When Concepts Travel In-Between: Knowledge Brokering and Design Justice in the Hybrid Translation of Competency-Based...

Competency-Based Education (CBE) has become the dominant paradigm for structuring medical training worldwide. Yet its foundational constructs (e.g., Entrustable Professional Activities (EPAs), milestones, and competencies) were conceived within resource-rich, institutionally stable, and culturally specific contexts. Their diffusion across global landscapes has not been neutral. When such frameworks travel, they carry embedded assumptions, epistemic values, and implicit universalizing authority. This article describes how The East, Central, and Southern Africa College of Paediatrics and Child Health (ECSAPACH), in partnership with the Center for Research, Innovation, and Scholarship in Health Professions Education (CRIS) at Baylor College of Medicine, reimagined CBE for African pediatric training through a process guided by design justice and implemented using knowledge brokering. Anchored in Homi Bhabha's concept of the Third Space and Culture's In-Between, we argue that the translation of CBE into new contexts is not merely a technical or linguistic act but an ethical, dialectical, and generative one. ECSAPACH's translation process demonstrates that when frameworks encounter contextual resistance and epistemic contestation, they can be reconstituted into hybrid forms that unsettle universality while deepening both global and local understanding. The resulting hybrid framework represents not a replication or simple adaptation of imported theory but a co-created, contextually anchored model for pediatric education that emerges from ongoing negotiation under conditions of asymmetrical power. We position this work as an instance of hybrid knowledge production in Bhabha's Third Space, offering lessons for equitable global partnerships and for the future evolution of CBE as a living, revisable theory.