Overcoming Challenges in Implementation of Competency- Based Medical Education in India: Leveraging Postgraduates for Multiple Choice Item Design for Undergraduate Assessments in Pathology

Background The implementation of Competency-Based Medical Education (CBME) in India has highlighted significant challenges, including faculty shortages and the need for standardized assessments. Pathology postgraduates, often involved in undergraduate teaching, represent an underutilized resource. Training them in Multiple Choice Item (MCI) development and validation can improve assessment quality while addressing gaps in CBME implementation. Method A structured training program was conducted for nine first-year pathology postgraduates at a single institution. The program included nine interactive sessions on CBME principles, Bloom’s taxonomy, MCI construction, identification of technical flaws, validation processes, and blueprinting. Participants’ reactions and self-perceived learning were evaluated using Kirkpatrick Levels 1 and 2 through pre- and post-program surveys and structured feedback forms. Product evaluation analyzed the MCIs for difficulty and discrimination indices, and the need for revalidation by subject matter experts (SMEs). Open-ended feedback was thematically analyzed. Results Participants showed significant improvements in knowledge and confidence in MCI development (p < 0.05). Product evaluation revealed that 43.2% of MCIs required revalidation, but most met acceptable thresholds for difficulty (62.5%) and discrimination (75%). Feedback highlighted the program’s structured and practical focus, while suggesting improvements in session pacing and content depth. Multiple choice items predominantly targeted lower order thinking skills, reflecting participants’ novice status and the need for longitudinal support to improve question complexity. Conclusion This study demonstrates the feasibility of leveraging pathology postgraduates to address CBME implementation challenges. By equipping postgraduates with assessment design skills, the program improved undergraduate assessment quality while addressing faculty shortages. Future efforts should focus on expanding such programs across institutions, incorporating longitudinal mentorship, and evaluating their long-term impact on medical education outcomes.