Challenges in Implementing Competency-based Medical Education in India – Stakeholders’ Perspective: A Mixed-method Analysis

Introduction: Competency-based Medical Education (CBME) was introduced in the year 2019 in India. It has brought about major changes in medical education. The curriculum is learner centric, outcome based, focuses on the development of core competencies and professionalism. However, many institutions have faced challenges during the implementation of the CBME curriculum. This study was aimed at assessing the challenges faced by all the stakeholders (students, faculty, and administrators) of various medical institutions and gather their insights on proposed solutions. Methodology: This cross-sectional study was conducted over a period of 3 months, from October 1, 2023, to December 31, 2023. The study was conducted in 32 medical colleges across India. A total of 60 faculty of various disciplines, 32 administrators of the institutes, and 580 undergraduate medical students were included in the study. Perception of students and faculty was collected using a validated survey form. One-on-one interview was done for all the 32 administrators using a facilitator guide. A mixed-methods approach was used for quantitative and qualitative data collection and analysis. Results: Around 40 (66.6%) faculty opined that that deficiency of trained faculty was a significant challenge in implanting CBME curriculum. Twenty (33.3%) of the faculty felt that there is a lack of adequate infrastructure required for the implementation of CBME curriculum. Among the administrators surveyed, 12 (37.5%) felt that dwindling student attendance was a major challenge, whereas 10 (31.5%) felt that there was the lack of collaboration between universities, colleges, and regulatory authorities. Four hundred and twenty-five (73.2%) of students opined that simulation-based training and 435 (75%) students opined that electives were very good initiatives by CBME curriculum. The students found the inclusion of integrated teaching, Attitude, Ethics, and Communication Module, early clinical exposure, and Family Adoption Programme in the CBME curriculum helpful. Conclusion: CBME curriculum was largely accepted across all the medical colleges. The training of faculty and administrators was considered an important challenge which needs to be considered. Students opined that the newer curricular reforms enhanced their learning. Keywords: Competency-based medical education curriculum, challenges in competency-based medical education, foundation course, integrated teaching, student centric