Why South Africa needs its own educational playbook

When university staff attend professional development workshops, how much of what they learn shapes what they do in their work environments? This simple question sparked a far-reaching exploration into how training translates into real-world academic practice – and why the answer, particularly in the Global South, might lie in crafting our own educational models rather than importing them wholesale.

In his inaugural lecture, titled “Theory from the Past, Theory for the Future: Rethinking Health Professions in Context”, Professor François Cilliers from the University of Cape Town’s (UCT) Faculty of Health Sciences reflected on a decades-long career in health professions education, unpacking the complex relationship between theory, research, and practice. The base of his talk was a re-evaluation of how South African academic institutions – and others in the developing world – engage with global knowledge and innovation in education.

A professor of health sciences education, Professor Cilliers’ lecture was delivered to a room filled with family, friends, colleagues, and students on 9 April. It was framed around four major themes: the context of health professions education; a personal journey into theory; the use of theory in educational research; and the future of theory-informed practice.

“How do we create conditions that enable someone to use what they’ve learned?”

His starting point was using theory to understand whether and how academics implement ideas they encounter in professional development events. This ranged from how best to evaluate whether practice changed to understanding the context in which changes needed to be made. “We started thinking about ecosystems. Not just the workshop, but everything around it – the department, the faculty, and the broader institutional environment. How do we create conditions that enable someone to use what they’ve learned?”

Questioning imported solutions

A founding member who served two terms as the president of the Southern African Association of Health Educationalists, Cilliers also discussed the ways educational ideas propagate from the Global North. He spoke of a pattern of “curriculum consultancy”, where experts from the Global North were brought in to advise South African institutions. “At best, this was a misguided endeavour,” he noted, pointing to the dominance of northern perspectives in global medical education literature and policy. Despite well-meaning efforts to transform, editorial boards of influential journals remain overwhelmingly populated by scholars from the United States (US) and Canada, with little representation from the Global South.

He further underlined this concerning the prestigious Karolinska Institute Prize for Research in Medical Education, awarded since 2004. Mapping the origins of this auspicious group shows stark geographical and demographic imbalances that mirror the historical path the study of health professions education has taken. All award winners have their roots in North America, the United Kingdom (UK) and the Netherlands, countries that also dominate Health Professional Education literature.

But the challenge wasn’t just in faculty development. A parallel focus in the lecture was assessment – often cited as the single most powerful driver of student learning. “Everyone says assessment drives learning,” Cilliers said. “You’ll find thousands of articles repeating that phrase. But almost no one can explain how it actually happens.”

Cilliers’ doctoral research uncovered a surprising gap: although widely accepted, the idea that assessment shapes learning lacked concrete evidence. That realisation led to the development of a more nuanced theoretical model – one that links specific features of assessment with learning outcomes, mediated by student behaviour and perception.

As with research into professional development, health behaviour theory – more familiar in medicine and psychology than in education – offered powerful explanatory tools. And this wasn’t an accident. “I drew on the theories I could access. There was no formal training in educational theory when I started. Psychology was my doorway.”

Global models, local realities

But as his work evolved, so too did his understanding of theory’s limitations, particularly when theories are detached from context. “There is no shortage of research in education. But most of it comes from contexts that are nothing like ours – well-funded institutions in the UK, Canada, the US, and the Netherlands. We can’t just lift and shift their models into our own systems.”

This critique extended to dominant global frameworks like problem-based learning, competency-based education, and standardised definitions of “excellence”. “Some ideas propagate like weeds. They’re everywhere – whether anyone asked for them.”

“It’s not just about who has the most money or the biggest staff. We need to talk about excellence under the circumstances.”

According to Cilliers, a particularly striking example came from a study of South African health professionals, who reimagined a competency framework to include concepts like “survive and flourish” and “navigating messy realities”. These are not core parts of Canadian or American competency frameworks but deeply relevant in the local context.

His argument? Excellence must be redefined. “It’s not just about who has the most money or the biggest staff. We need to talk about excellence under the circumstances.”

Even widely trusted research tools like systematic reviews came under scrutiny. “They create the illusion of utility. You end up with reviews that exclude all the useful studies – and the conclusion is always the same: we need more research.”

A call for thoughtful change

So, what’s the alternative? Cilliers proposed a deliberate process he called adaptation inquiry – a step-by-step approach to evaluating whether a global innovation is truly suitable for local application.

“This involves asking key questions: Why do we want to adopt this idea? Where did it originate? What made it work there? Does our context have the same enabling conditions? And if not, can it be adapted – or should it be abandoned?

“This is not something you do every day. But when we’re designing curricula, launching national programs, or making big changes, we owe it to our students, our country, and our profession to get it right.”