Elective Preferences and Their Influence on Career Perspectives among Undergraduate Medical Students

Abstract

Background: Electives introduced under the Competency-Based Medical Education (CBME) curriculum in India are intended to promote self-directed learning, broaden clinical and academic exposure, and facilitate informed career decision-making among undergraduate medical students. However, evidence regarding students' elective preferences and their influence on career perspectives remains limited. Methods: A cross-sectional analytical questionnaire-based study was conducted among 189 MBBS students from three academic cohorts (2019–2020 to 2021–2022 batches) who had completed both elective blocks at a tertiary teaching institution. Data were collected using a validated semi-structured questionnaire (Cronbach's α=0.81). Elective preferences, motivating factors, preference fulfilment, students' perceptions regarding electives, and changes in career interest across five professional domains were analysed using chi-square tests and paired t-tests, with effect sizes estimated using Cramer's V and Cohen's d. Results: Pathology and Pharmacology were the most preferred disciplines in Block 1, whereas General Medicine and Surgery predominated in Block 2, with no significant variation across academic cohorts. Specialty interest and improved subject understanding were the principal determinants of elective selection (p<0.001). Overall, 47.0% of students received their preferred electives in both blocks, while fulfilment differed significantly across allocation categories (p<0.001). Most participants reported improved understanding of career options (64.5%) and expressed strong support for structured pre-elective counselling (72.5%) and greater autonomy in elective selection (57.1%). Career interest increased significantly across all evaluated domains following elective participation (p<0.001), with the largest improvements observed in research and academic medicine. Conclusion: CBME electives positively influence career awareness and broaden professional interests among undergraduate medical students. Optimising elective programmes through transparent allocation procedures, structured mentoring, pre-elective counselling, and greater flexibility in elective selection may further enhance educational outcomes and support informed career planning. Keywords: Competency-based medical education; Career interest; Elective preferences; Motivational factors; Trend analysis; Undergraduate medical education.