351 International Journal of Human and Health Sciences Vol. 06 No. 04 October’22 Editorial: Students’ Elective in Undergraduate Medical Education and Reflective Writing as Method of Assessment Salam A1, Zainol J2 Keywords: Elective course, Medical Education, Reflective skills, Assessment method. Correspondence to: Dr Abdus Salam, Associate Professor and Head of Medical Education Unit and Community Medicine Unit, Faculty of Medicine, Widad University College, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia. Email: abdussalam.dr@gmail.com ORCID iD: https://orcid. org/0000-0003-0266-9747 1. Abdus Salam, Medical Education Unit and Community Medicine Unit, Faculty of Medicine, Widad University College, Kuantan, Malaysia. 2. Jamaludin Zainol, Surgery Unit and Dean Faculty of Medicine, and Deputy Vice-Chancellor (Academic and Internationalisation), Widad University College, Malaysia. In modern medical education, there is growing importance to include the elective program in the undergraduate medical curriculum1. Electives are the curricular contents that students choose freely as apart of their training2. These courses are designed to prepare the students for their future careers by increasing professional opportunities3. Elective courses allow students to have varied learning experiences outside the fixed curriculum. It permits inter-professional education, enhances students’ interest and motivation in the program as they can choose according to their choice, feel more responsible and build personal skills. Also, electives complement the core curriculum as students can select according to their interests and need1,2. This paper briefly describes the kind of activities offered for students’electives, how to plan and implement them successfully and how to assess, especially by reflective writing skills, as method of assessment aimed at conducting a sustainable, effective elective program in undergraduate medical education. The kinds of educational activity offered for electives range from meeting individual educational needs to the exploration of likely career pathways, with many factors influencing choice4. In the United States, electives range from courses like ethics, leadership, health policy, and foreign language to speciality-specific electives5. Short elective courses generally cover the fields of education, research, community postings, or other speciality-specific courses like laboratory electives, palliative care, neurology, emergency medicine, surgery, radiology, primary care, etc.3,5. In designing an elective, based on situation analysis and considering the available resources, the organizer should clearly spell out the specific learning outcomes of the electives. Students should have a clear understanding of the name of coordinating faculty, supervising faculty, mentoring faculty, details of students allowed to join the course, the duration of course, time tabling of the sessions, assessment procedures, resource materials or support services available and prerequisites for joining the elective3,6,7. The time assigned for electives should not be utilized to cover any shortage in their other courses3. All students should know about the content areas covered, including those which might require partnership from neighbouring or international institutions or agencies,3,4,6,8,9. Practicalities such as travel, accommodation, as well as risk management of the student and their elective supervisors also need to be addressed where necessary4. The elective course lays down the foundation for the students to become self-directed learners, as these courses are opted by the students on their own3,4. Assessment method Teaching and assessment are the two sides of the same coin10. Students’ electives need to be assessed toward the end of the course aimed to judge International Journal of Human and Health Sciences Vol. 06 No. 04 October’22 Page : 351-354 DOI: http://dx.doi.org/10.31344/ijhhs.v6i4.472 International Journal of Human and Health Sciences Vol. 06 No. 04 October’22 352 whether they have met their intended learning outcomes. Assessment of elective scan be done either by measuring the percentage of attendance or completion of a logbook or the submission of a project work or evidence for learning or any assignment -namely presentation in a seminar or in a conference, or recording the reflections on learning3,4,9.The reflections on learning or reflective writing make the learning deeper and predicts critical thinking3. Reflective writing Reflective writing is considered an essential component for the assessment of elective courses in modern medical education11 as reflection promotes critical thinking of the students.There are various formats or tools for writing reflection. One such format comprised of three parts: (1) descriptive reflection, (2) dialogic/analytic reflection and (3) critical reflection. Descriptive reflection is characterized by a description of actions or events. Dialogic/analytic reflection demonstrates a “stepping back’ from the actions or events, leading to discourse with self and exploring the possible alternative and possible hypothesis. Critical reflection demonstrates the analysis of actions or events as well as explores the various perspectives about the events influenced by various socio-political and historical contexts11. Another format of reflective writing comprised of six parts12, which are writing of: (1) description of the event about what happened, (2) feelings about the event, (3) evaluation, -what was good and bad about the event/experience (4) analysis of what sense make about the event /situation (5) conclusion drawn in general and specifically, (6) action plan about what will be done if it rose again in future.12 Another format is the 4Rs model of reflective writing skills13, which are: (1) reporting and responding, (2) relating, (3) reasoning, and (4) reconstructing13. The organiser needs to decide on one format. Implementation of Elective The key areas for sustaining a successful implementation of an elective program, the organiser should ensure that the following things have been considered before during and after elective placement4,14. Before elective Choose personal learning outcomes Before going to elective placement, students need to set their own personal learning outcomes, which will be included in their elective plan. Learning outcomes should be SMART, an acronym of S=Specific, M=Measurable, A=Attainable, R=Relevant and T=Timely. An example of a SMART personal learning outcome is: “While on my elective placement, I will participate in the postpartum nursing care of a mother who has given birth naturally and a mother who has had a caesarean, in order to better understand their contrasting needs14. Choose group learning outcomes If students work with a group, they need to select group learning outcomes together, which arerelated to cultural competency. This will empower them to expand their cultural competencies, such as supporting one another as peers, developing group management, teamwork and public speaking skills etc. Choose an elective placement that is best suited to achieve learning outcomes When choosing an elective placement, students need to think judiciously about what type of placement would best suit the learning outcomes that they have set. Learning outcomes should dictate where they choose to go for their elective placement. Students need to decide how to organise and prepare for their elective placement, how to achieve their learning outcomes, how their outcomes will be assessed, and what support services available. During elective While on placement, students must need to create and collect evidence of their activities to show how they meet their learning outcomes. The evidences may be: (i) written reflections (ii) photographs (iii) videos (iv) audio recordings etc. Students must ensure that they follow the guidelines on confidentiality, consent and copyright etc.while collecting evidence. After elective Teaching without ‘testing’ is somewhat cooking without ‘tasting’15.Students’ electives need to be tested, and students need to show evidence of how they have achieved their learning outcomes. Reflective writing is the most commonly used tool as evidence because it makes the learning deeper and predicts critical thinking3. There is no word limit of reflective writing, but the amount of time they spend on creating their evidence should be equivalent to the amount of time they would spend on a 2000-word essay14. This will be part of their 353 International Journal of Human and Health Sciences Vol. 06 No. 04 October’22 assessment and will be graded by their mentor / facilitator. Support Study showed that monitoring the elective course is a crucial element for its success which is opposed to the tendency to keep electives untouched1.Students have to be supported by a member of staff –a mentor to facilitate electives throughout the process. Medical teachers play the role of mentoring, one of the twelve important roles described by Harden 16. Mentors can guide the students or mentees under them during their elective posting17. This is extra work for the mentors’/course coordinators to handle the elective course, including the assessment2. During mentoring it is important to assess the knowledge or how much students or mentees grasped from what has been told and explained about activities on elective by the mentor18. Mentors play a great role in helping their mentees to reflect on their experiences and learning from elective placement, considering a standard format of reflective writing agreed upon by the faculty or organiser. Effective communication between mentor and mentee is important to guide the students17, 19. There is space for faculty development, as faculty need to pay more attention to improving student competency20. Conclusion An elective is an outstandingopportunity to take responsibility for students’ own learning and prepare themselves for their future careers by increasing professional opportunities through experiencing things in a different kind of environment. Before starting an elective, students need to identify their (i) personal learning outcomes that they would like to achieve from their undertaking elective opportunity (ii) elective placement which would be the best place for them to achieve the personal learning outcome (iii) evidence of their experiences to show the mentor for assessment purpose. The implementation of an effective elective course in an institution principally requires faculty development, and thus they should be briefed about the different aspects of the elective course and the need for the same in the current era. This paper offers medical schools, faculty and elective students a window or a guide to implement and assess a sustainable, effective elective program in undergraduate medical education. Funding No funding was received for this paper. Conflict of Interest The author declared no conflicts of interest. Authors’ Contribution Both authors participated well in preparing this paper and approved the final version for submission to the Journal for publication. International Journal of Human and Health Sciences Vol. 06 No. 04 October’22 354 References: 1. Ramalho AR, Vieira-Marques PM, Magalhaes-Alves C, Severo M, Ferreira MA, Falcao-Pires I. Electives in the medical curriculuman opportunity to achieve students’ satisfaction? 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