From fragmentation to integration: rethinking nutrition education in undergraduate medical curriculum in Pakistan through a mixed-methods study

Abstract

Nutrition plays a central role in the prevention and management of both communicable and noncommunicable diseases, yet its integration within undergraduate medical education remains inconsistent. This study aimed to assess the current status of nutrition education in MBBS programs in Pakistan and to propose a structured framework for curriculum enhancement. A mixed methods study was conducted in Rawalpindi and Islamabad, Pakistan. The study included a structured review of the Pakistan Medical and Dental Council MBBS curriculum 2024, a cross-sectional survey of 242 final-year medical students from four medical colleges, and in-depth interviews with 13 faculty members across key disciplines. The sample size for the quantitative component was calculated using OpenEpi, based on a population of 650 students. Data were collected using a structured questionnaire and a semi-structured interview guide. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were analyzed using thematic analysis. Findings from all components were triangulated. The curriculum review demonstrated that nutrition content is present but remains fragmented, with limited clinical integration and lack of defined competencies. Among students, 88.4 percent recognized the importance of nutrition in medical education, while only 28.1 percent perceived the curriculum as adequate. Exposure to nutrition was highest in community medicine (80.2 percent) and biochemistry (53.7 percent), but substantially lower in clinical disciplines such as internal medicine (28.9 percent) and pediatrics (36.4 percent). Teaching was predominantly lecture-based (78.5 percent), with limited use of interactive methods. Students reported moderate confidence in general nutrition knowledge but low preparedness for managing nutrition-related conditions. Qualitative findings highlighted gaps in integration, assessment, and clinical application, along with a need for structured curriculum reform. Despite recent curricular advancements, nutrition education in undergraduate medical training remains insufficiently integrated and clinically oriented. The proposed competency-based framework offers a practical approach to strengthening nutrition education within existing curricular structures, with the potential to improve clinical preparedness and align medical training with population health needs.