Building the 8-Star Doctor: A Modified Delphi Study to Define, Teach, and Assess Health Professions Education for Undergraduate Medical Students

Building the 8-Star Doctor: A Modified Delphi Study to Define, Teach, and Assess Health Professions Education for Undergraduate Medical Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Building the 8-Star Doctor: A Modified Delphi Study to Define, Teach, and Assess Health Professions Education for Undergraduate Medical Students Sara Jamil Khan, Rahila Yasmeen, Shazia Imran This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6209064/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Aug, 2025 Read the published version in BMC Medical Education → Version 1 posted 14 You are reading this latest preprint version Abstract Background Globally, medical education is evolving to align with integrated curricula; however, consensus on core Health Professions Education (HPE) content for undergraduate medical students remains limited. This study aims to identify, refine, and structure essential HPE topics within the MBBS curriculum to enhance students’ foundational skills in teaching, leadership, and professionalism. Additionally, it seeks to determine appropriate teaching methodologies and assessment strategies for the identified content, ensuring effective integration into undergraduate medical education. Methods This multi-phase study involved a literature review, refinement through the Nominal Group Technique (NGT) with 19 experts, and a three-round Modified e-Delphi process with 69 HPE experts across Pakistan. Experts rated the importance of topics using a three-point Likert scale, and items achieving ≥ 80% agreement were included. Stability was tested using McNemar’s test, and teaching strategies and assessment methods were aligned during the final round. Results The Nominal Group Technique (NGT) refined 54 initial content items into 37, eliminating 12, rephrasing 5, and adding 2. Through the Delphi process, 17 items achieved consensus, including bedside teaching, procedural skills, leadership, medical ethics, patient safety, and communication skills. Teaching strategies such as small-group discussions (SGD) and large-group interactive sessions (LGIS) accounted for over 50% agreement. Objective Structured Teaching Exercises (OSTE) emerged as the preferred assessment method. The response rates for the three Delphi rounds were 93%, 96%, and 90%, respectively Conclusion The study offers a structured framework for integrating HPE into undergraduate medical curricula, emphasizing pragmatic assessments and evidence-based teaching strategies. These findings are globally relevant, providing a roadmap for scalable curricular reform in five-year undergraduate medical programs. Learning content Medical Education Health professions education Integrated curriculum Medical education as a subject student as teacher program Learning by Teaching Delphi study Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Every doctor teaches whether they realise it or not. The term “doctor” derives from the Latin word docere , meaning “to teach” (1), underscoring the fundamental role of teaching in medical profession. Medical educators are not only responsible for imparting knowledge to students but also for cultivating the next generation of self-directed, reflective practitioners.(2) However, a structured undergraduate curriculum teaching medical skills to students remains absent in many countries. The 7-Star Doctor framework, introduced by the World Health Organization (WHO)(2)(3) and followed by many regulatory bodies throughout defines seven core competencies essential for medical professionals: Care Provider, Decision-Maker, Communicator, Community Leader, Manager, Researcher, and Lifelong Learner (WHO, 1996). However, one fundamental role remains unrecognized within this model—the Doctor as Teacher. Teaching is an implicit aspect of each competency: physicians educate patients, mentor colleagues, and disseminate knowledge as researchers.(4) Yet, despite its pervasive presence, teaching is not explicitly recognized as a distinct competency in many undergraduate programs. (5)(6)Educational frameworks such as WFME’s global standards (7),CanMEDS model and Tomorrow’s Doctors emphasize the importance of medical teaching, yet this role is often considered an assumed skill rather than a formally cultivated competency (7) ( Fig. 1 ). The lack of formalized teaching training leaves students underprepared to meet the multifaceted demands of clinical environments. (8)Additionally, the global variation in curricular structure further complicates efforts to standardize content. For example, U.S. students benefit from student selected model of student as teacher training program,(9)(10) while many other countries emphasize traditional, teacher-centred learning approaches(9). A review of 39 undergraduate HPE programs highlighted the absence of a standardized framework and the variation in curricular content across the institutions. (11) Alignment of what to learn with how to learn is essential for developing a structured, explicit, holistic, and integrated program in medical education. Such disparities highlight the need for a globally applicable, contextually adaptable framework for integrating HPE content into medical curricula.(12) Using Lattuca and Stark’s curriculum development framework(13)(14) ( Fig. 2 ) , this study develops a structured, accessible approach to integrating teaching content with its respective teaching methodology and assessment method into undergraduate medical curricula. Methods This study followed a systematic, multi-phased approach to develop, refine, and validate HPE content for the MBBS curriculum (Fig. 4). Phase I: Literature Review A comprehensive literature review was conducted using databases such as Google Scholar, PubMed, Scopus and Web of Science focusing on terms like “student as teacher program,” “medical education” “health profession education”, “learning by Teaching “, “teach to learn”, “learn to teach” and “health professions education.” The review identified 54 potential HPE topics, categorized domains based on the CanMEDS framework. Phase II: Nominal Group Technique (NGT) The identified topics were refined using the Nominal Group Technique (NGT). Nineteen medical education experts were selected based on minimum criteria of at least 2 years’ experience in curriculum designing, teaching and student assessment in an integrated curriculum. During a 90-minute virtual session, experts provided feedback, ranked items, and reached consensus.(15)(16). (Additional file 1, Appendix A). Phase III: Modified Delphi Study Delphi Expert Panel Selection Purposive sampling was used to select 69 experts from all provinces of Pakistan, ensuring diverse representation (17). Inclusion criteria required participants to have postgraduate qualifications (e.g., MHPE or PhD in HPE) and at least two years of teaching experience ( Table 1 ). The Delphi Rounds The questionnaire developed after literature review and nominal group was used in Delphi rounds (Additional file 1, Appendix B). Delphi method is a consensus-building approach, favoured for its ability to maintain expert anonymity and free expression. Decisions are made by the majority, and experts can adjust their responses based on group feedback (18)(19). A three-round Modified e-Delphi process was conducted to achieve consensus ( Fig. 3 ) (Additional file 1, Appendices C & D). Data Analysis Survey responses were collected using a secure online platform, ensuring participant anonymity to minimize response bias. Quantitative Analysis Consensus levels were assessed based on percentage agreement. McNemar’s test was used to evaluate response stability across rounds. Items meeting the ≥ 80% agreement threshold were included in the final curriculum framework. Qualitative Analysis Open-ended responses were thematically analysed to identify emerging themes. Content modifications were made based on recurrent themes and panellists suggestions. Table 1 Extreme Variation Characteristics of Delphi Participants Characteristics Frequency n (%) Professor 19 (29.6%) Associate Professor 6 (9.4%) Assistant Professor 21 (32.8%) Lecturer 6 (9.4%) Others 12 (18.7%) Department Medical Education 64 (100%) General Education 0 Gender Female 40 (62.5%) Male 24 (37.5%) Degree in Medical Education Diploma 12 (18.8%) MCPS-HPE 4 (6.3%) MHPE 42 (65.6%) PhD Health Profession Education 6 (9.4%) Experience 5–10 years 15 (23.4%) Less than 5 years 16 (25.0%) More than 10 years 27 (42.2%) More than 20 years 6 (9.4%) Teaching Capacity in Medical Education Full-Time Faculty Part-Time Faculty Visiting Faculty Not Working at the Movement 37 (57.8%) 17 (26.5%) 07 (10.9%) 03 (4.6%) Province Sindh 20 (31.3%) KPK 17 (26.6%) Punjab 14 (21.9%) Islamabad 9 (14.0%) Baluchistan 4 (6.2%) Results Refinement of HPE Topics From an initial 54 topics, the NGT process refined the list to 37 items by: 1) Eliminating 12 redundant items, 2) Rephrasing 5 items for clarity and 3) Adding 2 new items based on expert feedback. These 37 topics were categorized into five core themes ( Fig. 5 ) : Delphi Rounds A three-round Modified e-Delphi process was conducted to achieve consensus. Table 2 shows the content introduced in round 1 and not tested for stability. Table 3 shows the summary of three Delphi rounds. Table 2 Content introduced in Round 1 and not tested for stability Items suggested by experts in round 1 but not tested for stability Learning content Percentage response Reason for elimination Long-term, intermediate, and short-term memory 60 The consensus is less than 80 percent. “ Long term, Intermediate and short-term memory: it is already included in MBBS syllabus, in neurosciences.” Spiral curriculum 50 Percentage agreement falls in the plurality range (50 percent or less) Expert response "spiral curriculum, a type of curriculum-which has been included in "Basics of curriculum and its various types." Study guide, TOS, and blueprinting 60 The consensus is less than 80 percent. "These are more important for the teachers, not for the students." "More relevant to the teachers and applied to students." Online assessment 40 Percentage agreement falls in the plurality range (50 percent or less) "Not important as we have inferior net connectivity and residence of our students are far away from the Quetta city where online classes and assessment are not possible due to lack and/or poor net connectivity." " Due to unavailability/ poor net connection, we cannot conduct online classes and assessments. Our students have complained about a lack of internet connectivity or frequent net cut-off during COVID-19. Most students live in remote areas where the net assessment is impossible. Therefore, neither online teaching nor online exams are possible in these circumstances. That is why I do not favour online classes or assessment." Table 3 Summary of Results of Three Delphi Rounds Domain Content Teaching Strategy (With maximum Response Assessment Method (with maximum response) Educational Psychology 1. Self-Directed Learning LGIS MCQ Teaching & Learning 1. Beside Teaching Student presentation SGD OSTE 2. Procedural Skill Teaching Skill Lab OSTE 3. Simulation Learning SGD OSTE 4. Skill for delivering an effective presentation Student Presentation OSTE Assessment 1. Assessment of Skill Workshop Reflective Portfolio 2. Assessment of Attitude Small Group Discussion OSTE 3. Providing Feedback Student Presentation Reflective Portfolio 4. Reflection & Reflective Writing SGD Reflective Portfolio Leadership & Professionalism 1. Research and Scholarship LGIS Assignment 2. Critical Thinking & Problem Solution PBL Short Answer Questions 3. Interpersonal & Communication Skills Workshop Role Play Multisource Feedback OSTE 4. Leadership and Leading Clinical Teams LGIS Reflective Portfolio 5. Medical Ethics LGIS MCQ 6. Patient Safety & Quality Care LGIS MCQ 7. Professionalism & Medical Care LGIS SGD Reflective Portfolio 8. Stress Management Workshop Multisource Feedback *SGD: Small Group Discussion, LGIS: Large Group Interactive Session, PBL: Problem Base Learning, OSTE: Objective Structured Teaching Exercise, MCQ: Multiple Choice Question Delphi Consensus Outcomes At the end of Delphi rounds, 17 items were finalised (Fig. 6 ). Preferred Teaching and Assessment Strategies Out of multiple strategies, few were selected based on expert consensus ( Fig. 7 ). Teaching Methods Large-group interactive sessions (LGIS): 50% consensus Small-group discussions (SGD): Emphasized for experiential learning Assessment Methods Objective Structured Teaching Exercises (OSTE): Highest agreement (33%) Reflective portfolios: Highlighted for assessing professionalism Qualitative Insights Experts emphasized the importance of Educational Psychology in fostering lifelong learning. Participants noted that “teaching and learning are often underestimated in developing countries” and recommended incorporating feedback-based assessment in undergraduate education. Discussion Efforts by the World Federation for Medical Education (WFME) to reform traditional medical curricula emphasize student-cantered, lifelong learning through strategies such as case-based discussions, bedside teaching, and interprofessional education. Despite international progress in defining undergraduate learning objectives, significant variability persists in teaching content (20). Despite widespread recognition of its significance, teaching as a competency remains overshadowed, often relegated to elective modules or student-selected components rather than being an essential part of medical training. Burges (21) (22)Existing studies have highlighted its importance but have not integrated it as a mandatory competency within undergraduate curricula. (23) International studies have described the learning objectives of medical education content for undergraduate students(10) and its implementation for undergraduates. It has been noted that heterogeneity exists regarding these programs' content, teaching strategies, assessment, and format Burges (6)(20). The integration of new subjects into medical education presents significant challenges, requiring careful consideration of student engagement, curricular alignment, institutional resources, and time constraints(22). This study underscores the necessity of integrating Health Professions Education (HPE) content into undergraduate medical curricula to bridge gaps in teaching, leadership, and professionalism. The Delphi consensus identified 17 key topics, striking a balance between clinical and non-clinical competencies. Notably, bedside teaching, procedural skills, and communication align with global competency frameworks such as CanMEDS, reinforcing their relevance in diverse educational settings..(2) However, cognitive topics like curriculum and learning theories failed to achieve consensus, as experts noted that including such content in an already overloaded curriculum might not benefit students(24) (25). This emphasizes the importance of balancing cognitive and practical content in undergraduate medical education The findings indicate that incorporating student-centred teaching methods, competency-based learning, and structured assessment strategies fosters critical thinking, professional identity formation, and leadership skills among medical students. The findings align with prior research emphasizing the role of structured teaching and assessment strategies in HPE (8) (10). Unlike traditional curricula, which primarily focus on clinical knowledge acquisition, this framework prioritizes non-clinical competencies such as professionalism, patient safety, and leadership, addressing gaps previously identified in competency-based medical education (CBME) models. Prior studies have highlighted student resistance to integrated curricula, often attributed to cognitive overload and preference for traditional didactic methods(25)(24). This study corroborates these concerns, reinforcing the need for a balanced curriculum that integrates cognitive content with experiential learning approaches, ensuring optimal student engagement and retention. Core Learning Content: Competencies for the Modern Physician The integration of leadership, patient safety, and professionalism was strongly endorsed, reflecting the evolving role of physicians in multidisciplinary healthcare systems. These competencies are recognized as essential for contemporary medical practice yet remain inconsistently incorporated into undergraduate curricula. Despite a strong consensus on clinical teaching methods and professional competencies, topics such as online assessment and spiral curricula failed to achieve agreement, primarily due to contextual limitations such as faculty readiness, resource constraints, and institutional feasibility. These findings highlight the need for flexible curricular frameworks, allowing institutions to tailor HPE integration based on local educational contexts. Preferred Teaching Strategies: Shift Toward Student-Centred Learning A strong preference for student-cantered learning methodologies emerged, the findings of this study align with global recommendations, indicating a strong preference for small group discussions over large group interactive sessions (Soriano et al., 2010; Cohen et al., 2022SGD was regarded as the most impactful teaching modality, particularly for clinical subjects requiring direct observation, structured feedback, and reflective learning (Cohen et al., 2022). Small group discussions were identified as the most effective teaching modality for Health Professions Education (HPE), particularly for clinical subjects where direct observation and feedback are essential (Cohen et al., 2022). These discussions provide a structured yet flexible learning environment, promoting critical reflection and deeper engagement. This preference aligns with existing evidence highlighting small group teaching as a key driver of meaningful learning. Although LGIS was less favoured, it remains a pragmatic method for delivering core content, especially in resource-limited settings. Large group interactive lectures were the second most preferred modality, chosen due to familiarity, feasibility, and logistical advantages. These sessions serve as an early exposure to the hidden curriculum, significantly shaping professional identity formation (Hough & Hegazi, 2018). While large group teaching supports professionalism and leadership development, studies indicate that small groups often deviate from intended learning objectives, leading to inconsistent outcomes (Goldie et al., 2007; Irvine, 1999). Literature suggests that participatory learning models—such as case-based discussions, problem-based learning (PBL), and interprofessional education (IPE)—enhance knowledge retention and application more effectively than passive lectures (Hough & Hegazi, 2018). Student presentations play a complementary role, fostering self-reflection, motivation, and peer-assisted learning. Literature suggests that presenting in academic settings builds confidence, enhances experiential learning, and reinforces knowledge retention through feedback and iterative practice. Assessment Strategies: Transition Toward Competency-Based Evaluation The study highlights a transition from traditional knowledge-based assessments to competency-based evaluations, emphasizing Objective Structured Teaching Evaluations (OSTE) and reflective portfolios as key assessment tools. (26)(27) OSTE emerged as the most reliable assessment method, despite concerns about logistical feasibility, administrative complexity, and financial constraints (28) (Russel et al., 2021). Reflective portfolios were endorsed as mid-stakes assessment tools, facilitating professional identity formation, self-directed learning, and summative evaluation. The findings support the incorporation of structured reflection, peer feedback, and faculty-guided debriefing to ensure portfolios serve as a meaningful component of assessment (Irvine, 1999). Despite these advancements, standardizing assessment frameworks for HPE competencies remains a challenge. While 95% of U.S. medical schools assess teaching competencies, only 36% of Australian medical schools have implemented formal HPE evaluations (Liu et al., 2017). This disparity highlights the urgent need for institutional commitment, faculty development programs, and standardized assessment strategies to ensure effective implementation. Challenges remain in evaluating the effectiveness of these programs, as no formal guidelines exist to date. These programs are typically delivered as short, optional courses (Yeung, 26). Yeung’s evaluation of the Students as Teachers program concluded that such an approach enhances student learning. This study is the first in the region to formally establish teaching as a core component of medical education, ensuring that future physicians are not only skilled clinicians but also effective educators who contribute to continuous learning within healthcare (27). Several barriers were identified that hinder the effective integration of HPE content, including: Curriculum overload ,(24) Limited faculty expertise to teach HPE and Resource constraints. Addressing these challenges requires institutional flexibility, allowing medical schools to tailor HPE implementation to their specific educational, infrastructural, and cultural contexts. (29) Implications for Curriculum Design 1.Core Competencies: Emphasizing leadership, patient safety, and professionalism equips students for multidisciplinary roles in healthcare. 2.Innovative Teaching Strategies: The preference for SGD and case base learning underscores the need for active, participatory learning environments. The use of simulation and skill labs for procedural skills fosters experiential learning. 3.Pragmatic Assessment: The endorsement of OSTE, reflective portfolios and structured feedback reflects a shift toward holistic evaluation methods that go beyond knowledge testing. The proposed framework is applicable to medical programs worldwide, particularly five-year undergraduate programs seeking to integrate competency-based education. By addressing both core competencies and contextual challenges, this study provides a scalable model for HPE integration. Several items, such as online assessment and spiral curriculum, failed to achieve consensus due to contextual challenges, including limited internet connectivity in remote areas. This reflects the need for adaptable frameworks that consider resource limitations. Additionally, resistance to student-centred learning highlights the importance of faculty development programs to support curricular reforms. Strengths and Limitations The study’s strengths lie in its robust methodology, including a pre-survey nominal group to refine and align questions, a consensus threshold of ≥ 80%, and a response rate exceeding 90%. Data collection from multiple regions ensured broad representation, enhancing generalizability. Anonymity among participants reduced bias, and iterative rounds improved content validity. Alignment with global competency frameworks – The findings reinforce CanMEDS and CBME models, enhancing their applicability. However, the study is limited by the lack of inclusion of students’ perspectives and the need for further exploration of content feasibility in specific institutional contexts. Conclusion This study provides a structured framework for integrating HPE content in undergraduate medical education by aligning core content with evidence-based teaching and assessment methods. These recommendations provide a roadmap for curricular reform, bridging the gap between traditional medical education and the demands of integrated healthcare. The Teaching competency regarded as 8th Star should not remain obscured within the clouds of old traditional curriculum but rather outshine to bridge the gap between clinical excellence and educational leadership. Future Directions Implementation Studies: Pilot implementation of the proposed framework in MBBS curricula vertically or as a standalone subject to assess feasibility and impact. Faculty Development: Training programs to promote acceptance and effective delivery of student-centered teaching strategies. International Validation: Comparative studies to evaluate the global applicability of these recommendations. Abbreviations Health Profession Education (HPE) small group discussions (SGD) large group interactive sessions (LGIS) Objective Structured Teaching Exercises (OSTE) World Federation for Medical Education (WFME) Canadian Medical Education Directives for Specialists (CanMEDS) Declarations Ethical approval and consent to participate The study was approved by the Institutional Review Committee at Riphah International University (Riphah/IIMC/IRC/22/2014). Written informed consent was obtained from all the participants. Consent for publication Not applicable Availability of data and materials The data generated and analysed during the study are available on request. The corresponding author Sara Jamil can be contacted for the data. ( [email protected] ) Competing interest The authors declare no competing interest and are responsible for the content of the article. Funding The study received no grant or funding from any source. Author’s contributions SJ conceived and designed the study. SJ, RY & SI collected and analysed the data. SJ conducted and interpreted cognitive interviews. RY and SI helped in preparing the manuscript by providing feedback. All the authors read and approved the final manuscript. Acknowledgements The authors acknowledge and thank the experts for their prompt reply at all stages and the participants of the study. Author information Sara Jamil is the Director Medical Education at Frontier Medical & Dental College and the Executive Director of its affiliated hospital. She also serves as the Head of the Department of Obstetrics and Gynaecology at Shahina Jamil Trust Hospital. With an MHPE from Riphah International University, she has a strong interest in curriculum development, implementation, and assessment, contributing to advancements in medical education. Rahila Yasmin is a Professor of Medical Education, Director of the MHPE Program, and Dean of Riphah Academy of Research & Education, Riphah International University, Islamabad, Pakistan. She is a dentist by profession with BDS, DCPS, HPE, MHPE, and PhD Scholar HPE. https://orcid.org/0000-0001-9839-6987 Shazia Imran is a Professor of Anatomy at NUST School of Health Sciences, National University of Sciences and Technology, Islamabad. Her expertise lies in curriculum design, innovation, and assessment. She holds an MPhil in Anatomy and Master’s in medical education from Riphah International University. 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Supplementary Files 8starDoctorAdditionalFile1.docx Cite Share Download PDF Status: Published Journal Publication published 11 Aug, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 06 Jun, 2025 Reviews received at journal 04 Jun, 2025 Reviews received at journal 30 May, 2025 Reviewers agreed at journal 23 May, 2025 Reviewers agreed at journal 23 May, 2025 Reviewers agreed at journal 21 May, 2025 Reviewers agreed at journal 21 May, 2025 Reviews received at journal 21 May, 2025 Reviewers agreed at journal 21 May, 2025 Reviewers invited by journal 21 May, 2025 Editor assigned by journal 21 May, 2025 Editor invited by journal 14 May, 2025 Submission checks completed at journal 09 May, 2025 First submitted to journal 09 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6209064","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":460184516,"identity":"cd5fa9b4-83f3-4847-b21b-d4c22b8fa3e2","order_by":0,"name":"Sara Jamil 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University","correspondingAuthor":false,"prefix":"","firstName":"Rahila","middleName":"","lastName":"Yasmeen","suffix":""},{"id":460184519,"identity":"ee95a2e9-f8f9-44f7-a26e-e5a82d8d7af6","order_by":2,"name":"Shazia Imran","email":"","orcid":"","institution":"National university of Sciences and Technology (NUST)","correspondingAuthor":false,"prefix":"","firstName":"Shazia","middleName":"","lastName":"Imran","suffix":""}],"badges":[],"createdAt":"2025-03-12 06:23:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6209064/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6209064/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-07694-7","type":"published","date":"2025-08-11T15:58:09+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83513787,"identity":"487f8a76-86f0-4212-b05b-cdafad3f26f5","added_by":"auto","created_at":"2025-05-27 17:43:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":231140,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFrameworks from Literature Emphasizing Health Profession Education’s Significance\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6209064/v1/0c9811daf9860b64352371cc.png"},{"id":83514123,"identity":"eecf55fc-1a00-42b4-b99e-9c2d34274c17","added_by":"auto","created_at":"2025-05-27 17:51:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":152981,"visible":true,"origin":"","legend":"\u003cp\u003eLattuca and Starks Curriculum Development Framework\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6209064/v1/fcf070954bd8fb78ade31743.png"},{"id":83513781,"identity":"edd701c7-a990-4ddc-b2a5-96000b6f3eb3","added_by":"auto","created_at":"2025-05-27 17:43:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":39398,"visible":true,"origin":"","legend":"\u003cp\u003eThree-round Modified Delphi\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6209064/v1/8b50fb37358b6a4ad421c4ae.png"},{"id":83515126,"identity":"d57a6897-31d0-443c-a46f-5ac411f238a1","added_by":"auto","created_at":"2025-05-27 18:07:09","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":58014,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePhases of the Study to Determine Learning Content of HPE along with its Teaching Modalities and Assessment Methods\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6209064/v1/550af8ea34529d5af10f5e3c.png"},{"id":83515428,"identity":"a9ab17ae-8165-4f5d-94e4-54e8a8ded8c7","added_by":"auto","created_at":"2025-05-27 18:15:09","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":20369,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe five core themes of Learning Content of HPE\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6209064/v1/9f3e41a9c057179b8c3e6fcb.png"},{"id":83514124,"identity":"6b73fd6a-0c0e-4e73-b25b-527cf68e2722","added_by":"auto","created_at":"2025-05-27 17:51:08","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":38788,"visible":true,"origin":"","legend":"\u003cp\u003eResults of Three-round Modified e-Delphi\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6209064/v1/467f6e8ed46cc40ec3467b9b.png"},{"id":83514710,"identity":"b24a1756-1bd1-4d09-bb85-3c3de3aefd6b","added_by":"auto","created_at":"2025-05-27 17:59:09","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":47178,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRatio of Teaching methodology of Teaching Strategy and Assessment method\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-6209064/v1/58ef6d99435b8a2f0bdc1bcd.png"},{"id":89310590,"identity":"11a46aed-7e8b-4ac9-b491-7f16b810574a","added_by":"auto","created_at":"2025-08-18 16:08:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1803872,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6209064/v1/31cb3748-389a-4fb7-ba8f-7dd873e32f0d.pdf"},{"id":83513783,"identity":"fd82cd48-1947-402f-9fe3-169f52a68adc","added_by":"auto","created_at":"2025-05-27 17:43:08","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":150842,"visible":true,"origin":"","legend":"","description":"","filename":"8starDoctorAdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6209064/v1/f8d6eadd1e9b9e06fcbb255e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Building the 8-Star Doctor: A Modified Delphi Study to Define, Teach, and Assess Health Professions Education for Undergraduate Medical Students","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEvery doctor teaches whether they realise it or not. The term \u0026ldquo;doctor\u0026rdquo; derives from the Latin word \u003cb\u003edocere\u003c/b\u003e, meaning \u0026ldquo;to teach\u0026rdquo; (1), underscoring the fundamental role of teaching in medical profession. Medical educators are not only responsible for imparting knowledge to students but also for cultivating the next generation of self-directed, reflective practitioners.(2) However, a structured undergraduate curriculum teaching medical skills to students remains absent in many countries.\u003c/p\u003e \u003cp\u003eThe 7-Star Doctor framework, introduced by the World Health Organization (WHO)(2)(3) and followed by many regulatory bodies throughout defines seven core competencies essential for medical professionals: Care Provider, Decision-Maker, Communicator, Community Leader, Manager, Researcher, and Lifelong Learner (WHO, 1996). However, one fundamental role remains unrecognized within this model\u0026mdash;the Doctor as Teacher. Teaching is an implicit aspect of each competency: physicians educate patients, mentor colleagues, and disseminate knowledge as researchers.(4) Yet, despite its pervasive presence, teaching is not explicitly recognized as a distinct competency in many undergraduate programs. (5)(6)Educational frameworks such as WFME\u0026rsquo;s global standards (7),CanMEDS model and Tomorrow\u0026rsquo;s Doctors emphasize the importance of medical teaching, yet this role is often considered an assumed skill rather than a formally cultivated competency (7) \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe lack of formalized teaching training leaves students underprepared to meet the multifaceted demands of clinical environments. (8)Additionally, the global variation in curricular structure further complicates efforts to standardize content. For example, U.S. students benefit from student selected model of student as teacher training program,(9)(10) while many other countries emphasize traditional, teacher-centred learning approaches(9). A review of 39 undergraduate HPE programs highlighted the absence of a standardized framework and the variation in curricular content across the institutions. (11) Alignment of what to learn with how to learn is essential for developing a structured, explicit, holistic, and integrated program in medical education. Such disparities highlight the need for a globally applicable, contextually adaptable framework for integrating HPE content into medical curricula.(12)\u003c/p\u003e \u003cp\u003eUsing Lattuca and Stark\u0026rsquo;s curriculum development framework(13)(14) \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e, this study develops a structured, accessible approach to integrating teaching content with its respective teaching methodology and assessment method into undergraduate medical curricula.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study followed a systematic, multi-phased approach to develop, refine, and validate HPE content for the MBBS curriculum \u003cb\u003e(Fig.\u0026nbsp;4).\u003c/b\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePhase I: Literature Review\u003c/h2\u003e \u003cp\u003eA comprehensive literature review was conducted using databases such as Google Scholar, PubMed, Scopus and Web of Science focusing on terms like \u0026ldquo;student as teacher program,\u0026rdquo; \u0026ldquo;medical education\u0026rdquo; \u0026ldquo;health profession education\u0026rdquo;, \u0026ldquo;learning by Teaching \u0026ldquo;, \u0026ldquo;teach to learn\u0026rdquo;, \u0026ldquo;learn to teach\u0026rdquo; and \u0026ldquo;health professions education.\u0026rdquo; The review identified 54 potential HPE topics, categorized domains based on the CanMEDS framework.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePhase II: Nominal Group Technique (NGT)\u003c/h3\u003e\n\u003cp\u003eThe identified topics were refined using the Nominal Group Technique (NGT). Nineteen medical education experts were selected based on minimum criteria of at least 2 years\u0026rsquo; experience in curriculum designing, teaching and student assessment in an integrated curriculum. During a 90-minute virtual session, experts provided feedback, ranked items, and reached consensus.(15)(16). \u003cb\u003e(Additional file 1, Appendix A).\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003ePhase III: Modified Delphi Study\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDelphi Expert Panel Selection\u003c/h2\u003e \u003cp\u003ePurposive sampling was used to select 69 experts from all provinces of Pakistan, ensuring diverse representation (17). Inclusion criteria required participants to have postgraduate qualifications (e.g., MHPE or PhD in HPE) and at least two years of teaching experience \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe Delphi Rounds\u003c/h3\u003e\n\u003cp\u003eThe questionnaire developed after literature review and nominal group was used in Delphi rounds \u003cb\u003e(Additional file 1, Appendix B).\u003c/b\u003e Delphi method is a consensus-building approach, favoured for its ability to maintain expert anonymity and free expression. Decisions are made by the majority, and experts can adjust their responses based on group feedback (18)(19). A three-round Modified e-Delphi process was conducted to achieve consensus \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e \u003cb\u003e(Additional file 1, Appendices C \u0026amp; D).\u003c/b\u003e\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eSurvey responses were collected using a secure online platform, ensuring participant anonymity to minimize response bias.\u003c/p\u003e \u003cp\u003e \u003cb\u003eQuantitative Analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eConsensus levels were assessed based on percentage agreement.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMcNemar\u0026rsquo;s test was used to evaluate response stability across rounds.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eItems meeting the \u0026ge;\u0026thinsp;80% agreement threshold were included in the final curriculum framework.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eQualitative Analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eOpen-ended responses were thematically analysed to identify emerging themes.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eContent modifications were made based on recurrent themes and panellists suggestions.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExtreme Variation Characteristics of Delphi Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e19\u003c/b\u003e (29.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociate Professor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e (9.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssistant Professor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e21\u003c/b\u003e (32.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLecturer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e (9.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e12\u003c/b\u003e(18.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eDepartment\u003c/span\u003e\u003c/p\u003e \u003cp\u003eMedical Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e64\u003c/b\u003e (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eGender\u003c/span\u003e\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e40\u003c/b\u003e (62.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e24\u003c/b\u003e (37.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eDegree in Medical Education\u003c/span\u003e\u003c/p\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e12\u003c/b\u003e (18.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCPS-HPE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e (6.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMHPE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e42\u003c/b\u003e (65.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhD Health Profession Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e (9.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eExperience\u003c/span\u003e\u003c/p\u003e \u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e15\u003c/b\u003e (23.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e16\u003c/b\u003e (25.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e27\u003c/b\u003e (42.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e (9.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eTeaching Capacity in Medical Education\u003c/span\u003e\u003c/p\u003e \u003cp\u003eFull-Time Faculty\u003c/p\u003e \u003cp\u003ePart-Time Faculty\u003c/p\u003e \u003cp\u003eVisiting Faculty\u003c/p\u003e \u003cp\u003eNot Working at the Movement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e37\u003c/b\u003e (57.8%)\u003c/p\u003e \u003cp\u003e\u003cb\u003e17\u003c/b\u003e (26.5%)\u003c/p\u003e \u003cp\u003e\u003cb\u003e07\u003c/b\u003e (10.9%)\u003c/p\u003e \u003cp\u003e\u003cb\u003e03\u003c/b\u003e (4.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eProvince\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSindh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e20\u003c/b\u003e (31.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKPK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e17\u003c/b\u003e (26.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePunjab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e14\u003c/b\u003e (21.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIslamabad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e (14.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaluchistan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e (6.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eRefinement of HPE Topics\u003c/h2\u003e \u003cp\u003eFrom an initial 54 topics, the NGT process refined the list to 37 items by: 1) Eliminating 12 redundant items, 2) Rephrasing 5 items for clarity and 3) Adding 2 new items based on expert feedback. These 37 topics were categorized into five core themes \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDelphi Rounds\u003c/h2\u003e \u003cp\u003eA three-round Modified e-Delphi process was conducted to achieve consensus. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the content introduced in round 1 and not tested for stability. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the summary of three Delphi rounds.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eContent introduced in Round 1 and not tested for stability\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eItems suggested by experts in round 1 but not tested for stability\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning content\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePercentage response\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReason for elimination\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLong-term, intermediate, and short-term memory\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe consensus is less than 80 percent.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eLong term, Intermediate and short-term memory: it is already included in MBBS syllabus, in neurosciences.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpiral curriculum\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage agreement falls in the plurality range (50 percent or less)\u003c/p\u003e \u003cp\u003eExpert response \u003cem\u003e\"spiral curriculum, a type of curriculum-which has been included in \"Basics of curriculum and its various types.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStudy guide, TOS, and blueprinting\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe consensus is less than 80 percent.\u003c/p\u003e \u003cp\u003e\u003cem\u003e\"These are more important for the teachers, not for the students.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\"More relevant to the teachers and applied to students.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOnline assessment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage agreement falls in the plurality range (50 percent or less)\u003c/p\u003e \u003cp\u003e\u003cem\u003e\"Not important as we have inferior net connectivity and residence of our students are far away from the Quetta city where online classes and assessment are not possible due to lack and/or poor net connectivity.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\"\u003cem\u003eDue to unavailability/ poor net connection, we cannot conduct online classes and assessments. Our students have complained about a lack of internet connectivity or frequent net cut-off during COVID-19. Most students live in remote areas where the net assessment is impossible. Therefore, neither online teaching nor online exams are possible in these circumstances. That is why I do not favour online classes or assessment.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of Results of Three Delphi Rounds\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTeaching Strategy\u003c/p\u003e \u003cp\u003e(With maximum Response\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssessment Method (with maximum response)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational Psychology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Self-Directed Learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLGIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMCQ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eTeaching \u0026amp; Learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Beside Teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudent presentation\u003c/p\u003e \u003cp\u003eSGD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOSTE\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2. Procedural Skill Teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSkill Lab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOSTE\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3. Simulation Learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSGD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOSTE\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4. Skill for delivering an effective presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudent Presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOSTE\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAssessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Assessment of Skill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWorkshop\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReflective Portfolio\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2. Assessment of Attitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSmall Group Discussion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOSTE\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3. Providing Feedback\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudent Presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReflective Portfolio\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4. Reflection \u0026amp; Reflective Writing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSGD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReflective Portfolio\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eLeadership \u0026amp; Professionalism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Research and Scholarship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLGIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssignment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2. Critical Thinking \u0026amp; Problem Solution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePBL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eShort Answer Questions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3. Interpersonal \u0026amp; Communication Skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWorkshop\u003c/p\u003e \u003cp\u003eRole Play\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMultisource Feedback\u003c/p\u003e \u003cp\u003eOSTE\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4. Leadership and Leading Clinical Teams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLGIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReflective Portfolio\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5. Medical Ethics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLGIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMCQ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6. Patient Safety \u0026amp; Quality Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLGIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMCQ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7. Professionalism \u0026amp; Medical Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLGIS\u003c/p\u003e \u003cp\u003eSGD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReflective Portfolio\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8. Stress Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWorkshop\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMultisource Feedback\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*SGD: Small Group Discussion, LGIS: Large Group Interactive Session, PBL: Problem Base Learning, OSTE: Objective Structured Teaching Exercise, MCQ: Multiple Choice Question\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDelphi Consensus Outcomes\u003c/h2\u003e \u003cp\u003eAt the end of Delphi rounds, 17 items were finalised (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePreferred Teaching and Assessment Strategies\u003c/h2\u003e \u003cp\u003eOut of multiple strategies, few were selected based on expert consensus \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTeaching Methods\u003c/h2\u003e \u003cp\u003eLarge-group interactive sessions (LGIS): 50% consensus\u003c/p\u003e \u003cp\u003eSmall-group discussions (SGD): Emphasized for experiential learning\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAssessment Methods\u003c/h2\u003e \u003cp\u003eObjective Structured Teaching Exercises (OSTE): Highest agreement (33%)\u003c/p\u003e \u003cp\u003eReflective portfolios: Highlighted for assessing professionalism\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Insights\u003c/h2\u003e \u003cp\u003eExperts emphasized the importance of Educational Psychology in fostering lifelong learning. Participants noted that \u0026ldquo;teaching and learning are often underestimated in developing countries\u0026rdquo; and recommended incorporating feedback-based assessment in undergraduate education.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eEfforts by the World Federation for Medical Education (WFME) to reform traditional medical curricula emphasize student-cantered, lifelong learning through strategies such as case-based discussions, bedside teaching, and interprofessional education. Despite international progress in defining undergraduate learning objectives, significant variability persists in teaching content (20). Despite widespread recognition of its significance, teaching as a competency remains overshadowed, often relegated to elective modules or student-selected components rather than being an essential part of medical training. Burges (21) (22)Existing studies have highlighted its importance but have not integrated it as a mandatory competency within undergraduate curricula. (23) International studies have described the learning objectives of medical education content for undergraduate students(10) and its implementation for undergraduates. It has been noted that heterogeneity exists regarding these programs' content, teaching strategies, assessment, and format Burges (6)(20). The integration of new subjects into medical education presents significant challenges, requiring careful consideration of student engagement, curricular alignment, institutional resources, and time constraints(22).\u003c/p\u003e \u003cp\u003eThis study underscores the necessity of integrating Health Professions Education (HPE) content into undergraduate medical curricula to bridge gaps in teaching, leadership, and professionalism. The Delphi consensus identified 17 key topics, striking a balance between clinical and non-clinical competencies. Notably, bedside teaching, procedural skills, and communication align with global competency frameworks such as CanMEDS, reinforcing their relevance in diverse educational settings..(2) However, cognitive topics like curriculum and learning theories failed to achieve consensus, as experts noted that including such content in an already overloaded curriculum might not benefit students(24) (25). This emphasizes the importance of balancing cognitive and practical content in undergraduate medical education\u003c/p\u003e \u003cp\u003eThe findings indicate that incorporating student-centred teaching methods, competency-based learning, and structured assessment strategies fosters critical thinking, professional identity formation, and leadership skills among medical students.\u003c/p\u003e \u003cp\u003eThe findings align with prior research emphasizing the role of structured teaching and assessment strategies in HPE (8) (10). Unlike traditional curricula, which primarily focus on clinical knowledge acquisition, this framework prioritizes non-clinical competencies such as professionalism, patient safety, and leadership, addressing gaps previously identified in competency-based medical education (CBME) models.\u003c/p\u003e \u003cp\u003ePrior studies have highlighted student resistance to integrated curricula, often attributed to cognitive overload and preference for traditional didactic methods(25)(24). This study corroborates these concerns, reinforcing the need for a balanced curriculum that integrates cognitive content with experiential learning approaches, ensuring optimal student engagement and retention.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eCore Learning Content: Competencies for the Modern Physician\u003c/h2\u003e \u003cp\u003eThe integration of leadership, patient safety, and professionalism was strongly endorsed, reflecting the evolving role of physicians in multidisciplinary healthcare systems. These competencies are recognized as essential for contemporary medical practice yet remain inconsistently incorporated into undergraduate curricula.\u003c/p\u003e \u003cp\u003eDespite a strong consensus on clinical teaching methods and professional competencies, topics such as online assessment and spiral curricula failed to achieve agreement, primarily due to contextual limitations such as faculty readiness, resource constraints, and institutional feasibility. These findings highlight the need for flexible curricular frameworks, allowing institutions to tailor HPE integration based on local educational contexts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePreferred Teaching Strategies: Shift Toward Student-Centred Learning\u003c/h2\u003e \u003cp\u003eA strong preference for student-cantered learning methodologies emerged, the findings of this study align with global recommendations, indicating a strong preference for small group discussions over large group interactive sessions (Soriano et al., 2010; Cohen et al., 2022SGD was regarded as the most impactful teaching modality, particularly for clinical subjects requiring direct observation, structured feedback, and reflective learning (Cohen et al., 2022). Small group discussions were identified as the most effective teaching modality for Health Professions Education (HPE), particularly for clinical subjects where direct observation and feedback are essential (Cohen et al., 2022). These discussions provide a structured yet flexible learning environment, promoting critical reflection and deeper engagement. This preference aligns with existing evidence highlighting small group teaching as a key driver of meaningful learning.\u003c/p\u003e \u003cp\u003eAlthough LGIS was less favoured, it remains a pragmatic method for delivering core content, especially in resource-limited settings. Large group interactive lectures were the second most preferred modality, chosen due to familiarity, feasibility, and logistical advantages. These sessions serve as an early exposure to the hidden curriculum, significantly shaping professional identity formation (Hough \u0026amp; Hegazi, 2018). While large group teaching supports professionalism and leadership development, studies indicate that small groups often deviate from intended learning objectives, leading to inconsistent outcomes (Goldie et al., 2007; Irvine, 1999). Literature suggests that participatory learning models\u0026mdash;such as case-based discussions, problem-based learning (PBL), and interprofessional education (IPE)\u0026mdash;enhance knowledge retention and application more effectively than passive lectures (Hough \u0026amp; Hegazi, 2018).\u003c/p\u003e \u003cp\u003eStudent presentations play a complementary role, fostering self-reflection, motivation, and peer-assisted learning. Literature suggests that presenting in academic settings builds confidence, enhances experiential learning, and reinforces knowledge retention through feedback and iterative practice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eAssessment Strategies: Transition Toward Competency-Based Evaluation\u003c/h2\u003e \u003cp\u003eThe study highlights a transition from traditional knowledge-based assessments to competency-based evaluations, emphasizing Objective Structured Teaching Evaluations (OSTE) and reflective portfolios as key assessment tools. (26)(27) OSTE emerged as the most reliable assessment method, despite concerns about logistical feasibility, administrative complexity, and financial constraints (28) (Russel et al., 2021).\u003c/p\u003e \u003cp\u003eReflective portfolios were endorsed as mid-stakes assessment tools, facilitating professional identity formation, self-directed learning, and summative evaluation. The findings support the incorporation of structured reflection, peer feedback, and faculty-guided debriefing to ensure portfolios serve as a meaningful component of assessment (Irvine, 1999).\u003c/p\u003e \u003cp\u003eDespite these advancements, standardizing assessment frameworks for HPE competencies remains a challenge. While 95% of U.S. medical schools assess teaching competencies, only 36% of Australian medical schools have implemented formal HPE evaluations (Liu et al., 2017). This disparity highlights the urgent need for institutional commitment, faculty development programs, and standardized assessment strategies to ensure effective implementation.\u003c/p\u003e \u003cp\u003eChallenges remain in evaluating the effectiveness of these programs, as no formal guidelines exist to date. These programs are typically delivered as short, optional courses (Yeung, 26). Yeung\u0026rsquo;s evaluation of the Students as Teachers program concluded that such an approach enhances student learning. This study is the first in the region to formally establish teaching as a core component of medical education, ensuring that future physicians are not only skilled clinicians but also effective educators who contribute to continuous learning within healthcare (27).\u003c/p\u003e \u003cp\u003eSeveral barriers were identified that hinder the effective integration of HPE content, including: Curriculum overload ,(24) Limited faculty expertise to teach HPE and Resource constraints. Addressing these challenges requires institutional flexibility, allowing medical schools to tailor HPE implementation to their specific educational, infrastructural, and cultural contexts. (29)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Curriculum Design\u003c/h2\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003e1.Core Competencies:\u003c/h2\u003e \u003cp\u003eEmphasizing leadership, patient safety, and professionalism equips students for multidisciplinary roles in healthcare.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e2.Innovative Teaching Strategies:\u003c/h2\u003e \u003cp\u003eThe preference for SGD and case base learning underscores the need for active, participatory learning environments.\u003c/p\u003e \u003cp\u003eThe use of simulation and skill labs for procedural skills fosters experiential learning.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e3.Pragmatic Assessment:\u003c/h2\u003e \u003cp\u003eThe endorsement of OSTE, reflective portfolios and structured feedback reflects a shift toward holistic evaluation methods that go beyond knowledge testing.\u003c/p\u003e \u003cp\u003eThe proposed framework is applicable to medical programs worldwide, particularly five-year undergraduate programs seeking to integrate competency-based education. By addressing both core competencies and contextual challenges, this study provides a scalable model for HPE integration.\u003c/p\u003e \u003cp\u003eSeveral items, such as online assessment and spiral curriculum, failed to achieve consensus due to contextual challenges, including limited internet connectivity in remote areas. This reflects the need for adaptable frameworks that consider resource limitations. Additionally, resistance to student-centred learning highlights the importance of faculty development programs to support curricular reforms.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThe study\u0026rsquo;s strengths lie in its robust methodology, including a pre-survey nominal group to refine and align questions, a consensus threshold of \u0026ge;\u0026thinsp;80%, and a response rate exceeding 90%. Data collection from multiple regions ensured broad representation, enhancing generalizability. Anonymity among participants reduced bias, and iterative rounds improved content validity. Alignment with global competency frameworks \u0026ndash; The findings reinforce CanMEDS and CBME models, enhancing their applicability. However, the study is limited by the lack of inclusion of students\u0026rsquo; perspectives and the need for further exploration of content feasibility in specific institutional contexts.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides a structured framework for integrating HPE content in undergraduate medical education by aligning core content with evidence-based teaching and assessment methods. These recommendations provide a roadmap for curricular reform, bridging the gap between traditional medical education and the demands of integrated healthcare. The Teaching competency regarded as 8th Star should not remain obscured within the clouds of old traditional curriculum but rather outshine to bridge the gap between clinical excellence and educational leadership.\u003c/p\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eFuture Directions\u003c/h2\u003e \u003cp\u003eImplementation Studies: Pilot implementation of the proposed framework in MBBS curricula vertically or as a standalone subject to assess feasibility and impact.\u003c/p\u003e \u003cp\u003eFaculty Development: Training programs to promote acceptance and effective delivery of student-centered teaching strategies.\u003c/p\u003e \u003cp\u003eInternational Validation: Comparative studies to evaluate the global applicability of these recommendations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHealth Profession Education (HPE)\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003esmall\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003egroup discussions (SGD)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003elarge\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003egroup interactive sessions (LGIS)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eObjective Structured Teaching Exercises (OSTE)\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWorld Federation for Medical Education (WFME)\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCanadian Medical Education Directives for Specialists (CanMEDS)\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Committee at Riphah International University (Riphah/IIMC/IRC/22/2014).\u0026nbsp;Written informed consent was obtained from all the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data generated and analysed during the study are available on request. \u0026nbsp; The corresponding author Sara Jamil can be contacted for the data. ([email protected])\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interest and are responsible for the content of the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received no grant or funding from any source.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSJ conceived and designed the study. SJ, RY \u0026amp; SI collected and analysed the data. SJ conducted and interpreted cognitive interviews. RY and SI helped in preparing the manuscript by providing feedback. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge and thank the experts for their prompt reply at all stages and the participants of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSara Jamil is the Director Medical Education at Frontier Medical \u0026amp; Dental College and the Executive Director of its affiliated hospital. She also serves as the Head of the Department of Obstetrics and Gynaecology at Shahina Jamil Trust Hospital. With an MHPE from Riphah International University, she has a strong interest in curriculum development, implementation, and assessment, contributing to advancements in medical education.\u003c/p\u003e\n\u003cp\u003eRahila Yasmin is a Professor of Medical Education, Director of the MHPE Program, and Dean of Riphah Academy of Research \u0026amp; Education, Riphah International University, Islamabad, Pakistan. She is a dentist by profession with BDS, DCPS, HPE, MHPE, and PhD Scholar HPE.\u003c/p\u003e\n\u003cp\u003ehttps://orcid.org/0000-0001-9839-6987\u003c/p\u003e\n\u003cp\u003eShazia Imran is a Professor of Anatomy at NUST School of Health Sciences, National University of Sciences and Technology, Islamabad. Her expertise lies in curriculum design, innovation, and assessment. She holds an MPhil in Anatomy and Master\u0026rsquo;s in medical education from Riphah International University.\u003c/p\u003e\n\u003cp\u003eORCID https://orcid.org/0000-0001-8385-7568\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eFrontier Medical and Dental College, Abbottabad, Pakistan.\u003csup\u003e\u0026nbsp;2\u0026nbsp;\u003c/sup\u003eIslamic International Medical College, Riphah International University, Al-Mizan IIMCT Complex, Old Supreme Court Building, 274 Peshawar Rd, Rawalpindi, Pakistan. \u003csup\u003e3\u003c/sup\u003eNUST School of Health Sciences, National University of Sciences and Technology H-12, Islamabad, Pakistan.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNorman HA, Mehta AR. We are failing to fulfil the definition of a doctor. Lancet. 2024;403(10442):2376\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eWang Y, Wang T, Wang A, Chen S, Jiao L, Shi J, et al. Identifying the competencies of China\u0026rsquo;s paediatric residents: a modified Delphi method study. BMJ Open. 2021;11(2):e041741. \u003c/li\u003e\n\u003cli\u003eBaseer N, Huma Z, Habib SH, Mehboob U. Content analysis of undergraduate guiding documents for a medical graduate attributes in different healthcare systems. Adv Basic Med Sci. 2019;3(1). \u003c/li\u003e\n\u003cli\u003eSzucs LE, Andrzejewski JD, Robin L, Telljohann S, Pitt Barnes S, Hunt P. The health education teacher instructional competency framework: a conceptual guide for quality instruction in school health. J Sch Health. 2021;91(10):774\u0026ndash;87. \u003c/li\u003e\n\u003cli\u003ePasquinelli L, Greenberg L. A review of medical school programs that train medical students as teachers (MED-SATS). Teach Learn Med. 2008;20(1):73\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eBurgess A, McGregor D, Mellis C. Medical students as peer tutors: a systematic review. BMC Med Educ. 2014;14(1):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eTackett S, Whitehead CR, Rashid MA. Examining the WFME Recognition Programme at 10 years. Med Teach. 2024;46(5):711\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eRafiq A, Sethi A. Entrustable professional activities for bedside clinical teachers. BMC Med Educ. 2024;24(1):887. \u003c/li\u003e\n\u003cli\u003eOnorato SE, Schwartz AW, Beltran CP, Richards JB. \u0026lsquo;Educator with a capital E\u0026rsquo;: Comparing medical education experiences of student-as-teacher elective participants and peers. Med Teach. 2022;44(1):50\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eBlanco MA, Maderer A, Oriel A, Epstein SK. How we launched a developmental student-as-teacher (SAT) program for all medical students. Med Teach. 2014;36(5):385\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eGordon J, Hazlett C, Ten Cate O, Mann K, Kilminster S, Prince K, et al. Strategic planning in medical education: enhancing the learning environment for students in clinical settings. Med Educ. 2000;34(10):841\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eDandavino M, Snell L, Wiseman J. Why medical students should learn how to teach. Med Teach. 2007;29(6):558\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eLattuca LR, Stark JS. Shaping the college curriculum: Academic plans in context. John Wiley \u0026amp; Sons; 2011. \u003c/li\u003e\n\u003cli\u003eLattuca LR, Stark JS. Shaping the college curriculum: Academic plans in context. John Wiley \u0026amp; Sons; 2009. \u003c/li\u003e\n\u003cli\u003eSmith D, Cartwright M, Dyson J, Aitken LM. Use of nominal group technique methods in the virtual setting: A reflective account and recommendations for practice. Aust Crit Care. 2024;37(1):158\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eGusm\u0026atilde;o VC de L, Flausino TG do C, Couto DS, Abra\u0026atilde;o LM, Felix AM da S, Ciofi-Silva CL, et al. Adapting the Nominal Group Technique to a virtual version: an experience report. Rev da Esc Enferm da USP. 2024;58:e20230298. \u003c/li\u003e\n\u003cli\u003eNyimbili F, Nyimbili L. Types of Purposive Sampling Techniques with Their Examples and Application in Qualitative Research Studies. Br J Multidiscip Adv Stud. 2024;5(1):90\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eSteurer J. The Delphi method: An efficient procedure to generate knowledge. Skeletal Radiol. 2011;40(8):959\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eHumphrey-Murto S, Varpio L, Wood TJ, Gonsalves C, Ufholz L-A, Mascioli K, et al. The use of the Delphi and other consensus group methods in medical education research: a review. Acad Med. 2017;92(10):1491\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eFuchs MA, Schwartz AW, Caton JB, Gooding H, Richards JB. Defining Student-as-Teacher Curricula in the Absence of National Guidelines: An Innovative Model. Acad Med. 2022;97(6):832\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eBurgess A, McGregor D. Peer teacher training for health professional students: a systematic review of formal programs. BMC Med Educ. 2018;18(1):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eFreret T, Rana J, Schwartzstein RM, Gooding HC. Twelve tips for implementation of \u0026ldquo;student-as-teacher\u0026rdquo; programs. Med Teach. 2017;39(12):1221\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eRana J, Sullivan A, Brett M, Weinstein AR, Atkins KM, Group SDW. Defining curricular priorities for student-as-teacher programs: A National Delphi Study. Med Teach. 2018;40(3):259\u0026ndash;66. \u003c/li\u003e\n\u003cli\u003eJamil A. Perception of environment and educational outcomes by students and faculty in traditional versus integrated curriculum. measurements. 2018;12:13. \u003c/li\u003e\n\u003cli\u003eKeshavarzi Z, Akbari H, Forouzanian S, Sharifian E. Comparison the students satisfaction of traditional and integrated teaching method in physiology course. Educ Strateg Med Sci. 2016;8(6):21\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eKay HG, Mahoney MR, Edwards RA. The Objective Structured Teaching Encounter (OSTE) in health professions education: a systematic review. Med Teach. 2023;45(8):893\u0026ndash;905. \u003c/li\u003e\n\u003cli\u003eFakhouri SA, Nunes M do PT. Objective structured teaching examination (OSTE): an underused tool developed to assess clinical teaching skills. A narrative review of the literature. Sao Paulo Med J. 2019;137:193\u0026ndash;200. \u003c/li\u003e\n\u003cli\u003eKardong-Edgren S, Wells-Beede E, Wands L. Student abuse in simulation: causes and solutions. Teach Learn Nurs. 2024;19(2):145\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eSoriano RP, Blatt B, Coplit L, CichoskiKelly E, Kosowicz L, Newman L, et al. Teaching medical students how to teach: a national survey of students-as-teachers programs in US medical schools. Acad Med. 2010;85(11):1725\u0026ndash;31.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Learning content, Medical Education, Health professions education, Integrated curriculum, Medical education as a subject, student as teacher program, Learning by Teaching, Delphi study","lastPublishedDoi":"10.21203/rs.3.rs-6209064/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6209064/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eGlobally, medical education is evolving to align with integrated curricula; however, consensus on core Health Professions Education (HPE) content for undergraduate medical students remains limited. This study aims to identify, refine, and structure essential HPE topics within the MBBS curriculum to enhance students\u0026rsquo; foundational skills in teaching, leadership, and professionalism. Additionally, it seeks to determine appropriate teaching methodologies and assessment strategies for the identified content, ensuring effective integration into undergraduate medical education.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis multi-phase study involved a literature review, refinement through the Nominal Group Technique (NGT) with 19 experts, and a three-round Modified e-Delphi process with 69 HPE experts across Pakistan. Experts rated the importance of topics using a three-point Likert scale, and items achieving\u0026thinsp;\u0026ge;\u0026thinsp;80% agreement were included. Stability was tested using McNemar\u0026rsquo;s test, and teaching strategies and assessment methods were aligned during the final round.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe Nominal Group Technique (NGT) refined 54 initial content items into 37, eliminating 12, rephrasing 5, and adding 2. Through the Delphi process, 17 items achieved consensus, including bedside teaching, procedural skills, leadership, medical ethics, patient safety, and communication skills. Teaching strategies such as small-group discussions (SGD) and large-group interactive sessions (LGIS) accounted for over 50% agreement. Objective Structured Teaching Exercises (OSTE) emerged as the preferred assessment method. The response rates for the three Delphi rounds were 93%, 96%, and 90%, respectively\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study offers a structured framework for integrating HPE into undergraduate medical curricula, emphasizing pragmatic assessments and evidence-based teaching strategies. These findings are globally relevant, providing a roadmap for scalable curricular reform in five-year undergraduate medical programs.\u003c/p\u003e","manuscriptTitle":"Building the 8-Star Doctor: A Modified Delphi Study to Define, Teach, and Assess Health Professions Education for Undergraduate Medical Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-27 17:43:04","doi":"10.21203/rs.3.rs-6209064/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-06T08:42:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-04T18:44:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-30T12:20:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"40315433521395831884091492148390940840","date":"2025-05-23T17:55:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"58530705752200446005775018915004226214","date":"2025-05-23T13:26:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65443386899388017829677441989319084339","date":"2025-05-21T22:22:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77364193675067542763141217814194528280","date":"2025-05-21T15:03:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-21T14:19:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37991399917854451148094842742364688377","date":"2025-05-21T14:07:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-21T13:09:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-21T09:49:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-14T11:17:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-09T16:56:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-05-09T16:55:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"764dbec9-579b-40b9-992d-e3b0a1a64c42","owner":[],"postedDate":"May 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-18T16:03:48+00:00","versionOfRecord":{"articleIdentity":"rs-6209064","link":"https://doi.org/10.1186/s12909-025-07694-7","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-08-11 15:58:09","publishedOnDateReadable":"August 11th, 2025"},"versionCreatedAt":"2025-05-27 17:43:04","video":"","vorDoi":"10.1186/s12909-025-07694-7","vorDoiUrl":"https://doi.org/10.1186/s12909-025-07694-7","workflowStages":[]},"version":"v1","identity":"rs-6209064","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6209064","identity":"rs-6209064","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}