Clinical exposure is not enough: legitimacy as the missing link in preparing future doctors

Glocalization is commonly understood as the adaptation of globally endorsed educational ideals to the reality of local contexts. This framing often assumes a unidirectional flow of innovation from the Global North to the Global South. In this perspective, we challenge this assumption through the lens of preparedness for practice. Evidence from the Global North consistently identifies insufficient experience with patient care as a key contributor to graduates' lack of preparedness for clinical work, with an increasing use of tools such as simulation to try fill this gap. In many Global South settings, however, authentic clinical exposure is abundant, presenting an opportunity for the Global South to set the standard regarding the preparation of graduates while the Global North must grapple with local constraints. Yet concerns regarding graduate preparedness persist. Drawing on literature and our research with South African internship doctors, we argue that clinical exposure alone does not guarantee preparedness for practice. Rather, the critical factor is whether participation within clinical environments is legitimized. Students may be surrounded by authentic clinical work while remaining peripheral to it, prioritizing examination performance over meaningful engagement and experiencing exclusion from clinical teams. We propose legitimacy, a sense of belonging and validation within a community of practice, as the key bridge between exposure and preparedness. From a glocalization perspective, this argument highlights the responsibility in the Global South not to just simply implement Global North strategies but rather to identify local opportunities and solutions, and in doing so provide valuable insights that contribute to global discourse about how best to prepare future doctors.