Medical education, reflections and perspectives from South Africa: a review

Medical Education (ME) in South Africa has a century long legacy which continues to make a significant impact globally through its graduates. The aim of this paper is to showcase the evolving landscape of ME in South Africa, whiles addressing the legacy of socio-economic and educational disparities influenced by its colonial and Apartheid history. The paper focuses on the effectiveness of recent reforms to create a more equitable and inclusive healthcare education system that can meet the diverse needs of the population and prepare healthcare professionals for challenges in varied and resource-constrained environments. This reflection therefore contributes to setting the scene for the formulation of strategic objects for the future.Key areas explored include widening access and participation through student admission and selection processes designed to promote inclusivity and equity; the development of student and academic support programmes to meet the needs of a diverse student population; the implementation of integrated, outcomes-based curricula; and the decentralisation of clinical training to underserved and rural areas. These measures aim to align medical training with a primary healthcare approach and to foster socially accountable and contextually responsive practitioners equipped to address local health challenges. Indeed, transformative learning experiences are shaping a resilient, agile and competent healthcare workforce.However, this paper additionally identifies persistent challenges, including disparities in resource allocation, gaps in leadership and governance, accreditation and the tension between addressing historical inequities and ensuring robust academic standards. Moreover, the public healthcare system, which serves as the primary training ground for medical students, struggles to balance a quadruple burden of disease and infrastructural deficiencies with education needs.Opportunities for growth are noted in the increasing emphasis on research and scholarship in ME, supported by the creation of a dedicated journal and five departments for medical and health professions education out of the ten medical schools in the country, formalising faculty development and postgraduate qualifications. This highlights the need for expansion of similar approaches in the other medical schools to address the gaps in research and the dearth of skilled clinician-educators.Despite these strides, within the complexity of ongoing challenges, a focus on sustaining and strengthening robust quality assurance, a focus on primary healthcare, and expanding training of students and clinician-educators remains central.