Competency Based Medical Education (CBME) was introduced by the National Medical Council (NMC) to ensure that medical students acquire essential competencies and skills through a structured curriculum specifying competencies, time allocation, and duration for each subject [16]. Along with changes in teaching and assessment methods, NMC introduced elective postings as Module 6 in Part 2 of the third year MBBS, a relatively new concept with limited published literature [17]. Implemented in India in 2019, elective postings aim to help students explore specialized subjects for future career selection. The primary objective is transformative learning, comprising instrumental learning, which focuses on developing subject-specific clinical skills, and communicative learning, which emphasizes interpersonal skills and effective patient communication [18].

Laboratory competence is central to microbiology education; however, undergraduate curricula often provide limited exposure to advanced diagnostic techniques and clinically relevant practices⁸. Elective programs offer an effective means to bridge this gap by providing focused, skill-intensive training aligned with student interests and career goals⁶,⁷.

To implement successfully, we need to continuously evaluate the effectiveness of the elective program and make necessary revisions based on feedback, outcomes, and challenges faced during implementation, as it begins in the medical journey.

Antibiotic Susceptibility Testing (ABST) is a cornerstone of clinical microbiology, guiding antimicrobial therapy through standardized methodologies and interpretive criteria defined by CLSI and EUCAST¹,². Accurate ABST is essential for optimal patient management and surveillance of resistance patterns³,⁵.

The global rise of antimicrobial resistance (AMR) poses a major public health threat, with projections estimating up to 10 million deaths annually by 2050¹¹. In response, Antimicrobial Stewardship Programs (AMSP) have been promoted globally to optimize antimicrobial use, reduce resistance, and improve patient outcomes¹²,¹³. Effective stewardship relies heavily on accurate microbiological data and close collaboration between clinicians and microbiology laboratories.

Biomedical Waste Management (BMW) is another critical yet often underemphasized component of microbiology training. Improper handling of biomedical waste contributes to occupational hazards, environmental contamination, and healthcare-associated infections⁸.

This study describes the outcomes of two concurrent microbiology electives-ABST-AMR-AMSP and Biomedical Waste Management-and evaluates their impact on students’ knowledge, laboratory skills, critical thinking, and professional readiness. The present study also suggested to make the elective posting innovative as well as interesting that can help student to choose pre and para clinical subject in post graduate, as Presently, the students are more inclined towards clinical subjects.

MATERIALS AND METHODS

2.1 Study Design

This was a prospective cross-sectional study conducted from 01.12.2025 to 15.12.2025 at GMERS Medical College and General Hospital, Godhra, Gujarat, among 12 undergraduate students from a batch of 100 MBBS students (2022-2023 batch, Third MBBS Part I) who chose elective topics from different sections of the Department of Microbiology.

The 15-day elective posting was structured to include orientation, pre-test, small-group discussions, self-directed learning sessions, post-test, structured qualitative feedback, and final submission of a logbook maintained throughout the posting. The program was conducted based on principles of experiential and inquiry-driven learning. Such educational approaches have been shown to enhance skill acquisition and research readiness in microbiology students⁸,¹⁰.

Inclusion Criteria

1. III^rd MBBS medical students posted in the Department of Microbiology during their elective posting.
2. Medical students who willingly provided informed consent to participate in the study.

Exclusion Criteria

1. Students who did not meet the attendance requirement of at least 75% during the elective posting.

Aims & Objectives

• To Integrates diagnosis with stewardship & national AMR efforts by leaning AST, AMR & AMSP.
• To learn BMW management and enhances infection prevention awareness.
• The aim of elective posting is to give the student the chance to immerse themselves in a field of study, career stream, or profession.

2.2 Participants

Twelve final-year undergraduate students voluntarily enrolled after completing core microbiology practical courses. Students were allocated into:

• Elective 1 (n = 6): ABST, AMR, and AMSP
• Elective 2 (n = 6): Biomedical Waste Management

2.3 Program Components

Elective 1: ABST-AMR-AMSP

The elective integrated theory with hands-on laboratory exposure:

• Theoretical instruction:
• Mechanisms of antimicrobial action and resistance (ESBL, MRSA, CRE)
• Epidemiology and clinical impact of AMR¹¹,¹²
• Principles, objectives, and structure of AMSP¹³
• Hands-on training:
• Kirby-Bauer disc diffusion testing
• Minimum inhibitory concentration (MIC) determination
• Inoculum standardization and zone diameter measurement
• Interpretation using CLSI and EUCAST guidelines¹,²
• Data interpretation workshops:
• Analysis of culture and sensitivity reports
• Identification of major and minor AST errors³,⁵
• Preparation and interpretation of antibiograms.

Table 1: The Schedule for the elective-1 posting

Elective 2: Biomedical Waste Management

• Theoretical modules:
• BMW rules, colour coding, and regulatory requirements
• Infection control and occupational safety principles
• Practical exposure:
• Waste segregation exercises
• Demonstrations of handling, transport, and disposal
• Observation of hospital BMW workflows

Table 2: The schedule for the elective-2 posting

2.4 Evaluation and Data Collection

Student performance was assessed using:

• Pre- and post-test assessments to measure knowledge gain
• Practical skill scoring rubrics evaluating procedural accuracy and guideline adherence

• Logbook entry required: Signed logbook entry. Preceptor signature with ―Meets Expectation

• Structured qualitative feedback forms containing descriptive questions assessing learning outcomes, challenges, clinical relevance, and recommendations⁶,⁹

RESULTS

15 days duration elective program of 12 third part first MBBS students conducted in ttwo section in Department of Microbiology. Among the 12, 6 students posted in each section. All student successfully completed elective program with average attendance rate of 91% in Elective 1 and 94% in elective 2 reflecting strong participation.  Two student remain absent for 3 days, two students remain absent for 1 days in first elective, while two student remain absent 2 days, one student remain absent for 1 day in elective 2. (Fig-1)

Table- 1

Table- 2

(Fig. 1)

3.1 Knowledge Gain

All twelve students achieved higher post-test scores compared to pre-test assessments, indicating significant improvement in theoretical understanding across both electives. Similar gains have been reported in elective and research-based microbiology courses⁶,¹⁰.

Table- 3 Elective 1 (AST, AMR, AMSP) Assessment

(Fig. 2)

Table- 4 Elective 2 (BMW) Assessment

(Fig. 3)

Table- 5

(Fig. 4)

Overall improvement seen in elective 1 is 20% and improvement in knowledge of elective 2 is 19% as comparing result of post-test with pre-test.

3.2 Improvement in Practical Skills

Total six Students (2 Boys, 4 Girls) aged between 21-24 years were enrolled in the ABST-AMR-AMSP elective demonstrated improved aseptic technique, procedural accuracy, and interpretation of susceptibility results.

Feedback of the student were recorded as various Practical skill using scoring rubrics format given below.

Table- 6 AST feedback scoring rubrics

Most students rated the clarity of objectives and faculty guidance as excellent. Understanding and hands-on exposure to AST were rated very good to excellent by most participants. Prior knowledge of AST was moderate to average, but knowledge significantly improved after the elective. Overall, the AST elective was found to be useful.

Table- 7 AMR feedback scoring rubrics

Learning objectives and understanding of AMR were rated excellent by most students. Course content was considered highly relevant to clinical and academic needs. Hands-on exposure to resistance pattern identification was well appreciated. Students showed clear improvement in AMR knowledge after the elective. The AMR elective was overall useful with minimal average ratings.

Table- 8 AMSP feedback scoring rubrics

Faculty guidance and supervision received excellent ratings from most students. Learning objectives and understanding of AMSP were rated good to excellent. Hands-on exposure to antibiogram preparation and antibiotic policy showed mixed responses. Knowledge of AMSP improved noticeably after the elective. Overall, the AMSP elective was considered useful by most participants.

These findings align with prior studies emphasizing the value of structured AST training⁶,⁸.
BMW elective participants showed enhanced competence in waste segregation and compliance with infection control protocols.

Table- 9 BMW feedback scoring rubrics

DISCUSSION:

Enhanced Understanding & Development of Critical Thinking

The elective was highly effective in enhancing students’ understanding of Biomedical Waste (BMW) management. Most participants rated their understanding of BMW rules, faculty support, and overall effectiveness as excellent, reflecting strong teaching and supervision. Knowledge of waste segregation, infection control, and relevance to future clinical practice was rated as excellent or very good by all students, indicating comprehensive learning outcomes. Practical exposure showed some variability, suggesting scope for increased hands-on experience. Overall, the elective significantly improved students’ knowledge of BMW compared to their prior understanding and was perceived as highly relevant to future clinical practice.

Post-elective feedback indicated improved awareness of AMR mechanisms and the role of microbiology laboratories in resistance surveillance, along with appropriate biomedical waste (BMW) segregation, handling, and disposal practices¹². Students demonstrated a clearer understanding of AMSP objectives, infection control measures, and the clinician’s responsibility in rational antimicrobial prescribing and safe BMW management¹³. Additionally, participants reported enhanced ability to troubleshoot ambiguous results, distinguish technical errors from biological variation, and apply microbiology knowledge while adhering to biosafety and BMW regulations in clinical contexts³,⁵. This was accompanied by increased confidence and professional identity formation, consistent with findings from inquiry-based laboratory training emphasizing biosafety and BMW compliance⁷,¹⁴,¹⁵.

Students answered descriptive questions on learning outcomes, challenges, clinical relevance, and recommendations, providing positive feedback on the effectiveness of the elective. Their responses and suggestions are discussed below.

Table- 10 Reasons for Choosing the Elective

This table summarizes the reasons students reported for selecting the elective. The majority of students (58%) chose the elective for skill development, while 25% were influenced by faculty or senior recommendations, and 17% cited other reasons. No students selected career interest, research exposure, or availability as their reason.

Table- 11 Recommendation for Future Students

All students (100%) recommended this elective, with no negative responses.

Table- 12 Intended postgraduate specialty

The majority of students (75%) were undecided about their intended postgraduate specialty, indicating significant uncertainty at this stage of training. A smaller proportion planned to pursue the same specialty as their elective (17%), suggesting some positive influence of elective exposure. Only a minority (8%) intended to choose a different specialty, highlighting that electives may help guide decisions but are not the sole determinant of postgraduate career choice.

CONCLUSION:

The Biomedical Waste (BMW) management elective was highly effective in improving students’ knowledge and understanding of BMW rules, waste segregation, infection control, and their importance in future clinical practice. All participants rated the learning outcomes and overall effectiveness as excellent or very good, indicating successful achievement of the elective objectives. Faculty support and supervision were also highly appreciated. Although practical exposure varied among students, the elective significantly enhanced post-training knowledge compared to prior understanding, highlighting its educational value and clinical relevance.

REFERENCES

1. Jorgensen JH, Ferraro MJ. Antimicrobial susceptibility testing: a review of general principles and contemporary practices. Clin Infect Dis. 2009;49(11):1749-55. doi:10.1086/647952
2. Matuschek E, Brown DFJ, Kahlmeter G. Development of the EUCAST disk diffusion antimicrobial susceptibility testing method and interpretive criteria. Clin Microbiol Infect. 2014;20(4):O255-66. doi:10.1111/1469-0691.12481
3. Balouiri M, Sadiki M, Ibnsouda SK. Methods for in vitro evaluating antimicrobial activity: A review. J Pharm Anal. 2016;6(2):71-9. doi:10.1016/j.jpha.2015.11.005
4. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. 30th ed. Wayne (PA): CLSI; 2020.
5. Breakpoint tables for interpretation of MICs and zone diameters. Version 12.0. 2022.
6. Smith J, Kumar R, Patel A. Enhancing laboratory skill acquisition through elective microbiology modules. J Microbiol Educ. 2019;20(3):45-52. doi:10.1128/jmbe.v20i3.1842
7. Hawkins A, O’Donnell L. Investigative microbiology laboratories improve student research skills. FEMS Microbiol Lett. 2021;368(2):fnaa215. doi:10.1093/femsle/fnaa215
8. Sharma A, Gupta R. Strengthening clinical microbiology practical teaching in undergraduate education: faculty perceptions & challenges. Indian J Med Microbiol. 2021;39(4):444-51. doi:10.1016/j.ijmmb.2021.05.003
9. Gould T, Faiman R. A simulation-supported antibiotic sensitivity laboratory for undergraduates. Adv Physiol Educ. 2022;46(3):432-9. doi:10.1152/advan.00054.2022
10. O’Connor L, Taylor N, Newman L. Evaluation of a research-based microbiology laboratory course for undergraduates. J Biol Educ. 2020;54(3):249-58. doi:10.1080/00219266.2019.1583954
11. de Kraker MEA, Stewardson AJ, Harbarth S. Will 10 million people die annually due to antimicrobial resistance by 2050? PLoS Med. 2016;13(11):e1002184. doi:10.1371/journal.pmed.1002184
12. World Health Organization. Global Action Plan on Antimicrobial Resistance. Geneva: WHO; 2015.
13. Taintor NR, Nguyen V. An elective course on antimicrobial stewardship improves knowledge and attitudes. Curr Pharm Teach Learn. 2017;9(4):635-41. doi:10.1016/j.cptl.2017.03.018
14. Senan EM, Riehle C. Training undergraduates in detection of antimicrobial resistance genes. Antonie Van Leeuwenhoek. 2024;117(6):755-67. doi:10.1007/s10482-024-01790-2
15. McDonough PG, Harrison M. An undergraduate research course screening efflux pump inhibitors improves microbiology competence. BMC Med Educ. 2025;25:73-40. doi:10.1186/s12909-025-07340-2
16. Kaushik JS, Ramachandran P, Kukreja S, Gupta P, Singh T. Delivering Electives the Clerkship Way: Consolidating the Student Doctor Method of Training. Indian Pediatr. 2022 Sep 15;59(9):710-715. PMID: 36101951.
17. Dowell J, Merrylees N. Electives: isn't it time for a change? Med Educ. 2009 Feb;43(2):121-6. doi: 10.1111/j.1365-2923.2008.03253.x. PMID: 19161481.
18. Petrosoniak A, McCarthy A, Varpio L. International health electives: thematic results of student and professional interviews. Med Educ. 2010;44(7):683-689. doi:10.1111/j.1365-2923.2010.03688.x