Undergraduate medical students’ perceptions of case-based learning in preclinical physiology within a resource limited setting: a qualitative study

Case-based learning (CBL) is widely promoted in medical education to enhance engagement, conceptual understanding, and early clinical reasoning. However, most evidence supporting its effectiveness originates from well-resourced institutions, and their feasibility and impact within resource-limited preclinical settings remain uncertain, where large class sizes, limited infrastructure, and reliance on didactic teaching persist. This qualitative descriptive study explored undergraduate medical students’ perceptions of CBL implementation in preclinical physiology at a public-sector medical university. Four focus group discussions were conducted with 30 second-year Bachelor of Medicine, Bachelor of Surgery (MBBS) students. Data was audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke’s framework. Students valued CBL for promoting active participation, improved conceptual clarity, knowledge retention, and early development of clinical reasoning. However, its effectiveness was moderated by contextual constraints, including limited time, inconsistent facilitation, restricted clinical exposure, and lack of visual learning resources. Participants proposed feasible adaptations such as simplified case design, phased progression of complexity, standardized facilitation, and incorporation of low-cost multimedia aids. These findings suggest that while CBL is pedagogically valuable, successful implementation in resource-limited preclinical environments requires deliberate contextual adaptation rather than direct adoption of models developed in high-resource settings.