One hundred and fifty three students responded to the strengths and weaknesses questionnaire, of which 82 were males (53.6%). A high response rate of ≥82% was observed among all students, males and females. Sample characteristics are summarized in Table 1. Students highlighted 68 and 135 different responses on strengths and weaknesses respectively. After analysis of data, five themes were consistently expressed by a majority of students and were present in both focus groups. These five themes were considered as the 'major' themes. Three themes were deemed to be 'minor' as they were not consistently identified in both focus groups. The major emerging themes after the analysis of both questionnaire and FGD results were the following:
Inadequate knowledge provided on pharmacology and pathology during IBSS.
Structured and well-organized module system of the ASS.
Wide variety of clinical attachments during CS.
Inefficient community and behavioural sciences stream time allocation.
Lengthy duration and poor organization of entire course.
Summary of major themes
1. Inadequate knowledge provided on pharmacology and pathology during IBSS
The students felt that the IBSS was the most difficult time period at the faculty, as they were exposed to a vast amount of knowledge in seven subjects (Anatomy, Physiology, Biochemistry, Pathology, Pharmacology, Microbiology and Parasitology) over a relatively short period of time. Most of the subject matter was taught without emphasizing on the relevance to clinical application, and exam questions were mostly theory-oriented than clinical-oriented.
"We were not taught the clinical relevance of most of the subject matter in IBSS resulting in our studying being focused only towards passing exams with poor retention of clinically oriented subject-matter, which resulted in a substandard performance during clinical attachments"
This was mainly with regards to Anatomy and Biochemistry. The teaching activities in Physiology were seen as being more clinically oriented than the other six subjects and hence students' felt that it was an easier subject to study. Students' strongly felt that this irrelevant teaching in certain subjects compromised the teaching activities in Pathology and Pharmacology. In addition since Pathology and Pharmacology were taught during IBSS and the examination was a single 'combined' paper including all four subjects (together with Parasitology and Microbiology), more time, effort and attention was focused towards Anatomy, Biochemistry and Physiology.
"Due to inadequate teaching of Pathology and Pharmacology, we were at a disadvantage during clinical attachments and out inability to derive explanations to clinical scenarios from these two fundamental basic sciences were criticized frequently by clinicians during clinical attachments"
"Pathology and Pharmacology were taught during the ASS with separate modules, however since the individual module examinations in ASS were mainly clinical oriented we were able to pass exams without studying the Pathology and Pharmacology sections in each module"
The initial IBSS time period was also felt as being difficult due to several other reasons; a) it being a period of adjustment from teacher-based learning in schools to self-learning in the faculty, b) difficulties in language adjustment from 'Sinhala/Tamil' (native language) based school teaching to English based university teaching, c) inadequate guidance provided on study methods and recommended books, d) difficulties in adjusting to the university lifestyle and e) living separated from family members and loved ones.
2. Structured and well-organized module system of the ASS
The students felt that the module based system during the ASS as a whole was well-organized and gave a broader picture on clinical oriented learning. However, the individual module structures were different from one another and certain important modules such as the Cardiovascular system module were poorly organized. They strongly agreed that the module workload was comparatively less than the IBSS. In addition having frequent assessments at end of each module was seen as an advantage as it helped to maintain focus on studies. Sometimes modules were not well aligned with the clinical appointments that the students' were engaged in during the same time period.
"For most of us the motivation for learning was having exams and hence frequent exams during the ASS was very helpful"
"We completed the Neurology clinical attachment more than 8 months prior to the Neurology module during the ASS and if we had the relevant module teaching prior to the clinical attachment it would have been better"
Module lectures by clinicians were very efficient and helpful. Students felt that having no vacation period during the lengthy ASS was stressful. Students were strongly dissatisfied with the frequent changes to module lecture schedules.
"Each module concluded with a short study leave and exam, immediately followed by the commencement of the next module"
"When lecturers have other commitments there is frequent alteration in the lecture schedule, which should not happen"
3. Wide variety of clinical attachments during CS
The wide variety of clinical attachments during the CS was seen as being advantageous and clinical attachments significantly helped to retain studied knowledge. However teaching during individual clinical attachments varied immensely between different clinical groups and depended entirely on the in-charge consultant/specialist. This resulted partly due to inefficient interactions between the faculty staff organizing the curriculum and clinicians in charge of clinical attachments at hospitals.
"Objectives of each clinical attachment were not specific and they were poorly communicated to consultants/specialist in-charge of clinical attachments"
"Consultants/specialist should be given a basic training on teaching, as the variation in ability to teach among different specialist compromised our clinical knowledge"
The students' expressed their concern about not having a patient-oriented assessment at the conclusion of most clinical attachment. The viva-voca at the end or Gynaecology and Obstetrics clinical attachment and OSCE at the conclusion of Paediatric clinical attachment was seen as advantageous.
"Having an assessment at the end of each clinical attachment would help to lessen the performance anxiety during the final year patient oriented clinical examinations"
The time allocations for certain clinical attachments (Urology, Neurosurgery and Orthopaedics) were seen as being inadequate. In additions the clinical/hospital teaching environment was seen as more threatening than the faculty teaching environment.
4. Inefficient community and behavioural sciences stream time allocation
The students strongly felt that the final year compulsory CSS and BSS teaching activities placed a significant burden on final year clinical studies and compromised performance. In addition having the final CSS and BSS examinations during the study leave for the competitive final MBBS examination was seen as being disadvantageous. They felt that the teaching activities and examinations of CSS and BSS should conclude prior to the commencement of the final year. They suggested that CSS and BSS learning activities be condensed into individual modules and completed during a short period, rather than spreading over the entire curriculum. However, both subjects were seen as important in-spite of the inefficient time allocations.
"The CSS and BSS teaching gives us an added advantage over students from other medical faculties in the country both at undergraduate and postgraduate level, however there is potential for the teaching activities to be more efficiently organized"
5. Lengthy duration and poor organization of entire course
The students expressed their strong dissatisfaction about the avoidable lengthy duration of the faculty curriculum. This resulted from lack of proper organization and coordination between various departments.
"We were initially told that the duration of the curriculum would be four and a half to five years, however it took exactly six years to complete"
"There were long time periods (gaps) in the curriculum without any teaching learning activities for most students"
Summary of minor themes
Problem based learning (PBL), activities during various topics in the curriculum was seen as inefficient due to several reason;
"We were not able to grasp the concept of PBLs as it is a new concept to our faculty, and hence it failed to serve the expected purpose"
"Most facilitator were not properly trained on conducting PBLs, while PBLs conducted by experienced facilitators were very useful"
Having no ragging (a verbal, physical or psychological abuse on newcomers to educational institutions by senior students'; prohibited at the faculty) and no student union clashes leading to disruption of teaching activities was seen as an advantage when comparing to the other medical faculties in the country.
Students expressed concern about not having proper training on writing answers to Structured Essay Questions (SEQs).
"We were not given a proper training on writing SEQ answers as done in many other medical faculties in the country, hence we were at a disadvantage"
Students also felt that the faculty should take steps to initiate a training programme and assessment of clinical examiners as there was a large variation between examiners at clinical exams. The answers to MCQ papers not being discussed with students after completion of exams was seen as a disadvantage as it is immensely important for learning and correcting mistakes.