The achievement of the goals of CBME is dependent on effective implementation strategies. The challenges often highlighted in the implementation of CBME are the need for sensitization and participation of all stakeholders, coordination among implementing authorities, and the need for trained faculty [3]. Among the above often cited factors, it can be observed that the implementation cycle of CBME lacks active student participation. Efforts to make CBME succeed are lacking in discrete, explicit measures to educate the learners in adapting to the newer roles and responsibilities that are expected of them. Our current efforts in implementing CBME are singularly inequitable, with the largest share of decision-making and sensitization aimed at faculty and institutions. However, it is seen that despite the traditional roles assigned to learners, attempts to include them as partners in the teaching learning process elicit better engagement and open avenues of growth in teaching learning [4].

Pedagogical strategies in CBME are aimed at adult learners, with the intention of active engagement with the course content and syllabus. In reality, the learner remains a least-engaged and least-informed passive consumer of educational strategies that faculty determine best suited for achieving the intended learning outcomes. This trend might be due to a commonly held belief that our learners are not accustomed to learning in an environment that fosters higher-order thinking skills and instead are used to rote learning [5]. Learners are made to attend the class passively for attendance and are often forced to absorb cognitive load disguised as active pedagogical methods. While this indicates a failure in faculty training, the inclusion of students’ responsibility in CBME implementation might prove a vital factor in creating an ethos of active learning. The inclusion of students in the design and implementation of the teaching and learning activities and co-creation in learning will create an ethos of growth. A vital requisite for the success of such a collaborative venture is good communication [4].

Learners have reported that the foundation course prior to entry into regular academics was beneficial. However, there was a lack of satisfaction with aspects of training, regarding the medical course, including few of the proposed pedagogical methods involved [3]. Resource materials designed to support the learner’s transition to active learner-centric methods are not available. Under the CBME, learners are considered as being capable of a degree of autonomy and this makes them accountable for their academic development. This intention of the new curriculum must be clarified and explicitly stated in order to help the transition of all learners from passive to more active participants in their learning process. This will enable effective implementation of the curriculum with better chances of achieving course outcomes. Within an aspirational move such as CBME, a lack of understanding and engagement of learners is a weak link that will deter and eventually derail the vision of producing competent IMGs.

Studies show that student participation in medical education must be increased to allow active involvement in the design of educational experiences [4]. This must begin by creating clear guidelines and material that showcase what is expected of a learner in the CBME. This will serve a dual purpose. It clarifies the level of competence that he/she is expected to achieve and inspires the teacher to move towards active learning strategies. This will improve learner engagement and enable students to participate as informed evaluators of curriculum and partners in curriculum design.

The steps that have been reported to include students in the medical education process vary from obtaining feedback to being co-creators of the curriculum. Student-led feedback is essential to identify the curricular areas that need improvement and to design an improved curriculum. Focus group interviews with students and electing student representatives to voice overall students’ opinions are better than traditional end-of-course course evaluation surveys. When the curriculum was restructured at the Vanderbilt University School of Medicine (VUSM), a Student Curriculum Committee was formed. The inclusion of students from the early stages of implementation through feedback from the VUSM’s Student Curriculum Committee facilitated the transition by identifying areas of concern for the learner [6]. We are of the opinion that student engagement, not only in giving their opinion but also in designing and implementing curriculum is required in a structured and formal manner. Active student participation in curriculum design has been described based on Arnstein’s Ladder model [7]. Here the authors suggest levels of student participation in course design, with the lowest rung being a “dictated curriculum” and the highest rung being “students in control.” The intervening six levels denote variable levels of participation that may be based on multiple factors related to the institution, faculty, or learner. Reports from other institutions that report active student participation in course design talk about students being module co-directors, co-creators of curriculum, and partners in pedagogic planning and processes [8-10].

A culture to involve students in decision-making, curriculum development, and evaluation after requisite training and sensitizing the teaching faculty towards acceptance of such collaboration must be consciously fostered. Integrated learning and early clinical exposure of CBME curriculum which emphasizes reflection and communication skills will make learner engagement in teaching-learning achievable. Practices such as self-directed learning can enable individual learners to contextualize the process of learning and thereby empower them to give meaningful feedback and to actively participate in course curriculum development.

We opine that institutions that are implementing CBME must make an effort to include the learners through feedback for curriculum evaluation and in the design of curriculum implementation to any degree possible. This includes empowering students through the implementation of active learning strategies that improve engagement and foster higher-order thinking skills. The formation of student bodies that are dedicated to curriculum improvement and feedback will also consolidate the process of student participation. These methods can be applied to most medical schools in India since they are often affiliated with a statutory council/university that designs the curriculum. Continuous collaboration between faculty and students is a must for the successful implementation of CBME. It is imperative that the crucial stakeholder in CBME, the learner, be included in its implementation for it to reach its intended goal.