The Colleges of Medicine of South Africa (CMSA) is the apex organisation in South Africa for medical and dental specialists. It is a membership organisaton representng >11 000 medical and dental specialists, subspecialists, and diplomates. Its 29 constituent colleges represent all medical and dental specialies in South Africa in academia and in the public and private sectors. Its primary mission is “to promote the highest degree of skill, efficiency, ethical standards and professional conduct for the benefit of humanity and to promote the honour of the medical and dental profession.”
The CMSA was founded in 1955, prior to which all medical and dental specialist trainees had to travel to the United Kingdom or Ireland to write one of their Royal College examinations to register as a specialist in South Africa. Its founding therefore constituted decolonisation of specialist training and registration in South Africa.
The CMSA is a non-profit organization. It generates its income from conducting specialist examinations and from membership fees and from grants it may receive. Its elected leadership, examiners and moderators provide their services altruistically without any remuneration. The CMSA employs about 60 permanent staff members in offices located in Cape Town, Johannesburg, and Durban, with a local office in Bloemfontein, and offices in Mthatha, East London, Gqeberha, and Limpopo in the pipeline.

The CMSA runs the national unitary examinations for all medical and dental  specialties in South Africa and sub-Saharan Africa, as well as for diplomas to upskill general medical practitioners, and ensures that our diplomates, specialists, and subspecialists are educated and trained to international standards. Most practising medical specialist and sub-specialists and some dental specialists in South Africa have completed the CMSA examinations.

The CMSA collaborates very closely with South Africa’s 11 Faculties of Health, Medical and Dental Sciences from whose ranks most examiners, conveners and moderators are drawn. The Health Professions Council of South Africa (HPCSA) has contracted and accredited the CMSA to run the national unitary examinations for all medical specialist and subspecialist disciplines and also conducts dental specialist examinations, which some choose to take. The CMSA also offers dental specialist examinations for those who choose to take them. The CMSA is independent of government. Through accreditation with the Council for Higher Education, the CMSA’s unitary examinations serve as the examination component of the university MMed specialist degrees.

The CMSA is currently expanding its role in line with its mission “to promote the highest degree of skill, efficiency, ethical standards and professional conduct for the benefit of humanity and to promote the honour of the medical and dental profession” including:

• Online preparatory educational material is being developed to make study materials accessible and affordable for our candidates.
  
  
• The Journal of the Colleges of Medicine of South Africa (JCMSA), a high-quality, peer- reviewed medical and dental journal to share research in the medical, dental, and biomedical sciences focusing primarily on South Africa, Africa and Lower- and Middle- Income Countries (LMICs), was launched in July 2023 (jcmsa.org.za). The journal is fully online, open access, and will have high visibility and global impact. Important reasons for establishing the JCMSA include that Africa and LMICs should have a premier medical journal that competes with the very best journals in high income countries so that global health research about LMICs that is published in international journals is published in a LMIC journal where it belongs; many medical specialties need more opportunities to share their research in a South African journal; and open access publishing has become prohibitively expensive for authors in LMICs. In response to the later, an Article Processing Charge (APS) Waiver Fund has been established to ensure that “the ability to pay should never be a barrier to sharing research” …a matter of social justice.
  
  
• Online examinations for other African countries to award their own Diplomas are being planned so that the CMSA contributes to advancing healthcare beyond our borders.
  
  
• As a national body with representation of >11 000 members of all medical and dental specialties in academia and in the public and private sectors, the CMSA has exceptional expertise among its membership. The CMSA has engaged in advocacy and a CMSA Health Policy Committee has been established for national and provincial governments to engage with so that the CMSA can share perspectives of specialized medicine when deliberating about the shape and future of our healthcare.
  
  
• The CMSA has been engaging and building alliances with sister colleges in Sub-Saharan Africa, Canada, Pakistan, Australia, and New Zealand. The Alliance of Surgical Colleges of Africa comprises the West African College of Surgeons, the College of Surgeons of East, Central and Southern Africa, and the CMSA. It jointly represents 37 countries and hence speaks with a powerful, unified voice to advance surgical education, training, and services in Africa.

Every 3 years, the >11 000 members of the CMSA elect the 29 constituent college councils in their specialist disciplines. Additional non-voting councillors are co-opted to ensure representation on college councils from every university training department. Every council elects a constituent college president (who is ex officio a member of Senate), a second senator, and a secretary.

Senate is the highest academic decision-making body in the CMSA. The President, Senior Vice- President, and Vice-President are elected by Senate for 3-year terms. Senate meets biannually and has the following subcommittees: Examinations and Credentials Commitee (ECC), Education Commitee (EDCOM) and Finance and General Purposes Commitee (FGPC), each of which is led by a Chair and Honorary Registrar, and a Social and Ethics Commitee (SEC) and Risk Commitee with non-Senator Chairs. The Honorary Treasurer is also elected by

Senate. A Young Specialist Forum was recently established to include younger specialists in

CMSA activities and to capacitate future leadership.

The Board of Directors includes the President, Senior Vice-President, Vice-President, Immediate Past President, Chairs and Honorary Registrars of the FGPC, ECC and EC, the Honorary Treasurer, and the CEO, Executive Director of Administration and Finance, and the Academic Registrar. The Executive Director of Education and Assessment atends the Board by invitation.

The Board of Trustees includes both medical and non-medical members and is appointed by Senate. It is currently chaired by Dr Victor Litlhakanyane, an oncologist and businessman.

Senate 2021-2023

Elected (2022 – 2025) and Executive Leadership

Like many organisations emerging from the Apartheid era, the CMSA took active steps to transform its elected and executive leadership both in terms of race and gender. The CMSA’s transformation efforts were acknowledged when the CMSA received a Standard Bank Top Gender Empowered Company award in 2022. Transformation milestones as of 2024 include the following:

• Prof Lizo Mazwai elected first black president of the CMSA (2004-7)
• Prof Senkubuge elected first black female president (2019-22)

• 70% of BODs of colour
• 50% of BOD is female

• 55% of College Presidents of colour
• 35% of Colleges Presidents are female

• 63% of Senators of colour
• 33% of Senators are female

• Mrs Yolokazi Kanzi appointed first black academic registrar (2020)

Multiple role players contribute to training, assessment and registration of diplomates, specialists, and subspecialists, with the CMSA collaborating very closely with the universities and also engaging with the teaching hospitals. The Health Professions Council of South Africa

(HPCSA) accredits training programs and registers diploma, specialist, and subspecialist qualifications.

The CMSA runs the National Unitary Examinations using a high-tech examination platform with university and provincial hospital academics examining the candidates, and it confers postgraduate diplomas, fellowships, and certificates on successful candidates.

Provincial Departments of Health run the public hospitals that provide training platforms and is the primary employer of most trainers and trainees. The National Department of Health is responsible for overall policy, strategic frameworks and co-ordination.

Universities provide teaching and training, declare trainees to be “clinically competent” prior to entering the final examinations, and supervise the MMed and MDent or MChD research dissertations for the Master’s programmes in the relevant specialty.

The CMSA offers 102 qualifications by biannual certification examinations. It confers about 1100 Higher Diplomas, 1100 Fellowships, and 200 Subspecialist Certificates per year.

Diplomas (20)

 Diplomas are awarded to non-specialists and are very important in the South African healthcare setting as it equips medical officers to provide higher standards of care in the fields detailed below. Following 6-18 months of supervised clinical practice in an accredited public hospital within a specific discipline, candidates write an online CMSA Diploma examination. Some Diplomas also include a structed oral examination.

Specialist certifications (37)

Specialist registration in the medical specialties requires 4 – 5 years of university-based registrar training, being certified to be “Clinically competent” by the training department, passing the CMSA Fellowship entry and exit examinations, and completing an MMed research dissertation at the training university. Dental specialists may have the option of choosing the CMSA Fellowship examination. The CMSA confers the following fellowships:

Like Colleges around the world, the CMSA previously used long essay questions, clinical examinations with limited numbers of patient encounters and unstructured oral examinations to assess candidates. The COVID-19 pandemic disrupted this traditional examination format as examination scripts could not be couriered for marking, candidates and examiners could not travel to centralised clinical examination venues, and patients could not participate in clinical examinations in hospitals overburdened by the pandemic. The COVID-19 pandemic therefore hastened the introduction of further quality enhancement measures for the CMSA examinations: paper-based essay questions were replaced with online digital short answer questions / single best answer questions to improve the breadth and psychometric robustness of knowledge assessment, and unstructured face-to-face clinical exams were replaced by Structured Oral Examinations (SOEs) conducted on Zoom. The SOEs are multi-station online examinations which focus on clinical scenarios with structured questions and memoranda to assess diagnostic reasoning, complex clinical decision making and the provision of comprehensive patient care. Candidates atend local examination centres to participate in SOEs and examiners link in remotely from their workspaces at home or in their respective offices.

A survey of candidates taken immediately following the introduction of SOEs in 2020 yielded a high acceptance rate of the new format (article in press). Preliminary data also suggest that the new examination format has led to improved pass rates due to improved quality of examinations. Further work is needed to confirm this observation and beter understand what it means for the long-term assessment practices of the CMSA. Ongoing projects includebuilding and strengthening question banks and expanding standard setting for writen and oral examinations.

Predictably, the new digital format of the writen and oral examinations has increased the overall cost of running examinations. The CMSA has therefore had to increase examination fees, but there is still a substantial overall cost and time saving for candidates not having to travel and pay for accommodation, and less disruption of clinical services from the perspective of both examiners and candidates.

The CMSA has Regional Examination Centers in Bloemfontein, Cape Town, Durban, East London, Gqeberha, Johannesburg, Mthatha, and Polokwane as it recognises the financial cost and inconvenience for candidates to travel to central examination venues as they had to do prior to the COVID pandemic. The CMSA has annual Admission Ceremonies in Bloemfontein, Cape Town, Durban, Johannesburg, and Mthatha to make it possible for families and friends to share in the celebration.

The CMSA also runs examinations remotely for candidates in some other Sub-Saharan Africa countries to contribute to advancing specialised healthcare on the continent.

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