Gaining stakeholder consensus on core curriculum content for the clinical years of undergraduate medical education at the University of KwaZulu-Natal, South Africa: a mixed-methods study

A clearly defined core medical curriculum content is essential to address content overload and ensure alignment with contextual healthcare needs. Defining core curriculum content is a persistent challenge in medical education, particularly in resource-constrained settings where curricula must balance expanding medical knowledge with local healthcare priorities. This study aimed to achieve stakeholder consensus on the core knowledge, skills, and attitudes required during the clinical years of undergraduate medical training at the University of KwaZulu-Natal, South Africa. A sequential mixed-methods design was employed. Documentary analysis of module templates, course materials, and curriculum mapping data was conducted to identify existing curriculum content, which was categorised according to the Health Professionals Council of South Africa’s (AfriMEDS) roles for medical practitioners in South Africa. Content was verified by module coordinators. An electronic Modified Delphi process involving academics, recent graduates, and primary healthcare nurses was conducted over two rounds to establish consensus, defined as ≥ 70% agreement. Documentary curriculum mapping identified 724 curriculum items, of which 653 aligned with the Healthcare Practitioner role and 71 with other AfriMEDS roles. Seventeen academic clinicians verified the curriculum content. Twenty-one participants completed Delphi Round 1 and 17 completed Round 2. Eight additional items were proposed during the Delphi process, and seven duplicate items were subsequently removed, resulting in 725 unique KSA items considered across the complete consensus process. Of these, 698 achieved consensus for inclusion: 629 aligned with the Healthcare Practitioner role and 69 with the other AfriMEDS roles. Twenty-seven items did not achieve consensus. The agreed content reflected major health priorities encountered in South African primary care and district health services, including communicable and non-communicable diseases, maternal and child health, mental health, trauma, emergency care, and essential procedural skills. This study produced a stakeholder-informed definition of core undergraduate medical curriculum content aligned with local health system needs and the AfriMEDS competency framework. The method provides a practical approach to defining and contextually prioritising core curriculum content through stakeholder consensus. The methodology and resulting framework may assist other medical schools, particularly in low- and middle-income countries, in aligning curricula with community health needs while maintaining competency-based educational principles.