Opinion, perception and attitude towards family adoption program among MBBS students: a cross-sectional study

INTRODUCTION

The FAP is an innovative and significant aspect of latest the CBME proposed by the National Medical Commission of India. NMC is providing a new system of medical education that includes advocating universal healthcare by strengthening community health initiatives and ensuring services are accessible to everyone, increasing golden opportunities for standard medical education and cultivating a new generation of skilled and compassionate healthcare professionals ready to lead and heal by way of the FAP, which was implemented for MBBS students from the batch 2021-2022 as per CBME curriculum and it was initiated on August 2019.^1,2 The CBME (competency based medical education) curriculum aims to achieve the learning of all three domains: knowledge (cognitive), attitudes and values (affective) and practical skills (psychomotor) for the MBBS students.³ Under the program, each medical student in their first year is required to adopt five families. They will have to monitor the five family’s general health, provide health related advice, guide them on when to seek medical care and continue to follow up until their training is completed, all under faculty supervision.²

The main focus of this program can be included in the foundation course under the “Field Visit to Community Health Care,” as outlined in GMER 2019.³ This program guarantees that the future doctors are prepared to manage hands on challenges and emotional responsibilities of their profession.⁴ FAP also emphasizes community problems which includes lack of health awareness, disregarding the diseases, limited access to healthcare services and the need to take time off work, which affect people’s ability to receive timely and quality health care.⁵

In FAP, MBBS students will have 3 hours visits scheduled on one weekend each month until the hours requires by the NMC are completed.⁶ To achieve this goal more effectively, the FAP will include areas with population coverage or villages that are not currently served by the rural health and training centre (RHTC).⁷ FAP comes with both challenges and opportunities. As each student has been assigned to their following families, students find it difficult to maintain and follow-up throughout their undergraduate course. It is necessary to gather feedback during the early stages of implementation.⁵

According to the World Health Organization and World Federation for Medical Education, medical training approaching the community health requirements plays a vital role in helping students comprehend the medical and social determinants of health.⁸ The WHO defines social accountability as the responsibility to prioritize services, research and education on the most important health problems affecting the country, region and community they serve. These are the social responsibilities that all medical institutions should be committed to. Since the year 2000, the motto of “Health for All” has been realized for various reasons.⁹

The village outreach initiative has been launched by the community medicine department as part of the FAP with the involvement of faculties, social workers and support staffs.¹⁰ The Community Medicine plays a key role in upgrading a community-focused approach to healthcare, unlike the hospital-centred approach of other specialities.⁶ Before each visit, the supervisor explains about the purpose to the students. The students have to collect demographic and health information from the affected families, that took part in health check-ups and helps the community access health services by working alongside with the community-level workers like ASHA workers, Anganwadi workers and Auxiliary nurse midwives. The clinical medicine concentrates only on the individual patient, whereas community medicine acknowledges many other factors that also contributes to the development of health conditions. Integrating these different aspects is not simply a matter of skill.⁶

The intention of FAP is to develop strong communication skills, which is the foundation of this profession. It aspires the medical students to be compassionate, empathize with the rural communities, understand their customs and challenges and appreciate the positive aspects of community. The main goal of this FAP in the community medicine is to prepare students to become healthcare team leaders, primary health care providers and those with basic skills.¹² The main aim of this study is to assess and determine the future impact of FAP implementation in MBBS curriculum among students.

METHODS

The cross-sectional study was conducted among MBBS students at Sri Lalithambigai Medical College and Hospital in Maduravoyal from the period of March 2025 to May 2025. A sample size of about 454 has been collected in this study. The samples were collected from Phase I to Phase IV. Each was adopted by 5 families from Phase I. The families are located in the outskirts of the city, whose areas cover Avadi, Porur and Maduravoyal under FAP by NMC. All these 454 medical students have been recorded with a detailed history of demography, with their opinions and perceptions and attitude about FAP.

The questionnaire contains, 4 parts of the study, section A consists of demographic details and Section B is about opinion about FAP and section C consists of Perceptions of FAP among students and section D consists of Attitude which is the last part of questionnaire. The personal information and confidentiality maintained throughout the study. Informed consent obtained from each participant before the start of the study. The inclusion and exclusion criteria were included in the study. Exclusion criteria have two categories which are about the unwillingness of participants and students who are absent during the visits. The inclusion criteria have a major part of considering the participants who have attended one FAP, which has been organized as a part of the curriculum. The predesigned and pretested performa has been developed with questions having a likert scale and with each carrying 3 options of agree, disagree and neutral.

The data was collected in Google Forms individually. Only 454 participants gave willingness to participate in the study, those were included in the study. The study was conducted according to the preference of participants in English and Tamil. The data was entered in Excel and analysed using the Statistical method SPSS version.

RESULTS

Variable analysed

Opinion

Importance, understanding and psychological problems of FAP.

Perception

Effectiveness, need, emotions and motivation of FAP.

Attitude

Medical education, burden to the studies, satisfaction with FAP.

A total of 454 medical students from Phase I to Phase IV were enrolled in this FAP study. Among 454 students in total, the age of the participants was 18–20 years (71.1%), followed by 20–23 years (68.6%), whereas fewer participants belonged to the 23–26 years (4%) category. Among them, 72% were male students, whereas 28% were female students. Most participants were 2nd-year students (78%), followed by 1st-year students (11%), 3rd-year students (6%) and 4th-year students (5%). Regarding the place of residence, a higher proportion of participants were residing in the hostel (59%) and others are day scholars (41%). Figure 1 and 2 show the age and gender distribution among participants. Most of the study population was under 23 years of age.

Table 1 illustrates, among 454 medical students, the majority of students expressed a positive opinion towards the Family Adoption Programme (FAP). About 382 (84.1%) were agreed and 13.9% were (neutral) uncertain with FAP is essential to understand health and social problems of family which was not statistically significant (p=0.469) (p>0.05). 423 (93.2%) students felt that it improves communication skills and 397 (87.4%) students believed that it develops confidence among medical students. 357 (78.6%) students felt that FAP is useful to develop a positive attitude towards the community and to study ethical aspects of public health. Approximately 339 (74.7%) students agreed that FAP is useful to understand the structure and concept of family. However, these associations were not found to be statistically significant (p>0.05). From the Table 2, among 343 students,75.6% of students considered FAP to be an innovative method of learning and this finding was statistically significant (p=0.006) (p<0.05). Furthermore 299 (65.9%) students agreed that FAP is an innovative way for learning and also a foundation for community medicine. 337 (74.2%) felt that it guided them for the right approach and care for patients. In terms of effectiveness, 240 (52.9%) students felt that FAP is somewhat effective in achieving their goals, while 43.6% reported it as very effective. More than half of the students, 157 (34.6%), were believing FAP is addressing the needs of families in the community. In terms of emotional response, 264 (58.1%) frequently reported feeling supportive toward FAP. The majority of 215 (47.4%) students were primarily motivated by helping families in need and building a stronger community (208; 45.8%). Additionally, 235 (51.8%) students agreed that it helped them to manage stress related to patient care and medical training. Most of these findings were not statistically significant (p>0.05).

From table 3, it is understood that, in terms of attitude, a majority of students demonstrated favourable outlook towards FAP. About 369 (81.3%) agreed that the program helps in understanding healthcare challenges faced by families in rural and underserved areas. Similarly, 361 (79.5%) believed that FAP is an effective method to enhance medical education. 385 (84.8%) students believed that it helps their foster empathy and communication skills. 290 (63.9%) reported that FAP does not add an unnecessary burden to their medical studies. 350 (77.1%) and 309 (68.1%) students were happy with their mentors and allotted families, respectively. A total of 289 (63.7%) students stated that they were satisfied with their overall experience in FAP and 386 (85.0%) indicated that they would recommend it to future batches. Despite the overall positive attitude, these associations were also not statistically significant (p>0.05).

DISCUSSION

The present discussion is about opinion, perception and attitude towards FAP among medical students under the aspect of the CBME proposed by the NMC. The majority of students give a high level of acceptance and positive perception towards FAP.

Opinion of MBBS students towards fap

With regard to opinion, the study showed a higher rate of 93.2% of students had good communication skills with FAP compared to Gurav et al.⁴ Ganganahalli et al from his study, showed that 75.7% of participants had enhanced their communication skills with FAP.⁸ The current findings indicated that 87.4% and 78.6% of participants agreed that FAP helped to develop confidence among medical students and a positive attitude towards community, respectively whereas Shree et al showed that 53.1% were perceived that the adopted families would be indicating a generally positive attitude towards the program, although a substantial proportion (40.2%) remained uncertain. In the present study, a higher proportion of students (84.1%) believed that FAP helps in understanding health and social problems of families whereas Shree et al who reported that community-based learning enhances students understanding of real-life health issues.¹³ Similarly, Landge et al observed that early exposure to families improves awareness of social determinants of health.¹⁴ Although most students showed positive opinions, the associations were not statistically significant (p>0.05).

Perception of MBBS students towards FAP

A study conducted by Shikha et al who described FAP as a novel approach in medical education that bridges the gap between theory and practice.² In contrast, Shekhawat et al observed that (49.2%) and (44.4%) of participants reported agreeing and strongly agreeing with nearly same attitude of our response but compared with our study, their study was not statistically significant.¹⁵ The present study found that 75.6% of students perceived FAP as an innovative method of learning community medicine, which was found to be statistically significant (p=0.006) (p>0.05).

A study reported by Preeti et al where students acknowledged improved clinical approach and holistic care through family-based learning.⁷ This finding was compared to Shekhawat et al, where majority 95.3% of students felt FAP guides them towards right approach in patient care.¹⁵ In the present study, 74.2% of students felt that FAP guides them towards the right approach and care for patients. In the current study, 53.9% of participants perceived the FAP to be effective in achieving its goals with 52.9% as moderately effective and 43.6% as very effective. Similar findings have been reported by study conducted by Das et al.¹⁶ Sharma et al also reported similar mixed perceptions due to logistical challenges and variability in mentoring.¹⁷

In this study, more than half of the participants (53.3%) believed that FAP addresses needs of families in the community and a majority expressed supportive emotions (58.1%) towards FAP. These findings are comparable to Ganganahalli et al who reported that students felt socially responsible and more connected to the community.⁸ Although most students showed positive perception, the associations were not statistically significant (p>0.05).

Attitude of MBBS students towards fap

In the present study, a large proportion of students (81.3%) agreed that FAP helps in understanding healthcare challenges in rural and underserved areas whereas Shree et al who emphasized that community exposure improves awareness of healthcare disparities.¹³ In the study, 79.5% of students believed that FAP enhances medical education. This suggests that students appreciate learning beyond textbooks and recognize the importance of real-world experience in shaping their clinical understanding. This finding is similar to study conducted by Vanikar et al and Shikha et al who reported that FAP strengthens experiential learning and complements traditional teaching methods.^2,10

A study conducted by Gurav et al who observed improved empathy levels and interpersonal skills among students interacting with families over time.⁴ In the current study, a majority (84.8%) of students agreed that participation in FAP fosters empathy and communication skills.

In the current study, 63.9% of students felt that FAP does not add an unnecessary burden to their medical studies. In contrast, Sharma et al, from their study showed that where a subset of students perceived it as time-consuming, indicating that effective planning and integration can reduce perceived burden.¹⁷ In addition, most students expressed satisfaction with the guidance provided by their mentors. Good mentorship likely enhances the learning experience and helps students better understand their roles during field visits. Overall, the attitude of students towards FAP in this study was positive. Although statistical significance was not observed (p>0.05), the consistent trend of favourable responses indicates that students generally accept and value the programme as part of their medical training.

Strengths

The present study has several strengths. A relatively large sample size of MBBS students was included, which improves the reliability of the findings. The study comprehensively assessed three important domains-opinion, perception and attitude providing a broader understanding of students’ views towards the Family Adoption Program. Another strength is that the study provides practical insights into how students perceive the program, which can be useful for improving its implementation through better planning, continuous monitoring and structured guidance.

Limitations

This study has a few limitations that should be considered while interpreting the results. Since it was conducted as a cross-sectional study, the findings represent the opinions, perceptions and attitudes of students at a single point in time and changes over time could not be assessed.

The study was carried out among MBBS students from a single setting, which may limit the generalizability of the results to other institutions or regions. Also, variations in the implementation of the Family Adoption Program, such as differences in field exposure or mentorship, were not assessed, which could have influenced the responses. Despite these limitations, the study provides useful insights into how MBBS students perceive and respond to the family adoption program.

CONCLUSION

From our study, the final conclusion is that the family adoption program is well accepted among MBBS students, with a majority demonstrating positive opinion, perception and attitude. The programme appears to enhance students understanding of community health issues while also contributing to the development of communication skills, confidence, empathy and a patient-centred approach to care.

Although most findings were not statistically significant, the overall trend indicates that FAP is an effective and innovative teaching-learning method. Thus, FAP serves as a valuable bridge between theoretical knowledge and real-world community exposure and should be continued and optimized in medical education. Moreover, this study can be done in qualitative study among smaller samples for the clear understanding and perception of student’s view on FAP. FAP studies in even more larger samples for the better understanding of student’s perception towards FAP can be analysed.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Shree A, Rashmi S, Sunil Kumar D. Community as a classroom: Perception of an Indian medical graduate on family adoption program. Clin Epidemiol Glob Health. 2024;28:101630.
2. 2. Shikha S, Kumar A, Begum J, Ali SI, Tripathy S. Family Adoption Program for Undergraduate Medical Students at a New Medical School of Jharkhand: An Experience and SWOC Analysis. Indian J Community Med. 2024;49(1):218–22.
3. 3. Statistics D. Ministry of Finance. Republic of Cyprus: Nicosia, Cyprus. 2019. Available at: https://www.nmc.org.in/MCIRest/open/getDocument?path=/Documents/Public/Portal/LatestNews/Implementation.pdf. Accessed on 21 November 2025.
4. 4. Gurav RB, Nair AS, Tomar P. Opinion, perception and attitude of medical students towards family adoption programme- a cross-sectional study. Int J Community Med Public Health. 2024;11(12):4797–803.
5. 5. Landge J, Kasbe S, Singh R, Satardekar A. Experience of Family Adoption Programme Implementation in Phase I MBBS Curriculum in a Medical College of Western India. GAIMS J Med Sci. 2023;18;3(2):74–9.
6. 6. Sharma V, Arora P, Hossain SR, Budh N. First-year medical undergraduate students’ perceptions and experiences regarding family adoption program: Challenges and Lessons. J Med Acad. 2023;30;6(2):49–52.
7. 7. Preeti, Kanubhai TH, Dhapola VS. Family adoption programme implementation feedback from undergraduate medical students in Almora: A cross-sectional study. J Fam Med Prim Care. 2024;13(12):5609–14.
8. 8. Ganganahalli P, Yankanchi SG, Yadavannavar M, Udgiri R. Perception and Impact of the Family Adoption Program (FAP) Among Indian Medical Students: Benefits and Challenges. Cureus. 2024;18:56.
9. 9. Reshmi PS, Lunagariya R, Patel H, Patel N, Chauhan D, Patel R. Qualitative Study to Identify Strengths, Weakness, Opportunities and Challenges of Family Adoption Programs among Students. Indian J Community Med. 2024;49(4):610.
10. 10. Vanikar A, Kumar V. Unique program of Indian undergraduate medical education–family adoption Through Village Outreach. Indian J Community Med. 2024;49(3):459.
11. 11. Arulmozhi M, Raveendran A, Ganapathy K, Kandasamy P. Implementing and Evaluating Risk Assessment as a New Learning Tool in Family Adoption Program: A Qualitative Study. Indian J Community Med. 2019;2:865.
12. 12. Arumugam B, Sanjana L, Singh DG, Kuppuraj P, Sayee TSM. A narrative review on the experience of “Family Adoption Programme” in a tertiary care institute. J Community Health Manag. 2022;9(2):54–9.
13. 13. Shree A, Rashmi S, Kumar DS. Community as a classroom: Perception of an Indian medical graduate on family adoption program. Clin Epidemiol Glob Health. 2024;1;28.
14. 14. Landge J, Kasbe S, Singh R, Satardekar A. Experience of Family Adoption Programme Implementation in Phase I MBBS Curriculum in a Medical College of Western India. GAIMS J Med Sci. 2023;3(2):74–9.
15. 15. Shekhawat K, Acharya R, Lunia G, Yadav N. Assessment Of Opinions, Perception and Attitude of Medical Students Regarding the Family Adoption Programme Introduced by National Medical Commission. Eur J Cardiovasc Med. 2025;15:433–7.
16. 16. Das S, Baidya S, Mog C, Pal A, Pal A, Das P. Perception and challenges towards Family Adoption Program among undergraduate students of a Medical College of Tripura: a cross-sectional study. Int J Community Med Public Health. 2025;12(6):2650–5.
17. 17. Sharma V, Arora P, Hossain SR, Budh N. First-year Medical Undergraduate Students’ Perceptions and Experiences Regarding Family Adoption Program: Challenges and Lessons. J Med Acad. 2023;6(2):49–52.
18. 18. Yalamanchili VK, Uthakalla VK, Naidana SP, Kalapala A, Venkata PK, Yendapu R. Family adoption programme for medical undergraduates in India–the way ahead: a qualitative exploration of stakeholders’ perceptions. Indian J Community Med Off Publ Indian Assoc Prev Soc Med. 2023;48(1):142–6.
19. 19. Singh T, Sharma S. Mpox in India: Current insights and strategic recommendations. Indian J Community Med. 2025;50(3):539.
20. 20. Patra PR, Panda JN, Bisoyi SK. Perception of Medical Students on Family Adoption Programme; A Study conducted in a Medical College of Odisha. Indian J Community Med. 2024;49(1):71.
21. 21. Mallik S. Family Adoption Program, A Way Forward to Community Based Medical Education. Challenges Ahead. J Compr Health. 2022;10(1):1–3.
22. 22. shree A, Rashmi S, Shruddha K, Nath AR, Sunil Kumar D. Lived realities of family engagement: A thematic exploration of the family adoption program. Clin Epidemiol Glob Health. 2026;38:102305.
23. 23. Chakraborty A, Sarkar N, Lahiri U, Bhowmick S, Sen S, Majumdar R, et al. Family adoption program in medical education and role of community medicine in its implementation in India: An overview. J Integr Med Public Health. 2023;2(2):49.
24. 24. Shah HK, Virk AK, Dongre A, Datta SS, Gupta SS. Family Adoption Program: An NMC-mandated Initiative. Indian J Community Med. 2024;49(2):170.
25. 25. Thakur JS, Vinod A. Review of implementation of the family adoption programme in undergraduate medical education in India: a narrative synthesis of literature and institutional practice. NMO J. 2025;19(2):195.