Satisfaction with elective courses among undergraduate medical students at Al-Azhar and Jazan Universities | BMC Medical Education

Study design and setting

A descriptive cross-sectional comparative study was conducted among undergraduate medical students at Al-Azhar University (FMG), Cairo, Egypt) and Jazan University (Saudi Arabia). These institutions were chosen based on geographical representation of medical education in the region, similar curricular structures, and accessibility for data collection. At Al-Azhar, electives are limited in number and scope, often tied to departmental offerings without formal student selection mechanisms. In contrast, the Saudi institution offers a structured elective program aligned with the national competency framework, giving students broader choices and more academic guidance.

This comparison allowed us to identify potential differences and similarities in elective course satisfaction between the two countries, adding depth to our findings.

Sampling methods

A minimum of 20% of students from each academic year (first through fifth) were targeted using a stratified random sample technique with proportional allocation. Since there was no prior information on student satisfaction, 50% of the total scores provided the maximum sample size, the required sample size was determined at a 95% confidence level with a 5% margin of error.

Female students from Saudi Arabia and Egypt attending Al-Azhar and Jazan Medical School in the academic year 2023–2024 were included in the survey, while students of other nationalities and those who provided incomplete answers were excluded.

Ethical considerations

All operational actions are agreed with the Declaration of Helsinki. Ethical approval was obtained from the Standing Committee for Scientific Research at Jazan University (Approval No. HAPO-10-Z-001). Feedback from students was encouraged voluntarily and their agreement has been regarded as informed consent. All responses are completely anonymous and have been kept confidential. To clarify, the data consisted exclusively of responses to the evaluation questions, presenting minimal risk in relation to what could be gained regarding students’ views and their suggestions for improvement ECs.

Measurement

Data was collected via anonymous, self-administered questionnaire distributed through universities platforms and student groups. The questionnaire was developed after reviewing relevant literature [1,2,3]. To evaluate its validity and clarity, a sample of 20 students participated in a pilot study. The Cronbach’s alpha for the satisfaction items was 0.86, demonstrating good internal consistency. Three specialists in medical education first examined the content validity. They were chosen because of their expertise in elective courses teaching and assessment.

The questionnaire took 6–8 min to complete, that included the following information:

I-Personal data

age, university, country, academic year and study phase (preclinical/clinical).

II-Elective course experience

Number and type of electives taken, reasons for course selection, whether courses were self-selected or assigned and students’ experiences of former elective courses.

III-Satisfaction assessment

A 5-point Likert scale (1 being strongly disagree to 5 being strongly agree) was used to score nine items. Data were reduced to three nominal levels; a neutral option and combining all ‘agree’ and all ‘disagree’ answers into two groups. Each response’s frequency was stated as a percentage of the total participants. An overall satisfaction score was produced by adding up the scores. Low satisfaction was indicated by scores below the mean, whilst high satisfaction was indicated by scores above the mean.

IV-Optional open-ended items

Students provided suggestions for improving electives and described perceived benefits that can be added to students for future career needs.

Statistical design

Data was analyzed using SPSS version 25 (SPSS Inc, Chicago, IL, USA). Descriptive statistics (mean ± standard deviation (SD), frequency, percentage) were done. Independent samples t-tests were used to compare mean satisfaction scores across universities. Chi-square tests examined associations between categorical variables. Missing data was minimal (< 2%) and handled through listwise deletion. (Cohen’s d and Phi coefficient& Cramér’s V) as measures of effect size were applied following t test and chi-square test respectively. The researchers began by thoroughly revising the transcripts of the open-ended responses. Then they identified meaningful information and condensed these into concise units and comparing these units regarding their similarities thereby categorizing the responses. A significance level of p ≤ 0.05 was used throughout.