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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2024 | Month : June | Volume : 18 | Issue : 6 | Page : JC06 - JC10 Full Version

Learnings and Reflections on Transition to New Competency-based Medical Education, MBBS curriculum in Microbiology: A Cross-sectional Observational Study

Published: June 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/68438.19481

Vidya Sanjay Date, Sucheta Jitendra Lakhani, Himani Bhardwaj Pandya, Nidhi Mihir Bhalodia

1. Professor and Head, Department of Microbiology, Smt. B.K. Shah Medical College and Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India. 2. Professor, Department of Microbiology, Smt. B.K. Shah Medical College and Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India. 3. Associate Professor, Department of Microbiology, Smt. B.K. Shah Medical College and Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India. 4. Assistant Professor, Department of Microbiology, Smt. B.K. Shah Medical College and Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India.

Correspondence Address :
Himani Bhardwaj Pandya,
Associate Professor, Department of Microbiology, Smt. B.K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth An Institution Deemed to be University, At & Po. Piparia, Ta. Waghodia Dist., Vadodara-391760, Gujarat, India.
E-mail: himani22pandya@yahoo.com

Abstract

Introduction: Conventional teaching in microbiology revolved around the study of microorganisms without clinical relevance. Therefore, a New Competency-based Undergraduate (UG) Medical curriculum (New CBME) was rolled out in the academic year 2019 to make Indian Medical Graduates more clinically competent yet globally relevant.

Aim: To assess the impact of the change in curriculum on students’ performance and desired educational outcomes before and after the implementation of the new curriculum. Likewise, the study aimed to analyse the experiences and reflections of medical teachers towards these amendments.

Materials and Methods: A cross-sectional observational study was conducted on 82 students from the second year Bachelor of Medicine, Bachelor of Surgery (MBBS) with a traditional curriculum and 74 with the new Competency-based Medical Education (CBME) curriculum at the Department of Microbiology, Smt. B.K. Shah Medical Institute and Research Centre, Piparia, Vadodara, Gujarat, India, between February 2020 and November 2021. In both batches, topics from core as well as non core areas of various systems were included along with the Attitude, Ethics and Communication (AETCOM) modules. A comparison of both groups was done, and Chi-square values and p-values were calculated.

Results: The batch with the new CBME curriculum was able to provide a provisional diagnosis for a case-based question better than the Traditional batch {n=60/74 (81%) vs n=44/82 (54%), p-value=0.0005, significant}. However, the correct aetiology, pathogenesis, and laboratory diagnosis were written better in the traditional batch compared to the new one, n=44/82 (54%) vs n=24/74 (32%). Regarding the AETCOM skills, the new batch had a better understanding of proper communication and ethics, i.e., 73/74 (99%), p-value <0.00001, Significant, while 66/82 students (80%) of the traditional batch and 67/74 (90%) of the new batch were aware of confidentiality issues. In viva voce, the new batch showed a lot of confusion regarding the names, types of micro-organisms, and the laboratory diagnosis of diseases caused by them compared to the traditional batch (p-value <0.00156, significant).

Conclusion: After implementing the new CBME curriculum to undergraduate students and analysing the feedback of teachers and the performance of students, it was felt that an appraisal of the new curriculum is required for a satisfactory outcome in microbiology so that microbiology content can be incorporated with clinical relevance.

Keywords

Bachelor of medicine and bachelor of surgery, Comparison, Competency based education, Microbiology

Introduction
The definition of health and disease has changed over the years, as have lifestyles, cultural, social contexts, geographical and demographic situations that influence health and illness. The medical field has expanded enormously, and these changes must be reflected in medical education, making it more meaningful in the current context. Therefore, a review of the medical curriculum in India was welcomed. A new CBME curriculum was introduced in 2019. Emerging widespread infectious diseases are growing universally and resulting in significant human morbidity and fatality. Additionally, medical microbiology-oriented questions in competitive examinations have gained importance (1). This change in curriculum is unique for microbiology compared to other medical subjects in many ways. In the traditional curriculum (2), microbiology was taught broadly as bacteriology, virology, parasitology, and mycology with relevant clinical syndromes. However, the relevance of microbiology to clinical infectious diseases was not clearly understood by the students. A relevant association between knowledge of various aspects of microbiology and their role in understanding infectious diseases was lacking. In the previous attempts to improve learning, this was partly achieved by integrated teaching sessions and other innovative methods, like adding a part of clinical microbiology to the syllabus in the form of case-based problem-based sessions even before the CBME was implemented. The new CBME has addressed this problem and made certain changes (3). The approach has now entirely changed to incorporating microbiology into a system-based learning program of clinical information. At the beginning, teachers had apprehensions regarding the course, its implementation, and outcome. It was also during the Coronavirus Disease 2019 (COVID-19) pandemic. While rolling out and implementing the new CBME in 2019, authors analysed the experiences and reflections of teachers through a questionnaire. Authors also noted the important changes in objectives, content, teaching-learning methodology, and assessment in the traditional and new curriculum of microbiology (3). Any change in the curriculum needs to be evaluated. Authors closely observed all the changes and felt a need for a successful merger of core microbiology into clinical schemes. These changes prompted them to analyse there overall experience of teaching the competency-based curriculum of the microbiology course. The evaluation consists of a comparison of knowledge levels between the students of the traditional and new curricula (4),(5). With the above insights, the present study was designed to evaluate the impact of this change on students’ performance, analyse actual learning and desired educational outcomes before and after the implementation of the new curriculum, and similarly, to analyse the experiences and reflections of medical teachers towards these amendments. The challenges and solutions cited by the present study would surely assist in reviewing and amending certain areas in the new CBME curriculum for microbiology.
Material and Methods
The study was a cross-sectional observational study conducted for a period of one year and 10 months from February 2020 to November 2021 at the Department of Microbiology, Smt. B.K. Shah Medical Institute and Research Centre, Piparia, Vadodara, Gujarat, India. Ethical approval (SVIEC/ON/Medi/RP/20110) was obtained from the Sumandeep Vidyapeeth Institutional Ethical Committee (SVIEC). Informed consent was obtained from each student with a digital signature on their official email ID before initiating the study.

Inclusion criteria: Second-year MBBS students with a traditional curriculum and the New CBME batch of 2019 were included in the study.

Exclusion criteria: Second-year MBBS students who did not give consent and those appearing in University examinations for the first year MBBS and second year MBBS as casual students were excluded from the study.

Sample size: A total of 82 students from the second year MBBS batch of 2018 (Traditional curriculum) (2) and 74 from the batch of 2019 (New CBME curriculum) (3) were included for assessment analysis. The study was time-bound, so all the subjects who gave consent were part of the study.

Study Procedure

The various components such as objectives, content, teaching-learning methodology, assessment and time frame in both curricula were studied, and differences were noted. The outcome of the new curriculum was evaluated by noting the understanding and analytic ability of students in areas such as knows, knows how, shows, and shows how in selected topics through tests and viva. The study was conducted during the COVID-19 pandemic period, so classes were held on an online platform via Google Meet. The project was explained to all MBBS students with a traditional curriculum via Google Meet, while the batch with the new curriculum had offline teaching for almost one year. In both batches, topics from core as well as non core areas {Core: A competency that is necessary in order to complete the requirements of the subject (Traditional Must Know)} Non core: A competency that is optimal in order to complete the requirements of the subject (Traditional Nice To Know, Good To Know) of various systems was included. In addition, hospital acquired infection and control, recent advances, and AETCOM were also assessed. At the end of their respective terms, the traditional and new batches were given the same set of questions. Each time, three questions were given from the given topics (Table/Fig 1). Answers were submitted in Portable Document Format (PDF) format to authors Email ID (Traditional curriculum batch, online mode, due to the COVID-19 pandemic) and hard copy (new curriculum batch, offline mode). At the end of the session, 50 medical teachers (professors to Assistant professors) from seven medical colleges in India completed a questionnaire regarding their challenges, apprehensions, revisions done, implementation, and training on the new CBME curriculum. The seven Medical Colleges were: Shantabaa Medical College and General Hospital, Amreli, Gujarat; Banas Medical College and Research Institute, Palanpur, Gujarat; Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat; CU Shah Medical College, Surendranagar, Gujarat; Government Medical College, Datia, Madhya Pradesh; Saveetha Medical College and Hospital, Chennai, Tamil Nadu; and Lokmanya Tilak Municipal Medical College, Mumbai.

Statistical Analysis

Statistical analysis was conducted using International Business Machine (IBM) Statistical Package for Social Sciences (SPSS) version 25.0 software. A comparison of both groups was performed, and Chi-square values and p-values were calculated. The p-values <0.05 were considered significant.
Results
A theory test of selected topics in microbiology and viva voce was conducted for both traditional and new curriculum MBBS students. Results were analysed and noted in the form of tables.

A case-based long question is asked, then the new batch with the new CBME curriculum were able to do the provisional diagnosis better in comparison to the traditional batch (81% vs 54%, p-value 0.0005, significant) which is clearly depicted in (Table/Fig 2). However, the correct aetiology, pathogenesis, and laboratory diagnosis were written better in the Traditional batch compared to the new one (54% vs 32%). For non-case-based questions, 55 (67%) students from the traditional batch attempted well compared to the new batch (p-value=0.00033). When authors compared the AETCOM skills, authors found that in the new batch, as they have compulsory AETCOM modules from the first MBBS and were trained using various methods like role play, they all had a thorough understanding regarding proper communication and ethics (99%, p-value <0.00001, significant). In terms of confidentiality, 80% of traditional and 90% of new students were aware. Regarding working in a team, 50% of students with a traditional curriculum were aware as they learned these concepts while studying HIV reporting and teamwork; they had learned about the role of the Hospital Infection Control Committee (HICC) in the prevention of nosocomial infections.

In viva voce, the performance of the traditional batch was around 67%, while in the new batch it was around 40% (Table/Fig 2) (p-value- 0.00156, significant) as they showed a lot of confusion regarding the names and types of microorganisms, how they cause infection, and serological methods for diagnosis. They mixed up bacteria and viruses and were confused about the reference books. They readily named advanced methods of diagnosis like multiplex Polymerase Chain Reaction (PCR) without understanding their role.

The feedback taken from various faculties of the Microbiology Department from seven medical colleges in India is shown in (Table/Fig 3),(Table/Fig 4). The feedback questionnaire was designed considering the changes in the new CBME guidelines, such as introducing new teaching/learning methods, particularly case-based teaching, a system-wise approach, and time allotment. Additionally, teachers’ initial apprehensions, challenges, and concerns regarding the pattern and the need for Curriculum Implementation Support Program (CISP) training (as training was batch-wise, only 64% were trained by CISP) were addressed. The questionnaire was prepared by MD and PhD teachers with extensive teaching experience and validated by the Coordinator of the Medical Education Unit. Overall, the response was diverse as half of the faculties were happy about the curriculum change but still skeptical about the implementation part and felt that the new CBME curriculum is not motivating the students to learn subject-specific (Microbiology) due to the lack of clear-cut guidelines and uniformity in teaching across different institutions. While 64% of faculties appreciated some revisions in the new CBME curriculum, like alignment and integrated teaching. They felt that this approach would provide a comprehensive overview of a single concept and appreciated the concepts of Small Group Discussion (SGD) and Self-directed Learning (SDL). Many of them also believed that learning system-wise would shift the focus of the subject towards clinical medicine rather than the essentials of microbiology.
Discussion
After the induction and implementation of the new CBME curriculum in Microbiology in Phase 2, the test results in the two batches showed a statistically significant difference. The traditional curriculum batch students demonstrated more clarity in identifying the correct aetiology, understanding pathogenesis, and laboratory diagnosis (p-value=0.012, significant), while the new curriculum students had a better comprehension of AETCOM (Communication, Confidentiality, and Teamwork) and clinical diagnosis (p-value <0.00001, Significant). In viva voce, the traditional batch had better clarity regarding the names of microorganisms, their pathogenesis, and diagnosis (p-value=0.00156, Significant), while the new curriculum students showed a lot of confusion regarding the names of microorganisms. Similar studies have been conducted by many authors (6),(7). In 2020, Kotur N et al., studied the impact of the new curriculum on students’ performance and the differential time utilisation of the teaching faculty in the subject of Physiology (6). They compared the internal marks of the students and used a semi-structured questionnaire for the teaching faculty. The results of the present study were not consistent with this study as they found that the new curriculum students performed better, and the difference in marks was statistically significant (6). However, the time utilised for planning and administrative activities by teachers was high and took a toll on the teachers. They suggest that measures to promote research and faculty strength in the existing medical colleges should be prioritised (6).

Another analogous study was conducted in the Pharmacology subject by Sharp K et al., where he compared the academic performances of traditional versus new CBME MBBS curriculum students. The outcomes of the present study were in accordance with his results where the traditional curriculum batch performed better than the new curriculum batch in writing the pathogenesis and correct diagnosis (7). On the contrary, a study done by Thind A et al., compared traditional teaching with new CBME students in Phase 1 physiology subject and concluded that new curriculum students scored significantly higher than the traditional students in the pre and post-test questionnaire (8).

While there are some studies, like the one done by Begum N et al., in the subject of Pharmacology, who found marginal differences in the performance of students. In the feedback taken by students, 46.8% of students liked the new teaching methods, and 55% did not like the new teaching methods (9).

While assessing the feedback of medical teachers, authors found that 86% of the teachers desired more training sessions. A 93% of faculties found it difficult and felt the need for more time many felt that the faculties are deficient in number to implement SGD and SDL. Similar findings were cited by Kotur N et al., that although the newer MBBS curriculum is found to be promising for medical students, it is taking a huge toll on the teaching faculty (6). They suggest promoting research and faculty strength in existing medical colleges (6). The authors emphasised the need for a faculty development program, communication skills, and attitude (6).

Sharma R et al., also highlight that the new educational roles of teachers as a facilitator, planner, manager, and performance assessor are significant, and a mere three days of CISP cannot provide this competency and address the deficient staff (10).

Many studies mention that the time allocation for teaching microbiology during the preclinical curriculum has been considerably reduced due to the new approach. Medical students also overwhelmingly reported that there is a shortage of time to effectively learn the course material (11). When authors executed the course, authors found that during their tenure, students had various institutional functions, sports activities, vacations, and absenteeism for the practice of events and a few days before all examinations, which took a toll on curriculum time, reducing the period to a mere eight and a half months.

A comprehensive approach to incorporating microbiology into the clinical scheme without losing the basic clarity of the core subject is needed. New innovative methods of using virtual patients are suggested. The medical education scenario is changing as students embrace the accessibility and interactivity of e-learning. Virtual patients are e-learning resources that may be used to advance microbiology education (12). Mapping microbiology content in a clinical presentation curriculum is suggested by Pettit RK and Kuo Y-P (13). They have reported that clinically important microbes, their pathogenesis, symptoms, and diagnosis of corresponding infectious diseases should be integrated into clinical schemes within a clinical presentation curriculum.

While review and change are needed in the UG medical curriculum, there are points that need attention and further research. Knowledge of basic principles of microbiology and important features of micro-organisms like their morphology, virulence factors, antibiotic resistance (in bacteria) provide an understanding of the full spectrum of their pathogenicity and form the basis of learning the infectious syndromes they cause. Only an overview of microorganisms does not suffice, as students showed confusion when asked about the aetiological agents of syndromes. Students confused bacteria with viruses and fungi. Almost all microorganisms cause pathology in various organ systems and are not restricted to one system. The clinical syndromes belong to a system. This dichotomy causes confusion for students. Therefore, it is important to successfully incorporate microbiology into modules in the preclinical curriculum to maintain an equilibrium between fundamental sciences and clinical information.

Recent studies have revealed that medical students forget roughly 25-35% of basic science knowledge after one year, more than 50% by the next year, and 80-85% after 25 years (14),(15),(16). Thus, there is a lack of clinical relevance and inadequate connection between the practical application of basic sciences to clinical conditions and the teaching methods used (14). If authors were to develop a vision regarding these infections, their epidemiology, presentations, and the approach to laboratory diagnosis in UG students, it would be worthwhile to consider mapping microbiology content with clinical context effectively in the course.

Limitation(s)

The mode of teaching, one being offline and the other being online, transitioned from traditional to the new curriculum during the COVID-19 pandemic. It was crucial to note the initial impact, gather teacher feedback, and compare the students of both curricula during that period. The results and conclusions in the present study were drawn from a single centre. The findings of the study should not be generalised to other Medical Colleges in the country. Therefore, authors suggest conducting multicentric studies, which can provide a better outcome of changes in the curriculum.
Conclusion
After implementing the new CBME curriculum for UG students and analysing the feedback of teachers and the performance of students, it was felt that a review of the curriculum is required for a satisfactory outcome in microbiology so that microbiology content is incorporated with clinical relevance. From their answers in the theory and viva, it was clear that the understanding of the basics of microbiology was lacking in the new batch. Students used terminology and even wrote about advanced techniques in diagnosis without understanding. Students voiced their concern about the reduced time allotment. From the teachers’ responses, it was clear that many are not trained in CISP. They need more time to prepare and arrange content in an effective way. A larger multicentre study can further substantiate our observations. There is a need to review this curriculum to make it more effective. Reconsideration of time allotment, the number of faculty, faculty development, training, and developing relevant content are the need of the hour. This will form a firm basis for understanding infectious diseases in the future.
Acknowledgement
The authors would like to thank all the faculties of Microbiology Department, at Smt. B.K. Shah Medical College and Research Centre, Sumandeep Vidyapeeth and from other medical college for their support.

Authors’ contribution: VSD conceptualised and VSD, SJL and HP designed the study. VSD, SJL, HP and NB executed the study. VSD and HP wrote the manuscript. SJL guided and revised the manuscript. All authors read and approved the final manuscript for publication.
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DOI and Others
DOI: 10.7860/JCDR/2024/68438.19481

Date of Submission: Nov 02, 2023
Date of Peer Review: Jan 29, 2024
Date of Acceptance: Apr 24, 2024
Date of Publishing: Jun 01, 2024

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 07, 2023
• Manual Googling: Feb 15, 2024
• iThenticate Software: Apr 22, 2024 (8%)

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