Abstract:

Background:
Competence in ophthalmology and otolaryngology is essential for graduating medical practitioners, as related complaints account for a vast proportion of frontline primary care and emergency consultations. However, as the body of medical knowledge expands, curriculum committees face immense pressure. This curricular squeeze has led to the severe marginalisation of these specialties within undergraduate medical programs. This educational gap translates directly into the clinical realm, contributing to high rates of misdiagnosis that compromise patient safety. This systematic review aimed to delineate the current global state of undergraduate medical education in these fields, identifying temporal and geographical trends in teaching time and their relationship to objective student competence and learner self-efficacy.

Methodology:
A systematic review of the global literature from SCOPUS and Embase databases was conducted in accordance with Meta-analysis of Observational Studies in Epidemiology guidelines. From an initial yield of over 10,000 records, 72 eligible studies across 16 countries were synthesised. Data on course length, objective knowledge and skill assessments, and student self-evaluations were extracted and standardised. To ensure rigorous pedagogical evaluation, the methodological quality of the included studies was appraised using the Medical Education Research Study Quality Instrument.

Results:
The analysis revealed a consistent, decades-long decline in dedicated instructional hours globally, with significant geographical variation. Crucially, the data exposed a significant metacognitive gap among learners. While students demonstrated moderate objective knowledge assessment scores (mean: 70.4% for ophthalmology, 57.0% for otolaryngology), their self-assessed confidence in those same areas was strikingly low (mean: 37.3% and 35.9%, respectively). Students consistently failed to accurately self-assess their clinical abilities. Furthermore, for ophthalmology, increased course length was found to have a statistically significant positive relationship with students’ self-evaluation of their clinical skills (R²=0.475, p=0.027).

Conclusions:
The sustained reduction in instructional hours has generated a cohort of graduating physicians characterised by specific competency deficiencies and poorly calibrated confidence. This represents a systemic curricular failure that poses a direct, preventable risk to patient safety. To mitigate this risk within the strict constraints of a crowded syllabus, curricula must transition toward competency-based medical education frameworks. Furthermore, integrating high-yield pedagogical interventions, such as objective clinical simulation, virtual reality, and active learning strategies, is urgently needed to bridge the gap between theoretical knowledge and practical, safe clinical execution.

Keywords:

Medical Education, Undergraduate Curriculum, Curricular Squeeze, Ophthalmology, Otolaryngology.