Consensus-informed design of digital case-based learning for clinical and public health reasoning in undergraduate Community Medicine: a modified Delphi study

Community Medicine requires undergraduate medical students to integrate clinical reasoning with epidemiological interpretation, the social determinants of health, national health-programme linkage and preventive decision-making. Digital case-based learning (DCBL) may support this integration, but there is little agreement on how DCBL scenarios should be designed, delivered and assessed in this discipline. We aimed to identify expert agreement on essential elements of DCBL in undergraduate Community Medicine. We conducted a two-round modified electronic Delphi study at a medical college in Mysuru, India (October–December 2025). In Round 1, six purposively selected Community Medicine faculty answered an open-ended questionnaire; inductive thematic analysis produced a 23-item instrument across seven domains. In Round 2, ten experts rated each item once on a five-point relevance scale; controlled feedback and re-rating were not undertaken. Consensus was defined a priori as a median ≥ 4, an interquartile range ≤ 1 and ≥ 80% of ratings at 4 or 5. Consensus elements were then mapped to national undergraduate competencies as explicit or interpretative links. Reporting followed the ACCORD and CREDES guidance. Response rates were 100% in both rounds. Nineteen of 23 items (82.6%) met all three predefined consensus criteria; six of these met the agreement criterion exactly (8 of 10 experts). Consensus was complete for priority topics, case-design features, learning outcomes and reasoning steps. Interactive branching scenarios, embedded video or simulated interviews and decision trees reached consensus; text-based narratives did not. Clinical decision justification, reflective writing or case synthesis and OSPE/OSCE integration reached consensus; MCQs and short answers did not. Content and most reasoning elements mapped explicitly to national Community Medicine competencies; design and digital-format elements mapped only interpretatively. Expert item generation followed by a single independent rating round identified a provisional, consensus-informed framework for DCBL in undergraduate Community Medicine, emphasising authentic community-based cases, progressive disclosure, explicit clinical and public health reasoning, national-programme linkage, interactive formats and assessment of decision justification. Because ratings were not revisited after group feedback, the stability of this agreement is untested. The framework requires confirmation in a larger, multi-institutional panel and evaluation of its feasibility and effects on learner reasoning.