Challenges in implementing integrated undergraduate medical curricula across low- and middle-income countries: A scoping review.

OBJECTIVES

Integrated curricula have become a core element of undergraduate medical education (UGME) reforms worldwide, including low- and middle-income countries (LMICs). LMICs, which are often characterized as resource-constrained settings, encounter challenges in integrated curricula implementation. However, these challenges are reported fragmentarily. This review mapped the literature on the implementation of integrated curricula in LMICs, with attention to reported challenges, contextual variation and gaps in the evidence base.

METHODOLOGY: Electronic searches were conducted between August 2025 and January 2026 at the Department of Medical Education, Faculty of Medicine, Universiti Kebangsaan Malaysia following the frameworks of Arksey and O'Malley and Levac et al. The literature published between January 2010 and December 2025 within LMIC medical schools was searched through PubMed, Scopus, Web of Science, EBSCO MEDLINE Complete and ERIC databases. Original peer-reviewed studies in English reporting the functional enactment of integrated undergraduate medical curricula were eligible for inclusion.

RESULTS

From 925 records identified, thirteen studies met the inclusion criteria. Six broad themes (with sub-themes) were identified: resources and infrastructure constraints (faculty shortages, lack of skills labs), governance and organizational barriers (policy-practice gaps, limited departmental autonomy), faculty development needs (role-transition resistance), assessment misalignment (exit exams undermining delivery), curriculum integration issues (content overload) and training settings constraints (rural supervision shortages). The findings indicated that while structural reforms are widespread, a deficiency in reporting on implementation outcomes remains a critical evidence gap.

CONCLUSION

The findings suggest that the implementation of integrated UGME curricula in LMICs depends not only on curriculum design but also on the strength of institutional system and contextual readiness to support reforms into practice.