From Theory to Practice: Structural Barriers to Effective Clinical Training in Public Sector Teaching Hospitals

The transition from preclinical to clinical training is a critical phase in undergraduate medical education. In Pakistan, the MBBS curriculum spans five years, with the first two years primarily focused on basic sciences and the subsequent three years dedicated to clinical training. The third year marks the formal transition to hospital-based learning. While this structure aligns with regulatory frameworks, the shift from theory-based instruction to patient-centered clinical practice is often abrupt and challenging for students. Early clinical exposure has been shown to enhance student confidence, professional identity formation, and integration of theoretical knowledge into practice. 1 However, limited structured clinical orientation during the preclinical years may reduce preparedness forward-based learning. Strengthening case-based learning (CBL) and problem-based learning (PBL) during early years could help bridge this gap, as integrated curricula are associated with improved clinical reasoning skills. 2