Management and leadership competencies in Emergency Medicine specialist training: a review with implications for African programmes

Abstract

Introduction

Management and leadership are core competency domains in emergency medicine (EM) specialist training worldwide, yet they remain less clearly articulated and less consistently assessed than clinical skills, particularly in African and other low- and middle-income country (LMIC) settings.

Methods

Review of peer-reviewed and grey literature. Electronic searches of PubMed/MEDLINE, CINAHL, ERIC, and Web of Science were conducted from database inception to March 2026, supplemented by hand-searching of five journals and six organisational repositories. Sources were included if they described management or leadership competencies, educational approaches, assessment methods, or outcomes within postgraduate EM training.

Results

Survey data suggest young African EM specialists feel least prepared in manager and scholar roles. Six recurring competency domains were identified: team leadership; operational and resource management; quality improvement and patient safety; health advocacy; interprofessional and organisational dynamics; and self-management. The most granular taxonomy is a Canadian modified Delphi producing 59 consensus competency statements. Assessment approaches include simulation-based tools, multi-source feedback, and workplace-based methods, with validation evidence concentrated in high-income countries. No validated assessment tools or outcome data for management and leadership competencies were identified from African EM programmes.

Discussion

African EM curricula would benefit from contextually adapted competency statements and assessment strategies. A three-phase development pathway is proposed: (1) an African Delphi consensus process using the domains identified in this review as a starting framework; (2) contextual validation of assessment tools; and (3) embedded implementation science studies within existing curriculum reforms.

African Relevance

• •African EM graduates report feeling least equipped as managers and leaders.
• •No validated leadership assessment tools were identified for African EM settings.
• •Advocacy for emergency care system development is a distinctive African EM leadership demand.
• •The FCEM Living Curriculum is the most structurally documented African reform effort.
• •An African Delphi process is proposed to adapt global competency frameworks.

Introduction

Emergency medicine (EM) has expanded rapidly as a recognised specialty in Africa over the past two decades. South Africa formally recognised EM in 2003 [1], with registrar training commencing in 2004 and programmes since established in Ethiopia, Tanzania, Ghana, Kenya, and Rwanda [[2], [3], [4]]. Competency-based medical education (CBME) now underpins postgraduate training internationally. The Canadian Medical Education Directives for Specialists (CanMEDS) 2015 framework, an internationally adopted educational model defining physician competencies across multiple roles [5], renamed its Manager role as Leader, signalling a systems-oriented understanding of this domain that encompasses both operational management and clinical leadership. The Accreditation Council for Graduate Medical Education (ACGME) addresses management and leadership through Systems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBLI) [6]. The Colleges of Medicine of South Africa (CMSA) Fellowship in EM (FCEM[SA]) initially referenced CanMEDS, but the ongoing Living Curriculum reform, a collaborative process developing an evolving, context-specific competency framework, has produced an independent South African model retaining Manager and Leader as discrete domains alongside nine further roles, graphically rendered as a Baobab [7,8]. The International Federation for Emergency Medicine (IFEM) Model Curriculum describes specialist emergency physicians as integral participants in health-care organisations [9].

Despite this normative consensus across major frameworks [5,6,9], management and leadership competencies are among the least well-specified dimensions of EM training worldwide. Bae and colleagues [10] surveyed early-career African EM specialists in 2016 and found respondents felt least equipped in Manager and Scholar roles]. Although that survey is now a decade old and was conducted when several African programmes were in their formative stages, the finding remains salient as programmes mature from establishing clinical competence towards strengthening non-clinical domains. Descriptions from several African countries emphasise heavy service demands, limited protected time, and scarce faculty for non-clinical development [[11], [12], [13]].

This review asks: how are management and leadership competencies described, taught, and assessed in postgraduate EM training, and what are the implications for African programme development? The objectives are to: [1] synthesise global and African evidence on management and leadership competency frameworks, educational approaches, and assessment methods in postgraduate EM training; [2] identify gaps in the evidence base, particularly for African and lower-middle-income country (LMIC) contexts; and [3] propose a development pathway for contextually adapted competency statements and assessment strategies. The review generates a competency domain framework, defined here as a structured synthesis of recurring competency areas derived from the included literature, intended to serve as starting material for a future African Delphi consensus process. Reporting follows the Scale for the Quality Assessment of Narrative Review Articles (SANRA) checklist [14]. A narrative review was chosen because the literature is heterogeneous, spanning frameworks, descriptive programme reports, and small-scale studies, requiring interpretive synthesis rather than exhaustive aggregation of homogeneous evidence [15].

Methods

We conducted a narrative review informed by prior reviews in African emergency care [16] and guidance on knowledge synthesis in health professions education [17,18]. This approach allows for interpretive synthesis across frameworks, empirical studies, and contextual reports [15].

Search strategy

Electronic searches of PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCOhost), the Education Resources Information Center (ERIC), and Web of Science were conducted from database inception to 15 March 2026. Three concept groups were combined: [1] "emergency medicine" AND ("specialist training" OR "residency" OR "registrar" OR "fellowship"); [2] "leadership" OR "management" OR "administration" OR "non-technical skills" OR "systems-based practice" OR "quality improvement" OR "health advocacy"; [3] "competency" OR "curriculum" OR "assessment" OR "outcomes" OR "entrustable professional activity". Medical Subject Headings (MeSH) terms were used where available. No language restrictions applied.

Hand-searching covered issues published 2015 to 2026 in the African Journal of Emergency Medicine (AfJEM), the Emergency Medicine Journal (EMJ), the Canadian Journal of Emergency Medicine (CJEM), Academic Emergency Medicine Education and Training (AEM Education and Training), and Emergency Medicine Australasia. Grey literature was sought from IFEM, the African Federation for Emergency Medicine (AFEM), ACGME, the Royal College of Emergency Medicine (RCEM), the Australasian College for Emergency Medicine (ACEM), and CMSA repositories, which include African EM materials available in English translation or originally published in English. Six anchor papers were selected on the basis of their foundational role in defining EM competency frameworks or synthesising evidence across multiple settings [9,13,19,[20], [21], [22]], and were used for forward and backward citation chaining as a supplementary search strategy.

Eligibility and selection

Sources were included if they described management or leadership competencies, educational approaches, assessment methods, or outcomes within postgraduate EM training. Sources were excluded if focused exclusively on undergraduate or non-physician cadres, did not address management or leadership content, or were opinion pieces without substantive description.

Selection was performed by a single reviewer (WK). SL independently reviewed a 15% random subsample of final sources (n = 5/34); initial agreement was good (kappa=0.65) and all discrepancies were resolved through discussion to consensus. Database searches yielded 847 records after deduplication; title and abstract screening excluded 712 records (Fig. 1). Full-text review of 135 records identified 52 sources meeting inclusion criteria. Hand-searching and citation chaining contributed 22 further sources (total: 74). The majority (n = 58) originated from high-income country (HIC) settings; 16 addressed LMIC or African contexts, of which nine were African-specific.

Fig. 1.

Literature search and selection flow.

Sampling

Sampling was purposive and non-exhaustive, in keeping with narrative review methodology. Sources were selected to capture key conceptual frameworks, empirical studies, and literature relevant to African and LMIC contexts. Sampling continued until the domains and their interrelationships stabilised, that is, until additional sources reinforced existing patterns without introducing new conceptual categories [23]. This threshold of conceptual sufficiency relates to the stability of the analytic framework rather than to the completeness of evidence within each domain; gaps in evidence, such as the absence of African validation studies, are substantive findings rather than indicators that sufficiency was not reached.

Data extraction and synthesis

From each source we extracted: country, income level, study design, target group, competency content, educational methods, assessment approaches, and reported outcomes. Analysis was iterative and interpretive, conducted alongside data extraction, using constant comparison to identify areas of convergence and divergence [24]. Competency domains were not predetermined by the search terms but emerged through iterative grouping of specific competencies described across sources. Initial coding identified over 40 discrete competencies, which were consolidated into six domains on the basis of conceptual coherence and alignment with existing frameworks. SL reviewed the proposed domains and their constituent competencies; discrepancies were resolved through discussion. Consistent with narrative review methodology, formal quality appraisal was not performed [17,18], but evidence types are distinguished throughout Results (Table 3). Beyond description, we sought to interpret how these competencies are operationalised in practice and where assumptions from high-income settings may not transfer to African programmes [24].

Table 3.

Assessment methods and evidence from LMIC and African contexts. Miller's pyramid [39] levels used to classify the cognitive or performance demand of each method.

Tool or method	Miller's level [39]	EM-validated?	Evidence from Africa or LMICs	Sources
TEAM Tool	Shows How / Does	Yes (HIC)	No African EM validation identified	[33]
Ottawa GRS	Shows How	Yes (HIC)	No African EM adaptation identified	[25,26]
360-degree feedback / MSF	Does	Partially (HIC)	Absent in African EM literature	[19,20]
ACGME Milestones (SBP/PBLI)	Knows How / Does	Yes (US)	Not adapted for African context	[6,29]
QIKAT	Knows How	Yes (HIC)	No African adaptation identified	[35]
EPA-based portfolio (FCEM)	Does	In development	SA from 2024; outcome data pending	[7,8]
Written examination (MCQ/SAQ)	Knows	Yes (multiple settings)	Used in FCEM Part II; no published leadership-specific content validity data for African EM	[7,8]

MSF = multi-source feedback; QIKAT = Quality Improvement Knowledge Application Tool; EPA = Entrustable Professional Activity; SBP = Systems-Based Practice; PBLI = Practice-Based Learning and Improvement; FCEM = Fellowship of the College of Emergency Medicine; SA = South Africa.

Reflexivity

The authors' roles within emergency medicine training and curriculum development informed the interpretive lens applied to this review. WK is a programme convenor and Chair of the FCEM Living Curriculum Working Group, and SL is President of the College of Emergency Medicine. These positions shaped the review in specific ways: familiarity with South African curriculum structures informed the selection and interpretation of FCEM-related sources, and involvement in assessment reform oriented attention towards workplace-based and programmatic approaches. This positionality also carried risks, including potential over-representation of South African perspectives and a predisposition towards frameworks aligned with the FCEM model. To mitigate these risks, sampling deliberately included international frameworks, empirical studies from HIC and LMIC settings, and African literature beyond South Africa where available. Interpretations were grounded in comparison across sources, and we distinguished between evidence-derived findings and contextually informed recommendations. The FCEM Living Curriculum is therefore presented as an illustrative example of ongoing reform rather than a prescriptive model for other African programmes.

Results

Overview of the evidence base

The literature is dominated by high-income country (HIC) perspectives. The evidence base comprises: (a) competency frameworks and consensus statements; (b) cross-sectional survey data; (c) intervention studies, predominantly pre-post simulation designs; and (d) descriptive reports. Key contributing sources include the Canadian Delphi (consensus study [19],) the UK Emergency Medicine Leaders (EMLeaders) evaluations (cross-sectional survey [20],) and North American SBP/PBLI literature [6,25,26]. LMIC contributions include systematic reviews of EM training [13] and a scoping review of leadership in emergency care systems (ECS) development [27]. African contributions include young specialist surveys (cross-sectional [10],) national EM descriptions (descriptive [11,12],) and FCEM(SA) reform reports (grey literature) [7,8]. Table 1 summarises key contributing sources. Of the 74 included sources, approximately 40% were competency frameworks or consensus statements, 25% were empirical studies, and 35% were descriptive programme reports or reviews. This distribution underscores the predominance of normative over empirical evidence in EM leadership and management.

Table 1.

Key contributing sources, by evidence type, setting, design, and contribution.

Source	Setting	Design	Evidence type	Key contribution
Thoma et al. 2015 [19]	Canada (HIC)	Modified Delphi	Consensus	59 competency statements for EM administration and leadership mapped to CanMEDS roles
Palmer et al. 2024 [20]	UK (HIC)	Cross-sectional survey (n = 417)	Survey	Higher self-reported leadership knowledge among EMLeaders participants; no evidence of wellbeing or career impact
Kneafsey et al. 2024 [21]	UK (HIC)	Qualitative	Intervention	Perceived impact of EMLeaders on confidence, identity, and practical skills
Bae et al. 2016 [10]	SA, Ethiopia, Tanzania, Ghana	Cross-sectional survey	Survey	Young EM specialists least prepared in Manager and Scholar roles
Rybarczyk et al. 2020 [13]	Global (LMIC focus)	Systematic review	Review	LMIC programmes adapted HIC curricula with limited leadership content
Phillips et al. 2025 [27]	Global (LMIC focus)	Scoping review	Review	Inadequate leadership and governance as barrier to ECS development
Cooper et al. 2010 [33]	Australia (HIC)	Instrument development	Validation	TEAM tool for resuscitation team performance assessment
FCEM Living Curriculum [7,8]	South Africa	Curricular reform	Framework	Eleven-domain Baobab framework; EPA-based WBA
CanMEDS 2015 [5]	Canada (HIC)	Framework	Framework	Leader role; resource stewardship; QI and patient safety
IFEM Model Curriculum [9]	Global	Framework	Framework	Specialist EM organisational competencies
Bandiera et al. 2012 [30]	Canada (HIC)	Qualitative	Qualitative	Leadership skills learned passively vs active clinical skill acquisition

HIC = high-income country; LMIC = low- and middle-income country; SA = South Africa; TEAM = Team Emergency Assessment Measure; EPA = Entrustable Professional Activity; WBA = workplace-based assessment; QI = quality improvement; ECS = emergency care systems.

Global competency frameworks

Three frameworks provide the dominant reference points for EM leadership and management competencies globally. CanMEDS 2015 defines the Leader role as encompassing resource stewardship, quality improvement (QI), patient safety, and sustainable practice [5]. The IFEM Model Curriculum references both CanMEDS and ACGME competency domains [9]. The ACGME Milestones provide developmental descriptors for SBP and PBLI [6,25,26,29]. The RCEM underpins the EMLeaders programme [20,21], and the FCEM(SA) Living Curriculum is developing entrustable professional activities (EPAs), portfolios, and Progress Committee oversight as its assessment architecture [7,8]. Each of these frameworks recognises management and leadership as core physician competencies, though with varying levels of granularity and contextual specificity.

Competency domains and the Canadian Delphi

Six inter-related domains emerged from iterative grouping of competencies described across the included sources (Table 2) [5,9,13,19,20]. Initial coding identified over 40 discrete competencies from frameworks, empirical studies, and programme descriptions. These were consolidated into six domains on the basis of conceptual coherence: team leadership; operational and resource management; quality improvement and patient safety; health advocacy; interprofessional and organisational dynamics; and self-management. The most granular published taxonomy is from Thoma and colleagues, who derived 59 competency statements via a two-round modified Delphi with 57 panellists (14 EM programme directors and 43 leadership and administration experts) mapped to CanMEDS roles, with predefined agreement thresholds [19]. These provide a detailed reference, though developed entirely within a Canadian HIC context with no LMIC or African representation.

Table 2.

Domains of management and leadership competency in EM specialist training and their African relevance.

Domain	Representative competencies (HIC)	Assessment methods	African EM relevance	Key sources
Team leadership	Direct resuscitation teams; shared leadership; CRM; coaching	Simulation (TEAM, Ottawa GRS); MSF	Managing high-acuity patients with varied skill-mix under resource constraints	[5,19,20,30,33]
Operational and resource management	Allocate resources; implement change; optimise flow; scheduling	Portfolio; supervisor assessment; WBA	Severe resource constraints; dual public-private navigation	[5,6,19]
QI and patient safety	Apply QI science; M&M reviews; error reporting; safety culture	QIKAT; QI project assessment; portfolio	Building QI infrastructure in nascent systems	[5,6,19,35]
Health advocacy	Advocate for patients/communities; shape policy; influence ECS	Portfolio; 360-degree feedback	Central: specialty recognition advocacy across Africa	[5,9,10,27]
Interprofessional dynamics	Conflict resolution; communication across hierarchy; situational awareness	MSF; simulation debriefing; direct observation	Leading diverse teams with varied training	[19,20,32]
Self-management	Sustainable practice; reflective practice; career planning	Portfolio; reflective writing; coaching	Sustaining academic engagement in high-burden settings	[5,19,20]

Authors' contextual interpretation for African relevance. CRM = crisis resource management; TEAM = Team Emergency Assessment Measure; GRS = Global Rating Scale; MSF = multi-source feedback; WBA = workplace-based assessment; QIKAT = Quality Improvement Knowledge Application Tool; M&M = morbidity and mortality; QI = quality improvement; ECS = emergency care systems.

Teaching and learning approaches

In HIC settings, management and leadership competencies are acquired through workplace learning, simulation, formal curricula, and QI projects. A qualitative study found EM residents learned leadership passively and incidentally, in contrast to active clinical skill acquisition [30]. Simulation with structured debriefing is the most evidence-supported approach for teaching team leadership and crisis resource management (CRM), though most studies use pre-post designs without controls [[31], [32], [33],34]. The EMLeaders programme (cross-sectional survey; n = 417) found significantly more positive self-reported ratings on 7 of 14 leadership items among participants compared with no training (all p < 0.05), including clinical leadership knowledge and confidence in facilitating teams. Perceived ability to influence the EM environment was identified as a unique benefit of EMLeaders [20]. The absence of demonstrable effects on wellbeing or career intentions suggests that leadership training may build knowledge and confidence without necessarily addressing broader professional outcomes [20]. QI project completion is mandated in ACGME programmes [35].

Assessment of management and leadership competencies

Assessment approaches described in the literature include simulation-based tools (Team Emergency Assessment Measure [TEAM], Ottawa Global Rating Scale [GRS], ACGME Milestones), multi-source feedback (MSF), and portfolio-based or EPA approaches (Table 3) [[25], [26], [27], [28], [29],33,34]. A systematic review of EM assessment identified 73 studies but few programmes with rigorous, validated systems [25]. Our searches did not identify published validation studies for non-technical skills or leadership assessment tools in African EM, though this may reflect publication gaps rather than complete absence of activity.

LMIC and African EM training

Rybarczyk and colleagues found that LMIC programmes adapted HIC curricula with variable contextualisation and limited leadership content [13]. Bae and colleagues (n = 47 graduates from four African countries) found young African EM specialists felt least equipped in Manager and Scholar roles, with leadership development identified as the most critical professional need [10]. Phillips and colleagues identified inadequate leadership and governance as a key barrier to ECS development in LMICs [27].

African EM programmes are structurally diverse. The FCEM(SA) Baobab framework, with its eleven competency domains, EPA-based workplace-based assessment (WBA), and Progress Committee oversight across six university-based sites, is the most structurally documented African model in the published and grey literature [7,8]. East African programmes operate with fewer specialist faculty and limited formal WBA infrastructure [3,4,12], while West African programmes face additional challenges of accreditation through regional colleges rather than national specialist bodies [4]. These structural differences mean that recommendations should be interpreted with attention to programme maturity and local capacity.

Three contextual features shape African competency priorities and distinguish them from HIC frameworks: health advocacy as central to specialty recognition; resource management under extreme scarcity; and navigation of dual public-private systems [[11], [12], [13],27]. These map onto three of the six domains identified in this review (health advocacy, operational and resource management, and interprofessional dynamics) while adding context-specific content not captured in HIC taxonomies. The FCEM Living Curriculum has drafted twenty EPAs, of which the first ten are in active implementation; outcome data are not yet available [7,8].

Outcome evidence

Most reported outcomes across the included studies cluster at Kirkpatrick levels 1 (learner reaction) and 2 (knowledge or skill acquisition) [20,[30], [31], [32],36]. Kirkpatrick's four-level evaluation model provides a hierarchy for assessing training impact, with level 4 representing organisational or patient outcomes, the most meaningful but most difficult to demonstrate evidence of effectiveness [36]. The absence of level 4 evidence is not unique to African settings; no studies in any setting have convincingly linked EM specialist leadership or management curricula to patient outcomes or system-level metrics [13,30,32].

Discussion

The findings address three propositions aligned with the review objectives. First, leadership and management are recognised as core EM competencies across all major international frameworks [5,6,9]. Second, the evidence base for teaching and assessing these competencies is concentrated in HIC systems with limited African validation. Third, African programmes therefore need locally adapted competency statements and assessment strategies developed through an African-led consensus process. The global systematic review by Wilson and colleagues [28], which identified only 26 empirical studies of EM physician leadership across seven databases, confirms that this evidence gap extends beyond Africa to the discipline as a whole.

From domains to granular competencies

The six domains synthesised in this review (Table 2) provide a structured organising framework, but framework-level descriptors alone are insufficient for curriculum design. Each domain requires granular, observable competency statements to be actionable in training programmes. The Canadian 59-item list provides the most detailed existing reference [19], but it was developed without African or LMIC representation and cannot be assumed to capture African priorities. The three African contextual features identified in the Results (health advocacy for specialty recognition, resource management under scarcity, and dual public-private navigation) illustrate where the six domains require context-specific content that no existing HIC taxonomy provides. The Phase 1 African Delphi should therefore use the six domains identified in this review as its primary organising structure, with the Canadian taxonomy and other framework items serving as reference material rather than as a starting checklist [37]. This approach prioritises African-generated content while drawing on existing evidence.

Contextual adaptation

The African context demands particular emphasis within several domains. Health advocacy (domain 4) extends beyond individual patient advocacy to encompass specialty recognition and ECS development, a function largely absent from HIC frameworks where EM is established [11,12,27]. Operational and resource management (domain 2) operates under conditions of extreme scarcity rather than optimisation [13]. Interprofessional dynamics (domain 5) must account for leading heterogeneous teams with widely varied training backgrounds and navigating dual public-private systems [11,12]. These contextual demands are not merely modifications of HIC competencies but represent substantively different professional requirements. Translation barriers extend beyond curriculum content to structural prerequisites: faculty scarcity, limited protected academic time, absence of established WBA infrastructure, and competing clinical service demands [3,4,12,13]. The FCEM Living Curriculum illustrates one approach to adaptation, with its Baobab framework derived from African stakeholder engagement [7,8]. Whether similar processes are feasible in programmes with fewer structural resources remains an open question.

Proposed development pathway

We propose three phases. Phase 1: African Delphi using the six domains as the organising framework, with panellists from established, newer, and resource-constrained programmes across the continent [37]. Phase 2: Cultural adaptation and psychometric evaluation of assessment tools (TEAM, Ottawa GRS, MSF) in African settings. Phase 3: Embedded implementation science studies within the FCEM Living Curriculum and other African programmes to generate evidence at Kirkpatrick levels 3 (behavioural change in practice) and 4 (organisational or patient outcomes) [7,36]. Faculty development is a prerequisite at each phase [38], given that the hidden curriculum, the implicit values, norms, and behaviours transmitted through institutional culture and role modelling rather than formal teaching [38], may be as influential as explicit instruction in shaping leadership development.

Implications for resource-restricted settings

Leadership development need not depend on expensive infrastructure. Low-cost approaches, including structured portfolios, workplace-based observation, mentored QI projects, and peer-facilitated CRM debriefing, are consistent with the assessment methods described in Table 3 and align with several of the six domains identified in this review. The critical requirement is intentional curriculum design, supported faculty, and institutional structures such as progress committees.

Limitations

This narrative review is inherently limited by its non-exhaustive and interpretive approach and is therefore susceptible to selection bias. Source identification and data extraction were conducted by a single reviewer (WK), partially mitigated through purposive sampling to conceptual sufficiency and an independent inter-rater check by SL on a 15% subsample of final included sources (n = 5/34), with agreement reached through discussion to consensus on all items reviewed. Formal quality appraisal was not undertaken, although evidence types are distinguished throughout. Recent FCEM developments are represented largely through grey literature and may be incompletely captured in the peer-reviewed record. Claims regarding the absence of African evidence should be interpreted cautiously, as they may reflect limitations of the search strategy rather than a true absence of activity.

Conclusion

Management and leadership competencies are recognised within global EM frameworks but remain under-specified and under-assessed, particularly in African contexts. Six recurring domains emerged from this review, with three contextual priorities specific to African settings. Outcome evidence is concentrated at Kirkpatrick levels 1 and 2, with no robust demonstrations of system-level impact in any setting. Three recommendations emerge: [1] an African-led Delphi to generate contextually adapted competency statements using the six domains as a starting framework; [2] cultural adaptation of assessment tools for African settings; and [3] embedded implementation science studies within the FCEM Living Curriculum and other African programmes [5,10,19,37].

Dissemination of results

Findings will be shared with the FCEM Living Curriculum Working Group, the six South African MMed EM programme convenors, and the AFEM education committee. A summary will be submitted for presentation at the next African Conference on Emergency Medicine.

Author contributions

WK: Conceptualisation, Methodology, Investigation, Data curation, Writing (original draft), Writing (review and editing), Project administration. SL: Writing (review and editing), Validation. All authors approved the version to be published and agreed to be accountable for all aspects of the work. The authors confirm that no generative AI tools were used in the preparation, writing, or revision of this manuscript. All content reflects the authors' original synthesis and interpretation of the literature.

Declaration of competing interest

WK is programme convenor for the MMed in Emergency Medicine at the University of Cape Town and serves as Chair of the FCEM Living Curriculum Working Group. WK is also a guest editor for the Health Science Education Special Issue of the African Journal of Emergency Medicine, but was not involved in the editorial processes and decisions for this submission. SL is President of the College of Emergency Medicine of South Africa. The authors declared no further conflict of interest.