Beyond compliance: evaluating AfriMEDS competencies in South African medical education.

South African medical education confronts systemic challenges rooted in colonial legacies, demanding transformative pedagogies that redress inequities and integrate community health through culturally responsive frameworks. This convergent mixed-methods study, guided by a transformative paradigm emphasizing ethical engagement and social justice, evaluated the implementation of the AfriMEDS framework, a local adaptation of CanMEDS incorporating community-based education (CBE) and community-oriented primary care (COPC) at the University of the Free State (UFS). Methods included curriculum mapping, document analysis, 15 educator interviews, and surveys of 71 medical interns. Document review revealed that health advocate, leader and manager, and scholar roles were minimally featured in phase guides and that existing assessment tools diverged from CanMEDS recommendations. Educator interviews identified three principal barriers: insufficient faculty development (87% of participants), resource constraints, and misaligned assessment practices. Intern surveys showed only 63% felt leadership training was adequate, 71% felt prepared for CBE, and 72% felt competent in collaboration. These findings expose critical gaps in embedding AfriMEDS competencies, particularly intrinsic roles, within undergraduate training. Our methodological framework highlights how CBE and COPC can serve as catalysts for meaningful curricular reform by fostering sustained collaboration between learners, educators, and communities. We recommend systemic reforms including decolonial pedagogical strategies, robust faculty development in cultural competency, alignment of curricula with national health priorities, and the creation of benchmarked assessment tools that reflect African healthcare contexts and community needs. Failure to implement these reforms risks perpetuating inequity and undermining South Africa’s health transformation agenda.