Perspectives of faculty, students and patients on clinical skills teaching in undergraduate medical education in Pakistan: a qualitative study

OBJECTIVES: To explore the challenges and opportunities in clinical skills teaching and learning among faculty, final-year medical students and patients at a private medical university in Pakistan, within the context of a low- and middle-income country (LMIC) medical education system. DESIGN: An exploratory descriptive qualitative design using inductive thematic analysis utilising in-depth interviews and focus group discussions, framed within a metaphorical lens. SETTING: A single private-sector tertiary care teaching hospital and affiliated undergraduate medical college in an urban setting in Pakistan. PARTICIPANTS: A total of 48 participants were included in the study: 12 clinical faculty members representing various disciplines and levels of experience, 16 final-year medical students and 10 house officers and 10 patients from adult inpatient wards. Participants were purposively selected to ensure maximum variation in perspectives. RESULTS: Six key metaphorical themes emerged, each reflecting both the challenges and opportunities within the clinical learning journey: (1) The Safety Harness-simulation as an opportunity for structured, risk-free skill development, yet limited by authenticity; (2) The Underwater Life-the irreplaceable but unpredictable nature of bedside learning in fostering empathy and communication; (3) The Stormy Seas-systemic and cultural barriers such as patient availability, gender constraints and limited faculty resources; (4) The Ship-students navigating self-development amid evolving expectations, digital distractions and shifting motivations; (5) The Engine Room Tools-balancing diverse teaching modalities while seeking optimal time distribution between simulation and bedside learning; and (6) The Guiding Compass-the pivotal role of clinical teachers as mentors and professional exemplars. Triangulated perspectives revealed that while structured simulation and bedside experiences complement one another, significant institutional, ethical and pedagogical challenges persist, many amplified by the realities of resource-limited LMIC settings. CONCLUSIONS: This study underscores the complexities of clinical teaching and learning in an LMIC context, highlighting the need for a balanced, context-sensitive model that integrates simulation with authentic bedside exposure, supported by mentorship and reflective practice. Addressing structural and faculty-related barriers is essential to advancing equitable, patient-centred clinical education in resource-constrained environments.