Beyond the Checklist: Developing Effective Communication in a South African Multilingual Clinical Training Programme

Effective communication is a core graduate attribute (GA) in health professions education, yet its development is fragmented and under-theorised in under-resourced and multilingual contexts, which are typical of the Global South, where postcolonial histories and structural inequities continue to shape educational practice.

We investigated how effective communication is understood, experienced and developed in a South African Clinical Technology programme, using a qualitative design underpinned by Engeström's Activity Theory as an interpretive lens. Interviews and focus groups were conducted with final-year students (n = 10), recent graduates (n = 5), academic educators (n = 4), and clinical educators (n = 6), and thematic analysis was applied.

Four themes emerged: (1) effective communication as a situated, adaptive practice; (2) Barriers to effective communication (linguistic, cultural, structural); (3) Role modelling and relational dynamics; and (4) Adaptability and resilience in workplace communication. Effective communication development was largely relational and experiential rather than shaped by formal curriculum, with students learning communication through immersion and mentorship amid systemic challenges. Structural misalignments between formal curricular goals and clinical realities constrained students' communication practice and confidence.

For educators, the findings suggest practical steps: 1) reconceptualise effective communication as a situated, socially mediated practice; (2) embed multilingual and multimodal communication opportunities into routine clinical teaching and assessment; (3) strengthen alignment and dialogue between universities and clinical training sites; and (4) prioritise faculty development to support inclusive role modelling and psychologically safe learning environments. Re-conceptualising effective communication as a situated, socially mediated practice (instead of a generic skill), enables intentional curriculum design and assessment that better prepare graduates for the complex socio-cultural clinical environments of the Global South.