method that has the potential to improve clinical skills and patient outcomes. However, it also poses some challenges that must be addressed to ensure its effective implementation.

Application of project-based service-learning courses in medical education: trials of curriculum designs during the pandemic.

BACKGROUND: Due to COVID-19, face-to-face service activities in service-learning courses have become unfeasible. To address this challenge, this study aims to integrate project-based learning into medical education's service-learning curriculum. This study also seeks to evaluate the effectiveness of this instructional approach and identify factors that influence its success. METHODS: A total of 135 first-year medical students enrolled in a mandatory 1-credit service-learning course were recruited. The course involved various service activities aligned with the needs of the local community. The students were organized into 12 groups, each working on different service-learning projects, such as raising health awareness or educating the public about specific diseases. Following the completion of the course, a questionnaire was distributed among the students to gather feedback on the course, and 122 (valid responses were collected, representing a response rate of 90.3%). RESULTS: The results indicated that the project-based service-learning course significantly improved students' "interpersonal communication skills," their ability to "learn and grow from work," and their sense of "professionalism" (all p ≤ 0.037). Among the various aspects of service learning, the highest agreement was observed for "executing the project," followed by "group discussions and project formulation," "overall course review," "review of project outcomes," "outcome presentations," "teaching proposal writing and project brainstorming," "sharing of service-learning experiences by teachers," and "sharing of service-learning experiences by teaching assistants." Students also found certain factors to be beneficial in enhancing the learning effectiveness of service-learning courses, including "prize money for service-learning outcomes," "funding for service-learning activities," and "consultations from medical personnel" (all p ≤ 0.01). However, "course credit" and "photography software" did not show significant effects (both p > 0.05). The most preferred resources or activities for future service-learning courses were "course credit" and "face-to-face service-learning activities." CONCLUSIONS: The project-based learning method improved the learning effectiveness in service-learning courses. Students perceived that the number of course credits reflects the course value and plays a pivotal role in enhancing the learning effectiveness in service-learning courses. During the epidemic, students still expect to have face-to-face service activities in service-learning courses. Therefore, without the impact of the epidemic, service learning courses should return to face-to-face service activities.

Flexner has fallen: Transitions in medical education system across time, a gradual return to pre-Flexnerian state (de-Flexnerization).

The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner, his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur. He could say what other reformers could not, due to their links to the medical education community. But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students, the decline in the number and quality of investigator initiated research among clinical researchers, lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis, poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes. The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations. This de-Flexnerization trend and regression to pre-Flexnerian era standards, ideologies, structures, processes, and attitudes, are bound to beget pre-Flexnerian outcomes, for you get what you designed for.

Implementation of Pediatric Allergic Rhinitis Module as a Part of AETCOM among First-Year Medical Undergraduates: Mixed Methods Evaluation.

Background: Children suffering from allergic rhinitis (AR) in their earlier days of life, not receiving proper treatment, subsequently develop asthma. To sensitize the first-year medical undergraduates about AR by implementing pediatric allergic rhinitis (PAR) module as a part of their attitude, ethics, and communication (AETCOM) curriculum. Materials and Methods: Triangulation type of mixed method study was conducted from January 2021 to June 2021 among 125 first-year medical undergraduate students. The PAR module communication checklist was developed and validated by an interprofessional (IP) team. Twenty multiple-choice questions (MCQs) were framed for both pretest and posttest cognitive assessment of the students. The pretest assessment was done (first 15 min) followed by the teaching of the PAR module (30 min), and lastly the posttest assessment along with open-ended feedback (last 15 min). Objective Structured Clinical Examination (OSCE) communication checklist along with the guidelines was given to the observer during the student-patient encounter to score the learner and to assess the communication skill. Apart from descriptive analysis, paired t-test and content analysis were done. Results: A statistically significant difference in the mean scores before and after the PAR module and communication checklist (P < 0.001). Majority (78/81, 96%) of the students favored this module, while (28/81) 34.6% suggested modifications. Most of the parent's feedback was good about the student's communication skill in terms of empathy (118), behavior (107), and greet (125); however, 33 parents were about the opinion of difficulties in closing the session, 17 parents commented about student's language problem and 27 about feedback. Conclusion: The PAR module should be taught in the current medical curriculum as a part of AETCOM in the foundation course as early clinical exposure with some modifications in the existing module.

Early clinical exposure in medical education: the experience from Debre Tabor University.

BACKGROUND: The idea of early clinical exposure in Ethiopian medical schools is a young concept. Old and newly established universities across the nation are shifting towards incorporation of early clinical exposure (ECE) in their curricula. Debre Tabor University introduced ECE in undergraduate medical education from inception. This study generated evidence on students' experience and academic leaders' reflection on early clinical exposure implementation. OBJECTIVE: This study was carried out to investigate medical students' perception towards early clinical exposure and its implementation process by instructors in undergraduate medical education at Debre Tabor University. METHOD: A cross-sectional survey design that combines quantitative and qualitative methods was conducted in 2021. We asked fifth year medical students (42) to complete a self-administered questionnaire on 5-point Likert scale. The data were supplemented by semi-structured interview with 6 purposively selected academic leaders on the factors that facilitate or impede early clinical exposure implementation. The quantitative data were entered and analyzed using SPSS 20 to compute frequency, median and interquartile range. The qualitative data were analyzed thematically. RESULTS: The study findings suggest that early clinical exposure (ECE) has a positive impact on the development of students' professional knowledge, problem-solving skills, motivation, active learning, and community orientation. Specifically, 64.3% of the surveyed students believed that ECE was effective in constructing their professional knowledge, while 52.4% felt that it improved their problem-solving skills and facilitated constructive/active learning. Additionally, 57.1% of students reported that ECE improved their motivation and 50% noted that it facilitated community orientation. The study also identified several barriers to the implementation of ECE, with the heavy workload being the most commonly mentioned (78.6%). Other challenges included a loose linkage between academic and healthcare institutions (59.5%) and a lack of orientation on the implementation process (35.7%). Academic leaders reflected that ECE was beneficial in familiarizing students with the clinical environment, but staff commitment was crucial for its successful implementation. The study also found that heavy workload, lack of assessment dedicated to ECE on the curriculum, and poorly oriented staff about the program impeded its implementation. CONCLUSION AND RECOMMENDATIONS: The findings of this study suggest that early clinical exposure was beneficial learning method. Teachers' commitment to their roles with adequate preparation, and the contribution of curriculum in providing the learning objective and cases for each session were factors that facilitate effective implementation of ECE. Heavy workload and poor orientation about the program could impede ECE implementation.

Early clinical exposure in undergraduate medical education: A questionnaire survey of 30 European countries.

PURPOSE: Fifteen years ago, a European survey demonstrated widespread adoption of early clinical exposure (ECE) programmes but little emphasis in the curricula of medical schools. We now repeat the survey in light of the ample emerging data suggesting multiple positive outcomes of ECE. METHODS: Online cross-sectional survey in European medical schools conducted by the EURACT Basic Medical Education Committee in 2021. Descriptive quantitative analyses and a thematic analysis approach were used. RESULTS: Eighy-nine (48%) medical schools in 30 European countries responded. ECE was used in 65 (73%) of the medical schools, and 88% of ECE programmes took place in primary care. The median total time spent on the ECE programme was 5 days. Teaching methods covered unstructured learning opportunities such as observation or shadowing doctors, as well as work-based learning whilst seeing real patients or reflecting on own encounters. Learning goals included knowledge, skills, and attitudes. More than half of the respondents expressed barriers to implementing or expanding ECE. CONCLUSIONS: Compared to the previous survey, there was no significant change in the adoption or curricular emphasis of ECE programmes. Institutional attitudes towards certain disciplines and a lack of willingness to experiment with new teaching methods may be partially responsible.

An Overview of Early Clinical Exposure for Undergraduate Medical Education in Japan / 医学教育

Introduction: Early clinical exposure (ECE) is an educational methodology where medical students are exposed to the clinical settings in the undergraduate curriculum. This study aimed to examine the implementation status of ECE at medical schools in Japan. Methods: Based on published syllabi, we investigated the existence, location, and subjects (medical/non-medical staffs) of the training programs in medical schools. Results: Of 78 universities, 74 (95%) offered a total of 173 ECE practical training courses, and 51 (69%) combined on-campus and off-campus ECE training. Regarding the location and subjects, 81% of the on-campus ECE training was for medical personnel, 47% of the off-campus was for non-medical personnel, and 61% of the on- and off-campus was for both medical and non-medical personnel. Conclusions: More medical universities combined ECEs on-campus and off-campus and did not offer exposure only to medical staffs. The national trend can serve as a reference to discuss the circumstance of ECE and to plan ECE courses in the near future.

Clinical Competence and Perception of Medical Students after Early Clinical Exposure through Pre-clerckship Education at an Ethiopian Medical School: A Cross-sectional Study.

Background: Conventional medical curriculum is the mainstay in the long history of modern medical education. Innovative integrated medical curriculum attracted significant attention in improving conventional curriculum. In the integrated curriculum, basic sciences are incorporated horizontally with each other, and students are exposed early to clinical settings. This is expected to improve students' knowledge and skills in clinical medicine by the time they start their clerkship rotation. Method: the study aims to make a baseline assessment on the overall knowledge and skills of medical students towards clinical medicine. An institution-based cross-sectional study was conducted from March to April of 2020 using 91 third year medical students (convenience sampling). A three-section self-administered survey instrument, short written MCQ exam, and practical (OSCE) students' examination were used for this survey. Result: participants tend to exhibit better knowledge on basics of history taking and physical examination with an average score of 79%. Comparatively, the score for average physical examination skill was low (56.3%). Students' perception on ECE showed, over 50% of participants believe ECE increases burden on their overall workload. Even then, the majority (92.3%) still think that ECE has positive impact on their clerkship education. Taken together, it appears more hands-on interventions is needed to further improve skills of medical students in physical examination with particular emphasis on the clinical examination of breast, thyroid, musculoskeletal, and neurologic systems.

Impacts of early clinical exposure on undergraduate student professionalism-a qualitative study.

INTRODUCTION: Early clinical exposure (ECE), or authentic human contact in a social or clinical context during preclinical training, has been adopted by many medical schools. This study aims to investigate how medical students' sense of professionalism changed after ECE intervention, with the aim of informing curriculum design to enhance student awareness of the importance of medical professionalism. METHOD: Focus groups of ECE students were held to collect data for the study. All participants read interview guidelines before starting. During the focus groups, the students discussed their medical obligations as perceived throughout the course, which offered a choice between four different ECE tracks. They were then asked to report their understanding of the situations they encountered during the course and reflect on their implications. RESULTS: Six focus groups of 22 students in total from a medical school in northern Taiwan were held shortly after the students completed an ECE course in September 2019. From their responses, 10 categories relating to medical professionalism were deduced categorized under 5 major dimensions. An additional 8 sub-dimensions on attitudes and 2 sub-dimensions on personal well-being were also identified as new categories separate from but related to medical professionalism. After the ECE intervention, about 59% of participants redefined their understanding of medical professionalism. CONCLUSION: ECE and intensive interaction with key stakeholders, including patients and their families, help students in the early stages of medical education form and cultivate a sense of medical professionalism. However, the relationship between participants' personalities, motivations, and clinical activities requires further investigation.

Simulation-based Clinical Education Versus Early Clinical Exposure for Developing Clinical Skills in Respiratory Care Students.

Background: Early clinical exposure (ECE) has been shown to improve clinical skills, but several factors limit its implementation. Objective: To compare the use of simulation-based education (SCE) and ECE in improving respiratory care students' clinical skills in laboratory settings. Methodology: This experimental prospective study was conducted among respiratory care students at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Students from one batch were allocated to the ECE group, and students from another batch were allocated to the SCE group to concurrently undergo clinical training. On completion of the course, students completed the Clinical Learning Environment Inventory (CLEI), and their clinical practice course grades were evaluated. Results: A total of 72 students from the two batches completed the CLEI and clinical performance evaluation; 32 (45%) were female. The mean age was similar across both groups. Between the groups, there was no statistical difference in the mean clinical grade (95% CI) (ECE: 167.29 [164.74-169.84], SCE: 166.88 [164.12-169.65]; P = 0.837) and the CLEI score (ECE: 128.25 ± 3.9, SCE: 123.08 ± 4.2; P = 0.381). Multivariable linear regression analyses revealed no significant difference in the clinical performance grades (ß = -0.09; 95% CI: -0.78-0.59; P = 0.788). Conclusion: The study found no significant difference in the performance between ECE and SCE in laboratory settings, indicating that SCE is a viable alternative to ECE in RC clinical training. Studies with larger cohorts are required to corroborate this finding.

Perception Regarding Early Clinical Exposure among Second Year Medical Students after Educating Pregnant Women on Physiological Changes during Pregnancy: A Mixed Methods Study.

INTRODUCTION: The traditional teaching-learning process should reform to improve the academic performance and understanding of the students. This study aimed to determine the perceptions of second-year medical students towards early clinical exposure about their approach to educating pregnant women on the physiology of pregnancy. METHODS: This was a descriptive cross-sectional study with a mixed-method design comprising both quantitative and qualitative components among second-year medical students of a medical college in Nepal from September 2019 to September 2020. After ethical approval from the Institutional Review Committee (Reference number: 207), 40 students included through the convenience sampling method. These students were subjected to early clinical exposure in the form of educating pregnant women on physiological changes during pregnancy. Data was entered and analyzed using Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Among 34 responses, majority of the students 29 (85.28%) (73.36-97.20 at 95% Confidence Interval) were motivated to learn the physiology of pregnancy after the activity; 15 (44.11%) strongly agreed and 14 (41.17%) agreed to this statement. Thirty-two students (94.11%) claimed that the activity improved their understanding of the physiology of pregnancy. The majority of the students expressed that this approach is pragmatic which ignited more curiosity regarding the subject matter. CONCLUSIONS: The majority of the students had satisfactory perceptions regarding their early clinical exposure which was similar to standard data and they expressed that they would like to have similar activities in the future.

A task-based learning strategy in preclinical medical education.

Preclinical task-based learning (TskBL) is a simulated learning approach in which the focus for students is a real task done by a medical professional. TskBL includes standardized patient encounters and is helpful to provide early clinical exposure. Our study aimed at planning, implementing, and assessing TskBL among first-year medical students and comparing it to the conventional method of tutorials in the physiology MBBS curriculum. This is a nonequivalent group quasi-experimental study approved by the institutional ethics committee. TskBL was conducted for seven topics among first-year medical students of Kasturba Medical College, Mangalore for three academic years. Participants were divided into a TskBL group and a control group. Both groups attended the theory classes in physiology, practical sessions, and clinical examinations concerning the tasks. After this, the TskBL group underwent TskBL, and the control group underwent tutorials. Pretest and posttest assessments were conducted by using a multiple choice question (MCQ) test and objective structured clinical examinations (OSCEs).The mean TskBL scores for MCQ (exception: hypertension, myasthenia gravis, and chronic obstructive pulmonary disease) and OSCE (exception: anemia and hypertension) were significantly higher than the tutorial group. Pretest and posttest scores revealed significantly higher MCQ and OSCE scores for TskBL (exception: MCQ score for hypertension and chronic obstructive pulmonary disease). The tutorial group did not show a significant improvement in test scores for all the tasks. The TskBL strategy could be used for topics that are likely to be encountered by the students during clinical attachments. Small group teaching can include TskBL in preference to tutorials to provide early clinical exposure in medical schools.

Evaluation of Preclinical Task Based Learning program in Medical Education.

The conventional curriculum in preclinical medical education has a need for early clinical exposure programs that help in correlation of basic science data with clinical skills. This is helpful to develop clinical reasoning skills, problem-solving abilities, team work, communication skills and overall attitudes and behaviour relevant for a healthcare provider. Preclinical task based learning (TskBL) is an active learning strategy in which the focus for the first year medical student is a real task done by a doctor. In this strategy the student-doctors undergo a standardized patient encounter and discuss the learning issues related to the task in the first year of medical school. The current study is focussed on the student perception of the effectiveness of task based learning module.The TskBL was conducted among first year medical students for nine topics that are commonly encountered in the clinics. After TskBL was planned and implemented the evaluation of the modules was done using focus group discussions. The students highlighted the importance of standardized patients in the TskBL strategy in providing early clinical exposure in preclinical medical education. They reported its usefulness gaining essential knowledge, skills and attitudes for medical learning. They reported positive outcomes of module design and processes and activities in TskBL. Based on the negative aspects of the modules, future improvement was suggested in improving the usefulness of standardized patient encounter. This study showed the novice learners' outlook of the potency of TskBL for several other topics of clinical relevance to provide early clinical exposure in medical schools.

Clinical Competence and Perception of Medical Students after Early Clinical Exposure through Pre-clerckship Education at an Ethiopian Medical School: A Cross-sectional Study

BACKGROUND: Conventional medical curriculum is the mainstay in the long history of modern medical education. Innovative integrated medical curriculum attracted significant attention in improving conventional curriculum. In the integrated curriculum, basic sciences are incorporated horizontally with each other, and students are exposed early to clinical settings. This is expected to improve students' knowledge and skills in clinical medicine by the time they start their clerkship rotation. METHOD: the study aims to make a baseline assessment on the overall knowledge and skills of medical students towards clinical medicine. An institution-based cross-sectional study was conducted from March to April of 2020 using 91 third year medical students (convenience sampling). A threesection selfadministered survey instrument, short written MCQ exam, and practical (OSCE) students' examination were used for this survey. RESULT: participants tend to exhibit better knowledge on basics of history taking and physical examination with an average score of 79%. Comparatively, the score for average physical examination skill was low (56.3%). Students' perception on ECE showed, over 50% of participants believe ECE increases burden on their overall workload. Even then, the majority (92.3%) still think that ECE has positive impact on their clerkship education. Taken together, it appears more hands-on interventions is needed to further improve skills of medical students in physical examination with particular emphasis on the clinical examination of breast, thyroid, musculoskeletal, and neurologic systems

Exploring faculty perspectives on competency-based medical education: A report from India.

INTRODUCTION: Medical education in India is experiencing a paradigm shift from traditional curriculum to competency-based medical education (CBME). It de-emphasizes time-based training and promises greater accountability, flexibility, and learner centeredness. Faculty development is integral in the context of CBME. Considering faculty perceptions toward the new CBME and addressing the difficulties will play a vital role in successful implementation. MATERIALS AND METHODS: A cross-sectional study was carried out among 297 teaching faculty in 91 medical colleges across 20 states all over India between February and July 2020. A structured validated questionnaire on CBME was used to collect the responses through Google forms and was exported and analyzed in Microsoft Excel. RESULTS: More than 80% opined that Faculty members in departments are not adequate for successful CBME implementation. Reflective learning, early clinical exposure, and elective posting were accepted by 60.2%, 70.4%, and 45.5% of the faculty, respectively. Around 81.8% welcomed horizontal integration, whereas only 54.2% favored vertical integration during the Phase I MBBS. CONCLUSION: Few reforms such as curtailing the duration of foundation course, sensitization of all medical teachers through faculty development programs, better synchronized vertical integration, increasing the strength of faculty in each department, and adequate infrastructure for skills laboratory can be undertaken as per faculty suggestions.

Exploring the learners' perspectives on competency-based medical education.

BACKGROUND: A novel innovation in medical education was initiated by the Medical Council of India after 21 years. Competency-based medical education (CBME) is an effective outcome-based strategy, which requires integration of knowledge, attitude, skills, values, and responsiveness. The aim was to assess the students' perspectives on competency-based medical curriculum. MATERIALS AND METHODS: This cross-sectional descriptive study was conducted among 1st year MBBS students (2019-2020 batch). A validated questionnaire was administered through Google link among phase I medical students of various medical colleges across India by multistage sampling. RESULTS: A total of 987 students from 74 medical colleges in India responded. Nearly three-fourths opined that foundation course (FC), attitude ethics communication module, and early clinical exposure were necessary. Horizontal integration was more appreciated to vertical integration. Maintaining log books was perceived as time-consuming and cumbersome. CONCLUSION: The CBME when meticulously adopted will inspire student enthusiasm for learning. Few reforms such as curtailing the duration of FC, diffuse sessions on stress and time management, better synchronized vertical integration, and an exemplary implementation of adult learning techniques can be undertaken.

Effectiveness of early clinical exposure in medical education: Settings and scientific theories - Review.

Early clinical exposure (ECE) is a teaching-learning methodology which fosters the exposure of medical students to the patients as early as the first year of medical college. A worldwide number of research studies investigated the outcome of ECE and found, ECE sessions motivate the medical student in various ways making their academic strength, improve clinical skills, and improve communication skills and making them more confident. In the medical curriculum, ECE makes an overall impact on student's performance and confidence. Planning of ECE in real-time practices can be done in different settings with the use of appropriate resources such as logbook, textbooks, notes, instruments, learning material, case record sheets, and computers. Herewith, we reviewed the scientific base responsible for these outcomes and discussed different ECE settings and their outcome. The Medical Council of India in new educational reforms made ECE sessions compulsory from 2019 in undergraduate medical curriculum. In conclusion, the challenge for health professions education is to look for ways to improve the quality of clinical education by comparing students' understanding and modifying practices of clinical education in new circumstances. Early clinical experience will definitely play a crucial role in this context, only if proper strategies are implemented. This systemic review article highlights ECE settings and scientific basis in a theoretical way helpful for medical faculties during its implementation in regular teaching.

Effectiveness of early clinical exposure in improving attitude and professional skills of medical students in current Indian medical education set up.

INTRODUCTION: As a part of education reforms Medical Council of India has introduced early clinical exposure (ECE) as an important intervention in Medical teaching. It is stated in the literature, ECE helps to relieve stress of the students pertaining to patient handling, developing real-time clinical reasoning ability, communication skills, professional attitude, and patient empathy. With this view, this study was planned to assess effectiveness of early clinical exposure in improving attitude and professional skills in the current Indian medical education set up. METHODS: This cross-sectional study was carried out amongst 820 students for three years duration. Students were randomly divided into two groups viz. ECE exposed group (Group A) and Traditional teaching exposed group (Group B). We conducted periodical sessions (Each duration: 60 minutes). We used a validated 10-point questionnaire for feedback collection. RESULTS: Using perception-based 10-point questionnaire based on Likert scale we found, 93.21% of students strongly agreed that the method of ECE teaching aroused interest in learning. 86.03% of students strongly agreed that the method of ECE teaching technique helped in better retention of topic. 89.91% of students strongly agreed that the method of ECE teaching imparts better clinical context. 92.75% of students strongly agreed that the method of ECE teaching allows better assimilation of knowledge gained during learning. With ECE-based teaching 87.42% of students found highly satisfied while 81.22% of students found highly competent about the knowledge and skills thus acquired via this teaching methodology. 95.11% of students liked ECE teaching methodology and these students enjoyed it a lot and with interest. CONCLUSION: This study concluded that early clinical exposure is the most important teaching tool in improving attitude and professional skills in the current Indian medical education set up.

Introducing reflective narrative for first-year medical students to promote empathy as an integral part of physiology curriculum.

Guided reflective narratives facilitate deeper understanding and learning. The study was aimed at exploring the scope of guided reflective narratives on early clinical exposure, for first-year medical students, in promoting empathy. Strengths and limitations of the process of reflective narratives were also explored. First-year medical students (n = 150) were exposed to guided reflective narrative writing following each of the three "early clinical exposure" sessions integrated into a physiology curriculum. A feedback on the entire program was obtained through a semistructured questionnaire. The contents of the reflective narratives and feedback on the program were analyzed. Students empathized with the situation and needs of patients and caregivers and could relate to responsibilities and challenges faced by members of health care team. They realized the importance of cooperation from patients and caregivers and work efficiency, communication, behavior, and teamwork from members of healthcare and thereby emerged with the idea of the coordinated effort in patient care. Students opined that reflective narratives made them reflect and empathize with people and situations. Too many narrative writing sessions and hesitation to share their thoughts were some of the suggested limitations. The process led to emergence of a working model for guided reflections to promote empathy. Guided reflective narratives made students reflect and relate to people and situations. While promoting empathy, the reflections also gave them an idea of holistic approach to patient-centered care. Inferences led to a conceptual model for guided reflections to promote empathy among medical students.