A metaphysical framework for transforming South Africa’s undergraduate medical curricula is proposed within a transformative research paradigm

South African medical education is challenged by the dual challenges of meeting accreditation standards while addressing pressing community health needs amid healthcare reform demands. The AfriMEDS framework, adapted from CanMEDS, incorporates community-based education (CBE) and community-oriented primary care (COPC) to bridge these gaps. Using a transformative mixed-methods approach as a metaphysical framework—including curriculum mapping, document analysis, educator semi-structured interviews, and intern surveys—this study evaluates AfriMEDS implementation at the University of the Free State (UFS). Findings reveal systemic challenges: misaligned assessments, faculty development gaps, and competence deficiencies. Integrating competencies shows uneven emphasis, with significant disparities in health advocacy, leadership, and CBE roles. Educator interviews highlight structural barriers such as resource constraints and compressed timelines in UFS’s five-year program, while intern surveys reflect gaps in preparedness for non-clinical competencies. The transformative metaphysical framework paradigm proves effective in exposing structural inequities and fostering stakeholder co-creation, positioning CBE as essential for sustainable reform. The study concludes with recommendations for systemic reforms, including decolonial pedagogies that integrate indigenous languages and knowledge, faculty capacity building in competency-based assessment, and structural alignment with national healthcare priorities. These insights emphasise the need to transcend technical curriculum adjustments, centring transformative paradigms that address power dynamics and cultural complexities in medical training.