BACKGROUND:
Medical Managers play pivotal leadership roles in health systems across South Africa and the broader African region, yet no formalized, accredited training programmes exist to prepare them for this[1-4]. Prior to launching the Post-Graduate Diploma in Medical Management, a Competency Based Medical Education (CBME) model centred on Entrustable Professional Activities (EPAs) and Workplace-Based Assessment (WBA) was adopted by the South African Council of Public Health Medicine[5,6]. To define these EPAs, the Competencies of Medical Managers in Training (COMMIT) study is being undertaken to establish curriculum consensus amongst practicing South African Medical Managers.

METHODS:
A multi-round, modified Delphi survey was designed using the seven AfriMEDS Medical Specialist roles[7,8]. Competencies were converted into behaviourally anchored Agree/Disagree statements, incorporated into a 27-item pilot questionnaire and distributed by email nationally through the South African Society of Medical Managers. Responses were anonymised and analysed descriptively; consensus was indicated by high agreement, low standard deviations, and tight confidence intervals[9].

RESULTS:
A total of 47 of 85 emailed Medical Managers completed the pilot round. Consensus was exceptionally high across all competency domains (mean 1.00–1.20). The highest consensus EPAs corresponded to top ranked competency domains[8]: • Medical Expert: o Aligning training with local disease burden. o Balancing training needs with patient safety. o Applying health systems science. • Leader: o Applying quality improvement methods. o Ensuring stewardship of financial and human resources. o Negotiating training resources. • Professional: o Demonstrating integrity, fairness and ethical decision making.

CONCLUSIONS:
These results provide strong national validation for the core set of EPAs required of Medical Managers, forming a robust foundation for CBME within an apprenticeship environment[9]. This facilitates curriculum finalization, selection of appropriate supervisors, accreditation of suitable training sites and preparation of teaching materials. Implementation in South Africa will be followed by regional scale-up throughout Eastern, Central, and Southern Africa.