The keynote presenters included Prof Johan Fagan who gave the overview of the CMSA, During the COVID times, CMSA managed to covert the educational project and macro spoken about examinations, graduation events, contributing to geographical equity, E platforms, improving research access footprint. Prof Mike Sathekge who talk highlighted exciting advancement in nuclear medicine. Showcasing potential to enhance the diagnosis and treatment of different patient and sectors. The vision for the future of nuclear medicine was emphasised. not only national progress but also contribution to global health solutions. He discussed the genetic giants multi mobility, which ultimately leads to frailty including ageing issues related to marketing morbidity.

Prof Bilkish Cassim who explored the challenges for aging in specialist medicine. The challenges ageing holds for specialist medicine and healthcare in South Africa. He summarised advancing age-related physiological change, and the need to have a holistic approach and embrace complexity and clearly recognise the burden on patients, families, communities, caregivers and society in general. Average life expectancy has increased quite significantly and that's due to a number of things and mainly to improvements in public health decrease, fertility decrease, infant mortality decreases adult mortality.

The MEC for health EC, gave a keynote address and message to CMSA. She emphasized that CMSA is an institution that has been put in the production line of great clinicians in the Eastern Cape. The training platform of the universities in the health sector is widely recognised throughout the country. She acknowledged the challenges faced in the training platforms which are constrained in terms of numbers, to admit the spaces that are limited in the number of trainings that is needed. The department is planning to decentralise a nephrology service in Oliver Tambo Regional Hospital. As well as Saint Elizabeth, as well as Frontier Hospital. There is a demand for this specialist in services supported by the College of Medicine of South Africa. MEC concluded with the good news that in the past financial year 2024-2025, the department managed to appoint about 15 specialists in various clinic domains within the teacher and regional levels of care. The appointments are aimed at addressing surgical padlocks and strengthening health system capabilities.

Dr Dave Morell spoke on CMSA in the SA health ecosystem. He presented that the healthcare system is quite a big network of people and includes pharmaceutical companies, private people, hospitals, parent patients, investors. Insurance companies and the whole host of things of which we form a part, and which patients interact with. The transformation that CMSA has had in the past years, the change in gender equity, change in exams processing and that the college can hold their head up anywhere when it comes to assessing. The role of HPCSA as overriding master.

Dr Rolene Wagner further explored the specialist medicine in Eastern Cape; her presentation was entitled navigating the future of healthcare towards a shared vision for medical and dental specialist training in the Eastern Cape Province. EC is undergoing a significant demographic and epidemiological transition characterised by the quadruple burden of disease coupled with the complexities of a largely rural population. This transition requires A robust, adaptable and innovative healthcare system. In the Eastern Cape, there has been a significant stride in improving basic socioeconomic conditions like access to water, electricity and sanitation. Nonetheless, poverty remains high, and there has been a huge dependence on the public sector in our province around 9.1% only have medical aid. There is a need to rebuild the health system utilising systematic, integrated approach as now to be able to provide clinical support, non-clinical support and health services, and a need to have resources including human resources. Province faced budget pressures of around 900 million Rand and at the end of March with over 342 million Rand over expenditure. Developing health and business intelligence is essential to improving our performance and promoting accountability. sustainable financing for health and care, the emphasis is on a compassionate and quality health and care service and focusing on strengthening our systems and pursuing organisational excellence towards NHI. Disruptive technologies and digitalization to improve efficiencies. The quantity and quality of specialist skills to address the burden of disease effectively, and the less numbers of specialists required per population per discipline needs to be assessed. Conducting appropriate research and contributing to evidence-based practise and system strengthening is essential by specialists. partnership of the department, the universities and the CMSA. 75% of the specialists that were produced were retained, out of 106 graduates, 76 were retained. CMSA is already using the e-learning platforms that comes to ethical considerations, together with the HPCSA, they are the custodians and guardians of that. The collaborative and interdependent roles require us to look at a conscious, deliberate attempt to integrate technologies into the stance of healthcare. In conclusion it’s important to invest in infrastructure, strengthen partnerships so that we can be more effective and more deliberate in meeting the needs of the EC province, prioritising rural healthcare so that we have. Strategies that attract and retain specialists in rural areas and then embracing technology so that both technology and data can be utilised to improve services.

Panel discussion on specialist medicine. Concerns were raised that doctors are using the diplomas to actually leave public sector, so they train right the diplomas, then they leave public sector, go to the private sector. Retention still a challenge. The acknowledgement that the College of Medicine is committed to advancing equitable access to specialist and specialised medicine diplomas specialists for all S Africans, However the reality that people in the Eastern Cape don't have that same access as in other provinces to specialists and specialised medicines. A request to have CMSA to have the Diploma in medical management and Prof Buch responded that it is finally in the pipeline, and awaiting HPCSA approval and it will then commence.

In conclusion, the seminar explored the fantastic story that organisational change happens with the CMSA, and it happened with structure, function and international uniqueness. Partnering and collaboration between public and private healthcare providers must become integral part of our system going forward for specialist training platforms. There is a need to look at specialists and sub specialist training by discipline in under resourced disciplines, who subsequently may then be placed in the health system that provides services to rural and underserved areas