By: Roberta Inés Ladenheim, MD, MHPE and Marije P. Hennus, MD PhD MClinEd FHEA
Competency-Based Medical Education (CBME) emerged as a response to a global call for reform in how health professionals are trained — emphasizing outcomes, accountability, and relevance to societal needs. Yet, while the conceptual development, frameworks, and key publications of CBME have largely originated in the Global North, many meaningful applications have taken root in the Global South. Across Latin America, Africa, and Asia, educators have adapted CBME principles to local realities, often without visibility in English-language journals. These experiences enrich our collective understanding of what competent practice means in context and exemplify how global frameworks gain depth when co-constructed through equitable collaboration.
In this sense, the collaborative authorship between academics from the Global North and South — as in the story we share below — echoes the same aspirations that CBME promotes: to bridge divides, value diverse forms of knowledge, and translate global frameworks into meaningful local practice.
The Time-Zone Test
We come from different hemispheres and academic traditions, connected first by curiosity and later by friendship. One of us works in a resource-rich university in the Global North, the other in a rapidly developing context in the Global South; together, we navigate what it means to write, learn, and lead across those worlds. Finding a time to meet was our first challenge. For one of us, it meant early morning coffee; for the other, late-night tea. Between dropped connections, unstable internet, and half-saved Google Docs, our first collaboration felt like an exercise in endurance. Yet, as we navigated these small hurdles, we realized they symbolized something larger: the everyday realities of working, and learning, across worlds.
Health professions education (HPE) increasingly embraces global collaboration. Co-authorship between academics from the Global North and South offers the potential to bridge epistemic divides and ensure that a broader range of voices shapes the field. Yet, these partnerships are also marked by long-standing inequities — from structural power imbalances to uneven access to resources, networks, and visibility. Our collaboration began with enthusiasm and shared purpose, but also with different assumptions about process, pace, and recognition. We reflect here on what we have learned — about opportunities, challenges, and responsibilities — when academics from the Global North and South write together.
Our reflections are guided by the concept of epistemic justice, which calls for recognizing the equal credibility of all knowers and contexts (Fricker, 2007; Abimbola, 2019). In HPE and CBME alike, where frameworks and theories often originate in the Global North, this call is particularly relevant: whose knowledge counts, whose experience defines competence, and whose voice shapes the global narrative?
The Promise – Why We Keep Trying
Despite the logistical and cultural challenges, we keep showing up. Because when collaboration works, it can be genuinely transformative. When scholars from different regions write together, they bring complementary perspectives and strengths. The Global North often contributes access to infrastructure, mentorship networks, and established publication routes. The Global South brings contextual understanding, innovation under constraint, and insights grounded in the lived realities of teaching and care.
When these forms of expertise come together, they allow HPE to move from knowledge transfer to knowledge co-creation — a shift that values diverse epistemologies as equally legitimate (Khan, 2021). Co-authorship, thus, becomes a space of mutual learning rather than mere output production. It challenges participants to surface assumptions, confront biases, and re-examine what counts as “rigor” or “evidence.” In this way, collaborative writing can model the same mutual learning and accountability that CBME seeks to promote in professional formation.
Yet, the promise of collaboration can only be realized when it is intentionally structured around equity, transparency, and reciprocity. Without this, even well-meant partnerships risk unintentionally reproducing the very hierarchies they seek to dismantle.
The Reality Check – Barriers We Keep Meeting
The path toward equitable collaboration is rarely straightforward. We have felt, and sometimes inadvertently perpetuated, the very inequities we wish to overcome. These challenges often fall into three interconnected domains: access, visibility, and power.
Unequal Access. Funding, research time, and mentorship remain profoundly unevenly distributed. Many institutions in the Global South lack protected research time, administrative support, and stable funding. As a result, Northern partners often take on project design, resource management, and authorship leadership. While pragmatic, this can inadvertently reinforce dependency rather than partnership. True collaboration requires shared agency, not just shared workload.
Language and Visibility. Vibrant research communities across Latin America, Africa, and Asia publish in regional journals in Spanish, Portuguese, Arabic, and other languages. These journals are essential for local dialogue and professional development, yet, much of this scholarship remains invisible internationally. Language barriers, limited indexing, and differing publication norms mean that contributions from the South rarely enter global citation networks. As a result, what is often labeled “international” scholarship reflects a narrow linguistic and cultural subset of the world. Recognizing this invisibility is the first step toward addressing it.
Cultural and Power Dynamics. Even in well-intentioned collaborations, implicit hierarchies persist. Context-specific insights from the South may clash with standardized frameworks dominant in Northern literature. When global partners unconsciously privilege their own epistemologies or academic rhythms, collaboration risks becoming extraction rather than exchange. Recognizing these dynamics is not about assigning blame; it is about cultivating reflexivity, awareness, and trust — essential foundations for equitable partnership.
The Human Layer – Inclusion, Privilege, and Responsibility
I (RL) am underrepresented from one perspective, as a scholar from the Global South. But in my own region, I hold privileges others don’t: access to networks, education, and collaboration opportunities. This layered privilege reminds us that inequity exists within as well as between regions.
Inclusion is often celebrated when a few individuals from underrepresented regions appear as co-authors or keynote speakers. Yet, inclusion for one is not inclusion for all. When only a select group — those fluent in English, institutionally supported, or internationally connected — gain access to global platforms, the system remains unchanged. Real inclusion requires structural effort: redistributing opportunity, mentoring others, and strengthening local infrastructure.
True equity means using access as a bridge, not a boundary. Scholars who cross between worlds carry a dual responsibility — to represent their context authentically and to create pathways for others to do the same. As one of us wrote in our notes: “Real inclusion means creating ladders, not trophies.” The goal is not personal advancement but collective capacity.
As Gert Biesta (2015) reminds us, education is not only about qualification or socialization; it is also about subjectification — the ethical process of becoming responsible in relation to others. The same applies to collaboration: to learn to act with rather than for our partners and to recognize that equity is practiced through relationships, not statements.
The Way Forward – Practicing Genuine Collaboration
Equity is not a checklist. It is a continuous practice — something we learn, unlearn, and return to, again and again.
Equitable collaboration does not happen automatically. It must be cultivated intentionally, through everyday practices that value relationships as much as results. Through our own experience, we have learned several lessons that might resonate with others engaged in cross-regional authorship:
- Practice humility. Begin with curiosity about your collaborator’s context and assumptions.
- Share leadership. Rotate first authorship, agenda setting, and decision-making.
- Value local knowledge. Read, cite, and credit regional scholarship, even when it falls outside mainstream databases or languages.
- Build capacity, not dependency. Design collaborations that strengthen both partners’ institutions.
- Stay in the relationship. Authorship is a milestone, not an endpoint.
These may seem like small steps, but together they help reframe collaboration from logistics to learning, from production to relationship. Equitable authorship, like equitable education, is less about the distribution of credit and more about the ethics of how we work, learn, and grow together.
Closing – Full Circle: What Remains
Months later, our meetings still span two time zones. The Internet still cuts out sometimes. But now those pauses feel less like obstacles and more like quiet reminders — that what connects us isn’t bandwidth, but shared purpose.
We have learned that collaboration is not simply about combining skills or perspectives; it is about practicing patience, empathy, and generosity in the face of difference. When we make room for each other’s contexts, when we listen across worlds, we learn as much about ourselves as about our research. After all the drafts, deadlines, and differences, what endures is not the publication but the relationship: colleagues who have become friends, and a sense of learning that transcends geography.
In many ways, collaborative authorship mirrors the aspirations of CBME itself: to move from prescriptive frameworks toward contextualized competence, from knowledge transfer to mutual learning. Just as CBME seeks to align global standards with local needs, equitable collaboration calls us to align scholarly practices with ethical partnership. Both require humility, reflection, and reciprocity — learning with and from others across contexts.
Because in the end, after all the drafts, deadlines, and time zones, it’s about people — learning, growing, and writing side by side.
Refrences:
- Abimbola S. The foreign gaze: authorship in academic global health. BMJ Glob Health. 2019 Oct 18;4(5):e002068. doi: 10.1136/bmjgh-2019-002068. eCollection 2019.
- Fricker, M. (2007). Epistemic Injustice: Power and the Ethics of Knowing. Oxford University Press.
- Khan M, Abimbola S, Aloudat T, Capobianco E, Hawkes S, Rahman-Shepherd A. Decolonising global health in 2021: a roadmap to move from rhetoric to reform. BMJ Glob Health. 2021 Mar;6(3):e005604. doi: 10.1136/bmjgh-2021-005604.
- Perry M, Madundo K, Narayanasamy S, Knettel B. Advancing equity in global health: a call for collaborative research partnerships. Front Health Serv. 2025 May 21;5:1541472. doi: 10.3389/frhs.2025.1541472.
- Biesta, G. (2015). Good education in an age of measurement: Ethics, politics, democracy. Routledge.
About the Author:
Roberta Inés Ladenheim, MD, MHPE is an internal medicine specialist and medical educator from Buenos Aires, Argentina, dedicated to transforming health-professions education across Latin America. She is Senior Advisor to the Rectorate and former Vice-Rector at the Universidad del Hospital Italiano de Buenos Aires. She has held university and Argentina’s Ministry of Health leadership, focused on policies for health workforce education and development. Her work advances CBE and EPAs through regional and international collaboration.
Marije P. Hennus, MD PhD MClinEd is a pediatric intensivist, PICU program director and Associate Professor of Teaching at the Wilhelmina Children’s Hospital, University Medical Center Utrecht. Her educational research and innovations focus on CBE, with a particular interest in workplace-based learning and EPAs.
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