Designing and conducting a two day orientation program for first semester undergraduate medical students.

Dear editor

Xavier University School of Medicine (XUSOM) is an offshore medical school in Aruba, Kingdom of the Netherlands admitting students from the United States (US), Canada and other countries to the undergraduate medical (MD) and the premedical program. The school shifted to a partially integrated curriculum with the normal human subjects of anatomy, physiology and biochemistry being learned during the first two semesters while the abnormal subjects of pathology, microbiology, pharmacology and introduction to clinical medicine are covered during the next two semesters [1,2]. From January 2014, the school shifted to a fully integrated, organ system based curriculum with early clinical exposure and modules on patient, doctor and society and healthcare quality improvement [3]. Modifications to student assessment with a greater emphasis on formative assessment and assessment of student behavior, attitudes and professionalism have also been carried out [4]. A two day orientation program is offered to all first semester MD students from January 2014. In XUSOM like in most offshore Caribbean medical schools a semester of study is of 15 weeks duration and students are admitted three times a year in January, May, and September. In this letter, I will briefly describe the process we followed during the design and conduct of the orientation program. During the summer and fall 2013 semesters the institution had a one day orientation program and prior to that there was no formal orientation program.

Orientation programs and commencement addresses are common in medical schools around the world [5]. At KIST Medical College, Lalitpur, Nepal a week long orientation program is offered to all first year students introducing them to teaching­learning activities, the curriculum and faculty members [6]. At a medical college in Hyderabad, India a three day orientation program addressing study skills, history of medicine, ethics and values, time management, communication skills and community health among other topics was conducted for first year students [7]. At XUSOM, I as the Chair of the Curriculum Committee in consultation with the Dean, Dr Dubey and senior faculty members decided to conduct a two day program for newly admitted first semester MD students. During the program we planned to introduce students to the institutional learning objectives, the curriculum, the future of international medical graduates, the United States Medical Licensing Examination (USMLE) Step 1, the assessment system followed at the institution and small group work and problem­based learning. Table 1 shows the various topics addressed during the two day program.

Table 1.

Topics addressed during the orientation program

	Topic	Time
Day 1	Institutional educational objectives	8:00–8:30
	What the future holds for international medical graduates	8:30–9:00
	The XUSOM MD curriculum	9:00–9:45
	The XUSOM premed curriculum	9:45–10:00
	Student discipline, behavior and professionalism	10:00–10:45
	Crossing the river	11:00–12:00
	Learning in a team—an exciting experience	13:00–13:45
	The art of medicine	13:50–14:30
	Meet the experts	14:40–15:30
Day 2	Preparing for self-directed learning	8:00–8:45
	Preparing for USMLE step 1	9:00–9:45
	The US healthcare system	10:00–10:45
	Early clinical exposure	11:00–11:45
	Class notes	13:00–13:30
	Student assessment during the MD program (basic sciences)	13:30–14:00
	Small group activity	14:00–15:30

XUSOM, Xavier University School of Medicine; USMLE, United States Medical Licensing Examination.

At XUSOM like in other offshore Caribbean medical schools, students complete the basic sciences in Aruba and then do their clinical rotations in the United States. The sessions on the US healthcare system, the future of international medical graduates and preparing for the USMLE Step 1 were delivered by faculty in the United States through Skype. Crossing the river is an activity which is fun, involves a certain amount of physical activity and introduces participants to small group work [8]. The session on the art of medicine introduces students to the medical humanities and the role art can play in medical education. A medical humanities module is offered to all first semester medical students at XUSOM, Aruba from the January 2013 semester [9]. During the session ‘Meet the experts’ we emphasize the importance of students assuming increasing responsibility for their learning and not being dependent on the faculty to provide answers and solutions. Students are grouped in pairs and each student introduces his/her partner to the larger group and the faculty under specified headings.

During the session on self­directed learning students are introduced to self­directed learning (SDL) and the importance of SDL in the curriculum is emphasized. Resources for SDL including those available in the library are highlighted. Students during the first two semesters visit a local general practitioner every fortnight and during the third semester spend sixteen hours at the local general hospital. The formative assessment rubric followed during early clinical exposure (ECE) and the summative assessment during the objective structured clinical examination are mentioned and the benefits of ECE are highlighted. Class Notes is a server based system on which the calendar of operation, the handbooks, syllabi, other resources and the class room handouts and slides are deposited. A hands­on demonstration of the system is provided during the session. The assessment scheme followed during different semesters and the rubrics and other instruments used are discussed during the next session. During the small group session students are introduced to problem based learning and a mock session is conducted with students working in small groups.

The major challenges in organizing an orientation program for students in the institution were the short 15 weeks semester duration, the difficulty in getting experts in medical education from outside the institution, and providing a mixture of interactive lectures and small group activity based sessions within a two day period. Also an orientation program is a recent development in the institution and we had difficulties initially in convincing faculty members about the importance of and the need for such a program. When we initiated the program students were skeptical about the advantages of the two day program. Recently students have become convinced about the advantages the orientation program provides them with regard to introduction to the curriculum, teaching­learning activities and learning resources. The program also serves to introduce the newly admitted students to their batch mates and the faculty and will be helpful in promoting effective small groups during the course of study. Skype and meeting and collaboration software can ensure that faculty and experts not physically present at the venue can deliver their presentations, interact with students and answer their queries and problems.

Informal student feedback about the program has been positive. We plan to study the influence of the program on student knowledge and perception during future sessions. We also plan to obtain more formal feedback in the future. Our experience with conducting an orientation program in an offshore medical school with a 15 weeks semester will be of benefit to medical educators planning to conduct short orientation programs in their institutions.