Converging and diverging factors for CBME curriculum for Indian medical graduates: insights from a qualitative meta-synthesis

Abstract

Background: Since the implementation of Competency-Based Medical Education (CBME) for undergraduate medical education in India, stakeholders have expressed diverse perspectives. While many appreciated its structured framework and emphasis on competency development, others voiced concerns about implementation challenges, assessment strategies, and overall institutional readiness. Objective: The present qualitative meta-synthesis explored the converging and diverging factors influencing the implementation of CBME. Methods: Using a systematic search strategy, we selected seven qualitative and mixed-methods studies published between 2019 and 2025 from PubMed, Scopus, and Google Scholar. The integration of qualitative findings across studies was guided by Critical Interpretative Synthesis. A total of 130 descriptive codes were developed and categorized under six curricular components: competencies, curriculum content, teaching-learning methods, assessment, curriculum governance, and student support and faculty development. Results: Key challenges included difficulties in framing competency objectives, overlapping content in foundation courses, limited faculty training in self-directed learning and assessments, inadequate support for simulation-based teaching, and misalignment between student priorities and curricular goals. Notable enablers included small-group teaching, simulation-based sessions, well-organized timetables, motivated faculty, and constructive student engagement. However, systemic issues such as infrastructure constraints, inadequate staff, their training in new methodologies, and poor interdepartmental coordination hindered full-scale implementation. Conclusion: The study explored the collective dissonance experienced by stakeholders across various curricular components. Effective implementation of CBME would require committed faculty, adaptive leadership, and a context-sensitive regulatory framework that enables innovation and local relevance. This synthesis offers insights for educators, curriculum planners, and policymakers to refine CBME design and foster improvements in medical education in India.