The Three Cs of Integrated Tuberculosis-Diabetes Modules: A Competency-Based Medical Education Framework

The introduction of Competency-Based Medical Education (CBME) in India emphasizes outcome-oriented training and provides a framework for implementing integrated teaching strategies. Traditional discipline-based medical education often limits the ability of learners to integrate knowledge across domains required to manage such complex comorbidities. Evidence suggests that integrated teaching approaches improve knowledge acquisition, clinical reasoning, and learner engagement. The coexistence of tuberculosis (TB) and diabetes mellitus (DM) represents a significant and evolving public health challenge, particularly in high-burden countries such as India. Diabetes increases the risk of developing active TB and is associated with adverse treatment outcomes, including delayed sputum conversion, treatment failure, relapse, and increased mortality. This bidirectional interaction necessitates an integrated approach to both clinical management and medical education for TB and DM. This review synthesizes existing literature on the epidemiological and clinical interplay between TB and DM, along with educational frameworks supporting integration. This review of literature additionally presents a curriculum innovation comprising structured aligned integrated teaching (AIT) modules that integrate TB and DM across the MBBS curriculum using both horizontal and vertical integration strategies. The proposed framework may serve as a practical model for institutions implementing CBME. Adoption of structured integrated modules may enhance undergraduate medical training and better prepare future physicians for managing TB-DM comorbidity in high-burden settings.