Medical education in India has witnessed a paradigm shift with the introduction of the Competency-Based Medical Education (CBME) curriculum. The CBME framework was introduced with the objective of producing an Indian Medical Graduate who is not only clinically competent but also an effective communicator, lifelong learner, leader, professional, and a socially accountable healthcare provider. The curriculum emphasizes outcome-based learning and the development of competencies required for addressing the healthcare needs of individuals and communities.^1-4

One of the significant innovations introduced under the CBME curriculum is the Foundation Course, which is conducted at the beginning of the MBBS program. The Foundation Course serves as a bridge between school education and medical training, helping newly admitted students adapt to the academic, professional, and social environment of a medical college. The course is designed to orient students to the medical profession, familiarize them with the healthcare system, and equip them with essential skills required for their future role as medical professionals.^5-8

The Foundation Course encompasses a wide range of components, including orientation to the medical profession, professionalism and ethics, communication skills, language and computer skills, stress management, time management, sports and extracurricular activities, community orientation, and basic life support training. Through these components, the course aims to promote holistic development and facilitate the smooth transition of students into the rigorous medical curriculum.^9-11

The transition from school to medical college can be challenging for many students due to increased academic demands, a new learning environment, and heightened expectations regarding professional conduct and patient care. The Foundation Course attempts to address these challenges by creating a supportive learning environment and providing students with the knowledge, skills, and attitudes necessary for successful integration into medical education. It also seeks to foster self-confidence, empathy, teamwork, and professionalism at an early stage of training.^12,13

As the Foundation Course represents a relatively recent curricular innovation, its effectiveness and relevance need to be evaluated periodically. Students, being the primary beneficiaries of the program, are uniquely positioned to provide valuable feedback regarding its content, organization, utility, and overall impact. Their perceptions can offer important insights into the strengths and limitations of the course and help educators and curriculum planners identify areas for improvement.^14-16

Although several medical colleges across India have implemented the Foundation Course, the experiences and perceptions of students may vary depending on institutional settings and local contexts. Therefore, obtaining systematic feedback from students is essential for ensuring the successful implementation of the program and for strengthening future curricular initiatives.

In this context, the present study was undertaken among first-year MBBS students of Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, to assess their perspectives regarding the Foundation Course implemented under the Competency-Based Medical Education curriculum and to evaluate their feedback on various components of the program. This assessment is expected to provide useful evidence for further refinement and effective implementation of the Foundation Course in undergraduate medical education.

MATERIALS AND METHODS

Study Design and Setting

A descriptive cross-sectional study was conducted among first-year MBBS students at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. The study was carried out after the successful completion of the Foundation Course implemented under the Competency-Based Medical Education (CBME) curriculum. The study aimed to assess students' perceptions and feedback regarding various components of the Foundation Course.

Study Population

The study population comprised first-year MBBS students who had attended and completed the Foundation Course conducted at the beginning of the MBBS program.

Inclusion Criteria

• First-year MBBS students enrolled at IGIMS, Patna.
• Students who attended the Foundation Course.
• Students willing to participate and provide informed consent.

Exclusion Criteria

• Students who were absent during the feedback session.
• Students who declined to participate in the study.
• Incompletely filled questionnaires.

Sample Size

A total of 100 first-year MBBS students who completed the Foundation Course and fulfilled the eligibility criteria were included in the study.

Study Tool

Data were collected using a pre-designed, semi-structured, self-administered feedback questionnaire developed to assess students’ perceptions regarding different components of the Foundation Course. The questionnaire consisted of two sections.

The first section collected basic demographic information of the participants, including age, gender, and place of residence.

The second section comprised feedback items related to various domains of the Foundation Course, including orientation to the medical profession, communication skills, professionalism and ethics, basic life support training, community orientation, language and computer skills, stress management, sports and extracurricular activities, teaching-learning methods, and overall satisfaction with the course.

Students were asked to rate each statement on a five-point Likert scale:
1 = Strongly Disagree,
2 = Disagree,
3 = Neutral,
4 = Agree,
5 = Strongly Agree.

At the end of the questionnaire, students were also provided an opportunity to offer suggestions and comments regarding the Foundation Course.

Data Collection Procedure

After completion of the Foundation Course, students were informed about the purpose and objectives of the study. Participation was voluntary, and confidentiality of responses was assured. Written informed consent was obtained from all participants before administration of the questionnaire.

The questionnaires were distributed to the students in a classroom setting and collected immediately after completion to ensure a high response rate and minimize non-response bias.

Study Variables

The primary outcome variable was students’ perception of the Foundation Course as assessed through responses to individual feedback items and overall satisfaction scores.

The major domains evaluated included:

• Introduction to medical profession
• Professionalism and ethics
• Communication skills
• Basic life support skills
• Community orientation
• Computer and information technology skills
• Language and soft skills
• Stress and time management
• Sports and extracurricular activities
• Teaching-learning methods
• Overall usefulness of the Foundation Course

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using Epi Info version-7 Statistical Software.

Descriptive statistics were used to summarize the data. Categorical variables were presented as frequencies and percentages, while continuous variables were expressed as mean and standard deviation. Responses to individual feedback items were analyzed using frequencies, percentages, mean Likert scores, and standard deviations.

For ease of interpretation, responses of "Agree" and "Strongly Agree" were combined and considered indicative of a positive perception, whereas responses of "Disagree" and "Strongly Disagree" were considered indicative of a negative perception. Overall perception scores were computed by summing the scores of individual Likert-scale items, with higher scores representing a more favorable perception of the Foundation Course.

Ethical Considerations

The Institutional Ethical Committee (IEC) of IGIMS, Patna approved the study with the approval letter 460/IEC/IGIMS/2022. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Participation was voluntary, anonymity was maintained throughout the study, and all information collected was kept strictly confidential and used solely for research purposes

RESULTS

A total of 100 first-year MBBS students participated in the study. The majority of participants belonged to the 19–20 years age group (61%), while 34% were aged 18 years or younger and 5% were older than 20 years.

Table-1: Socio-demographic Characteristics of Study Participants (N = 100)

Male students constituted 57% of the study population, whereas females accounted for 43%. Regarding place of residence, nearly two-thirds (63%) of the participants were from urban areas, while 37% belonged to rural backgrounds. Overall, the study population comprised predominantly young students in the typical age range for entry into the MBBS program, with a slight male predominance and a higher representation of students from urban areas.

Table-2: Students’ Perception Towards Different Components of the Foundation Course (N = 100)

* Positive perception = Agree + Strongly Agree

† Negative perception = Disagree + Strongly Disagree

Table 2 depicts students’ perceptions regarding various components of the Foundation Course. Overall, the majority of participants expressed a positive perception towards all domains of the course. Basic Life Support (BLS) training received the highest positive feedback, with 91% of students reporting a favorable perception, followed by professionalism and ethics (89%) and orientation to the medical profession (88%). Communication skills sessions were positively perceived by 86% of the participants, while community orientation and computer skills were favorably rated by 84% and 81% of students, respectively. Stress management sessions received the comparatively lowest positive perception (79%); however, a substantial majority of students still viewed this component favorably. Negative perceptions were minimal across all domains, ranging from 2% to 5%, indicating overall acceptance and appreciation of the Foundation Course by the students.

Table 3. Students’ Perception Regarding the Utility of the Foundation Course (N = 100)

* Positive perception = Agree + Strongly Agree

† Negative perception = Disagree + Strongly Disagree

Table 3 presents students’ perceptions regarding the overall utility and effectiveness of the Foundation Course. An overwhelming majority of participants reported that the Foundation Course was beneficial in facilitating their transition to medical college, with 90% agreeing that it helped them adjust to the new academic environment. Nearly all students (93%) felt that the course enhanced their understanding of the medical profession, while 88% reported increased confidence as future medical professionals. Furthermore, 87% believed that the course improved their communication and interpersonal skills, and 85% felt that it contributed to the development of professional attitudes and values. Notably, 94% of students recommended that the Foundation Course should continue for future MBBS batches, reflecting a high level of acceptance and perceived usefulness of the program among first-year medical students.

Table 4. Overall Perception of Students Towards the Foundation Course (N = 100)

Table 4 illustrates the overall perception of students towards the Foundation Course based on the cumulative perception scores obtained from the feedback questionnaire. Nearly half of the participants (46%) demonstrated a good overall perception, while 35% reported an excellent perception of the course. Only 15% of students had an average perception, and a small proportion (4%) expressed a poor perception. Overall, more than four-fifths (81%) of the students rated the Foundation Course as either good or excellent, indicating a highly favorable response towards its content, organization, and relevance. These findings suggest that the Foundation Course was well received by the majority of first-year MBBS students and effectively fulfilled its intended objectives.

Table 5. Suggestions Provided by Students for Improvement of the Foundation Course (Multiple Responses Allowed) (N = 100)

Table 5 summarizes the suggestions provided by students for further strengthening the Foundation Course. The most frequently reported recommendation was the inclusion of more practical sessions and demonstrations (34%), highlighting students’ preference for experiential and skill-based learning. Approximately one-fourth of the participants suggested increasing the duration of Basic Life Support training (27%), while 22% recommended incorporating more interactive teaching-learning activities. Additional community exposure visits were suggested by 18% of students, and 15% felt that better time allocation among various sessions would enhance the overall effectiveness of the course. Notably, nearly one-third of the students (29%) reported that no major modifications were required, indicating a high level of overall satisfaction with the existing structure and content of the Foundation Course.

DISCUSSION

The Foundation Course was introduced under the Competency-Based Medical Education (CBME) curriculum with the objective of facilitating a smooth transition of students from school education to the medical profession while providing them with the essential knowledge, skills, attitudes, and values required for their future roles as medical practitioners. The present study assessed the perceptions of first-year MBBS students regarding various components of the Foundation Course and demonstrated an overwhelmingly positive response towards the program. The findings indicate that the Foundation Course was successful in achieving its intended objectives and was well accepted by the majority of students.

In the present study, most participants expressed favorable perceptions towards all major components of the Foundation Course. Basic Life Support (BLS) training received the highest level of positive feedback among all domains assessed. This observation reflects the importance of practical and skill-oriented learning experiences in undergraduate medical education. Newly admitted medical students often appreciate opportunities to acquire hands-on skills that provide a sense of professional identity and confidence at an early stage of training. The strong positive response towards BLS training observed in the present study is consistent with the increasing emphasis on competency acquisition and experiential learning within the CBME framework.^11,13

The domains related to professionalism and ethics, orientation to the medical profession, and communication skills were also highly appreciated by the students. These findings are particularly significant because professionalism, ethical conduct, and effective communication form the cornerstone of quality healthcare delivery. Early exposure to these concepts enables students to develop a patient-centered approach and fosters the values expected of a competent and compassionate medical graduate. The favorable perception towards these sessions suggests that students recognized their relevance and importance in shaping their future professional conduct.^6,12

A major finding of the study was that a substantial proportion of students reported that the Foundation Course facilitated their adjustment to the medical college environment and enhanced their understanding of the medical profession. The transition from school to medical college is often associated with significant academic, psychological, and social challenges. Students are required to adapt to a demanding curriculum, new learning methodologies, and heightened expectations regarding professionalism and patient care. The positive feedback observed in the present study indicates that the Foundation Course effectively served as a bridge between school education and medical training, helping students acclimatize to their new environment and responsibilities.^8,11,14

The majority of participants also perceived that the Foundation Course improved their confidence and interpersonal communication skills. Communication is a critical competency for medical professionals, influencing patient satisfaction, treatment adherence, teamwork, and clinical outcomes. The positive response towards communication skills training highlights the value of introducing these competencies at the beginning of medical education. Similarly, the reported increase in confidence among students suggests that the Foundation Course contributed to reducing apprehension and uncertainty commonly experienced during the initial phase of medical training.^13,16

Community orientation sessions were viewed positively by a large proportion of students. Exposure to community settings during the Foundation Course helps students appreciate the social determinants of health, healthcare delivery systems, and the broader responsibilities of medical professionals within society. Such experiences are essential for nurturing socially accountable physicians who understand the healthcare needs of diverse populations. The favorable perception towards community orientation observed in this study reflects students’ recognition of the relevance of community-based learning within the medical curriculum.^9,10

Although all domains received predominantly positive feedback, comparatively lower positive perceptions were observed for stress management and computer skills sessions. This finding may be attributed to variations in students’ prior exposure to these topics before entering medical school. In addition, students often demonstrate greater enthusiasm towards practical and clinically relevant activities than towards sessions perceived as theoretical or informational. Nevertheless, the majority of students still viewed these components positively, indicating their perceived utility within the overall structure of the Foundation Course.^12,15

Another important finding was the overwhelming support for continuation of the Foundation Course for future MBBS batches. The vast majority of students agreed that the course should remain an integral part of undergraduate medical education. Such strong endorsement reflects the perceived value of the program and underscores its role in preparing students for the academic and professional challenges of medical training. The high levels of satisfaction observed in the present study further reinforce the relevance of the Foundation Course as an important introductory component of the CBME curriculum.

Students also provided constructive suggestions for enhancing the effectiveness of the Foundation Course. The most common recommendations included increasing the number of practical sessions, extending the duration of Basic Life Support training, incorporating more interactive teaching-learning activities, and enhancing community exposure. These suggestions reflect students’ preference for active, participatory, and experiential learning approaches. Such feedback is valuable as it provides insights into learner expectations and highlights opportunities for further strengthening the educational impact of the Foundation Course.^14,16

Overall, the findings of the present study demonstrate that the Foundation Course was perceived positively across multiple domains, including professional orientation, ethics, communication skills, practical training, and community engagement. The overwhelmingly favorable responses indicate that the course plays a pivotal role in facilitating students’ transition into medical education and contributes meaningfully to the development of competencies envisioned under the CBME curriculum. The results also emphasize the importance of maintaining a balanced curriculum that combines theoretical orientation with practical skill development and interactive learning experiences to maximize student engagement and educational outcomes.

Strengths and Limitations

The present study provides valuable insights into the perceptions of first-year MBBS students regarding the Foundation Course implemented under the CBME curriculum and offers important feedback from the primary stakeholders of the program. The study achieved complete participation from all eligible students, ensuring comprehensive representation of the study population and minimizing non-response bias. Furthermore, the use of a structured feedback questionnaire allowed systematic assessment of multiple domains of the Foundation Course. However, the findings should be interpreted in light of certain limitations. Being a single-centre study conducted among students of one medical college, the results may not be generalizable to all institutions. In addition, perceptions were assessed immediately after completion of the Foundation Course and therefore reflect short-term impressions rather than long-term educational outcomes or retention of knowledge, skills, and attitudes. As the study relied on self-reported responses, the possibility of social desirability and response bias cannot be completely excluded. Despite these limitations, the study provides useful evidence regarding students’ perspectives on the Foundation Course and contributes to the ongoing evaluation and refinement of CBME implementation in undergraduate medical education.

CONCLUSION

The Foundation Course was well received by the majority of first-year MBBS students and was perceived as an effective initiative for facilitating their transition into medical education. Students reported positive experiences across various domains, particularly Basic Life Support training, professionalism and ethics, communication skills, and orientation to the medical profession. The course helped students adapt to the medical college environment, enhanced their understanding of the medical profession, and fostered essential professional competencies. The overwhelmingly favorable perceptions and high level of student satisfaction underscore the importance of the Foundation Course as a key component of the CBME curriculum and support its continued implementation and periodic refinement based on learner feedback.

Recommendations

Based on the findings of the present study, the Foundation Course should be continued as an integral component of the CBME curriculum for all incoming MBBS students. Greater emphasis may be placed on practical skill-based learning, particularly Basic Life Support training, through increased hands-on sessions and demonstrations. Incorporating more interactive teaching-learning methods, small-group activities, and community exposure visits may further enhance student engagement and learning outcomes. Regular collection and utilization of student feedback should be encouraged to facilitate continuous evaluation and improvement of the Foundation Course, ensuring that it remains relevant, learner-centered, and aligned with the evolving needs of undergraduate medical education.

REFERENCES

1. Padmanabhan P, Kowale AN. Current medical education: A bird's eye view. Int J Clin Med Educ Res. 2024;3(1):1-8.
2. Gehlawat M, Thumati G, Samala P, Alekhya CL, Shailaja A, Sharma A. Competency-Based Medical Education for Indian undergraduates: Where do we stand? APIK J Intern Med. 2024;12(1):7-12.
3. Ramanathan R, Shanmugam J, Sridhar MG, Palanisamy K, Narayanan S. Exploring faculty perspectives on competency-based medical education: A report from India. J Educ Health Promot. 2021;10:402.
4. Soundariya K, Nishanthi A, Mahendran R, Vimal M. Evaluation of competency-based medical education curriculum implementation for phase II medical undergraduates: A qualitative study. J Adv Med Educ Prof. 2025;13(1):36-48.
5. Velou MS, Ahila E. Foundation course for first-year MBBS students in India: Disparity between its intentions and implementations. IAIM. 2020;7(8):91-96.
6. Bhatnagar KR, Oberoi A. Students' perceptions on newly designed Foundation Course at MBBS entry level: A mixed-method study. Indian Psychiatry J. 2022;31(1):141-150.
7. Raveendra L, Tikare SN, Dandage S. Foundation course conducted under the new CBME curriculum of Indian Medical Council: Analysis of students' perspective in South Indian medical institutions. Med Innovatica. 2022;11(2):24-32.
8. Jain S, Verma N. Perception analysis of first-year MBBS students after attending the first one-month Foundation Course in a North Indian medical college. J Educ Technol Health Sci. 2020;7(3):96-100.
9. Sethi S, Verma P, Srivastava V, Mittal R. Perceptions of first-year MBBS students about the Medical Council of India mandated Foundation Course. CHRISMED J Health Res. 2021;8(1):10-14.
10. Aristotle S, Ramamoorthy B, Radhakrishnan A. Programmatic assessment of Foundation Course for undergraduate medical students immediately following the course and one-year thereafter: A post-test quasi-experimental study. J Clin Diagn Res. 2024;18(10):JC01-JC05.
11. Medhi S, Das D, Hazarika K. Evaluation of the Foundation Course of the CBME curriculum in Indian medical education using the CIPP model. Educ Adm Theory Pract. 2024;30(10):2676-2683.
12. Shanmathi KA, Meena TS, Selvam V, Revathy TG. Assessing the impact of competency-based medical education: Insights from medical students. Texila Int J Public Health. 2024;12(4):1-9.
13. Datta M, Bhattacharya S, Mondal S. Evaluation of Foundation Course for first-year medical undergraduates in a medical college of Eastern India. J Med Educ. 2022;21(1):e122116.
14. Chatterjee S, Kar SK. Undergraduate research elective under competency-based medical education in India: Challenges and directions. Indian J Psychol Med. 2023;45(5):548-551.
15. Udgiri R, Patil V. Feedback on Foundation Course curriculum from the new Indian medical graduates. South East Asian J Med Educ. 2020;14(1):68-71.
16. Khilnani AK, Patel J, Khilnani G. Students' feedback on the Foundation Course in competency-based medical education curriculum. Int J Res Med Sci. 2019;7(11):4408-4409.