A good understanding of Physiology in first year of MBBS is essential for the foundation of Medicine.  In  didactic lectures, students face difficulty in retention and application of concepts in Physiology. So, students may not perform well in studies.[1,2] This adds to anxiety and difficulty in understanding  the subject. Cardiovascular physiology  provides the foundation for understanding cardiac function, hemodynamics and systemic regulation. However, undergraduate students often struggle to connect theoretical knowledge with its clinical relevance when taught exclusively through traditional lectures. AND it may lead to passive learning and poor retention. Early Clinical Exposure (ECE) introduces students to clinical environments during the preclinical phase, which expose them  to the patients in the first year itself [3]. This helps to reduce stress and also motivate them to increase their confidence level. This gap between theory and practice is bridged by competency based medical education (CBME) and experiential learning strategies[4]. This study investigates the impact of ECE on cardiovascular physiology learning outcomes among undergraduate medical students.

AIM

To evaluate the effectiveness of Early Clinical Exposure in learning cardiovascular physiology among undergraduate medical students .

OBJECTIVES

1. To assess knowledge gain in cardiovascular physiology through ECE compared to traditional teaching.
2. To evaluate student attitudes toward ECE as a learning strategy.
3. To determine whether ECE improves clinical application of cardiovascular physiology concepts.

MATERIAL AND METHOD

Present cross-sectional study was done among 150 first year MBBS students. After approval by Ethical Committee, the details of the study was explained to them and written informed consent was obtained.  The150 students were divided in two groups.

In  Group A (ECE group, n = 75) : Students exposed to clinical settings (Medicine  ward visits, patient case discussions, ECG demonstrations).

In Group B (Control group, n = 75): Students taught using traditional lectures.

In both group Pre-test MCQs on cardiovascular physiology were performed. In the ECE group In the classroom, following a brief lecture and with  paper based case scenarios discussions  was done whereas in the hospital, students were taken to inpatient wards, where they were demonstrated the signs of cardiovascular diseases along with its social implications.

The outcome was assessed in both groups by MCQs post test was done. Applied performance measures (eg., ECG interpretation OSCEs, BP practicals). Also we have collected student’s perceptions by feedback with validated questionnaire (Likert-scale).

Statistical Analysis:

All the parameter were expressed as mean and standard deviation  (mean ±SD). They were tabulated in microsoft excel sheet. Statistical analysis was done using SPSS. Data was compared using : Paired t-test within groups, independent t-test  between groups. ‘p’ value  less than 0.05 was considered  significant.

Questionnaire design. The correct  answers were counted and the scores were categorized.

Questionnaire:

Also their perception was taken by feedback form in following aspects                

Improved Understanding  

Linking Theory to Practice             

Motivation & Engagement

Retention of Knowledge  

Confidence in Learning    

Preference over Lectures  

Clinical Relevance            

Likert Scale Options- For each statement, please select one option:

1 = Strongly Disagree

2 = Disagree

3 = Neutral

4 = Agree

5 = Strongly Agree

Additional Open-Ended Questions were asked  for qualitative feedback:

1 What aspects of the AMI ECE module did you find most useful?

2 What improvements would you suggest for future sessions?

3 Any additional comments?

This design balances both quantitative (Likert scale) and qualitative (open-ended) feedback,  also in capturing student perspectives in depth.

RESULTS

Knowledge Assessment (Pre-Test vs Post-Test MCQ) : 

Table I : Learning Gain & Intervention Effectiveness (N= 150)

Figure 1 : comparing Group A vs Group B Pre-Test vs Post-Test  Learning Gain

Group A (ECE) : Average score improved from 9.3 → 12.5, showing a gain of +3.1.

Group B (Control) : Average score improved from 10.2 → 13.0, showing a gain of +2.8.

• Paired t-test (within groups):

Group A (ECE): t = 13.49, p < 0.05 →  significant improvement

Group B (Control): t = 11.09, p < 0.05 → significant improvement

• Independent t-test (between groups):

t = 2.19, p = 0.030 95% CI [0.04, 0.70])→ Significant difference, favoring Group A (ECE).

Thus both groups improved significantly, but the ECE group showed  a slightly greater improvement, highlighting the added value of early clinical exposure.

Table II: Comparison of  Skill Performance using OSCE Scores

Figure2 : Comparing Group A vs Group B average OSCE scores

• Group A (ECE) : Higher performance, reflecting stronger integration of knowledge into practice.
• Group B (Control) : Lower performance, reflecting less skill application.

Statistical Analysis:

• Independent t-test showed significantly higher OSCE performance in Group A compared to Group B (t = 3.25, p = 0.0015; 95% CI [0.7, 2.7]). p = 0.0015: It indicates strong evidence against the null hypothesis (that there is no difference between the groups).

95% CI [0.7, 2.7]:  The 95% confidence interval for the true mean difference between the groups. Since both the lower bound (0.7) and the upper bound (2.7) are positive, it further confirms that  true difference is likely positive, meaning Group A's performance was higher

Figure 3 : Combined outcomes of MCQ knowledge gain (Cognitive) and OSCE applied performance (Practical) of both Group.

Observations:

• Group A (ECE):

MCQ knowledge gain = +3.1 points

OSCE applied performance = 16.2 / 20

Shows stronger improvement in both cognitive and practical domains.

• Group B (Control):

MCQ knowledge gain = +2.8 points

OSCE applied performance = 14.5 / 20

Improvement noted, but less pronounced compared to ECE group.

statistically significant, p<.05 on appling the Independent t-test .

Table III : Feedback Assessment in Two Groups (N= 150)

Interpretation:

Majority of students in both groups gave positive feedback but number of positive feedbacks were more in ECE group. The difference in positive feedback (20%) highlights the effectiveness of ECE in improving student satisfaction and engagement in reinforcing  &  enhancing cardiovascular physiology learning

DISCUSSION

In present study, Both groups demonstrated significant knowledge improvement, confirming the effectiveness of structured teaching. However, the greater learning gain in the ECE group highlights the added value of clinical exposure in reinforcing theoretical knowledge.

The ECE group outperformed the control group in applied skills, particularly in clinical reasoning and ECG interpretation. This demonstrates that early clinical exposure not only improves knowledge but also enhances practical competencies, bridging the gap between classroom learning and patient care. Thus ECE modules  foster into deeper learning and skill acquisition ².

Usha et al  ⁵ compared ECE with traditional teaching in first‑year physiology practicals using blood pressure measurement. ECE led to superior outcomes, supporting early, clinical contact, confidence  and skill acquisition .

Singh RA ⁶.  Studied  Phase I MBBS students’ perceptions of ECE from North eastern India  in 2024 documented high acceptance and perceived benefits in linking theory to practice, motivation and confidence.

The findings align with prior studies ^7-10  emphasizing experiential learning as a cornerstone of medical education.

CONCLUSION

From present study it was concluded that Early clinical exposure enhances both cognitive learning , retention, clinical application and applied performance. Also it is perceived as more engaging and clinically relevant. Thus it  is an effective pedagogical approach in undergraduate medical students which can foster holistic learning and better prepare students for clinical practice.

Recommendations

1. Faculty Development: Training programs for faculty to facilitate ECE effectively.
2. Infrastructure Support: Collaboration with clinical departments to ensure patient availability and structured exposure.
3. Continuous Evaluation: Regular assessment of ECE outcomes to refine teaching strategies.

Limitations

Challenges such as faculty training, patient availability and time constraints must be addressed for successful implementation.

Short follow‑up  may not fully capture long‑term retention, single‑institution settings may limit generalizability and potential instructor effects are frequent constraints.

Acknowledgement : We sincerely thank all participants and all  authors we referred in the present  study.

Conflict of Interest: Nil

Source of Funding: Self  Funding

REFERENCES

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