# Integrating health disparities and environmental health into community-based medical education: a qualitative study

## TL;DR

This study explores how to better integrate health disparities and environmental health into medical education in Pakistan to train socially accountable doctors.

## Contribution

The study provides insights into practical approaches for embedding health disparities and environmental health in competency-based medical education in a low-income country context.

## Key findings

- Six key themes emerged for integrating health disparities and environmental health into CBME, including community engagement and institutional support.
- Participants emphasized the need for early longitudinal placements and collaboration with local organizations to improve community responsiveness.
- Sustainable CBME requires structured planning, faculty training, and stakeholder partnerships.

## Abstract

Community-Based Medical Education (CBME) provides experiential learning that links medical training with real-world health needs. Integrating themes of health disparities and environmental health within CBME is critical for developing socially accountable physicians in low- and middle-income countries. However, limited evidence from Pakistan describes effective approaches for embedding these domains in undergraduate curricula. This study explored stakeholders perceptions on pragmatic approaches for incorporating health disparity and environmental health within competency-based learning at a public medical university.

A qualitative study using focus group discussions (FGDs) was conducted at Dow University of Health Sciences (DUHS), Karachi, Pakistan, f

rom April to June, 2025. Two FGDs were held with final-year medical students (n = 18; 9 participants per group), three with residents from different clinical departments (n = 30; 10 per group), and one with faculty members (n = 12). Participants were selected through convenience (learners) and purposive (faculty) sampling. The discussions were audio-recorded and transcribed verbatim, and Braun and Clarke's six steps approach was applied for thematic analysis.

Six themes emerged: (1) Enhancing medical education through CBME, (2) Addressing health inequalities through community engagement, (3) Issues in implementation (logistics, safety, cultural barriers), (4) Creating sustainable long-term partnerships with communities, (5) Integration of environmental and public health education, and (6) Monitoring and Evaluation for sustainable CBME. Participants emphasized putting early integrated longitudinal placements, institutional support, and collaboration with local organizations into practice to promote equitable and environmentally responsible practice.

Health-disparity and environmental health content integrated within CBME will improve learning context and responsiveness to the community. Structured planning, faculty training, and stakeholder partnerships are essential for sustainable implementation and for preparing graduates to address emerging community health challenges.

The online version contains supplementary material available at 10.1186/s12909-025-08485-w.