Leveraging the Educational Climate: Addressing Challenges and Developing Strategies for Competency-Based Curricula in Ethiopian Health Science Colleges

Abstract

Background

Health professional education is essential for training effective clinicians and skilled health workers, supporting universal healthcare. It includes disciplines like medicine, nursing, and allied health across various institutions. The educational climate significantly affects teaching, learning, and student satisfaction, impacting curriculum success and academic achievement. A competency-based curriculum (CBC) focuses on applying knowledge, skills, attitudes, and values, enhancing graduates’ readiness for the labor market. While instructors have concerns about CBC adoption, its proper implementation can improve educational quality and graduate competencies. This study will examine the experiences and challenges faced by university instructors in implementing CBC in Ethiopian health science colleges and seek strategies to address these challenges effectively.

Methodology

This study adheres to the phenomenological theory and uses a qualitative research methodology. The study includes 20 male and 16 female instructors, school deans, department heads, and module coordinators from 2 universities. The investigation focuses on themes related to training, administration, motivation, and resources as well as potential strategies to overcome the challenges in CBC implementation.

Results

The study investigated various factors affecting the implementation of CBC. The findings indicate that the most common challenges are inadequate training for instructors regarding the curriculum and shortage of educational resources necessary for its implementation. Additionally, challenges related to motivation, administration, and resources were identified as contributing factors that hindered CBC implementation. Beyond identifying these barriers, the study proposes context-specific strategies, including targeted faculty development programs, optimized resource allocation, and enhanced administrative support, which collectively aim to improve curriculum adoption and effectiveness. These findings provide actionable insights to inform policy and practice in similar educational environments facing implementation hurdles.

Conclusion and Recommendation

To effectively implement a CBC in Ethiopian health science colleges and prepare graduates for the job market, several key actions are necessary. University administrators, departments, and instructors must engage in discussions to identify solutions. Continuous awareness, capacity-building training, and organized workshops on CBC are crucial for overcoming the major challenges. Moreover, prioritizing human and material resources, equipping demonstration and simulation rooms, and expanding practical sites are essential interventions to facilitate its implementation. Additionally, effective communication with all stakeholders is vital for successful CBC implementation.

Introduction

Health professional education is a field of study in higher education that aims to empower clinicians to become effective educators, fostering skilled health workers to ensure universal healthcare, all within an evolving healthcare landscape. ¹ Health professional education includes various disciplines including medicine, nursing, midwifery, radiology and other allied health science disciplines in a wide array of academic settings. The educational climate in higher education embodies the holistic environment and culture of an institution, significantly shaping teaching, learning, and student experiences. Recently, there has been growing attention to the learning environment in undergraduate health professionals’ education. It is a key determinant of curriculum success, impacting behavior, academic achievements, satisfaction, and aspirations. ²

Competency-based curriculum (CBC) has emerged as a prominent education system, emphasizing the application of knowledge, skills, attitudes, and values by learners. In response to the rapidly evolving job markets, educational institutions worldwide are striving to implement curricula that prepare students effectively. However, this endeavor poses challenges as educational institutions struggle to meet the increasing demands.^3–5 Major obstacles include insufficient resources, inadequate training, and overwhelming workloads, hampering the effective implementation of CBC.^6,7

To address these issues, studies suggest involving heads of departments and deans of faculties in monitoring colleagues to provide essential administrative support during the implementation process, others emphasize the importance of strong leadership in overcoming technical and adaptive alignment issues associated with instructional standards.^8–10 This includes designing effective Teacher Professional Development (TPD), addressing content overload, accommodating diverse learner characteristics, ensuring proper integration of courses within textbooks, and providing appropriate preservice training to navigate the challenges of CBC implementation.

In Africa, conventional content-based curriculum has been a primary method of education for a long time, yet it has encountered rising criticism due to its shortcomings in sufficiently preparing graduates for the ever-changing and demanding job market. Graduates often lacked essential skills, practical knowledge, and the ability to adapt rapidly to the dynamic work environment.^11,12

Recognizing this significant gap between traditional education outcomes and the skills needed in the modern workforce, educational policymakers in various African nations, including Ethiopia, embarked on transformative educational reforms. In this regard, educational institutions integrate competencies into the undergraduate curriculum to produce well-rounded graduates equipped for the contemporary job markets, an approach advocated by researchers whose works highlights the significance of CBC in enhancing graduates’ employability and skills in African countries like Ethiopia. ¹¹

The introduction of a CBC has resulted in a substantial transformation in medical and health science education programs in Ethiopia in recent years, with the goal of producing qualified healthcare professionals and ensuring that medical education progress in alignment with the healthcare needs of the community. ¹³ In order to fulfill this pledge, Ethiopia has implemented the “New Innovative Medical Education Initiative” and Competency-Based Medical Education, which are based on the Canadian Medical Education Directives for Specialists competency framework, since 2012 and 2015, respectively.^14,15 Furthermore, programs in health sciences at the undergraduate level have adapted to the new curricular standards as part of this reform.

Despite these efforts, new recent events such as the triple dangers of COVID-19, conflict, and climate change posed significant difficulties for Ethiopian medical education, particularly at the undergraduate level. As a result, despite the fact that effective CBC implementation can elevate education quality and graduates’ competencies, the existing gap between graduates’ competencies and job market demands persists. ³ Consequently, implementing CBC in health science colleges poses significant challenges.

Scarce evidence exists regarding the experiences and challenges of CBC implementation in health science programs, hindering educational reforms. Instructors and undergraduate program coordinators have raised concerns about CBC implementation, highlighting the need for further research to explore and address these challenges.

Therefore, this study aims to fill the existing knowledge gap by investigating the firsthand experiences and perspectives of university instructors regarding the challenges faced in implementing the CBC within selected health science colleges in Ethiopia. Additionally, the research seeks to identify and explore effective, context-specific strategies to overcome these challenges and improve the implementation process.

Methodology and Materials

Study area

The research was carried out in 2 public universities in Ethiopia, each offering health science programs and actively implementing the CBC. The universities included in this study were Addis Ababa University and Hawassa University.

Study period

The study period spanned from November 15, 2023, to January 23, 2024, allowing for a comprehensive assessment of the implementation of CBC in the selected health science departments. Specifically, the departments of Medicine, Midwifery, Nursing and Medical Radiology Technology were selected as the focal areas of investigation to gain valuable insights into the challenges and experiences faced by university instructors in the context of CBC implementation.

Study design

This research adopted a qualitative approach to address its research questions, recognizing the significant role of participants as key sources of information. Specifically, the study design employed was a descriptive exploratory study, aiming to delve deeply into the experiences and challenges faced by university instructors in implementing and managing CBC. Qualitative research was deemed suitable for this investigation as it allows participants to vividly describe their encounters and difficulties related to CBC implementation. Qualitative research entails a naturalistic inquiry employing noninterfering data collection strategies to explore the natural flow of events and processes and the participants’ interpretations. ¹⁶

The foundation of this study rested upon the phenomenological theory, which aims to unravel the meaning of lived experiences for multiple individuals concerning a particular concept or phenomenon. ¹⁷ Adopting the phenomenological perspective, the researcher set aside any preconceived notions and sought to gather data on how individuals make sense of their encounters. Phenomenology, as a form of qualitative research, examines an individual's lived experiences within their world. While this approach is potent, it can also be intimidating to researchers. However, given the focus on the lived experiences and challenges of CBC implementation in this study, the phenomenological theoretical perspective was chosen to explore the complexities and intricacies faced by university instructors.

Finally, in addition to exploring experiences and challenges, the study sought to propose potential strategies to address CBC implementation problems. The exchange of experiences among various stakeholders, including departments, instructors, and students, was deemed essential in devising effective solutions for these challenges. By fostering open communication and sharing insights, this study aimed to contribute to the advancement of CBC implementation and ultimately enhance the quality of health professional education in Ethiopia.

To ensure the rigor and credibility of the study, the recommended standards for reporting qualitative research were adhered to. ¹⁸

Reflexivity statement

This study involved 4 investigators with diverse expertise shaping the research. Two PhD holders, TF and AA, led the qualitative design and methodology, while YM and AB, medical educators pursuing PhDs, contributed practical insights from curriculum design and collaboration with Ethiopian educational bodies. All researchers participated in transcription and translation to enhance data reliability and collaboratively reviewed themes to reduce bias. Their familiarity with local policies informed the focus on competency-based curricula. Reflexive journaling and peer debriefing were used to minimize bias, and professional relationships with participants promoted trust while addressing social desirability bias. These combined factors ensured the study's transparency and trustworthiness.

Study population

The study participants consisted of department heads, school deans, program coordinators and faculty members who possessed substantial experience in implementing the CBC within the designated study area. These individuals were chosen based on their expertise and direct involvement in the CBC implementation process, ensuring that their insights and perspectives would be valuable in shedding light on the challenges and successes of the curriculum's adoption. The selection of participants aimed to capture a diverse range of experiences and perspectives, providing a comprehensive understanding of the nuances and intricacies associated with CBC implementation in the academic setting.

Sampling technique

A combination of purposeful and convenient sampling techniques was employed to select participants from 2 Ethiopian university health science colleges. In each university, 4 departments that had implemented CBC were carefully chosen. The study included the department heads and 5 senior instructors from each selected department, ensuring a comprehensive representation of experiences and perspectives. Furthermore, the dean and undergraduate program coordinators from each university were also included in the study, adding valuable insights from key stakeholders involved in CBC implementation.

To ensure data saturation and achieve a comprehensive understanding, the number of interviews was determined by the point at which additional data ceased to yield new codes or themes, consistent with Caulfield's approach to thematic analysis. ¹⁹ This iterative process involved repeatedly coding and reviewing data to identify patterns until redundancy was reached, indicating saturation. Multiple coders independently analyzed the transcripts to enhance reliability, and discrepancies were resolved through discussion to maintain coding consistency. By systematically assessing for the absence of novel insights, we ensured that the data collected were sufficiently rich and detailed for a robust thematic interpretation. This practice aligns with established qualitative research principles that define saturation as the threshold beyond which further data collection offers no substantive analytic benefit, thereby reinforcing the validity and thoroughness of the findings.

Data collection tool and procedure

For data collection, a meticulously designed semistructured interview guide was developed, drawing insights from various relevant literature sources. ²⁰ To enhance the tool's validity, it was critically reviewed and refined by 2 experts in the field prior to the actual data collection phase. This iterative process ensured that the interview guide effectively captured the key aspects of the study objectives.

Upon obtaining informed consent from the participants, a team of 5 skilled data collectors conducted the interviews using the prepared interview guide. To ensure accuracy and completeness, a voice recorder was utilized to record the interview proceedings. Additionally, detailed field notes were maintained throughout the data collection process, providing valuable context and facilitating improvements in subsequent interviews. These field notes served as a reflective tool to enhance the overall data collection process, ensuring that essential insights were captured comprehensively.

Data analysis technique

The data collected from the participants underwent meticulous transcription, wherein the verbatim Amharic interviews were translated into an English transcript. To ensure the credibility and dependability of the data, the primary researcher and an external expert independently conducted the transcription and translation processes. Any discrepancies that emerged between the 2 transcriptions were resolved through rigorous discussions.

During the transcription and translation, the data was carefully anonymized to protect the participants’ confidentiality and privacy.

For the qualitative data obtained from in-depth interview, a systematic approach was adopted for analysis, following Jack Caulfield's 6-step thematic analysis method.

Step 1 (Familiarization): The audio recordings were repeatedly listened to, and the transcripts were thoroughly reviewed to gain a comprehensive understanding of the data.

Step 2 (Coding): Coding was carried out by meticulously describing shorthand levels from the relevant sections of the text, closely aligned with the study's objectives. This enabled the researchers to create concise and meaningful summaries of recurring themes and patterns evident in the data, while eliminating irrelevant or ambiguous coding.

Step 3 (Generating themes): Once patterns and connections were identified in the codes, themes were thoughtfully generated, capturing the essence and key findings of the data.

Step 4 (Reviewing themes): The representativeness and accuracy of the emerged themes were rigorously evaluated by cross-referencing them with the entire data set, ensuring their alignment with participants’ perspectives.

Step 5 (Defining and naming themes): Clear and straightforward names were assigned to the themes, ensuring their intelligibility and coherence.

Step 6 (Writing up): The final write-up was meticulously crafted, incorporating the outcomes of each previous step to present a robust and meaningful analysis of the data.

By employing this rigorous analytical approach, the study aimed to present a comprehensive and reliable exploration of the experiences and challenges faced by university instructors in implementing the CBC within selected health science colleges in Ethiopia.

Results

In this comprehensive study, a total of 36 participants (20 male and 16 female), including school deans, department heads, module coordinators, and instructors, were actively involved. These participants were meticulously selected from 2 esteemed universities, all of which offered health science programs and had embarked on the challenging journey of implementing CBC.

The gathered data was subjected to a rigorous thematic analysis, yielding an extensive dataset comprising 235 distinct codes and 12 categories. These categories represented a diverse range of insights and perspectives on the CBC implementation process. Guided by the research objectives, the emerging data led to the identification of 2 major overarching themes.

The first major theme delves into the significant challenges that significantly impact the successful implementation of CBC. These challenges revolve around crucial aspects such as training, administration, motivation, and availability of resources. The study diligently explored the multifaceted nature of these challenges, shedding light on the complexities and interdependencies that arise during the implementation of this CBC.

Conversely, the second major theme encompasses potential strategies that have the power to effectively address and overcome the challenges encountered in the CBC implementation process. These strategies were carefully examined and categorized into subthemes, representing actionable approaches and recommendations for enhancing the curriculum's successful implementation.

Theme 1: Major challenges that affect the implementation of CBC

Subtheme 1.1.: Training-related challenges

One of the prominent challenges hindering the successful implementation of CBC, as voiced by the participants, revolves around training-related issues. The lack of proper training emerged as a major concern, with instructors expressing their limitations in effectively implementing the CBC. Participants revealed that there were no organized training programs or workshops specifically tailored to equip instructors with the necessary knowledge and skills required for CBC implementation (Table 1).

I believe the lack of appropriate training to implement CBC is the major issue we face. (Participant 2)

Table 1.

Themes, Subthemes and Codes for CBC Implementation Challenges.

Themes	Subthemes	Codes
Major challenges to CBC implementation	Training-related challenges	Lack of capacity-building for department heads, coordinators, instructors
	Administrative-related challenges	Limited leadership support and poor organizational buy-in
	Resource-related challenges	Insufficient human resources and inadequate infrastructure
	Motivation-related challenges	Resistance and skepticism among instructors

Note. CBC, competency-based curriculum.

Additionally, the rapid implementation of CBC without sufficient preparatory measures was highlighted as a significant obstacle. The swift rollout of the new curriculum without providing instructors enough time to adequately prepare created a substantial gap, adding complexities to the implementation process.

Quickly starting the implementation of the new curriculum, without giving enough time for teachers to effectively prepare, is one factor that adds difficulty to CBC implementation. (Participant 3)

Moreover, the lack of involvement of instructors in the curriculum development process was identified as another noteworthy concern. Participants shared their experiences of not being included or informed about the drafting of the curriculum, which left them disconnected from crucial decision-making stages.

Me and my colleagues did not have any information about the draft curriculum preparation. (Participant 10)

The sentiment was echoed by another participant who highlighted that the majority of instructors were not invited to contribute their insights during the curriculum's preparation phase.

The majority of instructors were not invited to comment on the drafted curriculum during curriculum preparation. (Participant 2)

These training-related challenges have manifested as significant barriers in the smooth implementation of CBC, underscoring the importance of comprehensive and tailored training programs for instructors to effectively embrace and execute the CBC.

Subtheme 1.2.: Administrative-related challenges

Within this subtheme, a range of administrative problems were identified that significantly affected the successful orientation and implementation of the CBC. Participants highlighted issues related to the orientation of instructors about the new CBC, lack of awareness creation and capacity building initiatives, and the presence of irrelevant contents in the developed curriculum. Additionally, administrative problems extended to the fragmentation of courses in the module, the demand for different instructors from various departments simultaneously, and communication gaps at different levels of the university hierarchy (Table 1).

One of the primary administrative problems observed was the lack of effective orientation for instructors about the new CBC, resulting in a significant gap in their understanding and ability to implement it effectively.

Our department heads did not inform us about the new curriculum. (Participant 17)

Furthermore, participants reported that no prior awareness creation or capacity building programs were organized for staff members regarding the implementation of CBC. This lack of preparation hindered instructors from confidently delivering the new curriculum.

Without any prior knowledge about the new curriculum, our department head instructed us to teach based on the newly developed curriculum. (Participant 3)

Concerns were raised about the inclusion of irrelevant contents in the newly developed curriculum, making it challenging to apply certain competencies in practice. Participants stressed the need for modification by department heads and program coordinators to address these issues effectively.

There were some contents (competencies) added that were not relevant and difficult to put into practice. So, it needs some modification by department heads and program coordinators. (Participant 20)

In addition, fragmentation of the course within the module emerged as a major problem affecting the curriculum's coherence and manageability. Combining basic science courses within 1 or 2 modules based on their similarity created an overload for students, resulting in difficulties in content alignment when some instructors missed their classes.

Without learning Anatomy, that is if they have not covered basic science courses and if they learn Pathology, students will become incompetent. (Participant 36)

Moreover, the curriculum's demands necessitated the involvement of different instructors from various departments to deliver courses simultaneously, creating significant challenges for departments in managing their schedules and resources.

Inviting instructors from different departments to deliver one course is very challenging. (Participant 21)

Lastly, communication gaps were identified as another crucial issue hindering effective CBC implementation. Participants highlighted the need for better vertical and horizontal communication to ensure that all stakeholders were well-informed about the CBC process.

There is a gap in communication about the curriculum. When the curriculum was implemented, only the department head was invited. There was no communication to make sure everyone knew in detail about the process. Only some individuals took the initiative to update themselves. (Participant 17)

Addressing these administrative challenges is imperative to facilitate the successful implementation of CBC and ensure a coherent and efficient learning experience for instructors and students alike.

Subtheme 1.3.: Resource-related challenges

Within this subtheme, several challenges related to the availability of human and material resources were identified as significant factors affecting the successful implementation of the CBC. Participants highlighted increased demand for additional human resources, shortage of essential material resources, and the impact of large student to instructor ratio on CBC implementation (Table 1).

The newly designed CBC curriculum requires a diverse pool of instructors with different specializations, placing a considerable demand on human resources. Participants emphasized the need for additional staff members to share the workload and facilitate effective CBC delivery.

Without additional staff employment, it is difficult to overtake the curriculum CBC, as it needs more human resources than the traditional curriculum. (Participant 14)

Moreover, the implementation of CBC resulted in increased workload for both teachers and students, with rigid schedules posing additional challenges.

Because of the implementation of competency-based curriculum, it increased workload on both teachers and students with rigid schedules. (Participant 26)

In addition to human resources, the successful implementation of CBC necessitates adequate material resources and well-organized facilities. Participants reported that the scarcity of practical skill learning materials served as a bottleneck for proper CBC implementation.

There was a scarcity of available resources and facilities for the implementation of the curriculum. (Participant 4)

The lack of preparation of skill lab materials posed a significant challenge to CBC implementation, as health science education heavily relies on practical skill learning materials to acquire appropriate skills.

Without the preparation of skill lab materials, it was difficult to implement the curriculum, as health science education demands different skill lab materials to acquire appropriate skills. (Participant 15)

Furthermore, the large number of students enrolled in health science departments was identified as another obstacle to effective CBC implementation. The high student-to-teacher ratio posed difficulties in fully executing the curriculum, particularly within laboratory and hospital settings.

Large class size (imbalance between the numbers of teachers to students’ ratio) has a great impact on competency-based curriculum implementation. (Participant 4)

When there are a large number of students, the time they spend practicing in laboratories and hospitals may be short. (Participant 29)

Addressing these resource constraints is crucial to ensure the successful implementation of CBC and provide students with a conducive and enriching learning experience. Allocating adequate human and material resources and managing student numbers effectively can greatly enhance the delivery and impact of the CBC curriculum in health science programs.

Subtheme 1.4.: Motivation-related challenges

This subtheme delves into the challenges posed by certain instructors who were resistant to accepting the CBC. These instructors expressed a belief that the previous traditional curriculum was more effective in facilitating students’ knowledge and skill acquisition compared to the newly developed CBC. Consequently, they exhibited a lack of interest and willingness to implement CBC, making them change-resistant and unmotivated (Table 1).

Participants in the study observed that some instructors demonstrated rigidity in accepting change, particularly when transitioning from the traditional learning method to the new CBC approach.

Some instructors are rigid to accept change…. (Participant 5)

This resistance was perceived to be one of the significant factors hindering the effective implementation of CBC. Instructors who were reluctant to embrace the CBC model lacked motivation to adapt their teaching practices to align with the new curriculum's objectives.

Lack of motivation of the teachers to shift from the traditional learning method to the new approach is one factor affecting the curriculum implementation…. (Participant 28)

Addressing this resistance and lack of motivation among certain instructors is vital to ensure the successful implementation and adoption of CBC in health science colleges. Engaging with these instructors through targeted professional development programs, highlighting the benefits of CBC for student learning outcomes, and addressing their concerns can facilitate a smoother transition and foster a more positive attitude towards the curriculum changes. Creating a supportive and collaborative environment for instructors to share their experiences and best practices can also contribute to overcoming resistance and encouraging active participation in CBC implementation.

Theme 2: Potential strategies to overcome CBC-related challenges

Under this theme, participants highlighted several potential strategies to address the challenges encountered during the implementation of the CBC. These strategies aimed to enhance the successful adoption of CBC and improve the overall educational environment for health science programs (Table 2).

Table 2.

Strategy Matrix for CBC Implementation.

Challenge	Strategy	Outcome
Training-related	Continuous in-service training and capacity building	Improved educator knowledge and CBC implementation
Administrative	Engagement and active support from university leadership	Streamlined administration and enhanced coordination
Resource-related	Hiring additional staff; improving facilities and materials	Reduced workload; better practical learning environments
Motivation-related	Awareness campaigns and motivational initiatives	Increased instructor buy-in and positive attitudes
Cross-cutting (collaboration)	Experience sharing and interdepartmental collaboration	Best practice diffusion and adaptive problem-solving

Note. CBC, competency-based curriculum.

Strategy 1: Continuous in-service training for department heads, module coordinators, and instructors

Participants emphasized the importance of continuous in-service training for department heads, module coordinators, and instructors to gain a comprehensive understanding of the CBC's full range and its implementation. They recognized that providing on-the-job training through seminars, workshops, and relevant capacity-building initiatives could significantly contribute to resolving certain CBC-related issues.

Provision of on-the-job training through in-service training, seminars, and workshops can solve some problems of CBC. (Participant 1)

Strategy 2: Infrastructure development to support CBC implementation

Another key strategy mentioned by participants was the need to fulfill the necessary infrastructure requirements for effective CBC implementation. This included the provision of demonstration materials, teaching and student guide manuals, and adequate classroom spaces. Additionally, participants emphasized the importance of investing in skill and demonstration laboratories to support students’ hands-on learning experiences.

Ensuring adequate infrastructures, such as employing more teachers, providing adequate teaching and learning materials, and establishing well-equipped skill and demonstration laboratories, might overcome the CBC-related problems. (Participant 33)

Strategy 3: Experience sharing and collaboration among departments and instructors

Participants identified the value of experience sharing between different departments, module coordinators, and instructors to address the challenges faced during CBC implementation. Collaborative efforts and open communication were seen as important strategies for finding effective solutions to common problems.

Experience sharing between instructors and departments about the challenges and strategies on how to solve the problem is very important. (Participant 5)

Strategy 4: Awareness creation and capacity building for implementers

Awareness creation and briefings were highlighted as essential strategies to build the capacity of implementers and ensure a successful curriculum implementation. Participants stressed the significance of constant awareness creation through workshops, seminars, and training sessions to explain the rationale behind CBC and its benefits.

Constant awareness creation and briefing workshops and seminars about the rationale of the CBC is one important strategy to solve the problem. (Participant 8)

Strategy 5: Higher officials’ cooperation and support

Participants emphasized that the effective implementation of CBC requires the cooperation and support of higher officials, both within the university and beyond. They recognized that CBC demands substantial human, material, and financial resources, and it is essential for higher officials to understand the specific needs of Health Science departments to integrate CBC successfully into their colleges.

It requires many human resources, material resources, and financial resources. The higher officials do not fully understand the demands of Health Science departments to integrate CBC in their colleges. (Multiple Participants)

Implementing these potential strategies requires collaboration and commitment from various stakeholders, including university administrators, faculty members, and policymakers. By adopting these strategies, health science colleges in Ethiopia can overcome the challenges of CBC implementation and create an educational environment that fosters competency development and academic achievement among students.

Discussion

This study aimed to investigate the major challenges faced in implementing the CBC and to identify practical strategies for overcoming these obstacles. The findings revealed that key barriers include inadequate awareness creation and training about the CBC, coupled with a scarcity of essential educational resources. Importantly, these constraints are not unique to the present context but resonate with findings from similar educational settings globally, suggesting systemic issues associated with curriculum reforms in resource-limited environments.

For instance, consistent with the research undertaken at the University of South Africa, ineffective capacitation of teachers and insufficient resource availability significantly impeded the successful execution of curriculum changes.^1,21 This points to a broader pattern wherein teacher preparedness and material sufficiency are critical determinants of curriculum success. In South Africa, and likewise in this study, high teacher workloads and limited training opportunities further exacerbated the challenges, underscoring the multifaceted nature of barriers in educational reform implementation. This aligns with international researches conducted in other settings, indicating that merely revising curricular content without simultaneously enhancing TPD and resourcing is insufficient to produce substantive pedagogical change. ¹

A particularly salient finding in the present study relates to a lack of capacity development for department heads, module coordinators, and instructors. This gap mirrors findings emphasize that insufficient TPD, along with course content overload and complexity, undermines effective curriculum implementation. ²²

Moreover, the study underscores the critical importance of instructor involvement in curriculum development. The observed disconnect between curriculum designers and frontline educators is a recurring theme in educational reform literature. Similar to the recommendations, teachers not only enhance ownership but also enriches curriculum relevance and feasibility. ²² Comparative evidence from countries like Finland and Singapore suggests that curricula codesigned with active teacher participation tend to achieve higher implementation success and adaptability. Thus, this study's findings strengthen global calls for participatory curriculum design processes coupled with ongoing professional growth opportunities. ²³

Administrative challenges emerged as another formidable barrier. Without proactive support and collaboration from university administrators and higher-level authorities, effective implementation remained elusive. This finding aligns with broader governance issues documented in curriculum reform literature, where leadership commitment and institutional buy-in are consistently identified as pivotal enablers. ²⁴ The study further revealed that class size and instructor-to-student ratios significantly impact CBC delivery, echoing findings that highlight the detrimental effects of overcrowded classrooms on educational outcomes, particularly in rural or developing country settings. ²⁴ Such challenges have been widely corroborated; for example, the World Bank's analysis of emphasizes that optimal learner–teacher ratios are fundamental for achieving competency-based instructional goals. ²⁵

Instructor motivation and resistance to pedagogical change emerged as additional impediments. Resistance to innovation in teaching methods is a well-documented phenomenon that requires targeted interventions. The study's suggestion of continuous, in-service awareness creation training echoes strategies used successfully in OECD countries, where sustained professional development has been linked to greater teacher buy-in and competency acquisition. ²⁶ This approach recognizes that change management is integral to curriculum reform and that addressing teachers’ attitudes and beliefs is as crucial as enhancing their technical skills.

In proposing strategies for improvement, the study appropriately emphasizes infrastructure investment including recruitment of additional faculty, procurement of teaching and learning materials, and upgrading of skill and demonstration laboratories. These recommendations cohere with prior research that highlighting insufficient infrastructure and understaffing critically undermine CBC implementation efforts. ²⁶ Globally, educational reforms show that infrastructure deficits can negate even the most well-intentioned curricular innovations, reinforcing the importance of systemic and resource-focused reforms. ²⁶

Furthermore, this study's recognition of early resource preparation and comprehensive training is consistent with empirical evidence that effective curriculum rollout depends heavily on timely availability of materials, appropriate scheduling, and robust capacity-building frameworks. ²⁷ Such findings mirror recommendations from international studies advocating for frontloaded investment into teacher preparation and material readiness to smooth transitional challenges in competency-based education.^28,29 Capacity building through workshops and seminars emerges as a proven mechanism for raising instructor awareness and competence, as also argued by Chemagosi. ²⁹

Lastly, the study advocates for knowledge-sharing and benchmarking with institutions that have successfully implemented CBC. This aligns well with global best practices in educational innovation diffusion, where interinstitutional collaboration fosters learning, accelerates problem-solving, and enhances contextual adaptation of reforms. ³⁰ while the study identifies infrastructure and human resource deficits as primary challenges, it would benefit from deeper analysis of underlying systemic issues, such as policy incoherence, political will, and socioeconomic factors influencing educational reform sustainability. For example, contrasting with high-income countries where CBC reforms often succeed due to integrated policy frameworks and robust educational ecosystems, resource-constrained settings experience compounded difficulties that transcend mere resource inadequacies. ³¹

Moreover, the findings highlight an implementation gap that suggests top-down curriculum mandates may clash with ground-level realities. Comparative studies in countries like Kenya and Ghana reveal that curriculum reforms driven primarily by centralized policymaking often face resistance or adaptation challenges at school and instructor levels when insufficient participatory planning or contextual tailoring occurs. ³² Thus, advancing CBC requires more holistic, multistakeholder engagement strategies and adaptive policy designs that acknowledge local constraints and teacher agency.

In summary, the findings reveal persistent global challenges in implementing competency-based curricula, including the critical need for teacher empowerment, sufficient resources, strong leadership support, and responsiveness to local contexts. However, in low-resource settings, the feasibility of proposed interventions must be carefully considered, as limited infrastructure and funding may constrain their implementation. This study's findings align with international CBC literature emphasizing that technical curriculum changes alone are insufficient without addressing systemic, cultural, and motivational factors.^33,34 Therefore, policy efforts at institutional and national levels should prioritize comprehensive support mechanisms that address these multifaceted challenges. Future research should include longitudinal mixed-methods studies to explore how interventions evolve and how contextual adaptations influence CBC effectiveness across diverse educational environments.

Conclusion and Recommendations

This study contributes novel, context-specific insights to the global discourse on CBC implementation by identifying unique challenges faced within Ethiopian health science colleges, including gaps in capacity building, administrative support, instructor motivation, and resource availability. Notably, insufficient training for department heads, module coordinators, and instructors emerged as a central barrier, underscoring the urgent need for continuous professional development tailored to local conditions. The critical role of administrative engagement and strong leadership in overcoming organizational challenges was also confirmed, alongside the necessity of addressing educator resistance through clear communication and supportive environments. Adequate human and material resources remain essential to facilitate practical, hands-on training. Moving forward, Ethiopian health science colleges should prioritize sustained capacity building, enhanced resource allocation, and leadership involvement to improve CBC implementation. These measures will help produce competent healthcare professionals prepared to meet the evolving needs of the sector, thereby advancing more effective and sustainable educational reform within the country.

Based on the findings of this study, several key recommendations emerge to address the major challenges identified in implementing CBC. University administrators, departments, and instructors should engage in thorough discussions to understand and tackle the issues hindering the successful implementation of CBC. Collaborative efforts among these stakeholders are essential to find viable solutions and ensure a smoother adoption of the curriculum.

To enhance CBC implementation, continuous awareness creation and capacity building training should be prioritized. Regular seminars and workshops focusing on CBC can equip department heads, module coordinators, and instructors with the necessary knowledge and skills to effectively navigate the challenges associated with the curriculum. These training sessions should emphasize innovative teaching methodologies, curriculum development, and assessment strategies that align with the competency-based approach.

Moreover, it is imperative to address the shortage of human and material resources hindering the implementation process. Universities and departments should invest in recruiting additional qualified instructors with diverse specialization mixtures to share the workload and meet the demands of the CBC. Equipping demonstration and simulation rooms with the necessary teaching and learning materials will facilitate experiential learning, a crucial aspect of CBC.

Furthermore, expanding the number of practical sites and ensuring adequate resources in these sites will enhance students’ hands-on learning experiences. These practical opportunities are essential for students to acquire the competencies needed for their future roles in the healthcare field.

Lastly, proper vertical and horizontal communication with all stakeholders is vital to support the effective implementation of CBC. Regular and transparent communication channels between university administrators, department heads, module coordinators, instructors, and students will foster a collaborative environment that allows for feedback, problem-solving, and continuous improvement.

By implementing these recommendations, universities can better address the challenges of CBC implementation and create an environment that fosters effective teaching, learning, and curriculum delivery, ultimately producing competent and well-prepared healthcare professionals.

Strengths and Limitations

This study addressed a crucial and pressing issue that significantly impacts department heads and instructors involved in CBC implementation. By focusing on the common challenges faced during the adoption of CBC and identifying potential strategies to overcome these obstacles, the study provides valuable insights that can aid in enhancing the implementation process.

However, it is essential to acknowledge the study's limitations. The research was conducted within a relatively short period of time, which may have limited the depth and breadth of data collection. Additionally, the fact that the universities were in the early stages of CBC implementation might have impacted the study's ability to assess the curriculum's overall success.

Despite these limitations, the study's findings offer valuable contributions to the understanding of CBC implementation challenges and potential solutions. It highlights the importance of addressing capacity building, administrative support, motivation, and resource availability to improve the curriculum adoption process. As more universities progress in CBC implementation, future research can build upon this study to assess the long-term impact and success of the curriculum, thus providing a more comprehensive evaluation of its effectiveness in producing competent healthcare professionals.

Ethical Considerations

Prior to commencing the study, ethical clearance was diligently sought and obtained from the Institutional Review Board of Addis Ababa University, College of education and behavioral studies, ensuring that all ethical considerations were meticulously addressed. Moreover, formal permission to conduct the research was sought and granted from the selected universities, establishing a strong foundation of ethical compliance.

The study participants were actively engaged in the informed consent process, where they were comprehensively informed about the study's purpose, objectives, and potential implications. Both verbal and written consent were obtained from each participant, signifying their voluntary willingness to partake in the study.

To uphold the participants’ confidentiality and protect their privacy, the data collection procedures were designed to maintain anonymity. The researchers diligently ensured that no personal identifiers were included in the data collection process or the subsequent analysis, providing a shield of confidentiality for each participant.

By adhering to these ethical guidelines, the study aimed to safeguard the rights and well-being of the participants, foster trust and transparency, and uphold the highest standards of ethical conduct in health research.