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Mr. Editor
After reviewing Arja et al.’s study on the influence of electives in medical education on students’ interest in teaching and research, we commend the authors for exploring a crucial topic.1 As advocates for innovative medical education, we hope to provide additional perspective on this topic. The qualitative phenomenological approach used was well suited to delve deeper into students’ experiences and perceptions of the elective. This approach allowed for a nuanced exploration of the topic, providing valuable insights into students’ perspectives.
The authors should be commended for critically appraising their methodology, acknowledging limitations such as the use of a small sample size and the risk of bias due to convenience sampling. However, the importance of these factors as a source of type I error may compromise the relevance of the study results in practice.2 The study could greatly benefit from a larger, more diverse sample, as limiting the sample to a single institution prevents generalization and may amplify characteristics of that population, such as pre-existing enthusiasm for research. Additionally, repeating the study with students who did not participate in an elective could help visualize the different experiences, creating a control group.
The multi-modular structure of the option allows students to choose modules covering educational research methods, curriculum development, learning theories, accreditation and regulation. However, the form of assessment was consistent across all students in the option, regardless of the modules selected. With educational research methodology and learning theories being more commonly chosen, the study could benefit from individualised assessment of each module, in order to maintain its relevance for the design of future optional modules.
Although the online survey method is effective, the use of free-text and self-reported data may introduce internal response bias and may not capture the benefits of the depth of semi-structured interviews or the generalizability of quantitative data. For example, less engaged individuals may also be less willing to provide in-depth free-text responses, limiting the breadth of information collected. The use of unobtrusive data collection via closed-ended questions may offer quantitative insights that would allow for better comparison of the results of this study with the broader literature. Conversely, in-depth face-to-face interviews such as those used by Hayashi et al., may provide a richer understanding of student experiences because they are more personalized.3,4
Furthermore, the lack of divergent opinions on the identified themes suggests a potential bias in the analysis in favour of positive results. Therefore, exploring the positive and negative aspects of elective courses, for both students and locals, could provide a more balanced perspective.5
Despite these limitations, Arja et al. highlighted the positive impact of electives in medical education, highlighting the need for future studies to address methodological gaps.1 Improved sampling methods, rigorous data collection and analysis procedures, and consideration of broader contextual factors may ameliorate this effect. Investigating the long-term effects of electives on students’ career and academic outcomes would be an interesting avenue for future research, as it may indicate benefits that extend beyond electives, similar to the findings of Hayashi et al.3
We congratulate the authors for highlighting this important topic in medical education.
Disclosure
The authors report no conflict of interest in this communication.
The references
1. Arja S, Arja SB, Ponnusamy K, Kottath Veetil P, Paramban S, Laungani Y. Electives in medical education can promote teaching and research interests among medical students. Advan Med Educ Pract. 2024;15:173–180. doi:10.2147/amep.s453964
2. Akobeng AK. Understanding Type I and Type II Errors, Statistical Power, and Sample Size. Acta Paediatrica. 2016;105(6):605–609. doi:10.1111/apa.13384
3. Hayashi M, Son D, Nanishi K, Eto M. Long-term contribution of international medical student internships to professional identity formation: a qualitative study. BMJ open. 2020;10(8):e039944. doi:10.1136/bmjopen-2020-039944
4. Jain N. Survey versus interviews: a comparison of data collection tools for exploratory research. Qual Representative. 2021. doi:10.46743/2160-3715/2021.4492
5. Chmura M, Nagraj S. A scoping review of the ethical impacts of international medical internships on local students and patient care. BMC Medical Ethics. 2024;25(1). doi:10.1186/s12910-023-00998-7