The coalition of the willing: A deliberate leadership strategy for reforming postgraduate emergency medicine assessment in South Africa.

This commentary reflects on two consecutive terms as President of the College of Emergency Medicine of South Africa and examines a deliberate leadership strategy used to reform postgraduate assessment within a voluntary professional body. At the outset, the postgraduate emergency medicine curriculum required reform, and existing assessment approaches had developed over time in ways that were not always fully aligned with evolving training goals or contemporary validity expectations. As competency-based medical education and entrustable professional activity frameworks gained traction, the need for closer alignment between curriculum and assessment became more pressing. Rather than framing the challenge as resistance, this account conceptualises it as a legitimate constraint, encompassing limited faculty capacity, uneven institutional readiness and competing clinical demands. Drawing on adaptive leadership and change management theory, the article argues that sustainable reform may depend less on achieving broad consensus and more on mobilising those already prepared to act. A 'coalition of the willing', composed largely of early-career specialists with expertise in competency-based education and digital systems, enabled both curriculum reform and alignment with assessment, alongside key changes including digital examination processes and a standardised objective structured clinical examination across training institutions. This approach was balanced by deliberate strategies to maintain institutional cohesion through ongoing engagement with governance structures. The commentary argues that mobilising readiness is a principled leadership response and that meaningful reform requires acting within constraint while preserving institutional cohesion. In this balance lies the work of leadership in complex professional systems.