Competency-Based Medical Education and Student Wellness in Andhra Pradesh:A Multicentric Mixed-Methods Study

Abstract

Background: India’s transition to Competency-Based Medical Education (CBME) under the National Medical Commission (NMC) in 2019 represents the most sweeping reform in undergraduate medical education in decades. While CBME’s pedagogical intent is to produce competent, patient-centred physicians, its structural demands — continuous assessment, reflective documentation, longitudinal tracking, and accelerated clinical integration — have raised substantive concerns about student mental health. Empirical multicentric data from Indian medical colleges examining this relationship remain scarce. (1,5,10)

Methods: We conducted a cross-sectional, multicentric, mixed-methods study across five medical colleges in Andhra Pradesh (two government, three private), enrolling 1,064 MBBS students in Phases II, III, and Compulsory Rotating Medical Internship (CRMI) between February and April 2026. Validated instruments included the Perceived Stress Scale-10 (PSS-10), Maslach Burnout Inventory–Student Survey (MBI-SS), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and an institution-specific 20-item CBME Perception Survey (Cronbach’s α = 0.956). Focus group discussions (FGDs) were conducted at all five sites (n = 35). Quantitative data were analysed using descriptive statistics, t-tests, ANOVA, Pearson correlation, and multiple linear regression. Qualitative data underwent six-phase reflexive thematic analysis. (16,17,18,21,22,23)

Results: The mean PSS-10 score was 19.74 (±5.52), with 80.6% of students reporting moderate-to-high perceived stress. Clinically significant anxiety (GAD-7 ≥10) was present in 39.7% and depression (PHQ-9 ≥10) in 47.8% of participants. Burnout emotional exhaustion (MBI-EE ≥15) was elevated in 44.0% of students. Female students reported significantly higher stress (PSS: 20.55 vs 18.45, p < 0.001), anxiety (8.87 vs 7.93, p = 0.006), and emotional exhaustion (14.64 vs 12.57, p < 0.001). Private institution students demonstrated consistently higher distress versus government counterparts (all p < 0.001). Third-year MBBS students (Phase III Part I) showed peak emotional exhaustion (MBI-EE: 16.11). CBME perception correlated negatively with anxiety (r = −0.154) and depression (r = −0.144), and positively with academic efficacy (r = +0.407; all p < 0.01). Five cross-cutting qualitative themes were identified: assessment overload, documentation burden, value of early clinical exposure (ECE), mentorship deficit, and appreciation for AETCOM modules.

Conclusions: CBME implementation in Andhra Pradesh is generating a substantial and measurable wellness burden, particularly at private institutions and during the third year of training. Better CBME perception correlates with lower distress, underscoring the importance of implementation quality. Structural interventions — rationalised assessment schedules, formalised mentorship, and accessible psychological support — are urgently needed to align CBME’s educational promise with student well-being.