Gaining consensus among stakeholders on the core undergraduate medical curriculum at the University of KwaZulu-Natal, Durban, South Africa: a mixed-methods study

Gaining consensus among stakeholders on the core undergraduate medical curriculum at the University of KwaZulu-Natal, Durban, South Africa: a mixed-methods study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Gaining consensus among stakeholders on the core undergraduate medical curriculum at the University of KwaZulu-Natal, Durban, South Africa: a mixed-methods study Mergan Naidoo, Kimera Tamzin Suthiram, Lucie Byrne-Davis This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9325137/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Introduction A clearly defined core medical curriculum is essential to address content overload and ensure alignment with contextual healthcare needs. The Health Professions Council of South Africa recommended that the University of KwaZulu-Natal define its undergraduate core medical curriculum. This study aimed to achieve stakeholder consensus on the core clinical curriculum by identifying essential knowledge, skills, and attitudes for the senior years of training. Methods A sequential mixed-methods design was employed. Documentary analysis of module templates, course materials, and curriculum mapping data was conducted to identify existing curriculum content, which was categorised according to the African Medical Education Directives for Specialists competencies. Content was verified by module coordinators. An electronic Modified Delphi process involving academics, recent graduates, and primary healthcare nurses was conducted over two rounds to establish consensus, defined as ≥ 70% agreement. Results Documentary analysis identified 724 curriculum items, of which 653 were aligned with the healthcare practitioner role and 71 with other AfriMEDS roles. Seventeen module coordinators verified the curriculum content. Twenty-one participants completed Delphi round 1, and seventeen completed round 2. After the Delphi process, consensus was achieved on 629 healthcare practitioner items and 69 items related to other competencies. A small number of items ( n = 27) did not reach consensus for inclusion. Discussion This study defined a stakeholder-informed core clinical undergraduate medical curriculum at UKZN. The findings highlight a strong emphasis on the healthcare practitioner role, reflecting the demands of generalist practice in a resource-constrained health system. The resulting curriculum framework provides a foundation for curriculum renewal aligned with AfriMEDS and supports the training of socially accountable, context-responsive graduates. undergraduate medical education core curriculum curriculum development Delphi technique competency-based education AfriMEDS Medical education mixed-methods research INTRODUCTION Educators widely recognise the importance of a core medical curriculum as a means of defining essential and common content within training programmes ( 1 ). Training institutions and regulatory bodies advocate for such curricula primarily to manage content overload and to respond to the increasing demand for specialisation. Disciplinary experts often seek to expand inclusion of their specific content, which may inadvertently compromise contextual relevance and balance within the curriculum ( 1 ). In South Africa, the Health Professions Council of South Africa (HPCSA) is the statutory body responsible for accrediting medical curricula. The HPCSA conducted accreditation visits to the University of KwaZulu-Natal (UKZN) undergraduate medical programme in 2018 and again in 2024. These reviews highlighted several recommendations, including strengthening a community-based, primary care-oriented curriculum and developing a clearly defined core curriculum to address ongoing content overload ( 2 ). The 2024 accreditation report reiterated key priorities relevant to curriculum development. These included continuing curriculum renewal processes, enhancing community engagement in curriculum design, achieving an appropriate balance between content and process aligned with graduate outcomes, integrating disciplines with limited exposure (such as otorhinolaryngology, ophthalmology, and urology) using contextually appropriate strategies, and addressing previously identified gaps in forensic medicine ( 3 ). Collectively, these recommendations aim to ensure that graduates are adequately prepared for internships, community service, and subsequent roles as medical officers or general practitioners within the South African healthcare system. Progress toward implementing the 2018 recommendations was delayed by the COVID-19 pandemic. However, a dedicated task team was subsequently established to advance curriculum review and renewal, with progress reported during the 2024 HPCSA visit. Within this context, defining a core curriculum is a critical enabling step. A core curriculum delineates the essential knowledge, skills, and attitudes required of a medical graduate ( 4 ), while remaining responsive to the healthcare needs of the communities served ( 5 ). Importantly, it mitigates the effects of knowledge expansion by prioritising depth over excessive breadth, thereby supporting meaningful learning. Without such prioritisation, students may struggle to identify and internalise the key competencies required for effective clinical practice ( 5 ). Currently, there is no formally defined core curriculum for the undergraduate medical programme at UKZN. The HPCSA has adopted and contextualised the CanMEDS competency framework for use within South African medical schools ( 6 ). Many institutions have aligned their curricula accordingly ( 7 ). The CanMEDS framework outlines a set of integrated competencies, including medical expert, communicator, collaborator, leader, health advocate, scholar, and professional ( 8 ). Curriculum developers must therefore define contextually relevant knowledge, skills, and professional behaviours required for practice within the local healthcare system ( 9 ). A curriculum, however, extends beyond a mere compilation of content; it encompasses learning outcomes, teaching and learning strategies, assessment approaches, and the broader educational environment ( 10 ). The theoretical underpinning for this curriculum development process is provided by social constructivism, which emphasises that knowledge is constructed through social interaction and experiential learning. Lev Vygotsky, a key proponent of this theory, highlighted the central role of social engagement in cognitive development ( 11 ). In the final three years of undergraduate training, students participate in service-based clinical learning within healthcare settings, where they develop competencies through interaction with patients and multidisciplinary teams. The conceptual framework for this study integrates the CanMEDS framework ( 8 ), HPCSA core competencies ( 12 ) and the UKZN College of Health Sciences competencies collectively adapted into the AfriMEDS framework ( 13 ). Given these considerations, there is a clear and pressing need to define a core medical curriculum at UKZN. The current curriculum is challenged by content overload, and the HPCSA has specifically highlighted the absence of a clearly articulated core. A stakeholder-engaged approach has been recommended to address this gap. Accordingly, this study aimed to achieve consensus among key stakeholders on the core clinical undergraduate medical curriculum at UKZN. METHODS Study design and setting A sequential mixed-methods design was used, comprising documentary analysis followed by a Modified Delphi consensus process. The documentary analysis informed the development of the Delphi instrument, and integration occurred by interpreting the final consensus in relation to the AfriMEDS competency framework. The study was conducted within the undergraduate Bachelor of Medicine and Surgery (MBChB) programme at the UKZN. The six-year programme includes three pre-clinical years followed by three clinical years (years 4–6), during which students rotate through major disciplines in modular attachments ( 14 ). Each clinical attachment is a stand-alone module with specific learning outcomes aligned to the expected knowledge, skills, and behaviours. Each discipline decides the content of each module, and academics in that discipline assess it. Each module has a discipline module coordinator. The study was conducted in 2023 and 2024. Documentary analysis A comprehensive documentary analysis was undertaken to identify the current curriculum content in terms of knowledge, skills, and attitudes. Data sources included module templates, course handbooks, student resources, and curriculum mapping data from the Learning Opportunities, Objectives and Outcomes Platform (LOOOP)( 15 , 16 ). Documents were analysed through iterative processes of familiarisation, coding, and categorisation. Content was organised according to AfriMEDS roles. Where gaps in skills documentation were identified, a nationally developed skills list from the Nelson Mandela–Fidel Castro collaboration programme was incorporated to ensure comprehensive coverage ( 17 ). To enhance trustworthiness, module coordinators were invited to verify the extracted content. Credibility was ensured through the use of institutional documents and participant verification, while representativeness was supported by the use of standardised, institutionally approved module templates ( 18 ). The Modified Delphi process Participants Participants included clinicians involved in teaching years 4–6, recent UKZN graduates (interns and community service medical officers), and experienced primary healthcare (PHC) nurses. These groups were selected to reflect both academic and service-delivery perspectives relevant to the expected competencies of graduates. Procedure The Delphi questionnaire was developed using Research Electronic Data Capture (REDCap) ( 19 ) and populated with curriculum items derived from the documentary analysis. Participants were asked to classify each item as: essential for inclusion in the core curriculum, desirable but not core, or not required. Participants were also invited to suggest additional items. Two Delphi rounds were conducted. In round 1, all items were rated. Items achieving ≥ 70% agreement for inclusion were retained as core and removed from subsequent rounds. Items that did not reach consensus, along with newly suggested items, were recirculated in round 2. Consensus definition and analysis Consensus was defined a priori as ≥ 70% agreement for inclusion. ( 20 ) Data were analysed descriptively, and frequencies and proportions were used to determine consensus levels. The iterative process continued until responses stabilised after two rounds. Ethics considerations Ethical approval was obtained from Keele University, the UKZN Humanities and Social Sciences Research Ethics Committee, and the UKZN registrar. Written informed consent was obtained from all participants. RESULTS Participants and verification of curriculum content A total of 17 discipline-based specialists participated in verifying the curriculum content, including three representatives each from Obstetrics and Gynaecology, Internal Medicine, Surgery, Paediatrics, and Family Medicine, and two from Psychiatry. These individuals were either module coordinators or experienced discipline-based experts with in-depth knowledge of the MBChB programme. In addition, six recent graduates (three interns and three CSOs) and four experienced PHC nurses were purposively selected to participate in the Delphi process. Interns and CSOs were recruited from the Durban hospital complex, while PHC nurses had at least five years’ experience in primary care settings. These groups were selected to ensure representation of both academic and service-delivery perspectives relevant to undergraduate training. See Table 1 for details of the Delphi study participants. Table 1 Demographics of participants of the Delphi Study Age Gender Highest level of education completed Professional designation Years of experience since qualifying with your basic qualification Years of experience in your current job? Document analysis Delphi round 1 Delphi round 2 32 Female Diploma Primary healthcare nurse practitioner 12 10 N Y N 52 Male Subspecialist qualification Surgeon 27 14 Y Y Y 50 Female Master's Degree/ Fellowship Family Physician 20 10 Y Y Y 26 Female MBChB Medical intern 2 2 N Y Y 37 Male Subspecialist qualification Internal Medicine Physician 14 7 Y Y Y 37 Female Master's Degree/ Fellowship Paediatrician 12 3 Y Y Y 41 Female Subspecialist qualification Paediatrician 17 11 Y Y Y 43 Female Master's Degree/ Fellowship Surgeon 19 10 Y Y Y 29 Female Undergraduate degree Community Service Medical Officer 3 3 N Y Y 61 Male Master's Degree/ Fellowship Obstetrician and gynaecologist 36 28 Y Y N 27 Male Undergraduate degree Community Service Medical Officer 3 1 N Y Y 47 Female Master's Degree/ Fellowship Psychiatrist 23 10 Y Y Y 27 Male Undergraduate degree Community Service Medical Officer 3 3 N Y Y 50 Female Diploma Primary healthcare nurse practitioner 26 26 N Y N 26 Male Undergraduate degree Medical intern 3 2 N Y Y 35 Female Diploma Primary healthcare nurse practitioner 10 10 N Y Y 58 Male Subspecialist qualification Obstetrician and gynaecologist 29 23 Y Y Y 61 Male Master's Degree/ Fellowship Family Physician 38 20 Y Y Y 54 Female Undergraduate degree Primary healthcare nurse practitioner 17 17 N Y Y 44 Male Subspecialist qualification Internal Medicine Physician 19 8 Y Y N 26 Male Undergraduate degree Community Service Medical Officer 2 0 N Y Y 27 Male Subspecialist qualification Paediatrician Y N N 28 Male Master's Degree/ Fellowship Family Physician Y N N 29 Male Master's Degree/ Fellowship Surgeon Y N N 30 Male Subspecialist qualification Internal Medicine Physician Y N N 31 Male Master's Degree/ Fellowship Obstetrician and gynaecologist Y N N 32 Female Master's Degree/ Fellowship Psychiatrist Y N N Of the 26 individuals invited to participate in the Delphi process, 21 completed Round 1 and 17 completed Round 2. The final cohort included: 17 doctors and 4 PHC nurses 11 females and 10 males Mean age: 41.1 years (SD 12.1) Mean years of experience: 16.0 years (SD 11.2) Mean years in current role: 10.4 years (SD 8.3) Participants represented a range of professional backgrounds, including interns, CSOs, family physicians, specialists across major disciplines, and PHC nurses. Six participants were recent graduates (interns and CSOs), providing insights into early-career practice expectations. Documentary analysis Seventeen participants confirmed the accuracy and completeness of the extracted curriculum content. The documentary analysis identified curriculum content across all clinical disciplines in years 4–6, which was subsequently categorised according to AfriMEDS roles based on HPCSA descriptors. A total of 724 curriculum items were identified. Of these, 653 items aligned with the healthcare practitioner role, while 71 aligned with other AfriMEDS roles (Table 2 ). Table 2 Summary of curriculum content identified through documentary analysis AfriMEDS Role Number of Items Percentage (%) Healthcare practitioner 653 90.2 Communicator 19 2.6 Collaborator 10 1.4 Leader and manager 16 2.2 Health advocate 14 1.9 Scholar 4 0.6 Professional 8 1.1 Total 724 100 The distribution of content across disciplines is shown in Table 3 . Table 3 Distribution of curriculum content by discipline Discipline Number of Items Percentage (%) Skills list 200 27.6 Internal Medicine 145 20.1 Surgical disciplines 95 13.1 Child health 90 12.4 Obstetrics and Gynaecology 85 11.7 Integrated primary care 57 7.9 Mental health 52 7.2 Total 724 100 The healthcare practitioner role constituted the majority of the curriculum content. In contrast, fewer items were identified for the remaining AfriMEDS roles. Not all disciplines contributed content across all roles, highlighting variability in the representation of non-clinical competencies within the curriculum. Full details of the curriculum content are provided in Supplementary Table 1. Delphi outcomes The Delphi process consisted of two rounds. Following Round 1, items achieving ≥ 70% consensus were retained and removed from further rounds. A total of 48 items (including eight newly proposed items and those that did not reach consensus) were recirculated in Round 2. Final consensus After two Delphi rounds: 629 items were retained as core curriculum content aligned with the healthcare practitioner role 69 items were retained across other AfriMEDS roles 27 items did not achieve consensus for inclusion Most items reached consensus in Round 1, although additional mental health content was incorporated following Round 2. The majority of items removed after Round 1 were from paediatrics and mental health, but several were reconsidered and included in Round 2 (Table 4). Participants proposed eight additional items for inclusion: ultrasound training (point-of-care ultrasound and focused abdominal sonography for trauma), operative deliveries (ventouse/vacuum), head and neck trauma/maxillofacial injury, trauma debriefing, management of an episiotomy, basic surgical skills, and ENT conditions. See supplementary table 2. Table 3 Delphi process outcomes Delphi Stage Number of Items Items from documentary analysis 724 New items added after Round 1 8 Items reviewed in Round 2 48 Items removed because of duplication 7 Final items reaching consensus 698 Items not reaching consensus 27 Content aligned to non-healthcare practitioner roles Consensus was achieved on content across all non-healthcare practitioner roles, although the number of items remained relatively limited compared to the healthcare practitioner domain (Table 5 and supplementary Table 3). Table 5 Final core curriculum by AfriMEDS role AfriMEDS Role Number of Items Percentage (%) Healthcare practitioner 629 90.1 Communicator 18 2.6 Collaborator 10 1.4 Leader and manager 15 2,2 Health advocate 15 2.2 Scholar 3 0.4 Professional 8 1,1 Total 698 100 These items included competencies related to communication skills, multidisciplinary collaboration, clinical governance, advocacy for vulnerable populations, reflective practice, and professional conduct. Content not reaching consensus A total of 27 items did not achieve the predefined threshold of ≥ 70% agreement for inclusion in the core curriculum. Of the newly proposed items introduced after Round 1, operative deliveries (ventouse/vacuum) and head and neck trauma did not reach consensus. (Supplementary Table 4). Healthcare practitioner content The majority of agreed core curriculum content was aligned with the healthcare practitioner role. These items spanned all major clinical disciplines and included both knowledge areas and practical skills required for generalist practice. The final list of 629 healthcare practitioner items, along with their percentage agreement, is presented in Supplementary Table 2. Duplicate items identified were removed. These items reflect a broad range of competencies, including: recognition and management of common and critical conditions procedural skills emergency care clinical reasoning and decision-making DISCUSSION This study achieved stakeholder consensus on the core clinical undergraduate medical curriculum at the University of KwaZulu-Natal, providing a comprehensive, contextually grounded framework aligned with AfriMEDS competencies. By integrating documentary analysis with a Delphi consensus process, the study moves beyond descriptive curriculum mapping to define an agreed core curriculum that is responsive to both educational imperatives and health system needs. Importantly, the findings address the dual challenges of content overload and curricular fragmentation, which are widely recognised in health professions education ( 1 , 5 ). Principal findings interpreted through a theoretical lens A central finding of this study is the predominance of content aligned with the healthcare practitioner role. This reflects the realities of the South African healthcare system, where newly qualified doctors are expected to function as generalists in district hospitals and primary care settings with limited access to specialist support ( 21 – 23 ). From a competency-based education (CBE) perspective, this emphasis is appropriate, as CBE prioritises clearly defined outcomes that reflect real-world practice requirements ( 8 , 24 ). The extensive range of clinical content identified in this study can therefore be understood as a necessary adaptation to context, rather than an indication of curricular excess. However, when viewed through the lens of constructive alignment ( 25 ), the findings raise important considerations regarding the balance between curriculum content, teaching strategies, and assessment ( 10 ). While the curriculum appears strongly aligned with clinical knowledge and skills, the relatively limited representation of non-healthcare practitioner roles suggests a potential misalignment between intended graduate attributes (AfriMEDS roles) and the enacted curriculum. Constructive alignment requires that learning outcomes, teaching activities, and assessments are coherently structured to achieve desired competencies ( 10 ). The uneven distribution of content across roles observed in this study indicates that certain competencies—particularly communication, leadership, and scholarship—may not be systematically reinforced through teaching and assessment practices. The findings can also be interpreted through a social constructivist framework, particularly drawing on Lev Vygotsky’s concept of the Zone of Proximal Development (ZPD) ( 11 ). Clinical training in the final years of undergraduate education occurs within workplace-based environments, where learning is mediated through interaction with supervisors, peers, and patients. Within this paradigm, knowledge and competence are co-constructed through participation in authentic clinical activities. The strong emphasis on healthcare practitioner competencies reflects the nature of these learning environments, where clinical problem-solving and procedural skills are foregrounded. However, competencies such as communication, collaboration, and professionalism require intentional scaffolding and guided reflection within the ZPD. Their relative underrepresentation in the curriculum suggests that these competencies may be assumed to develop implicitly, rather than being explicitly taught and supported. From a programmatic assessment perspective, the findings also highlight important gaps. Programmatic assessment emphasises the collection of multiple low-stakes data points across competencies to inform high-stakes decisions about learner progression ( 24 ). While the curriculum content identified in this study provides a comprehensive blueprint of expected competencies, the uneven emphasis across AfriMEDS roles suggests that assessment systems may similarly prioritise clinical knowledge and skills over other domains. This imbalance risks reinforcing a narrow conception of competence and may limit the development of well-rounded practitioners. Aligning the defined core curriculum with programmatic assessment strategies—such as workplace-based assessments and Entrustable Professional Activities (EPAs)( 26 )—could enhance the validity and educational impact of assessment practices. Comparison with existing literature This study contributes to a growing body of literature on core curriculum development in medical education. Previous studies have primarily focused on defining discipline-specific curricula using Delphi methods, including in surgery, anaesthesia, dermatology, and palliative care ( 27 – 30 ). While these studies have identified essential competencies within specific domains, few have attempted to define a comprehensive core curriculum across the entire clinical training programme. The breadth of the current study, therefore, represents a significant advancement, particularly in a low- and middle-income country context. The large number of items identified in this study contrasts with the smaller core curricula described in high-income settings. This difference can be understood through the lens of contextual curriculum design, which emphasises the importance of aligning educational content with local health system needs ( 9 ). In South Africa, the burden of disease is characterised by a complex interplay of communicable and non-communicable conditions, compounded by resource constraints and inequities in access to care ( 31 , 32 ). As a result, undergraduate medical curricula must prepare graduates to manage a wide spectrum of conditions independently. The extensive list of core competencies identified in this study reflects this reality and emphasises the limitations of adopting universally standardised curricula without contextual adaptation. The findings also align with literature highlighting challenges in operationalising competency frameworks such as CanMEDS and AfriMEDS ( 8 , 12 ). While these frameworks provide a comprehensive set of roles, their translation into curriculum content and assessment remains inconsistent across institutions. The uneven representation of non-clinical competencies observed in this study is consistent with reports that roles such as scholar, leader, and health advocate are often underdeveloped in practice (( 33 , 34 ). This suggests that additional strategies are needed to meaningfully embed these competencies within clinical training. Implications for curriculum design and integration The findings of this study have important implications for curriculum renewal at UKZN and similar institutions. First, the current discipline-based, modular curriculum structure may contribute to fragmentation and limit opportunities for integration across competencies. From a constructive alignment perspective, reorganising the curriculum around clinical presentations or patient pathways may facilitate more coherent integration of knowledge, skills, and professional roles. Such approaches have been shown to enhance clinical reasoning and contextual learning ( 35 ). Second, the limited articulation of non-healthcare practitioner roles highlights the need for more deliberate integration of these competencies. Drawing on social constructivist principles, this integration should occur within authentic clinical contexts, supported by supervision, feedback, and reflection. For example, communication skills can be developed through observed consultations and structured feedback, while leadership and collaboration can be fostered through participation in multidisciplinary team activities. Embedding these competencies within workplace-based learning aligns with the principles of experiential learning and supports the development of professional identity ( 36 , 37 ) Third, the study highlights the importance of aligning curriculum content with programmatic assessment systems. The defined core curriculum provides a foundation for developing assessment frameworks that capture performance across multiple competencies. The use of EPAs, in particular, offers a mechanism for integrating competencies into meaningful units of professional practice ( 38 ). While resource constraints may limit the immediate implementation of comprehensive EPA-based assessment systems, incremental integration of workplace-based assessments could enhance the alignment between curriculum and assessment. Fourth, the findings support the continued emphasis on social accountability in medical education. The strong alignment of curriculum content with community health needs reflects the principles articulated in national and international frameworks for socially accountable education ( 13 , 39 ). Ensuring that curricula remain responsive to local contexts is essential for addressing health inequities and improving population health outcomes. Strengths and limitations A key strength of this study is the inclusion of multiple stakeholder groups, including clinicians, recent graduates, and primary healthcare nurses. This diversity of perspectives enhances the credibility and relevance of the findings and aligns with best practices in participatory curriculum design. The mixed-methods approach, combining documentary analysis with Delphi consensus, provides both a comprehensive description of the existing curriculum and a structured mechanism for refinement. However, several limitations should be considered. Participation in the Delphi process was incomplete, and the representation of specialists was lower than anticipated, which may have influenced the balance of perspectives. The large number of curriculum items may have contributed to participant fatigue, particularly in the first round of the Delphi process. In addition, the study focused on defining core content and did not evaluate how this content is delivered, assessed, or translated into clinical competence. As such, further research is needed to examine the implementation and impact of the defined curriculum. Conclusion This study provides a comprehensive, stakeholder-informed definition of the core clinical undergraduate medical curriculum at UKZN. Interpreted through the lenses of CBE, constructive alignment, social constructivism, and programmatic assessment, the findings highlight both strengths and areas for development within the current curriculum. The strong emphasis on healthcare practitioner competencies reflects contextual realities, while the relative underrepresentation of other roles highlights the need for more deliberate integration. The resulting framework provides a robust foundation for curriculum renewal, producing socially accountable, contextually responsive graduates equipped to meet the complex healthcare needs of South Africa. Abbreviations ACGME Accreditation Council for Graduate Medical Education AfriMEDS HPCSA CanMEDS adaptation CanMEDS Royal College of Physicians and Surgeons of Canada competency framework CBE competency-based education CSO Community Service Medical Officer EPA Entrustable Professional Activities HPCSA Health Professions Council of South Africa LOOOP Learning Opportunities, Objectives and Outcomes Platform MDT Multidisciplinary team PHC Primary healthcare REDCap Research Electronic Data Capture SD Standard Deviation UKZN University of KwaZulu-Natal ZPD Zone of Proximal Development Declarations Data Availability All data generated or analysed during this study are included in this published article. Conflict Disclosure The authors declare that they have no financial or personal relationships that may have inappropriately influenced their writing of this article. Author contributions MN was responsible for conceptualising the research article, conducting a literature search, extracting relevant information, and drafting the initial manuscript. MN and KTS analysed the data. MN, KTS, and LBD reviewed and edited the manuscript. Funding statement Not applicable. Acknowledgements Not applicable. References Bandaranayake R. The concept and practicability of a core curriculum in basic medical education. Med Teach. 2000;22(6):560–3. Health Professionals Council of South Africa. Accreditation of the undergraduate education and training in medicine, College of Health Sciences, UKZN. Pretoria: Health Professionals Council of South Africa. 2018 11 May 2018. Health Professionals Council of South Africa. Draft evaluation report: Accreditation of the undergraduate education and training in medicine, College of Health Sciences, UKZN. Pretoria: Health Professionals Council of South Africa; 2024. 7 May 2024. Yamani N, Rahimi M. The core curriculum and integration in medical education. Res Dev Med Educ. 2016;5(2):50–4. Harden RM, Davis MH. Amee Medical-Education Guide No-5 - the Core Curriculum with Options or Special Study Modules. Med Teach. 1995;17(2):125–48. Knight SE, Ross AJ, Mahomed O. Developing primary health care and public health competencies in undergraduate medical students. S Afr Fam Pract. 2017;59(3):103–9. Stovel RG, Gabarin N, Cavalcanti RB, Abrams H. Curricular needs for training telemedicine physicians: A scoping review. Med Teach. 2020;42(11):1234–42. Frank JR, Danoff D. The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med Teach. 2007;29(7):642–7. Grant J, Zachariah A. Designing a contextual curriculum. FAIMER-Keele Master’s in Health Professions Education: Accreditation and Assessment. Module 4, Unit 5. London: CenMEDIC; 2020. Dent J, Harden RM, Hunt D. A Practical Guide for Medical Teachers, E-Book: A Practical Guide for Medical Teachers. E-Book: Elsevier Health Sciences; 2021. Bélanger P. Theories in adult learning and education. Verlag Barbara Budrich; 2011. Health Professionals Council of South Africa. Core Competencies for Undergraduate Students in Clinical Associate, Dentistry and Medical Teaching and Learning Programmes in South Africa. Pretoria: Health Professionals Council of South Africa. 2014 [Available from: https://www.hpcsa-blogs.co.za/wp-content/uploads/2017/04/MDB-Core-Competencies-ENGLISH-FINAL-2014.pdf Mnguni L. The Curriculum Ideologies Underlying the AfriMEDS Curriculum Framework for Undergraduate Medical and Dental Education in South Africa. Int Med Educ. 2024;3(1):44–61. Maphosa C, Mudzielwana NP, Netshifhefhe L. Curriculum development in South African higher education institutions: Key considerations. Mediterranean J social Sci. 2014;5(7):355. Ramklass S, Matthews M. Development of the MB ChB curriculum map at the University of KwaZulu-Natal, South Africa. Samj S Afr Med J. 2017;107(12):1049. Balzer F, Hautz WE, Spies C, Bietenbeck A, Dittmar M, Sugiharto F, et al. Development and alignment of undergraduate medical curricula in a web-based, dynamic Learning Opportunities, Objectives and Outcome Platform (LOOOP). Med Teach. 2016;38(4):369–77. Zungu SB, Mathu KM, Scheepers CB. Leading the South African Cuban-trained medical students’ assimilation in the local medical schools. Emerald Emerg Markets Case Stud. 2019;9(2):1–17. Morgan H. Conducting a Qualitative Document Analysis. Qual Rep. 2022;27(1):64–77. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inf. 2019;95:103208. Thangaratinam S, Redman CW. The delphi technique. obstetrician gynaecologist. 2005;7(2):120–5. Mabuza LH, Moshabela M. Understanding of 'generalist medical practice' in South African medical schools. Afr J Prim Health Care Fam Med. 2024;16(1):e1–13. Mabuza LH, Moshabela M. What are the experiences of medical students and their trainers regarding undergraduate training in primary health care at four South African medical schools? A qualitative study. Front Med. 2024;11:1337140. Blitz J, Couper I, Geldenhuys M, Klocke M, Van Zyl M. Longitudinal integrated clerkships from start to finish: A medical curriculum innovation. Afr J Prim Health Care Family Med. 2024;16(1):4401. Pangaro L, ten Cate O. Frameworks for learner assessment in medicine: AMEE Guide 78. Med Teach. 2013;35(6):e1197–210. Biggs J. Enhancing teaching through constructive alignment. High Educ. 1996;32(3):347–64. Ten Cate O, Graafmans L, Posthumus I, Welink L, van Dijk M. The EPA-based Utrecht undergraduate clinical curriculum: Development and implementation. Med Teach. 2018;40(5):506–13. Alayande BT, Forbes CW, Iradakunda J, Majyambere JP, Hey MT, Powell BL et al. Determining Critical Topics for Undergraduate Surgical Education in Rwanda: Results of a Modified Delphi Process and a Consensus Conference. Cureus. 2023;15(8):e43625. Rohan D, Ahern S, Walsh K. Defining an anaesthetic curriculum for medical undergraduates. A Delphi study. Med Teach. 2009;31(1):e1–5. Burger H, Krause R, Blanchard C, Ambler J, Ganca L, Barnard A, et al. Position paper on undergraduate Palliative Medicine education for doctors in South Africa. Afr J Prim Health Care Fam Med. 2022;14(1):e1–7. Clayton R, Perera R, Burge S. Defining the dermatological content of the undergraduate medical curriculum: a modified Delphi study. Br J Dermatol. 2006;155(1):137–44. Maphumulo WT, Bhengu BR. Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis. 2019;42(1):e1–9. Ngene NC, Khaliq OP, Moodley J. Inequality in health care services in urban and rural settings in South Africa. Afr J Reprod Health. 2023;27(5s):87–95. DiMarino LM, Boppana RC, Pincavage AT, Hemmer P, Ferris A, Chandrasekar J, et al. AAIM Recommendations for Undergraduate Medical Education to Graduate Medical Education Transition Curricula in Internal Medicine. Am J Med. 2023;136(5):489–95. Angus S, Vu TR, Halvorsen AJ, Aiyer M, McKown K, Chmielewski AF, et al. What skills should new internal medicine interns have in July? A national survey of internal medicine residency program directors. Acad Med. 2014;89(3):432–5. Bannister SL, Forbes KL, Moddemann DM, Lewis MA. From vision to implementation: Building a national undergraduate paediatric curriculum. Paediatr Child Health. 2022;27(2):99–104. Yardley S, Teunissen PW, Dornan T. Experiential learning: Transforming theory into practice. Med Teach. 2012;34(2):161–4. Miettinen R. The concept of experiential learning and John Dewey's theory of reflective thought and action. Int J lifelong Educ. 2000;19(1):54–72. Gummesson C, Alm S, Cederborg A, Ekstedt M, Hellman J, Hjelmqvist H, et al. Entrustable professional activities (EPAs) for undergraduate medical education - development and exploration of social validity. BMC Med Educ. 2023;23(1):635. Academy of Science of South Africa. Reconceptualising health professions education in South Africa. 2018. Additional Declarations No competing interests reported. Supplementary Files SupplementaryTables.xlsx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 13 May, 2026 Reviews received at journal 09 May, 2026 Reviews received at journal 24 Apr, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers invited by journal 15 Apr, 2026 Editor invited by journal 07 Apr, 2026 Editor assigned by journal 06 Apr, 2026 Submission checks completed at journal 06 Apr, 2026 First submitted to journal 05 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9325137","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627061839,"identity":"734e2c46-c5af-47a8-a56d-96bb8581bc03","order_by":0,"name":"Mergan Naidoo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYFACxgYJICnHwEOqFmNStDAwgLQkNhCtxZz9cOONDxXb0jecOf7sAUONHYN8+wH8Wix7EpstZ5y5nbvhbEO6AcOxZAbGngT8WgwOJLZJ87YBtZxnOCbBwHaAgZmBkJbzD8Fa0g3OM7ZJMPw7wMDG/4CAlhsQWxIMzjazSTC2HWDgkSBky42HYL8YzjxzjE0isS+ZR0KCkC3n0x8CQ+y2PN+Z9GcSH77Zycn3E7AFFQAVkxSjo2AUjIJRMApwAABrFENkzyps/wAAAABJRU5ErkJggg==","orcid":"","institution":"University of KwaZulu-Natal","correspondingAuthor":true,"prefix":"","firstName":"Mergan","middleName":"","lastName":"Naidoo","suffix":""},{"id":627061840,"identity":"84f36bf9-8e86-4e0e-9da4-6ff15ec324ef","order_by":1,"name":"Kimera Tamzin Suthiram","email":"","orcid":"","institution":"University of KwaZulu-Natal","correspondingAuthor":false,"prefix":"","firstName":"Kimera","middleName":"Tamzin","lastName":"Suthiram","suffix":""},{"id":627061841,"identity":"b72af8f3-3931-4e4b-9d0c-bc51bcea19c7","order_by":2,"name":"Lucie Byrne-Davis","email":"","orcid":"","institution":"University of Manchester","correspondingAuthor":false,"prefix":"","firstName":"Lucie","middleName":"","lastName":"Byrne-Davis","suffix":""}],"badges":[],"createdAt":"2026-04-05 09:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9325137/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9325137/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107650177,"identity":"c181ee90-0b7e-4410-8fd7-cbce3e64c763","added_by":"auto","created_at":"2026-04-23 14:56:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":442044,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9325137/v1/fb663b87-5213-448b-99b1-f556854ab753.pdf"},{"id":107650089,"identity":"3f9a6016-695a-4bb5-9dee-f4f650dab62c","added_by":"auto","created_at":"2026-04-23 14:56:02","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":50480,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTables.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9325137/v1/120b7d9f0b99418d6a450e09.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gaining consensus among stakeholders on the core undergraduate medical curriculum at the University of KwaZulu-Natal, Durban, South Africa: a mixed-methods study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEducators widely recognise the importance of a core medical curriculum as a means of defining essential and common content within training programmes (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Training institutions and regulatory bodies advocate for such curricula primarily to manage content overload and to respond to the increasing demand for specialisation. Disciplinary experts often seek to expand inclusion of their specific content, which may inadvertently compromise contextual relevance and balance within the curriculum (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In South Africa, the Health Professions Council of South Africa (HPCSA) is the statutory body responsible for accrediting medical curricula. The HPCSA conducted accreditation visits to the University of KwaZulu-Natal (UKZN) undergraduate medical programme in 2018 and again in 2024. These reviews highlighted several recommendations, including strengthening a community-based, primary care-oriented curriculum and developing a clearly defined core curriculum to address ongoing content overload (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The 2024 accreditation report reiterated key priorities relevant to curriculum development. These included continuing curriculum renewal processes, enhancing community engagement in curriculum design, achieving an appropriate balance between content and process aligned with graduate outcomes, integrating disciplines with limited exposure (such as otorhinolaryngology, ophthalmology, and urology) using contextually appropriate strategies, and addressing previously identified gaps in forensic medicine (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Collectively, these recommendations aim to ensure that graduates are adequately prepared for internships, community service, and subsequent roles as medical officers or general practitioners within the South African healthcare system.\u003c/p\u003e \u003cp\u003eProgress toward implementing the 2018 recommendations was delayed by the COVID-19 pandemic. However, a dedicated task team was subsequently established to advance curriculum review and renewal, with progress reported during the 2024 HPCSA visit. Within this context, defining a core curriculum is a critical enabling step. A core curriculum delineates the essential knowledge, skills, and attitudes required of a medical graduate (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), while remaining responsive to the healthcare needs of the communities served (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Importantly, it mitigates the effects of knowledge expansion by prioritising depth over excessive breadth, thereby supporting meaningful learning. Without such prioritisation, students may struggle to identify and internalise the key competencies required for effective clinical practice (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Currently, there is no formally defined core curriculum for the undergraduate medical programme at UKZN.\u003c/p\u003e \u003cp\u003eThe HPCSA has adopted and contextualised the CanMEDS competency framework for use within South African medical schools (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Many institutions have aligned their curricula accordingly (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The CanMEDS framework outlines a set of integrated competencies, including medical expert, communicator, collaborator, leader, health advocate, scholar, and professional (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Curriculum developers must therefore define contextually relevant knowledge, skills, and professional behaviours required for practice within the local healthcare system (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). A curriculum, however, extends beyond a mere compilation of content; it encompasses learning outcomes, teaching and learning strategies, assessment approaches, and the broader educational environment (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe theoretical underpinning for this curriculum development process is provided by social constructivism, which emphasises that knowledge is constructed through social interaction and experiential learning. Lev Vygotsky, a key proponent of this theory, highlighted the central role of social engagement in cognitive development (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In the final three years of undergraduate training, students participate in service-based clinical learning within healthcare settings, where they develop competencies through interaction with patients and multidisciplinary teams. The conceptual framework for this study integrates the CanMEDS framework (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), HPCSA core competencies (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and the UKZN College of Health Sciences competencies collectively adapted into the AfriMEDS framework (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven these considerations, there is a clear and pressing need to define a core medical curriculum at UKZN. The current curriculum is challenged by content overload, and the HPCSA has specifically highlighted the absence of a clearly articulated core. A stakeholder-engaged approach has been recommended to address this gap. Accordingly, this study aimed to achieve consensus among key stakeholders on the core clinical undergraduate medical curriculum at UKZN.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003e A sequential mixed-methods design was used, comprising documentary analysis followed by a Modified Delphi consensus process. The documentary analysis informed the development of the Delphi instrument, and integration occurred by interpreting the final consensus in relation to the AfriMEDS competency framework. The study was conducted within the undergraduate Bachelor of Medicine and Surgery (MBChB) programme at the UKZN. The six-year programme includes three pre-clinical years followed by three clinical years (years 4\u0026ndash;6), during which students rotate through major disciplines in modular attachments (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Each clinical attachment is a stand-alone module with specific learning outcomes aligned to the expected knowledge, skills, and behaviours. Each discipline decides the content of each module, and academics in that discipline assess it. Each module has a discipline module coordinator. The study was conducted in 2023 and 2024.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDocumentary analysis\u003c/h3\u003e\n\u003cp\u003eA comprehensive documentary analysis was undertaken to identify the current curriculum content in terms of knowledge, skills, and attitudes. Data sources included module templates, course handbooks, student resources, and curriculum mapping data from the Learning Opportunities, Objectives and Outcomes Platform (LOOOP)(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDocuments were analysed through iterative processes of familiarisation, coding, and categorisation. Content was organised according to AfriMEDS roles. Where gaps in skills documentation were identified, a nationally developed skills list from the Nelson Mandela\u0026ndash;Fidel Castro collaboration programme was incorporated to ensure comprehensive coverage (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo enhance trustworthiness, module coordinators were invited to verify the extracted content. Credibility was ensured through the use of institutional documents and participant verification, while representativeness was supported by the use of standardised, institutionally approved module templates (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eThe Modified Delphi process\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eParticipants included clinicians involved in teaching years 4\u0026ndash;6, recent UKZN graduates (interns and community service medical officers), and experienced primary healthcare (PHC) nurses. These groups were selected to reflect both academic and service-delivery perspectives relevant to the expected competencies of graduates.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eThe Delphi questionnaire was developed using Research Electronic Data Capture (REDCap) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and populated with curriculum items derived from the documentary analysis. Participants were asked to classify each item as:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eessential for inclusion in the core curriculum,\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003edesirable but not core, or\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003enot required.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eParticipants were also invited to suggest additional items. Two Delphi rounds were conducted. In round 1, all items were rated. Items achieving\u0026thinsp;\u0026ge;\u0026thinsp;70% agreement for inclusion were retained as core and removed from subsequent rounds. Items that did not reach consensus, along with newly suggested items, were recirculated in round 2.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eConsensus definition and analysis\u003c/h2\u003e \u003cp\u003eConsensus was defined a priori as \u0026ge;\u0026thinsp;70% agreement for inclusion. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) Data were analysed descriptively, and frequencies and proportions were used to determine consensus levels. The iterative process continued until responses stabilised after two rounds.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthics considerations\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from Keele University, the UKZN Humanities and Social Sciences Research Ethics Committee, and the UKZN registrar. Written informed consent was obtained from all participants.\u003c/p\u003e \u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and verification of curriculum content\u003c/h2\u003e \u003cp\u003eA total of 17 discipline-based specialists participated in verifying the curriculum content, including three representatives each from Obstetrics and Gynaecology, Internal Medicine, Surgery, Paediatrics, and Family Medicine, and two from Psychiatry. These individuals were either module coordinators or experienced discipline-based experts with in-depth knowledge of the MBChB programme.\u003c/p\u003e \u003cp\u003eIn addition, six recent graduates (three interns and three CSOs) and four experienced PHC nurses were purposively selected to participate in the Delphi process. Interns and CSOs were recruited from the Durban hospital complex, while PHC nurses had at least five years\u0026rsquo; experience in primary care settings. These groups were selected to ensure representation of both academic and service-delivery perspectives relevant to undergraduate training. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for details of the Delphi study participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics of participants of the Delphi Study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHighest level of education completed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProfessional designation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYears of experience since qualifying with your basic qualification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYears of experience in your current job?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDocument analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDelphi round 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelphi round 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary healthcare nurse practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubspecialist qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaster's Degree/ Fellowship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFamily Physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMBChB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical intern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubspecialist qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInternal Medicine Physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaster's Degree/ Fellowship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePaediatrician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubspecialist qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePaediatrician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaster's Degree/ Fellowship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUndergraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCommunity Service Medical Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaster's Degree/ Fellowship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObstetrician and gynaecologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUndergraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCommunity Service Medical Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaster's Degree/ Fellowship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePsychiatrist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUndergraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCommunity Service Medical Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary healthcare nurse practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUndergraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical intern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary healthcare nurse practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubspecialist qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObstetrician and gynaecologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaster's Degree/ Fellowship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFamily Physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUndergraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary healthcare nurse practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubspecialist qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInternal Medicine Physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUndergraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCommunity Service Medical Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubspecialist qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePaediatrician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaster's Degree/ Fellowship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFamily Physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaster's Degree/ Fellowship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubspecialist qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInternal Medicine Physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaster's Degree/ Fellowship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObstetrician and gynaecologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaster's Degree/ Fellowship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePsychiatrist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf the 26 individuals invited to participate in the Delphi process, 21 completed Round 1 and 17 completed Round 2.\u003c/p\u003e \u003cp\u003eThe final cohort included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e17 doctors and 4 PHC nurses\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e11 females and 10 males\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMean age: 41.1 years (SD 12.1)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMean years of experience: 16.0 years (SD 11.2)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMean years in current role: 10.4 years (SD 8.3)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eParticipants represented a range of professional backgrounds, including interns, CSOs, family physicians, specialists across major disciplines, and PHC nurses. Six participants were recent graduates (interns and CSOs), providing insights into early-career practice expectations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDocumentary analysis\u003c/h2\u003e \u003cp\u003eSeventeen participants confirmed the accuracy and completeness of the extracted curriculum content. The documentary analysis identified curriculum content across all clinical disciplines in years 4\u0026ndash;6, which was subsequently categorised according to AfriMEDS roles based on HPCSA descriptors.\u003c/p\u003e \u003cp\u003eA total of 724 curriculum items were identified. Of these, 653 items aligned with the healthcare practitioner role, while 71 aligned with other AfriMEDS roles (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of curriculum content identified through documentary analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfriMEDS Role\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthcare practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e653\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunicator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollaborator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeader and manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth advocate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScholar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe distribution of content across disciplines is shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of curriculum content by discipline\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscipline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkills list\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical disciplines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstetrics and Gynaecology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntegrated primary care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e724\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe healthcare practitioner role constituted the majority of the curriculum content. In contrast, fewer items were identified for the remaining AfriMEDS roles.\u003c/p\u003e \u003cp\u003eNot all disciplines contributed content across all roles, highlighting variability in the representation of non-clinical competencies within the curriculum. Full details of the curriculum content are provided in Supplementary Table\u0026nbsp;1.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDelphi outcomes\u003c/h2\u003e \u003cp\u003eThe Delphi process consisted of two rounds. Following Round 1, items achieving\u0026thinsp;\u0026ge;\u0026thinsp;70% consensus were retained and removed from further rounds. A total of 48 items (including eight newly proposed items and those that did not reach consensus) were recirculated in Round 2.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFinal consensus\u003c/h2\u003e \u003cp\u003eAfter two Delphi rounds:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e629 items were retained as core curriculum content aligned with the healthcare practitioner role\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e69 items were retained across other AfriMEDS roles\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e27 items did not achieve consensus for inclusion\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eMost items reached consensus in Round 1, although additional mental health content was incorporated following Round 2. The majority of items removed after Round 1 were from paediatrics and mental health, but several were reconsidered and included in Round 2 (Table\u0026nbsp;4). Participants proposed eight additional items for inclusion: ultrasound training (point-of-care ultrasound and focused abdominal sonography for trauma), operative deliveries (ventouse/vacuum), head and neck trauma/maxillofacial injury, trauma debriefing, management of an episiotomy, basic surgical skills, and ENT conditions. See supplementary table 2.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDelphi process outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelphi Stage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Items\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems from documentary analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e724\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNew items added after Round 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems reviewed in Round 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems removed because of duplication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal items reaching consensus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e698\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems not reaching consensus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eContent aligned to non-healthcare practitioner roles\u003c/h2\u003e \u003cp\u003eConsensus was achieved on content across all non-healthcare practitioner roles, although the number of items remained relatively limited compared to the healthcare practitioner domain (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and supplementary Table\u0026nbsp;3).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFinal core curriculum by AfriMEDS role\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfriMEDS Role\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthcare practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunicator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollaborator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeader and manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth advocate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScholar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e698\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThese items included competencies related to communication skills, multidisciplinary collaboration, clinical governance, advocacy for vulnerable populations, reflective practice, and professional conduct.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eContent not reaching consensus\u003c/h2\u003e \u003cp\u003eA total of 27 items did not achieve the predefined threshold of \u0026ge;\u0026thinsp;70% agreement for inclusion in the core curriculum. Of the newly proposed items introduced after Round 1, operative deliveries (ventouse/vacuum) and head and neck trauma did not reach consensus. (Supplementary Table\u0026nbsp;4).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eHealthcare practitioner content\u003c/h2\u003e \u003cp\u003eThe majority of agreed core curriculum content was aligned with the healthcare practitioner role. These items spanned all major clinical disciplines and included both knowledge areas and practical skills required for generalist practice.\u003c/p\u003e \u003cp\u003eThe final list of 629 healthcare practitioner items, along with their percentage agreement, is presented in Supplementary Table\u0026nbsp;2. Duplicate items identified were removed. These items reflect a broad range of competencies, including:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003erecognition and management of common and critical conditions\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eprocedural skills\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eemergency care\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eclinical reasoning and decision-making\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study achieved stakeholder consensus on the core clinical undergraduate medical curriculum at the University of KwaZulu-Natal, providing a comprehensive, contextually grounded framework aligned with AfriMEDS competencies. By integrating documentary analysis with a Delphi consensus process, the study moves beyond descriptive curriculum mapping to define an agreed core curriculum that is responsive to both educational imperatives and health system needs. Importantly, the findings address the dual challenges of content overload and curricular fragmentation, which are widely recognised in health professions education (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePrincipal findings interpreted through a theoretical lens\u003c/h2\u003e \u003cp\u003eA central finding of this study is the predominance of content aligned with the healthcare practitioner role. This reflects the realities of the South African healthcare system, where newly qualified doctors are expected to function as generalists in district hospitals and primary care settings with limited access to specialist support (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). From a competency-based education (CBE) perspective, this emphasis is appropriate, as CBE prioritises clearly defined outcomes that reflect real-world practice requirements (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The extensive range of clinical content identified in this study can therefore be understood as a necessary adaptation to context, rather than an indication of curricular excess.\u003c/p\u003e \u003cp\u003eHowever, when viewed through the lens of constructive alignment (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), the findings raise important considerations regarding the balance between curriculum content, teaching strategies, and assessment (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). While the curriculum appears strongly aligned with clinical knowledge and skills, the relatively limited representation of non-healthcare practitioner roles suggests a potential misalignment between intended graduate attributes (AfriMEDS roles) and the enacted curriculum. Constructive alignment requires that learning outcomes, teaching activities, and assessments are coherently structured to achieve desired competencies (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The uneven distribution of content across roles observed in this study indicates that certain competencies\u0026mdash;particularly communication, leadership, and scholarship\u0026mdash;may not be systematically reinforced through teaching and assessment practices.\u003c/p\u003e \u003cp\u003eThe findings can also be interpreted through a social constructivist framework, particularly drawing on Lev Vygotsky\u0026rsquo;s concept of the Zone of Proximal Development (ZPD) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Clinical training in the final years of undergraduate education occurs within workplace-based environments, where learning is mediated through interaction with supervisors, peers, and patients. Within this paradigm, knowledge and competence are co-constructed through participation in authentic clinical activities. The strong emphasis on healthcare practitioner competencies reflects the nature of these learning environments, where clinical problem-solving and procedural skills are foregrounded. However, competencies such as communication, collaboration, and professionalism require intentional scaffolding and guided reflection within the ZPD. Their relative underrepresentation in the curriculum suggests that these competencies may be assumed to develop implicitly, rather than being explicitly taught and supported.\u003c/p\u003e \u003cp\u003eFrom a programmatic assessment perspective, the findings also highlight important gaps. Programmatic assessment emphasises the collection of multiple low-stakes data points across competencies to inform high-stakes decisions about learner progression (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). While the curriculum content identified in this study provides a comprehensive blueprint of expected competencies, the uneven emphasis across AfriMEDS roles suggests that assessment systems may similarly prioritise clinical knowledge and skills over other domains. This imbalance risks reinforcing a narrow conception of competence and may limit the development of well-rounded practitioners. Aligning the defined core curriculum with programmatic assessment strategies\u0026mdash;such as workplace-based assessments and Entrustable Professional Activities (EPAs)(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u0026mdash;could enhance the validity and educational impact of assessment practices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eComparison with existing literature\u003c/h2\u003e \u003cp\u003eThis study contributes to a growing body of literature on core curriculum development in medical education. Previous studies have primarily focused on defining discipline-specific curricula using Delphi methods, including in surgery, anaesthesia, dermatology, and palliative care (\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). While these studies have identified essential competencies within specific domains, few have attempted to define a comprehensive core curriculum across the entire clinical training programme. The breadth of the current study, therefore, represents a significant advancement, particularly in a low- and middle-income country context.\u003c/p\u003e \u003cp\u003eThe large number of items identified in this study contrasts with the smaller core curricula described in high-income settings. This difference can be understood through the lens of contextual curriculum design, which emphasises the importance of aligning educational content with local health system needs (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In South Africa, the burden of disease is characterised by a complex interplay of communicable and non-communicable conditions, compounded by resource constraints and inequities in access to care (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). As a result, undergraduate medical curricula must prepare graduates to manage a wide spectrum of conditions independently. The extensive list of core competencies identified in this study reflects this reality and emphasises the limitations of adopting universally standardised curricula without contextual adaptation.\u003c/p\u003e \u003cp\u003eThe findings also align with literature highlighting challenges in operationalising competency frameworks such as CanMEDS and AfriMEDS (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). While these frameworks provide a comprehensive set of roles, their translation into curriculum content and assessment remains inconsistent across institutions. The uneven representation of non-clinical competencies observed in this study is consistent with reports that roles such as scholar, leader, and health advocate are often underdeveloped in practice ((\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). This suggests that additional strategies are needed to meaningfully embed these competencies within clinical training.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eImplications for curriculum design and integration\u003c/h2\u003e \u003cp\u003eThe findings of this study have important implications for curriculum renewal at UKZN and similar institutions. First, the current discipline-based, modular curriculum structure may contribute to fragmentation and limit opportunities for integration across competencies. From a constructive alignment perspective, reorganising the curriculum around clinical presentations or patient pathways may facilitate more coherent integration of knowledge, skills, and professional roles. Such approaches have been shown to enhance clinical reasoning and contextual learning (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSecond, the limited articulation of non-healthcare practitioner roles highlights the need for more deliberate integration of these competencies. Drawing on social constructivist principles, this integration should occur within authentic clinical contexts, supported by supervision, feedback, and reflection. For example, communication skills can be developed through observed consultations and structured feedback, while leadership and collaboration can be fostered through participation in multidisciplinary team activities. Embedding these competencies within workplace-based learning aligns with the principles of experiential learning and supports the development of professional identity (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThird, the study highlights the importance of aligning curriculum content with programmatic assessment systems. The defined core curriculum provides a foundation for developing assessment frameworks that capture performance across multiple competencies. The use of EPAs, in particular, offers a mechanism for integrating competencies into meaningful units of professional practice (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). While resource constraints may limit the immediate implementation of comprehensive EPA-based assessment systems, incremental integration of workplace-based assessments could enhance the alignment between curriculum and assessment.\u003c/p\u003e \u003cp\u003eFourth, the findings support the continued emphasis on social accountability in medical education. The strong alignment of curriculum content with community health needs reflects the principles articulated in national and international frameworks for socially accountable education (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Ensuring that curricula remain responsive to local contexts is essential for addressing health inequities and improving population health outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eA key strength of this study is the inclusion of multiple stakeholder groups, including clinicians, recent graduates, and primary healthcare nurses. This diversity of perspectives enhances the credibility and relevance of the findings and aligns with best practices in participatory curriculum design. The mixed-methods approach, combining documentary analysis with Delphi consensus, provides both a comprehensive description of the existing curriculum and a structured mechanism for refinement.\u003c/p\u003e \u003cp\u003eHowever, several limitations should be considered. Participation in the Delphi process was incomplete, and the representation of specialists was lower than anticipated, which may have influenced the balance of perspectives. The large number of curriculum items may have contributed to participant fatigue, particularly in the first round of the Delphi process. In addition, the study focused on defining core content and did not evaluate how this content is delivered, assessed, or translated into clinical competence. As such, further research is needed to examine the implementation and impact of the defined curriculum.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides a comprehensive, stakeholder-informed definition of the core clinical undergraduate medical curriculum at UKZN. Interpreted through the lenses of CBE, constructive alignment, social constructivism, and programmatic assessment, the findings highlight both strengths and areas for development within the current curriculum. The strong emphasis on healthcare practitioner competencies reflects contextual realities, while the relative underrepresentation of other roles highlights the need for more deliberate integration. The resulting framework provides a robust foundation for curriculum renewal, producing socially accountable, contextually responsive graduates equipped to meet the complex healthcare needs of South Africa.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACGME\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAccreditation Council for Graduate Medical Education\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAfriMEDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHPCSA CanMEDS adaptation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCanMEDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRoyal College of Physicians and Surgeons of Canada competency framework\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecompetency-based education\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCSO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity Service Medical Officer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEPA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEntrustable Professional Activities\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHPCSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth Professions Council of South Africa\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLOOOP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLearning Opportunities, Objectives and Outcomes Platform\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMDT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMultidisciplinary team\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePrimary healthcare\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eREDCap\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eResearch Electronic Data Capture\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUKZN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUniversity of KwaZulu-Natal\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eZPD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eZone of Proximal Development\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict Disclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no financial or personal relationships that may have inappropriately influenced their writing of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMN was responsible for conceptualising the research article, conducting a literature search, extracting relevant information, and drafting the initial manuscript. MN and KTS analysed the data. MN, KTS, and LBD reviewed and edited the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBandaranayake R. The concept and practicability of a core curriculum in basic medical education. Med Teach. 2000;22(6):560\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealth Professionals Council of South Africa. Accreditation of the undergraduate education and training in medicine, College of Health Sciences, UKZN. Pretoria: Health Professionals Council of South Africa. 2018 11 May 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealth Professionals Council of South Africa. Draft evaluation report: Accreditation of the undergraduate education and training in medicine, College of Health Sciences, UKZN. Pretoria: Health Professionals Council of South Africa; 2024. 7 May 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamani N, Rahimi M. The core curriculum and integration in medical education. Res Dev Med Educ. 2016;5(2):50\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarden RM, Davis MH. Amee Medical-Education Guide No-5 - the Core Curriculum with Options or Special Study Modules. Med Teach. 1995;17(2):125\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnight SE, Ross AJ, Mahomed O. Developing primary health care and public health competencies in undergraduate medical students. S Afr Fam Pract. 2017;59(3):103\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStovel RG, Gabarin N, Cavalcanti RB, Abrams H. Curricular needs for training telemedicine physicians: A scoping review. Med Teach. 2020;42(11):1234\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrank JR, Danoff D. The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med Teach. 2007;29(7):642\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrant J, Zachariah A. Designing a contextual curriculum. FAIMER-Keele Master\u0026rsquo;s in Health Professions Education: Accreditation and Assessment. Module 4, Unit 5. London: CenMEDIC; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDent J, Harden RM, Hunt D. A Practical Guide for Medical Teachers, E-Book: A Practical Guide for Medical Teachers. E-Book: Elsevier Health Sciences; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB\u0026eacute;langer P. Theories in adult learning and education. Verlag Barbara Budrich; 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealth Professionals Council of South Africa. Core Competencies for Undergraduate Students in Clinical Associate, Dentistry and Medical Teaching and Learning Programmes in South Africa. Pretoria: Health Professionals Council of South Africa. 2014 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hpcsa-blogs.co.za/wp-content/uploads/2017/04/MDB-Core-Competencies-ENGLISH-FINAL-2014.pdf\u003c/span\u003e\u003cspan address=\"https://www.hpcsa-blogs.co.za/wp-content/uploads/2017/04/MDB-Core-Competencies-ENGLISH-FINAL-2014.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMnguni L. The Curriculum Ideologies Underlying the AfriMEDS Curriculum Framework for Undergraduate Medical and Dental Education in South Africa. Int Med Educ. 2024;3(1):44\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaphosa C, Mudzielwana NP, Netshifhefhe L. Curriculum development in South African higher education institutions: Key considerations. Mediterranean J social Sci. 2014;5(7):355.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamklass S, Matthews M. Development of the MB ChB curriculum map at the University of KwaZulu-Natal, South Africa. Samj S Afr Med J. 2017;107(12):1049.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBalzer F, Hautz WE, Spies C, Bietenbeck A, Dittmar M, Sugiharto F, et al. Development and alignment of undergraduate medical curricula in a web-based, dynamic Learning Opportunities, Objectives and Outcome Platform (LOOOP). Med Teach. 2016;38(4):369\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZungu SB, Mathu KM, Scheepers CB. Leading the South African Cuban-trained medical students\u0026rsquo; assimilation in the local medical schools. Emerald Emerg Markets Case Stud. 2019;9(2):1\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan H. Conducting a Qualitative Document Analysis. Qual Rep. 2022;27(1):64\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inf. 2019;95:103208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThangaratinam S, Redman CW. The delphi technique. obstetrician gynaecologist. 2005;7(2):120\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMabuza LH, Moshabela M. Understanding of 'generalist medical practice' in South African medical schools. Afr J Prim Health Care Fam Med. 2024;16(1):e1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMabuza LH, Moshabela M. What are the experiences of medical students and their trainers regarding undergraduate training in primary health care at four South African medical schools? A qualitative study. Front Med. 2024;11:1337140.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlitz J, Couper I, Geldenhuys M, Klocke M, Van Zyl M. Longitudinal integrated clerkships from start to finish: A medical curriculum innovation. Afr J Prim Health Care Family Med. 2024;16(1):4401.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePangaro L, ten Cate O. Frameworks for learner assessment in medicine: AMEE Guide 78. Med Teach. 2013;35(6):e1197\u0026ndash;210.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBiggs J. Enhancing teaching through constructive alignment. High Educ. 1996;32(3):347\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTen Cate O, Graafmans L, Posthumus I, Welink L, van Dijk M. The EPA-based Utrecht undergraduate clinical curriculum: Development and implementation. Med Teach. 2018;40(5):506\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlayande BT, Forbes CW, Iradakunda J, Majyambere JP, Hey MT, Powell BL et al. Determining Critical Topics for Undergraduate Surgical Education in Rwanda: Results of a Modified Delphi Process and a Consensus Conference. Cureus. 2023;15(8):e43625.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRohan D, Ahern S, Walsh K. Defining an anaesthetic curriculum for medical undergraduates. A Delphi study. Med Teach. 2009;31(1):e1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurger H, Krause R, Blanchard C, Ambler J, Ganca L, Barnard A, et al. Position paper on undergraduate Palliative Medicine education for doctors in South Africa. Afr J Prim Health Care Fam Med. 2022;14(1):e1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClayton R, Perera R, Burge S. Defining the dermatological content of the undergraduate medical curriculum: a modified Delphi study. Br J Dermatol. 2006;155(1):137\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaphumulo WT, Bhengu BR. Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis. 2019;42(1):e1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNgene NC, Khaliq OP, Moodley J. Inequality in health care services in urban and rural settings in South Africa. Afr J Reprod Health. 2023;27(5s):87\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiMarino LM, Boppana RC, Pincavage AT, Hemmer P, Ferris A, Chandrasekar J, et al. AAIM Recommendations for Undergraduate Medical Education to Graduate Medical Education Transition Curricula in Internal Medicine. Am J Med. 2023;136(5):489\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAngus S, Vu TR, Halvorsen AJ, Aiyer M, McKown K, Chmielewski AF, et al. What skills should new internal medicine interns have in July? A national survey of internal medicine residency program directors. Acad Med. 2014;89(3):432\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBannister SL, Forbes KL, Moddemann DM, Lewis MA. From vision to implementation: Building a national undergraduate paediatric curriculum. Paediatr Child Health. 2022;27(2):99\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYardley S, Teunissen PW, Dornan T. Experiential learning: Transforming theory into practice. Med Teach. 2012;34(2):161\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiettinen R. The concept of experiential learning and John Dewey's theory of reflective thought and action. Int J lifelong Educ. 2000;19(1):54\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGummesson C, Alm S, Cederborg A, Ekstedt M, Hellman J, Hjelmqvist H, et al. Entrustable professional activities (EPAs) for undergraduate medical education - development and exploration of social validity. BMC Med Educ. 2023;23(1):635.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAcademy of Science of South Africa. Reconceptualising health professions education in South Africa. 2018.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"undergraduate medical education, core curriculum, curriculum development Delphi technique, competency-based education, AfriMEDS, Medical education, mixed-methods research","lastPublishedDoi":"10.21203/rs.3.rs-9325137/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9325137/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eIntroduction\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA clearly defined core medical curriculum is essential to address content overload and ensure alignment with contextual healthcare needs. The Health Professions Council of South Africa recommended that the University of KwaZulu-Natal define its undergraduate core medical curriculum. This study aimed to achieve stakeholder consensus on the core clinical curriculum by identifying essential knowledge, skills, and attitudes for the senior years of training.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA sequential mixed-methods design was employed. Documentary analysis of module templates, course materials, and curriculum mapping data was conducted to identify existing curriculum content, which was categorised according to the African Medical Education Directives for Specialists competencies. Content was verified by module coordinators. An electronic Modified Delphi process involving academics, recent graduates, and primary healthcare nurses was conducted over two rounds to establish consensus, defined as \u0026ge;\u0026thinsp;70% agreement.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDocumentary analysis identified 724 curriculum items, of which 653 were aligned with the healthcare practitioner role and 71 with other AfriMEDS roles. Seventeen module coordinators verified the curriculum content. Twenty-one participants completed Delphi round 1, and seventeen completed round 2. After the Delphi process, consensus was achieved on 629 healthcare practitioner items and 69 items related to other competencies. A small number of items (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;27) did not reach consensus for inclusion.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDiscussion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study defined a stakeholder-informed core clinical undergraduate medical curriculum at UKZN. The findings highlight a strong emphasis on the healthcare practitioner role, reflecting the demands of generalist practice in a resource-constrained health system. The resulting curriculum framework provides a foundation for curriculum renewal aligned with AfriMEDS and supports the training of socially accountable, context-responsive graduates.\u003c/p\u003e","manuscriptTitle":"Gaining consensus among stakeholders on the core undergraduate medical curriculum at the University of KwaZulu-Natal, Durban, South Africa: a mixed-methods study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-23 14:55:06","doi":"10.21203/rs.3.rs-9325137/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-13T09:10:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-09T17:08:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-24T05:42:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54160454519049925780760369742413805409","date":"2026-04-20T10:01:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"286690920458978863584247368562860902335","date":"2026-04-16T03:40:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-16T01:29:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-07T17:29:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-07T03:30:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-07T03:29:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-04-05T08:51:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"25de3cd5-d590-4db6-b634-b20aecf60a24","owner":[],"postedDate":"April 23rd, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-13T09:10:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-09T17:08:37+00:00","index":49,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T09:28:26+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-23 14:55:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9325137","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9325137","identity":"rs-9325137","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}