Electives as a Pedagogical Strategy for Fostering Medical Student Engagement and Exploration beyond the Standard Medical Curriculum

Abstract

Standard medical curricula typically consist of fixed
courses, often leave little room for students to
meticulously study subjects of particular
interest. The incorporation of electives within the
medical curriculum addresses this issue as it
facilitates self-directed learning, allowing
students to customize learning experiences to
meet their diverse needs and personal interests
in the ever-evolving field of medicine.

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South-East Asian Journal of Medical Education
Vol.18, no.1, 2024
Medical Education in Practice
Electives as a Pedagogical Strategy for Fostering Medical
Student Engagement and Exploration beyond the Standard
Medical Curriculum
Dias, N.W.G.L.T.L., Karunathilake, I. M., Hettiarachchi, D., de Abrew, A., Amarasiri, M.M.P.L.
Introduction
Revamping a medical curriculum at a pace
parallel to the development of medicine is an
unattainable goal. Academic institutions
consistently encounter difficulties in
determining the appropriate content to include
or exclude during curriculum development,
given the vast expansion of core medical
knowledge and the emergence of new medical
disciplines (Harden et al., 1984). Standard
medical curricula typically consist of fixed
courses, often leave little room for students to
meticulously study subjects of particular
interest (Harden et al., 1984).
The incorporation of electives within the
medical curriculum addresses this issue as it
facilitates self-directed learning, allowing
students to customize learning experiences to
meet their diverse needs and personal interests
in the ever-evolving field of medicine (Ramalho
et al., 2020). Elective components provide
significant benefits, as they enable students to
broaden their perspectives beyond the confines
of the standard curriculum (Lumb & Murdoch-
Eaton., 2014). This engagement allows them to
participate in activities that can shape their
future careers and identify persistent issues
within healthcare systems, ultimately seeking
innovative solutions (Harden et al., 1984).
The Faculty of Medicine, University of Colombo
transitioned from a traditional discipline-based
curriculum to a more integrated and student-
centered approach in 1995.
Faculty of Medicine, University of Colombo, Sri
Lanka.
Corresponding author: Mr. N.W.L.G.T.L. Dias
Email: diaz94tl.physio@gmail.com
Teaching and learning activities were thus
modified to incorporate methods that more
actively engage students (Karunathilake et al.,
2006).
As part of these reforms, the Faculty introduced
a 4-week electives programme to the
undergraduate medical curriculum, making it
the first institution in South Asia to implement
such an initiative. Over the past thirty years, this
program has consistently provided students
with a distinctive and enriching learning
experience.
Structure of the Electives Programme
The Electives Committee of the Faculty is
responsible for all aspects of the electives
programme. This Committee comprises a panel
of faculty-affiliated academics who are experts
in various fields of medicine. Students
commence the electives programme prior to the
onset of the final year “Professorial” rotation
during the 14th term of the curriculum. Students
are first required to submit a proposal that
includes the topic, a brief introduction, learning
objectives, and planned activities for the four
weeks. They have the autonomy to select a
topic of their interest, which need not be directly
related to health. They are encouraged to
discuss potential topics with peers, senior
students, and review previous electives to avoid
redundancy.
Students are then responsible for selecting a
supervisor with relevant expertise to guide
them. They are expected to discuss the
proposals and learning objectives with the
supervisors, ensuring that these objectives are
realistic, achievable and provide sufficient deep
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DOI: https://doi.org/10.4038/seajme.v18i1.608

Dias et al., 2024
South-East Asian Journal of Medical Education
Vol.18, no.1, 2024
knowledge in the chosen area of study.
Students must outline the activities to manage
their time effectively and ensure the objectives
are achieved by the end of the programme.
The Elective Committee reviews the submitted
proposals to ensure programme objectives are
met, and provides feedback. During the
electives programme, students are expected to
maintain a logbook documenting their activities.
They are advised to meet the supervisor at least
twice for feedback, fostering a good supervisory
relationship. Upon the conclusion of the elective
programme, participants are required to furnish
a detailed report encompassing all undertaken
activities and insights.
Current Situation
Evaluation of student electives can provide
valuable insights for curriculum developers,
enabling them to align and adapt core curricular
content to reflect evolving trends and needs in
medicine. This helps identify educational
opportunities that correspond with the areas of
knowledge and interest pursued by students
(Atkins et al., 1998)
The Sri Lankan health system is currently
experiencing significant challenges due to the
economic crisis that has led the country to be
declared in default for the first time in history.
To investigate the interests of medical students
during this unprecedented period, we analyzed
288 elective reports submitted between 2022
and 2023 by 573 students of the intake batches
of 2015, 2016, and 2017. These reports were
categorized to identify themes representing
areas of interest, and the frequency of each
theme and trends in their adoption were
documented.
We identified eight themes of interest among
students. Commonest area of focus is the
Healthcare facilities and Service Delivery
(n=104), emphasizing the roles of healthcare
institutions and management, the involvement
of multidisciplinary teams for effective patient
management, and the accountability of
individual healthcare professionals in patient
care. Another key theme, specialized medical
fields and procedures beyond the standard
medical curriculum (n=45), included various
disciplines and techniques such as surgical
methods, dermatology, critical care and
emergency medicine, ophthalmology, palliative
care, reproductive health and fertility, and the
management of common orthopedic issues.
Technological applications in healthcare also
emerged as an area of interest, with 39 elective
reports discussing novel diagnostic methods,
medical imaging, and the use of artificial
intelligence and information technology to
improve health services. Furthermore, 37
reports were on areas outside conventional
medicine, specifically traditional and alternative
medicine. Other notable themes included public
health and community-based interventions
(n=25), psychosocial support and mental health
(n=15), medical education and ethics (n=13),
and pharmaceuticals and toxicology (n=10)
(Figure 1).
Figure 1: Composition of Electives Reports submitted between 2022 and 2023
14%
13%
9%
36%
16%
3% 5% 4% Technological Applications in Healthcare
Traditional and Alternative Medicine
Public Health and Community based Interventions
Healthcare Facilities and Service Delivery
Specialized Medical Fields and Procedures
Pharmaceuticals and Toxicology
Psychosocial Support and Mental Health
Medical Education and Ethics
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Electives to Explore beyond the Curriculum
South-East Asian Journal of Medical Education
Vol.18, no.1, 2024
Figure 2: Number of Elective Reports related to Psychosocial Support and Mental Health submitted by
each batch
Figure 3: Number of Elective Reports related to Healthcare Facilities and Service Delivery submitted by
each batch
The trend analysis reveals a consistent
increase of interest in Psychosocial Support
and Mental Health, as well as in Healthcare
Facilities and Service Delivery. Specifically,
Psychosocial Support and Mental Health
exhibited a 100% increase from the batch of
2015 to the batch of 2016, followed by a further
125% increase from the batch of 2016 to the
batch of 2017. Reports pertaining to Healthcare
Facilities and Service Delivery showed a
16.67% increase from the batch of 2015 to the
batch of 2016, and an 11.43% increase from the
batch of 2016 to the batch of 2017.
Discussion
The growing interest in psychosocial support,
mental health, and healthcare services in Sri
Lanka may be driven by the contextual
challenges posed by the COVID-19 pandemic
and the ongoing economic crisis. The aftermath
of the COVID 19 pandemic and the Sri Lankan
economic crisis poses significant challenges to
the delivery of health services and the
management of healthcare facilities, due to
budget constraints and limited resources
(Gamage et al., 2022). Another issue arising in
this context is the deterioration of mental health,
due to challenges arising from the economic
crisis (Matthias & Jayasinghe., 2022).
The review of these 288 elective reports
highlights a wide range of student interests,
illustrating the dynamic and evolving nature of
healthcare in light of recent global and local
challenges. Recognizing students' interests is
essential for institutions to systematically
explore avenues for offering further educational
opportunities. Implementing an elective
program effectively allows students to explore
beyond the standard curriculum and become
aware of local and global challenges. This
approach is pivotal in cultivating graduates who
exhibit proficiency in comprehensive decision-
making and possess a progressive mindset,
while also being aware of the environment they
are entering as intern doctors.
0
2
4
6
8
10
2015 2016 2017
0
10
20
30
40
50
2015 2016 2017
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Vol.18, no.1, 2024
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