Any solid and/or liquid waste produced during the diagnosis, treatment, or immunization of humans or animals, or related research activities, or in the development or testing of biological or in health camps is referred to as bio-medical waste [1]. Because of their high potential for disease transmission, the waste formed from this can be dangerous, poisonous and fatal, posing a threat due to infectivity and other toxicities. If infectious, biomedical and radioactive waste, as well as sharps (hypodermic needles, knives, scalpels and other sharps), are not adequately segregated and disposed of, they pose a serious concern [2].

As per WHO guidelines, lack of awareness about the health hazards related to healthcare waste inadequate training in proper waste management is one of the most common problems connected with healthcare waste [3] However, with adequate planning and control, the hazard can be significantly decreased. These days, institutional/organizational setup, training and motivation are all given a lot of significance. Proper training of healthcare workers at all levels, combined with continuous motivation, can significantly improve the situation.

First professional year medical students enter a new environment in medical college when they are around 17 years old, which can be challenging. As a result, a period of acclimatization and familiarization with the new surroundings is recommended. This would include an overview of the course structure, learning methods, technology usage and peer interactions, all of which would help them transfer smoothly from high school to medical school. This is intended to be accomplished by a dedicated one-month "Foundation Course," the goal of which is to prepare a learner to effectively study medicine to orient and sensitize the student with essential knowledge and skills that would aid him/her in acclimating to the new professional setting that will be his/her milieu for a life-long career in the medical profession at the start of the MBBS course. The Foundation Course will also lay a solid foundation for studying in the MBBS course and later in their professional career [4].

As a part of the foundation course, students must be trained in various skill modules such as Basic Life Support, First Aid, Universal Precautions and biomedical waste and safety management before accessing the patient care areas. Therefore, this study was done to assess the effectiveness of skill-based learning on Biomedical Waste (BMW) management and skill attainment among first year MBBS students of a Government medical college, Visakhapatnam andhra Pradesh.

A cross-sectional descriptive study was done among 115 first year MBBS students who have attended skill-based training on a foundation course in the month of August 2019 at Andhra Medical College, Visakhapatnam andhra Pradesh. A checklist was used for assessing the ability to segregate the waste in five categories – yellow, red, green, blue and white. Yellow category was used for human and animal anatomical waste, soiled waste, discarded or expired waste and other clinical and laboratory waste. Red category was used for recyclable contaminated waste, green category for general waste, blue category for glassware and metallic body implants and white category was used for waste sharps including metals. The sample size was calculated by taking a prevalence of 50.4% of BMW management practises among MBBS 1^st professional students from a previous study [5] (by taking p = 50.4% and Q = 49.6% and absolute error as 10%) = 99, so a total of 115 students were selected by simple random sampling which were included in the study. Each student was given various biomedical waste like cotton, foleys catheter, urine bag, syringes, needles, Ryle’s tube, empty vials etc. and asked them to segregate into the respective categories. For each correct disposal, one mark was given with a maximum score of five. It’s divided into three groups of scores, four to five as good, three as average, zero to two as poor. Data was entered and analysed using MS Excel by proportions. The study was conducted after obtaining Institutional Ethics Committee clearance and approval from the respective authorities. Informed consent was taken from the study participants.

Since BMW management is an important requisite skill for all health care providers, it has been included in the MCI module. The present study was a novel study where a foundation course of one-month duration at the beginning of the MBBS Course was implemented in the year 2019 according to the erstwhile MCI guidelines to assess whether the skill-based module was effective in improving the student skills.

Figure 1 shows that 21.73 percent of the students who achieved a score of five, 35.65 percent obtained a score of four, 16.52 percent with a score of three, 11.30 percent with a score of two, 13.04 per cent with a score of one and 1.76 percent with a score of zero. Overall, 57 percent of the students had good skills, 17 percent had average skills and 26 percent had poor skills.

Figure 1: Percentage of Students according to Score Obtained who Performed Skills Correctly

In accordance with a study by Sobti et al. [6], it was found that positive feedback was recorded from 63% of the students regarding the overall experience of the course and the skill module was perceived as the most relevant module in the course with 73% students being in its favour. In contrast, a study by Velusami et al. [7], stated that skill module needed further improvement in planning the sessions and making them more interactive. In the present study, skill assessment on biomedical waste management in 57% of students was found to be good, which was higher from the findings from a study by Kumar et al. [5] where 50.4% of MBBS 1st year professional students had the knowledge and practise of colour coding and segregation.

Figure 2 illustrates that 80 per cent of students could correctly segregate the waste in the blue category, followed by white (71.3 percent), red (69.56 percent), yellow (62.6 percent) and green (53.91 percent), with green being the least. Similar findings were found in a study by Sood and Sood [8], which was conducted among dental students; it was found that 36% of the students practising the segregation at source into a yellow category, 32% into the red category, 67% into the green category and 13% into the white category. In contrast, a study by Singh et al. [9], most of the undergraduate dental students (92.3%) lack adequate knowledge regarding segregation at source, which was statistically significant. According to a study by Joseph et al. [10], which was done among healthcare workers, with adequate training sessions on Biomedical waste management, the practice of segregation at source has improved from 69% to 93% for the yellow category, 77% to 96% for the red category, 86% to 97% for the green category and from 86% to 96% for the white category.

Figure 2: Percentage of Students who Performed Skill Correctly of Segregation at Source

The correct response score for all the categories in the present study was 21.73% which was less when compared to a study by Singh et al. [9] of which 82%, correct response rate and the least response was 1.76% in this study, but as per a study by Singh et al. [9], it was found to be 27.1% for incorrect responses. This indicates the need for reassessing the skill module.

Though skill module sessions were the major strength of the foundation course for effective learning, skill-based learning of foundation course in this study was found to be poor in the retainment of knowledge on BMW management. Segregation of BMW management can be improved by providing re-training sessions for the medical students to improve the knowledge and practice about segregation for future practical application.

Acknowledgments

We are thankful to the Principal of Andhra Medical College, Medical Education Unit and the students who have participated in the study.

Authorship Contributions

VT and DMB has designed the study. VT, DMB and DE assisted with data collection of the study. VT contributed for interpretation of the study and drafted the study with input from DMB and DE. All the authors have read and approved the final manuscript.

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