When Concepts Travel In-Between: Knowledge Brokering and DesignJustice in the Hybrid Translation of Competency-Based Education forAfrican Pediatric Training

Abstract

Competency-Based education (CBe) has become the dominant paradigm for structuringmedical training worldwide. Yet its foundational constructs (e.g., entrustable professionalactivities (epas), milestones, and competencies) were conceived within resource-rich,institutionally stable, and culturally specific contexts. Their diffusion across global landscapeshas not been neutral. When such frameworks travel, they carry embedded assumptions,epistemic values, and implicit universalizing authority. This article describes how The east,Central, and Southern africa College of paediatrics and Child Health (eCSapaCH), in partnershipwith the Center for research, innovation, and Scholarship in Health professions education(CriS) at Baylor College of Medicine, reimagined CBe for african pediatric training through aprocess guided by design justice and implemented using knowledge brokering. anchored inHomi Bhabha’s concept of the Third Space and Culture’s In-Between, we argue that thetranslation of CBe into new contexts is not merely a technical or linguistic act but an ethical,dialectical, and generative one. eCSapaCH’s translation process demonstrates that whenframeworks encounter contextual resistance and epistemic contestation, they can bereconstituted into hybrid forms that unsettle universality while deepening both global andlocal understanding. The resulting hybrid framework represents not a replication or simple adaptation of imported theory but a co-created, contextually anchored model for pediatriceducation that emerges from ongoing negotiation under conditions of asymmetrical power.We position this work as an instance of hybrid knowledge production in Bhabha’s ThirdSpace, offering lessons for equitable global partnerships and for the future evolution of CBeas a living, revisable theory.