SA doctors warn new competency-based curriculum risks patient safety

The South African Medical Association (Sama) has warned that the country must guard against using the new World Health Organization curriculum as a shortcut to produce doctors faster without ensuring safe clinical readiness

This comes after the WHO Regional Office for Africa this week launched a new competency-based curriculum that promises to fast-track medical students into the workforce.

The WHO said its model, which integrates theory and clinical practice from day one, will allow countries to produce work-ready health professionals more efficiently.

However, Sama said adopting the curriculum wholesale could undermine patient safety, worsen clinical risks and ignore the realities of practising medicine in one of the world’s most demanding health systems.

“South Africa must guard against using the new curriculum as a shortcut to produce doctors faster without ensuring safe clinical readiness,” said Sama spokesperson Vezi Silwanyana.

“A curriculum alone, without supervised postgraduate rotations, cannot fast-track graduates directly into independent practice.”

Sama, which represents 17,500 doctors, said while it supports innovation in medical education and understands the WHO’s intention to strengthen health worker readiness across Africa, the model “is not realistic” for South Africa’s context.

“Our graduates contend with some of the world’s highest burdens of trauma, infectious disease, maternal morbidity and chronic conditions. Internship and community service provide structured, supervised exposure that bridges the gap between academic knowledge and safe independent clinical practice,” she said.

She noted that even countries with advanced competency-based models retain housemanship, foundation years or supervised residency-type programmes.

“No credible global system has eliminated supervised postgraduate clinical training entirely,” she said.

Concerns about removing internship and community service

Sama expressed “significant concern” about any proposal to remove internship and community service from the medical training pathway.

“These supervised years are essential for building clinical competence, especially in a country with high disease burden, trauma load and resource constraints,” Silwanyana said.

“Without them, newly graduated doctors would face high-stakes clinical decisions without the graded responsibility, mentorship and oversight required to ensure patient safety.”

She said that an internship exposes trainees to emergency medicine, obstetrics, anaesthetics, paediatrics, surgery, internal medicine and psychiatry, providing experience that “cannot be replaced” by classroom teaching or simulation-based assessments.

Community service, she added, prepares young doctors to work in rural and underserved areas and ensures equitable distribution of clinical skills.

SA has long practised elements of competency-based training

The Democratic Nursing Organisation of South Africa (Denosa) said elements of competency-based training already exist in South Africa.

General-secretary Kwena Manamela said nursing programmes have long required students to complete mandatory practical hours across specialised clinical areas.

“Not all African nurses can practise in Europe, whereas ours can. The training of doctors is also not uniform across Africa. Maybe minor adjustments have been made now, but we have been doing this all along,” he said.

Doctors remain unemployed because funded posts are not being created at the rate required to meet national healthcare needs. This is a workforce planning and resource allocation failure.

—  Vezi Silwanyana, Sama spokesperson

Curriculum experts defend the WHO model

North-West University’s Professor Christmal Dela Christmals, who is a member of the curriculum development advisory committee, said the competency-based model is designed to ensure that by graduation, medical students are certified as ready for independent practice because their progress is continuously monitored.

He explained that the shift moves training away from counting hours and toward assessing what students can actually do.

“If one student can complete a competency in three hours and another needs 1,000 hours, they should not be treated the same. People learn at different paces,” he said.

Under the new model, theory and practice are integrated from the beginning, with continuous or “programmatic” assessment replacing a single high-stakes final exam.

“We follow students from beginning to end to track how they progress,” he said.

A competency-based curriculum cannot replace supervised training

Silwanyana said competency-based education could enhance quality only if South Africa’s training system is adequately resourced with supervision, assessment capacity and real clinical exposure.

“In isolation, the new curriculum cannot compensate for or replace internship and community service,” she said.

The unemployment crisis among junior doctors

The debate comes as South Africa faces a growing crisis of unemployed medical graduates. Despite chronic shortages in hospitals, hundreds of doctors remain jobless after completing community service.

The government has blamed budget pressures, partly driven by a large public sector wage bill, but Dela Christmals said a competency-based curriculum could improve workforce planning if the government commits to a “plan, train and retain” approach. “Provision must be made for medical graduates from the first day they enter the system.”

Sama disagrees that curriculum reform can solve the problem.

“The root of the unemployment crisis is not educational but systemic,” Silwanyana said. “Doctors remain unemployed because funded posts are not being created at the rate required to meet national healthcare needs. This is a workforce planning and resource allocation failure.”

She added that curriculum improvements cannot offset the lack of funded medical officer posts, inadequate human resource forecasting, provincial budget constraints, or misalignment between training output and available positions.

“Fast-tracking graduates without addressing these structural bottlenecks could even worsen unemployment by increasing the number of doctors entering a system that cannot absorb them,” Silwanyana said.

The Health Professions Council of South Africa was approached for comment and this will be added once received.