Quality Assurance and Educational Guidelines for an Emergency Medical Preparatory Programme in South Africa: A Qualitative Case Study - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Health Sci Rep . 2026 Apr 16;9(4):e72308. doi: 10.1002/hsr2.72308 Search in PMC Search in PubMed View in NLM Catalog Add to search Quality Assurance and Educational Guidelines for an Emergency Medical Preparatory Programme in South Africa: A Qualitative Case Study E N Nell E N Nell 1 Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, South Africa Find articles by E N Nell 1, ✉ , M P Jama M P Jama 2 Division Student Learning and Development, Faculty of Health, University of the Free State, Bloemfontein, South Africa Find articles by M P Jama 2 , J G Du Plessis J G Du Plessis 1 Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, South Africa Find articles by J G Du Plessis 1 Author information Article notes Copyright and License information 1 Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, South Africa 2 Division Student Learning and Development, Faculty of Health, University of the Free State, Bloemfontein, South Africa * Correspondence: E. N. Nell ( [email protected] ) ✉ Corresponding author. Revised 2026 Feb 25; Received 2025 Mar 19; Accepted 2026 Mar 26; Collection date 2026 Apr. © 2026 The Author(s). Health Science Reports published by Wiley Periodicals LLC. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. PMC Copyright notice PMCID: PMC13087088 PMID: 42005655 ABSTRACT Background and Aims When full qualifications delivered by higher education (HE) institutions replaced vocational short learning programmes previously offered by emergency medical care colleges in South Africa, many employed emergency medical care staff did not meet the HE admissions criteria. This paper, therefore, explores the dilemma of HE access for success and prepares working emergency medical care staff seeking a higher level of education. Therefore, the aim of this study was to refine a set of education guidelines to inform a credit‐bearing preparatory programme that would provide employed emergency medical care staff with articulation into HE and prepare them to succeed in their HE journey. Methods Emergency medical care experts were consulted to evaluate the proposed education guidelines. A qualitative Delphi survey was used to scrutinize the contents of the guidelines to identify possible gaps. Thematic analysis was used to classify data into various components. Result The key components that emerged from the data for inclusion in education guidelines for a preparatory programme are admission criteria, curriculum design, assessment, physical preparedness, generic skills/competencies, and quality assurance. The data also revealed the following important aspects: (1) A preparatory programme should focus on the social, intellectual and cultural needs of the in‐service staff; (2) although physical preparedness and learning to swim should be part of the preparatory programme, this should not be included as a formally assessed module; (3) candidates need to be screened for eligibility and preparedness to engage with HE; and (4) at‐risk candidates should be identified early on. Conclusion The evaluation by the expert panel allowed for the refinement and validation of the education guidelines, which informed the development and implementation of an Emergency Medical Preparatory Programme (EMPP) to provide HE access for emergency medical care staff to acquire formal HE qualifications. Keywords: curriculum development, educational guidelines, emergency medical preparatory programme, quality assurance, student support 1. Background In South Africa, transitioning from basic education to higher education (HE) is a persistent challenge, and addressing it effectively requires a multifaceted approach [ 1 ]. Like in many other countries, alternative access programmes have gained prominence as a way to provide entry to HE for a broader range of entrants, including those who do not meet standard admission criteria [ 2 ]. Alternative access programmes, as reported in the literature, include the Extended Curriculum Programme (ECP) and Continuous Education Programmes (CEP). These programmes have specific admission criteria that grant students admission to HE institutions and provide foundational academic abilities and support [ 3 ]. However, extended curriculum programmes usually focus on students with the correct subject combinations required for mainstream programmes, excluding adult learners and those with other subject combinations [ 4 ]. Although the Council on HE's (CHE) 2019 policy on RPL, Credit Accumulation and Transfer and Assessment suggests that only 10% of a cohort should be admitted via RPL, the National Policy and Criteria for the Implementation of RPL, amended in March 2019, does not explicitly mention this 10% cap anymore. Instead, it emphasizes that RPL should be implemented within the context of the National Qualifications Framework (NQF) Act 67 of 2008, aiming to change the lives of RPL candidates, including workers and learners of all ages, unemployed people and other marginalized groups [ 5 , 6 ]. Generally, transferring from basic education to HE can be challenging, particularly for underprepared students [ 5 , 7 ]. In South Africa, the CHE released a report on the challenges of under‐preparedness and the articulation gap in HE [ 4 , 5 ], and acknowledges that many students, even those who had passed Grade 12 with university exemption, are significantly underprepared for HE [ 5 ]. Without structured quality assurance mechanisms, preparatory pathways risk inconsistent standards, weak articulation, and limited credibility within higher education. The CHE thus proposes that, instead of blaming the school system and underprepared students, HE institutions should design programmes that address underpreparedness [ 4 , 5 ]. Addressing under‐preparedness often requires extending the duration of university programmes and providing additional content and coursework to provide a foundation. Underprepared university students must be helped to develop literacy skills, cognitive strategies and the higher‐order and critical thinking skills they lack, which are crucial for success at the university level [ 8 ]. Pre‐university access programmes assist students in adjusting academically and socially and improve their chances of doing well in university [ 9 ]. Their study in Saudi Arabia showed that the preparatory year had a clear positive impact on student performance. It helped students explore their academic interests, build essential skills and make more informed choices about their future studies. Moreover, these kinds of programmes are beneficial in contexts where students may not be fully ready for the demands of higher education, and they create a stronger foundation for long‐term success. A similar model could be valuable in South Africa, particularly for adult learners in emergency medical care seeking access to formal study pathways. Globally, many countries are facing a shortage of qualified emergency medical services (EMS) workforce, which puts pressure on already stretched health systems. To address this, several educational systems have introduced preparatory or bridging programmes that help individuals, especially those already in the workforce, to access higher education. In SA, this issue is particularly important because many EMS staff were trained through short vocational courses that ended in 2018. These courses were not aligned with the National Qualifications Framework (NQF), and since their discontinuation, many experienced EMS staff have found themselves unable to progress academically [ 10 ]. In Sub‐Saharan Africa, the shortage of trained emergency medical staff presents a significant barrier to developing effective and equitable EMS. Many countries across the region lack formal EMS systems, and those that do exist often operate with minimal resources and fragmented coordination. Due to the limited availability of accredited prehospital training programmes, lay responders or inadequately trained individuals provide a large portion of emergency care. This human resource gap is particularly evident in rural areas, where access to emergency care is severely constrained. Without targeted investment in EMS training infrastructure, regulatory frameworks and system‐wide policy support, the region will continue to face significant challenges in delivering timely and life‐saving emergency care to its populations [ 11 ]. SA faces critical challenges in aligning emergency medical education with higher education entry requirements, particularly for those who entered the system through short‐course, vocational pathways [ 12 ]. According to the National Emergency Care Education and Training (NECET) policy, most registered emergency care staff have no formal higher education qualifications and only a few weeks of training, which hinders their academic progression [ 13 ]. This gap is compounded by limited articulation opportunities between vocational and educational pathways, often leaving experienced staff unable to access or succeed in formal qualifications. The Department of Higher Education and Training's policy on articulation highlights how systemic misalignments and under‐preparedness at the school level prevent smooth transitions into higher education [ 5 ]. Adding to this complexity, the importance of cultivating a sense of academic belonging through approaches considering learners' diverse intelligences and transitional needs is underscored [ 14 ]. These insights affirm the necessity of credit‐bearing preparatory programmes like the Emergency Medical Preparatory Programme (EMPP), which could bridge the current articulation gap and support academic success and broader health system resilience. The lack of accessible education pathways has serious consequences [ 10 ]. Many of these vocationally trained professionals deliver critical emergency services, particularly in rural and underserved areas. However, without opportunities to upskill or earn formal qualifications, their career development is blocked, and the overall capacity of the emergency care system suffers. Creating a structured, credit‐bearing EMPP could offer a solution. Not only would it help experienced professionals gain access to higher education, but it would also support the development of a more skilled and recognized workforce. In the long run, this could lead to better emergency care services, fewer preventable deaths and more equitable health outcomes for communities across SA. Mostly, EMS in‐service staff lack the required subject combinations or subject grades to be accepted in HE. In the past, these staff were trained using short learning programmes (SLPs), namely, a Basic Ambulance Assistant course over 3 weeks of training, an Ambulance Emergency Assistant course and a Critical Care Assistant course [ 13 ]. Unfortunately, these SLPs could not be aligned with the new HE Qualifications Sub‐Framework (HEQSF), as required by the South African Qualifications Authority (SAQA) [ 13 , 15 ]. In 2018, the EMPP was offered for the first time at the Central University of Technology (CUT) to provide an alternative access route for in‐service EMC staff to obtain HE qualifications. Although several studies report on the under‐preparedness of students for HE, merely providing access does not guarantee student success [ 16 ]. Therefore, the EMPP was designed specifically to assist EMS staff who did not meet the HE admission requirements in SA. This study aimed to provide clear education guidelines and quality assurance (QA) measures for the EMPP. This study aimed to develop QA and education guidelines for an EMPP in South Africa by addressing the following research questions: What are the key components of effective educational guidelines for an EMPP in South Africa? How can QA processes be applied to ensure the success and sustainability of the EMPP? In addition, the objective was to define the essential elements, including admission criteria, curriculum content, assessment methods and learner support, required to guide in‐service EMS staff who do not meet conventional HE entry requirements but hold existing vocational EMC qualifications and to propose academic and professional guidelines that prepare them for progression into HE. Furthermore, the study established QA mechanisms that underpin the design, implementation, monitoring, and continuous improvement of the EMPP, which would ensure its relevance, credibility, and long‐term success. In the context of this study, education guidelines refer to structured recommendations on the design, content, delivery and assessment of the EMPP. These guidelines outline the knowledge areas, learning outcomes, teaching methods and assessment strategies needed to prepare students for HE in EMC. QA refers to the systems, processes and standards ensuring the programme is relevant, effective, fair and aligned with HE policies and professional expectations. The goal of the EMPP is to provide EMS staff with an opportunity to access HE. The EMPP also addresses the absence of a clear pathway for career advancement in EMS and is designed to support achieving career‐specific outcomes. The educational guidelines and QA processes offer clear direction for improving the programme, making it more relevant to the EMS context. This allows adult learners to engage with real‐world examples from the EMC environment. In addition, the EMPP will expand access by offering online classes, enabling EMS staff from their respective districts to participate. 2. Methods 2.1. Study Design and Setting The study was conducted at the Central University of Technology in the Free State. A qualitative case study design was used to explore the educational and QA guidelines for the EMPP, as the study addressed the how and why questions related to these guidelines [ 17 ]. The design supported detailed analysis by allowing triangulation of multiple data sources and encouraged an interactive process between participants and the researcher in gathering rich data [ 18 ]. A case study focuses on investigating a programme, event, activity, process or group in depth, with the case as the central unit of analysis [ 19 ]. Qualitative case studies can be classified as single instrumental, collective, or multiple and intrinsic [ 20 ]. An intrinsic case study was appropriate because the research focused specifically on understanding educational and QA guidelines for the EMPP [ 21 ]. The design accounted for contextual factors influencing the programme [ 20 ] and aligned with criteria that describe case studies as particularistic, descriptive, and heuristic [ 22 ]. The qualitative Delphi method complemented the case study design by gathering narrative data from experts through a structured, iterative process [ 23 ]. This method supported refinement of statements and convergence of expert opinion regarding EMPP educational and QA components. The qualitative Delphi technique enabled consensus on guideline components, and expert input informed quality assurance processes and sustainability mechanisms. 2.2. Participants and Selection Process A total of 34 invitations were sent, and 16 individuals indicated their willingness to partake in the Delphi survey and completed the consent forms. Because the study's experts were geographically dispersed, a qualitative Delphi survey with free‐text responses was used to gather their views. The target population included lecturers involved in EMC education and training, EMPP lecturers, experts involved in QA in higher education, an expert involved in QA in HE, a representative from the HPCSA, and a member of the PBEC in South Africa. All participants held lecturer positions at higher education institutions. Purposive criterion sampling was used to include participants with extensive knowledge and experience in EMC education and training. This non‐probability method allowed deliberate inclusion of individuals who met predetermined criteria and could provide rich data aligned with the research objectives [ 24 ]. Inclusion criteria required 3 years of teaching experience in higher education, knowledge and experience in EMC education and training and willingness to participate. Exclusion criteria included unwillingness to participate or unavailability. The final qualitative Delphi survey consisted of 16 participants, which falls within the acceptable range for qualitative Delphi studies (typically 15–30 experts) [ 24 ]. The panel composition provided educational, regulatory, and QA‐related perspectives relevant to the EMPP. 2.3. Data Collection Data were collected through a qualitative Delphi survey. The Delphi survey was phase 3 of a bigger study. The Delphi survey was administered via the EvaSys management system. 2.4. Data Analysis Thematic analysis was done using ATLAS.TI Windows 9, which allowed efficient organization, coding and retrieval of qualitative data [ 19 , 21 ]. The analysis followed the five steps outlined by Creswell and Creswell: data preparation and organization, repeated readings for familiarization, in vivo coding, theme development through pattern recognition and compilation of findings into a coherent narrative with rich quotations [ 21 ]. Qualitative data were imported into ATLAS.ti for coding and analysis. These tools supported systematic organization, cross‐checking, and data retrieval. The study followed a constructivist paradigm that supported interactive meaning‐making between researcher and participants and allowed rich data collection from individuals involved in EMC education and HE programme management. An inductive approach with in vivo coding was used to identify emerging patterns and sections [ 24 ]. The Delphi process included two rounds to balance rigor and participant burden. Stability and data saturation were achieved without requiring additional rounds. A consensus threshold of 75% was adopted, a threshold widely cited in Delphi literature [ 3 , 24 ]. Stability was defined as the point at which feedback no longer led to substantive changes in statements [ 25 ]. 2.5. Ethical Considerations Ethics approval was granted by the Health Sciences Research Ethics Committee at the University of the Free State (Ref. No. UFS‐HSD2019/1095/270801). Participation in this study was voluntary, and participants' anonymity was guaranteed. Written informed consent was obtained from all participants. 3. Results Statements for the qualitative Delphi study were informed by a literature review (Phase 1) and an EMPP document (Phase 2). The document analysis of the existing EMPP material from CUT showed that the programme incorporated several components identified in the literature, including foundational sciences and academic literacy content (see Appendix 1 ). However, the analysis also revealed inconsistencies in the documentation of learning outcomes, gaps in the specification of assessment criteria and limited evidence of structured moderation processes. Admission criteria were outlined in the documents, but were not explicitly linked to indicators of student readiness or progression into higher EMC qualifications. The analysis further indicated the absence of an integrated quality assurance framework governing curriculum management, assessment moderation, lecturer competency expectations and programme evaluation processes. As shown in Appendix 2 , across all components of the qualitative Delphi survey, consensus levels were consistently high, indicating strong agreement among participants on the essential components of the EMPP. Participant comments added depth and context to these findings by often highlighting the need to align with HE EMC qualifications' admission requirements, including foundational science modules and to integrate transferable skills into the curriculum. Regarding curriculum design, participants stressed the importance of balancing theoretical knowledge with practical experience to adequately prepare students for progression to advanced EMC qualifications. As shown in Appendices 3 and 4 , the findings from the Delphi survey confirm that the EMPP should serve as an access route into HE and ensure that candidates develop the foundational knowledge, practical competencies and readiness required for academic and professional success. The identified topics and levels of consensus correspond with existing literature on bridging programmes in health sciences, emphasizing the importance of tailored admission requirements, well‐structured curricula, and rigorous assessment approaches that support adult learners who transition into professional healthcare training. 4. Admission Criteria All participants ( n = 16) emphasized that, to ensure quality education, the number of students admitted to the EMPP should not exceed the institution's capacity. One participant noted, “If the intake is too big, quality will drop, and students will not get enough individual attention” [P3]. Admission criteria were considered transparent and structured to facilitate access to HE, with 75% (12/16) of participants agreeing that the EMPP was intended for candidates who did not meet traditional entry requirements for EMC in HE but who held matriculation certificates or equivalent. One participant explained, “We must give access to those who missed out before but still have the basics to succeed” [P7]. Additionally, the findings align with what [P11] and [P12] stated, that “merely improving candidates' subject grades would not be sufficient”. The programme should address knowledge gaps to prevent underperformance and failure in HE, particularly for in‐service EMC staff who may be adult learners who face other challenges [ 14 ]. All participants ( n = 16) thought that the EMPP admission criteria should be clear and indicate how they contribute to assisting with access to Higher Education. As [P12] stated, “The entry requirements must fit the type of qualification; you cannot expect degree‐level entry from someone aiming for a Higher Certificate”. Some participants suggested accommodating candidates with lower Admission Point Scores (APS) and preparing them for various EMC programmes, with [P5] remarking, “APS should not be the only gatekeeper; we can use this programme to prepare them for success”. The results ( n = 16) from the Delphi survey confirm that the focus of the EMPP should be on providing candidates with access to HE while building their foundational knowledge. This is also the opinion of [P1], “Perhaps the curriculum should include EMC‐related outcomes and activities, but these may not necessarily be specific to EMC. EMPP should focus on bridging the gap identified from entry requirements of EMC. EMC‐specific content will be covered in the EMC programmes”. However, views varied regarding the levels of EMC programmes that should be targeted. While some believed the programme should focus on candidates with lower APS EMC programmes, “EMPP should focus on bridging the gap identified from the entry requirements of EMC. EMC‐specific content will be covered in the EMC programmes. Whilst we can use assessment opportunities that integrate the foundational level of knowledge and skills such as mathematics and let's say academic writing etc., these cannot entirely be aligned to healthcare treatments per se”. Others argued that successful EMPP students should also have the option to pursue higher‐level EMC qualifications, such as degrees. One participant explained, “If they prove themselves here, why not give them a pathway to a degree?” [P8]. This approach aligns with the broader goal of widening access to HE and of addressing the effects of past socio‐economic disparities in education [ 26 ]. Additionally, participants indicated that simply improving candidates' subject grades would not be sufficient. As [P2] stated, “A higher symbol without the understanding behind it will still set them up to fail”. The programme, therefore, should address underlying knowledge gaps to prevent underperformance and failure in HE, particularly for in‐service EMC staff who may be adult learners facing additional challenges [P11, P12]. One participant said, “Adult learners come with different struggles, work, family, gaps in learning, so we need more than just better marks” [P9]. 4.1. Curriculum Design EMPP curriculum design was regarded as critical by 14 participants. As [P4] explained, “You cannot prepare someone for EMC by theory alone they must see and feel the application”. However, one participant cautioned against including experiential learning in the EMPP, instead advocating for using examples from the EMC field to inform core theoretical subjects such as anatomy/physiology and physics. This view was reflected in [P6]'s comment: “We can bring the field to the classroom through patient report forms and case examples; no need for full practical placements yet”. Most participants ( n = 13) agreed that the curriculum should align with the outcomes of EMC education, particularly in building essential non‐technical skills such as decision‐making, leadership and teamwork, which are vital in the EMC profession. As [P10] noted, “They must learn to think, decide and work as a team; these skills are as important as the technical ones”. For the EMPP, the curriculum should cater to adult learners' diverse needs from different educational and socio‐economic backgrounds, recognizing that some may have been out of formal education for years. A participant highlighted, “We are dealing with people from all walks of life; the curriculum must respect and work with that” [P2]. All participants ( n = 16) agreed that facilitation methods should encourage an understanding of the relationship between the concepts presented and application in real life. Adult education curricula should be organized around life situations rather than rigid academic structures, to promote self‐directed learning and engagement [ 25 , 26 ]. As [P8] remarked, “If they can link it to their real‐life situations, it will stick”. In addition, participants agreed that the curriculum should focus on preparing students for the rigors of HE rather than only covering EMC‐specific content. [P5] confirmed this sentiment: “This is about getting them ready for HE EMC; examples are just the hook”. Participants also advised benchmarking the EMPP against similar programmes at other institutions, locally and abroad, to ensure it meets the necessary standards and provides the best possible preparation for HE. [P1] stated, “Let's not reinvent the wheel; there are examples out there we can learn from”. 4.2. Learning Outcomes In total, 11 participants emphasised that EMPP learning outcomes should extend beyond subject knowledge to promote deeper learning. As [P3] stated, “It's not just about facts it's about how they think and solve problems in real‐world contexts”. These outcomes should foster critical thinking and problem‐solving skills while requiring students to apply foundational knowledge in realistic scenarios. While opinions varied about including research skills, most participants agreed that essentials such as academic writing, referencing and critical thinking should receive attention [ 7 , 27 ]. [P9] expressed this clearly: “They must at least know how to write academically, reference properly and think critically; that's the foundation for everything else”. Although 68.8% (≈11/16) of the participants suggested that the EMPP should teach the fundamental principles of drug calculations and mathematics relevant to EMC, but should avoid delving into technical medical content, as this would be covered in subsequent EMC programmes. [P7] remarked, “Give them the maths they need for drug calculations, but don't overload them with medical content yet, that comes later”. There was strong support for including EMC examples in the teaching of core subjects such as mathematics and physics, as this could help students relate to the material and see its relevance to their future careers. [P12] noted, “When you use an EMC example, suddenly the maths makes sense”. All participants ( n = 16) agreed that learning outcomes should be articulated and measurable, ensuring students understand what is expected and how they can achieve the outcomes. As [P5] explained, “If they don't know what they're aiming for, they can't hit the target”. 4.3. Level Descriptors Participants ( n = 16) agreed that level descriptors and qualification descriptors, as defined by learning outcomes, clearly indicate the knowledge and skills expected for HE at NQF levels. For the EMPP, these descriptors should align with NQF Level 4 by balancing academic and occupational requirements [ 28 ]. Many participants highlighted the importance of aligning with NQF standards while ensuring the programme develops broad competencies. As [P8] explained, “Level 4 is about building a strong base, they need academic readiness and the ability to function in the EMC environment later”. Participants supported the focus on effective communication in the instructional language rather than on specific technical tasks such as patient handovers. [P2] said, “If they can't communicate effectively, nothing else will work; start there”. Several participants stressed that the aim should be to develop foundational knowledge, skills and attributes that enable students to pursue personal and professional growth in pre‐hospital EMC while fostering lifelong learning. As [P11] explained, “We're not just training for a job, we're building people who can keep learning and growing in the profession”. 4.4. Credits and Notional Hours Twelve participants (75%) agreed that the EMPP should be offered as a credit‐bearing SLP at NQF Level 4, focusing on improving candidates' scores and preparing them for HE by teaching generic skills, basic technologies and effective learning methods. As [P4] explained, “This is a bridge, we're getting them ready for the demands of HE, not trying to duplicate an EMC qualification”. Many believed that NQF Level 5 should be reserved for qualifications such as the Emergency Care Assistant because most students enrolling in the EMPP would be overcoming gaps left by NQF Level 4 (matric). [P9] noted, “Level 5 should be for formal EMC qualifications; here we focus on lifting them to that starting point”. One participant highlighted that EMC‐specific content should be covered in subsequent programmes and that notional time should focus on addressing the entry requirements for EMC programmes. [P7] commented, “We can't waste hours on content they'll do again later, use the time to fix the gaps”. The CHE defines an SLP as offering fewer than 120 credits and not constituting a full qualification [ 8 ]. Several participants emphasised that such programmes should be designed with the needs of students, employers and professional bodies, while aligning with an institution's goals and philosophy. As [P6] stated, “It has to make sense to students, to the EMC industry and to the institution, otherwise it's just a piece of paper”. Offering the EMPP as a credit‐bearing course would create a recognized pathway for EMC staff who have completed previous short courses to enter higher education [ 29 ]. [P1] reinforced this point, saying, “If you give them credits, you give them a real pathway, without that, the bridge leads nowhere”. 4.5. Learning Facilitation All the participants ( n = 16) agreed that students in the EMPP should receive clear guidance on how each component of the programme, such as subjects and modules, aligns with its overall learning outcomes. As [P2] emphasised, “Students need to know from day one how each subject links to the bigger picture, otherwise they get lost”. Lecturers should continuously update their teaching methods to support adult learners effectively, and facilitators must possess both subject knowledge and the ability to meet the unique needs of adult learners [ 30 ]. [P8] reflected, “It's not just what you know, it's how you connect with them; adult learners need that flexibility”. Fifteen participants favored active learning. While the programme should not focus solely on EMC, some EMC‐related content could be introduced contextually. [P5] explained, “A bit of EMC content keeps it relevant, but the goal is foundational skills”. The overall emphasis should remain on general knowledge rather than profession‐specific material. Suggestions to include management training were seen as beyond the scope of the EMPP. [P9] noted, “Management is for later, right now they need to survive academically first”. Financial support was identified as essential for reducing student stress and affecting mental well‐being positively and enabling them to focus on academics [ 31 ]. As [P3] observed, “If they're worrying about money, they're not learning; support here makes a huge difference”. The structure and delivery of the EMPP should accommodate diverse adult learners. Blended learning models combining online and in‐person learning were seen as promising, mainly by reducing travel costs and allowing students to study from home. [P11] suggested, “Use distance platforms so people can keep working while studying”. However, such models require a foundational face‐to‐face period to equip students with digital literacy before online engagement. There is a shortage of distance or part‐time EMC training in South Africa, particularly in rural areas [ 12 ]. As [P4] stated, “If we don't make it accessible, rural students will always be left out”. Any delivery model must balance accessibility, adaptability and the development of technological skills to support diverse learner needs. The structure and delivery of the EMPP are pivotal to ensuring accessibility and effectiveness while accommodating the diverse needs of adult learners. Blended learning models combining online and in‐person learning offer promising approaches, mainly by reducing travel costs and allowing students to study from home. One participant mentioned that: “the curriculum may be disseminated via means of a distance learning platform, digital platforms. This will allow applicable candidates to continue with primary jobs”. Addressing these gaps necessitates innovative solutions, and research underscores the importance of adult learners' computer and internet self‐efficacy for successful online learning (H Human, personal communication, November 5, 2020). 4.6. Assessment All participants ( n = 16) agreed that assessments in the EMPP should be a meaningful learning experience for both students and assessors. Assessment criteria and learning outcomes should be communicated clearly from the outset. As [P6] stated, “If they know exactly what's expected, they can focus their effort in the right place”. Participants emphasised the importance of constructive alignment by noting that assessments must accurately reflect the knowledge and skills required for the programme [ 15 ]. [P3] commented, “If the tests don't match the teaching, we're setting them up to fail”. Continuous monitoring of student progress was seen as essential, as was using assessments for grading, ranking and curriculum enhancement. [P10] stated, “We should be checking in regularly, not just at the end; that way we can catch issues early”. Feedback was highlighted as a critical part of the process for guiding students' learning and helping them take control of their educational journey. [P1] explained, “Feedback is the bridge between where they are and where they need to be”. Participants also stressed the need for ongoing staff development to ensure that assessors remain current with HE practices and are trained in setting reliable, valid and fair assessments. As [P8] stated, “Good assessment starts with well‐prepared lecturers; they need training too”. Several participants emphasised that facilitators should hold an introductory teaching qualification, such as a postgraduate certificate in education, to teach in HE [ 26 , 27 ]. In agreement, participant [P4] remarked, “If you're teaching in higher ed, you need the qualifications to do it properly”. 4.7. Generic Skills and Competencies Participants agreed that the EMPP should develop generic skills and competencies enabling students to demonstrate and contextualize the seven critical cross‐field outcomes defined by SAQA [ 8 ]. As [P1] explained, “These skills are the foundation; if they don't have them, they will struggle in any EMC programme”. A key focus was on establishing a strong link between the EMPP and subsequent EMC programmes, particularly for in‐service staff who do not meet admission requirements. [P4] noted, “We must connect this programme to their future studies so that it's not an isolated experience”. Academic readiness, especially in writing, mathematics and scientific reasoning, was seen as more important than early clinical skills. [P8] stated, “If they can't write properly or do the basic calculations, the rest won't follow”. Fourteen of the participants (86.7%) supported the inclusion of a numeracy module aligned to EMC mathematics needs by incorporating discipline‐specific scenarios. [P6] commented, “When maths is taught in the context of patient care or equipment, it suddenly makes sense to them”. Similarly, bridging gaps in physical sciences between Grade 12 and first‐year EMC was seen as vital for students with lower APS. As [P3] stated, “We need to take them from where they are to where they need to be for first‐year content”. Writing skills were considered essential, with some participants recommending practical tasks like compiling patient report forms. [P2] added, “They don't need to write a thesis, but they must be able to complete clear, accurate reports”. Although research skills such as searching literature were valued, several participants cautioned against in‐depth research training as part of the EMPP to avoid unnecessary programme extension. [P5] said, “Let's teach them how to find reliable information now; the deeper research skills can come later”. Overall, participants agreed that mathematics, basic sciences and writing should form the EMPP's academic core, while advanced clinical or administrative topics should be left for later stages of EMC education. 4.8. Quality Assurance All participants ( n = 16) agreed that robust QA processes are essential for the EMPP, to ensure it meets high academic standards and remains relevant to students and the EMC profession. As [P2] stated, “If we don't have strong QA, the programme will lose credibility very quickly”. Participants emphasised the need for regular curriculum review and updates, involving professional bodies and external specialists. [P6] explained, “We have to bring in outside experts to make sure we're not operating in a bubble”. Monitoring and evaluating student progress was critical for ensuring that teaching and learning strategies align with the programme's objectives. [P3] remarked, “QA is not just about the paperwork, it's about making sure students are actually learning what they need”. Moderation of assessments was highlighted as a key QA measure to maintain fairness and validity. [P5] commented, “Moderation ensures consistency; students deserve the same standards regardless of who marks their work”. Transparent feedback systems for students were also prioritized. [P1] noted, “Students need to see that their feedback leads to real change; otherwise, they stop engaging”. Finally, participants stressed that QA should be a continuous culture rather than a once‐off process. As [P4] stated, “Quality is not a box to tick at the end; it's something we live every day in the programme”. The summarized outcome of the two‐round qualitative Delphi is shown in Appendix 5 . 5. Discussion This study examined the educational and quality assurance requirements for an effective EMPP in South Africa. The findings position the EMPP as a structured academic access pathway designed to prepare underprepared candidates for success in higher EMC qualifications. In South Africa, many EMC staff do not meet higher education admission requirements, which constrains professional progression and workforce development [ 13 ]. The EMPP therefore responds to national priorities to widen access, redress historical inequities, and strengthen articulation into higher education. EMC education is regulated by the Health Professions Council of South Africa (HPCSA), while programme accreditation and quality oversight fall under the CHE and the South African Qualifications Authority (SAQA). Programme design, outcomes, and assessment must align with National Qualifications Framework (NQF) descriptors and institutional quality systems [ 5 ]. The findings indicate that the EMPP should prioritize academic preparedness rather than professional skills training. As a preparatory pathway, it must equip EMC staff who lack formal entry requirements for the academic demands of tertiary study. Research on alternative access and foundation provision shows that widening access must be accompanied by academic preparation to support epistemological access and student success [ 32 ]. Underprepared students frequently experience difficulties with academic literacy, cognitive demands, and integration into higher education [ 33 ]. Evidence further shows that academic support, combined with psychosocial support and institutional engagement, improves retention and progression [ 34 ]. Admission processes must therefore balance widening access with readiness for academic engagement. Reliance solely on school‐leaving results is inadequate in contexts shaped by unequal schooling quality. Holistic admission practices, including recognition of prior learning (RPL), readiness assessments, and consideration of adult learners' responsibilities, support inclusive access [ 34 ]. Although the CHE's 2016 policy on RPL, Credit Accumulation and Transfer, and Assessment suggests that only 10% of a cohort should be admitted via RPL, the National Policy and Criteria for the Implementation of RPL, amended in March 2019, no longer explicitly mentions this 10% cap. Instead, it emphasizes that RPL should be implemented within the context of the NQF Act 67 of 2008, to change the lives of RPL candidates, including workers and learners of all ages, unemployed people and other marginalized groups [ 5 ]. This shift suggests a move towards more flexible and inclusive RPL practices, focusing on recognizing prior learning rather than imposing strict numerical limits. Managing cohort size is equally important, as structured support and manageable class sizes improve student success and reduce attrition risk. Curriculum design emerged as a central determinant of EMPP effectiveness. The curriculum should address foundational gaps that commonly impede success in EMC qualifications, including academic communication and literacy, computer literacy, life sciences, physical sciences, mathematics and numeracy, and physical preparedness. Applied and contextualized learning approaches are important, particularly for adult learners transitioning from vocational environments, as contextualization improves comprehension and motivation. Scenario‐based and problem‐based tasks can simulate professional contexts while maintaining the programme's preparatory focus. Curriculum coherence is essential. SAQA defines curriculum as the integration of outcomes, content, teaching methods, and assessment practices [ 35 ], and constructive alignment supports coherence and learning progression [ 36 ]. Scaffolded learning is preferable to early clinical exposure, as premature exposure may overwhelm underprepared students, while scaffolded approaches support conceptual development and confidence. The EMPP should develop foundational competencies required for higher education success, consistent with NQF level descriptors that emphasize basic knowledge, conceptual tools, and cognitive skills for further study [ 35 ]. Core competencies include academic literacy and communication, numeracy and applied mathematics, critical thinking and problem‐solving, digital literacy, and self‐regulated learning. Communication competence supports academic integration and professional practice, while higher‐order thinking skills underpin university success. As a preparatory bridging programme aligned with NQF Level 4–5 expectations, the EMPP represents a developmental phase rather than an occupational qualification. Credit‐bearing status may strengthen legitimacy, articulation pathways, and student motivation, and SAQA guidelines permit credit allocation for short learning programmes where appropriate [ 15 ]. Effective delivery requires a learner‐centered approach that recognizes the diversity of EMPP students. Adult learners often balance employment, family responsibilities, and study demands, necessitating flexible delivery and supportive learning environments [ 7 ]. Blended learning may improve access for rural and working students; however, digital literacy, access to devices, and institutional readiness influence its effectiveness [ 7 ]. Digital readiness support is therefore necessary. Academic support alone is insufficient; psychosocial support, mentoring, and institutional support structures are required to improve retention and success. Assessment practices should support learning through formative assessment, timely feedback, and opportunities for improvement. Alignment between outcomes, teaching strategies, and assessment supports fairness and transparency, while lecturer competence and assessment literacy underpin credibility and reliability [ 5 ]. QA is central to EMPP effectiveness and sustainability. QA refers to planned and systematic processes used to maintain and improve educational quality [ 37 ] and should function as a continuous improvement system rather than a compliance activity. In South Africa, higher education QA operates through programme accreditation, institutional audits, national reviews, and quality promotion coordinated by the CHE [ 5 ], while the HPCSA Professional Board for Emergency Care oversees standards within EMC education. Effective EMPP QA should operate across interconnected components: transparent and fair selection criteria aligned with programme purpose; needs and market analyses to support relevance [ 5 ]; benchmarking and periodic review cycles; staff qualifications and ongoing professional development; and monitoring teaching effectiveness. Student feedback, stakeholder engagement, graduate tracking, and external review support continuous improvement, while closing feedback loops strengthens responsiveness and student engagement. The NECET policy emphasizes mobility, progression, quality improvement, and the redress of educational inequalities within EMC education [ 13 ]. EMPP sustainability, therefore, depends on responsiveness to workforce needs, regulatory developments, and student support requirements. A structured, quality‐assured EMPP can strengthen the EMC workforce pipeline while promoting equitable access and academic success. 5.1. Limitations of the Study Firstly, the distinction between the preparatory and access programmes required further clarification because the concepts of access versus preparation remained problematic for some participants and resulted in a few non‐applicable responses. Secondly, inputs from public EMC training colleges that did not partner with HE institutions when conducting this study were not included in this research. The decision to limit participation to institutions with existing partnerships was based on the study's focus and resource constraints. Hence, only institutions with experience in HE were included in the study. However, the researcher acknowledges that excluding EMC colleges may have limited the diversity of perspectives represented. Therefore, future research should involve non‐partnered public EMC training colleges to comprehensively understand sector‐wide experiences, challenges, and needs. Their inclusion would contribute valuable insights that could inform national policy, curriculum development and collaborative strategies across the broader EMC education landscape. It could propose specific strategies to address these limitations in future research, such as including public EMC training colleges. To enhance this section, the authors may suggest solutions for overcoming limitations in future studies. The third limitation was that one participant experienced technical difficulties with the online Delphi survey, specifically because of unfamiliarity with the EvaSys survey management software. However, they were able to complete an electronic version of the questionnaire. It is recommended that all participants be provided with guidelines about the EvaSys system. Furthermore, the length and complexity of some Delphi statements may have affected responses by panel members, which could have contributed to data misinterpretation. Moreover, certain panel members provided limited justification for their options and comments, which could have affected the depth of analysis and the validity of conclusions drawn from the survey. 6. Conclusion This study explored expert perspectives on the design, structure and delivery of an EMPP to bridge the articulation gap between basic and HE in SA. The findings revealed strong consensus that the EMPP should be offered as a credit‐bearing SLP at NQF Level 4, primarily focusing on developing foundational competencies in mathematics, writing and scientific reasoning. These skills were identified as critical for preparing students, particularly those who do not meet standard entry requirements, for success in HE and subsequent EMC qualifications. The results also showed that admission criteria should be transparent, capacity‐aligned and adaptable to EMC pathways. The curriculum must cater to adult learners' diverse needs while aligning with HE and EMC standards, incorporating theoretical, practical and contextually relevant content. Constructive alignment in assessment, continuous formative feedback and staff development emerged as essential to ensuring fairness, academic readiness and ongoing quality improvement. Participants agreed that physical preparedness should be encouraged informally rather than implemented as a formal admission or assessment requirement. Furthermore, robust QA processes, involving regular review and the input of professional bodies, are critical to maintaining programme relevance and credibility. By addressing these core design elements, the EMPP has the potential to refine a set of education guidelines to inform a credit‐bearing preparatory programme that would provide employed emergency medical care staff with articulation into HE and to prepare them successfully for their HE journeys. In doing so, it can contribute meaningfully to addressing historical inequalities in educational access and strengthening the capacity of the EMC workforce in SA. The shift with RPL and not limiting intake suggests a move towards more flexible and inclusive RPL practices, focusing on recognising prior learning rather than imposing strict numerical limits. Author Contributions E.N. Nell: conceptualization, methodology, data curation, investigation, validation, formal analysis, resources, project administration, visualization, funding acquisition, writing – original draft, writing – review and editing, software. M.P. Jama: supervision. J.G. Du Plessis: supervision. Funding The authors have nothing to report. Conflicts of Interest The authors declare no conflicts of interest. Transparency Statement The lead author, E.N. Nell, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. Acknowledgments The authors thank the participants for their valuable time in completing the Qualitative Delphi survey and Mrs. Hettie Human for the technical and editorial preparation of the article. Appendix 1. Documents Included in the Document Analysis 1.1. Category Document code Document title Year Purpose in programme Relevance to study Key content extracted Foundational F1 Mathematics study guide — Academic foundation Supports entry‐level competencies Numeracy skills development Foundational F2 Physics study guide — Academic foundation Scientific literacy Basic physics concepts Foundational F3 Chemistry study guide — Academic foundation Scientific preparedness Fundamental chemistry principles Foundational F4 Numeracy study guide — Academic foundation Quantitative skills Mathematical reasoning Foundational F5 Basic digital literacy study guide — Academic support Digital competence ICT skills Foundational F6 Life sciences study guide — Academic foundation Biological knowledge Human biology concepts Foundational F7 Academic literacy and communication study guide — Academic support Learning readiness Academic writing & communication Foundational F8 Physical preparedness and learn to swim — Physical readiness Fitness & safety preparedness Physical conditioning Quality assurance Q9 Procedure for the management of institutional CE courses at CUT — Programme governance Regulatory compliance Course management procedures Quality assurance Q10 EMPP short‐learning programme approval document 2019 Programme approval Institutional accreditation Approval criteria & requirements Quality assurance Q11 CUT moderator report template for pilot testing 2020 Quality monitoring Assessment moderation Moderation standards Quality assurance Q12 CUT quality enhancement project (QEP) 2019 Quality improvement Programme enhancement Continuous improvement strategies Quality assurance Q13 Policy for the management of institutional CE courses at CUT 2019 Policy framework Governance compliance Policy guidelines Quality assurance Q14 Good practice guide for quality management of short courses — Quality standards Benchmarking Quality management principles Quality assurance Q16 EMPP student feedback forms 2018 Student evaluation Programme improvement Student experience feedback Quality assurance Q17 EMPP student feedback forms 2019 Student evaluation Programme improvement Student satisfaction trends Quality assurance Q18 EMPP course feedback form 2018 Course evaluation Teaching effectiveness Course quality indicators Quality assurance Q19 EMPP course feedback form 2019 Course evaluation Teaching effectiveness Learning experience insights Assessment A20 EMPP learn to swim assessment criteria — Skills assessment Competency verification Performance criteria Assessment A21 CUT assessment policy 2018 Assessment governance Standards compliance Assessment regulations Open in a new tab Appendix 2. Summary of Key Participant Responses From Each Category 2.1. Category Participant quotations Admission criteria “If the intake is too big, quality will drop, and students will not get enough individual attention.” [P3] “We must give access to those who missed out before but still have the basics to succeed.” [P7] “Merely improving candidates' subject symbols would not be sufficient.” [P11, P12] “The entry requirements must fit the type of qualification; you cannot expect degree‐level entry from someone aiming for a Higher Certificate.” [P12] “APS should not be the only gatekeeper; we can use this programme to prepare them for success.” [P5] “Perhaps the curriculum should include EMC‐related outcomes and activities, but these may not necessarily be specific to EMC.” [P1] “EMPP should focus on bridging the gap identified from entry requirements of EMC. EMC‐specific content will be covered in the EMC programmes.” “Whilst we can use assessment opportunities that integrate foundational knowledge such as mathematics and academic writing, these cannot entirely be aligned to healthcare treatments per se.” “If they prove themselves here, why not give them a pathway to a degree?” [P8] “A higher symbol without the understanding behind it will still set them up to fail.” [P2] “Adult learners come with different struggles, work, family, gaps in learning, so we need more than better marks.” [P9] Curriculum design “You cannot prepare someone for EMC by theory alone; they must see and feel the application.” [P4] “We can bring the field to the classroom through patient report forms and case examples; no need for full practical placements yet.” [P6] “They must learn to think, decide and work as a team; these skills are as important as the technical ones.” [P10] “We are dealing with people from all walks of life; the curriculum must respect and work with that.” [P2] “If they can link it to their real‐life situations, it will stick.” [P8] “This is about getting them ready for HE EMC; examples are just the hook.” [P5] “Let's not reinvent the wheel; there are examples out there we can learn from.” [P1] Level descriptors “Level 4 is about building a strong base; they need academic readiness and the ability to function in the EMC environment later.” [P8] “If they can't communicate effectively, nothing else will work; start there.” [P2] “We're not just training for a job, we're building people who can keep learning and growing in the profession.” [P11] Learning outcomes “It's not just about facts; it's about how they think and solve problems in real‐world contexts.” [P3] “They must at least know how to write academically, reference properly and think critically; that's the foundation for everything else.” [P9] “Give them the maths they need for drug calculations, but don't overload them with medical content yet, that comes later.” [P7] “When you use an EMC example, suddenly the maths makes sense.” [P12] “If they don't know what they're aiming for, they can't hit the target.” [P5] Credits and notional hours “This is a bridge; we're getting them ready for the demands of HE, not trying to duplicate an EMC qualification.” [P4] “Level 5 should be for formal EMC qualifications; here we focus on lifting them to that starting point.” [P9] “We can't waste hours on content they'll do again later; use the time to fix the gaps.” [P7] “It has to make sense to students, to the EMC industry and to the institution, otherwise it's just a piece of paper.” [P6] “If you give them credits, you give them a real pathway; without that, the bridge leads nowhere.” [P1] Learning facilitation “Students need to know from day one how each subject links to the bigger picture; otherwise, they get lost.” [P2] “It's not just what you know, it's how you connect with them; adult learners need that flexibility.” [P8] “A bit of EMC content keeps it relevant, but the goal is foundational skills.” [P5] “Management is for later; right now, they need to survive academically first.” [P9] “If they're worrying about money, they're not learning; support here makes a huge difference.” [P3] “Use distance platforms so people can keep working while studying.” [P11] “If we don't make it accessible, rural students will always be left out.” [P4] Assessment “If they know exactly what's expected, they can focus their effort in the right place.” [P6] “If the tests don't match the teaching, we're setting them up to fail.” [P3] “We should be checking in regularly, not just at the end; that way we can catch issues early.” [P10] “Feedback is the bridge between where they are and where they need to be.” [P1] “Good assessment starts with well‐prepared lecturers; they need training too.” [P8] “If you're teaching in higher ed, you need the qualifications to do it properly.” [P4] Quality assurance “Lecturers should be evaluated on a regular basis, for example, quarterly.” “As per one of my previous comments, the curriculum should talk to the core outcomes and aims of the EMPP, not be based on student needs and differences within an institution. These are addressed at the curriculum delivery level using appropriate pedagogical techniques to deliver the curriculum.” “I definitely agree with this statement, and just to add, this is why the sentiment of physical fitness not being treated as a compulsory module. We would not be very willing to be addressing students needs and differences if this were the case.” “What about industry and patient needs? How will you meet each student's needs?” Open in a new tab Appendix 3. Consensus and Stability Results of the Two‐Round Qualitative Delphi 3.1. Delphi round Statements evaluated Consensus achieved (>75%) Stability achieved Notes Round 1 194 178 (91.7%) 17 (8.7%) 100% response rate Round 2 25 9 16 No substantial changes in responses Open in a new tab Appendix 4. Results of the Qualitative Delphi Results by Topic 4.1. Topics Round 1 Round 2 Consensus on statements % Consensus Statements reached consensus % Consensus Stability on statements % Stability Admission criteria 4/9 44% 3/5 60% 2/5 40% Curriculum design 32/38 84% 2/6 33% 4/6 67% Level descriptors 11/13 85% 1/2 50% 1/2 50% Learning outcomes 17/18 94% 1/1 100% Credits and notional hours 6/8 75% 2/2 100% Learning facilitation 27/29 93% 1/2 50% 1/2 50% Assessment 41/41 100% Physical preparedness 4/8 50% 1/4 25% 3/4 75% Generic skills and competencies 3/6 50% 3/3 100% Quality assurance 24/24 100% Total 169/194 87.1% 9/20 16/24 Open in a new tab Appendix 5. Outcome of the Two‐Round Delphi 5.1. Round Statements presented to participants Consensus achieved Stability achieved Percentage consensus or stability achieved Cumulative percentage of consensus or stability achieved 1 194 169 0 87.1% 87.1% 2 25 9 16 100% 100% Open in a new tab Data Availability Statement Data are available from the corresponding author upon reasonable request. References 1. Department of Higher Education and Training (South Africa) ., Green Paper for Post‐School Education and Training, (Department of Higher Education and Training, Pretoria, 2012), https://share.google/Mh0w4olnntOIh7ppS . 2. Thompson M., Pawson C., and Evans B., “Navigating Entry Into Higher Education: The Transition to Independent Learning and Living,” Journal of Further and Higher Education 45, no. 10 (2021): 1398–1410, 10.1080/0309877X.2021.1933400. [ DOI ] [ Google Scholar ] 3. Slabbert R. and Friedrich‐Nel H., “Extended Curriculum Evolution: A Road Map to Academic Success?,” South African Journal of Higher Education 29, no. 1 (2015), 10.20853/29-1-458. [ DOI ] [ Google Scholar ] 4. Megbowon F. K., Palesa M.‐K., Bongiwe K., and Sipokazi M., “Challenges of First‐Year Extended Curriculum Programme Students at a University in South Africa,” International Journal of Learning, Teaching and Educational Research 22, no. 4 (2023): 178–194. [ Google Scholar ] 5. Council on Higher Education (South Africa), A Good Practice Guide for the Quality Management of Short Courses Offered Outside of the Higher Education Qualifications Sub‐Framework (CHE, Pretoria, 2016), https://www.che.ac.za/publications/frameworks/good-practice-guide-quality-management-short-courses-offered-outside-higher . 6. South African Qualifications Authority, National Policy and Criteria for the Implementation of Recognition of Prior Learning (amended March 2019). (SAQA, 2019). 7. Kara M., Erdoğdu F., Kokoç M., and Cagiltay K., “Challenges Faced by Adult Learners in Online Distance Education: A Literature Review,” Open Praxis 11, no. 1 (2019): 5, 10.5944/openpraxis.11.1.929. [ DOI ] [ Google Scholar ] 8. Moyo J., “Under‐Preparedness in South African Higher Education: A Limited Test of the English Grammar Awareness of First‐Year Students,” South African Journal of Higher Education 34, no. 6 (2020): 166–184, 10.20853/34-6-4236. [ DOI ] [ Google Scholar ] 9. Brdesee H. and Alsaggaf W., “Is There a Real Need for the Preparatory Years in Higher Education? An Educational Data Analysis for College and Future Career Readiness,” Social Sciences 10 (2021): 396, 10.3390/socsci10100396. [ DOI ] [ Google Scholar ] 10. Winstanley D. and Cunningham C., “A Descriptive Literature Review of Recognition of Prior Learning for Vocational Learners in Emergency Medical Care in South Africa,” South African Journal of Higher Education 37, no. 4 (2023): 322–333, 10.20853/37-4-5313. [ DOI ] [ Google Scholar ] 11. World Bank , The State of Emergency Medical Services in Sub‐Saharan Africa (World Bank, 2022). [ Google Scholar ] 12. Sobuwa S. and Christopher L. D., “Emergency Care Education in South Africa: Past, Present and Future,” Australasian Journal of Paramedicine 16 (2019): 1–5, 10.33151/ajp.16.647. [ DOI ] [ Google Scholar ] 13. Department of Health (South Africa), National Emergency Care Education and Training Policy (Department of Health, 2017), https://www.hpcsa-blogs.co.za/wp-content/uploads/2018/08/national-emergency-care-education-and-training-policy.pdf . 14. Mabulana K., “Learners' Preparedness for Higher Education in South Africa: Developing a Sense of Academic Belonging Through the Selective Learning Approach,” Frontiers in Education 10 (2025), 10.3389/feduc.2025.1465786. [ DOI ] [ Google Scholar ] 15. South African Qualifications Authority, National Policy and Criteria for Designing and Implementing Assessment for NQF Qualifications and Part Qualifications and Professional Designations in South Africa [Internet] (SAQA, 2017), https://www.saqa.org.za/wp-content/uploads/2023/02/National-Policy-for-AssessmentPrintReady.pdf . 16. Mkwananzi F. and Vargas C. M., “Exploring an Alternative Access Route to Higher Education in South Africa: A Human Development and Social Justice Analysis,” Critical Studies in Teaching and Learning 12, no. 1 (2024): 22–39, 10.14426/cristal.v12i1.2120. [ DOI ] [ Google Scholar ] 17. Campbell R., Goodman‐Williams R., Feeney H., and Fehler‐Cabral G., “Assessing Triangulation Across Methodologies, Methods, and Stakeholder Groups: The Joys, Woes, and Politics of Interpreting Convergent and Divergent Data,” American Journal of Evaluation 41, no. 1 (2020): 125–144, 10.1177/1098214018804195. [ DOI ] [ Google Scholar ] 18. Payne A., Keulen L., and Mischlewksi E., Qualitative Research Methods: Case Study Methodology (2020). 19. Botma Y., van Rensburg G. H., Coetzee I. M., and Heyns T., “A Conceptual Framework for Educational Design at Modular Level to Promote Transfer of Learning,” Innovations in Education and Teaching International 52, no. 5 (2015): 499–509, 10.1080/14703297.2013.866051. [ DOI ] [ Google Scholar ] 20. Baxter P. and Jack S., “Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers,” Qualitative Report 13, no. 4 (2008): 544–559, 10.46743/2160-3715/2008.1573. [ DOI ] [ Google Scholar ] 21. Creswell J. W. and Creswell J. D., Research Design: Qualitative, Quantitative and Mixed Methods Approaches, (Sage Publications, 2018). 4th ed.. [ Google Scholar ] 22. Merriam S. B. and Tisdell E. J., Qualitative Research: A Guide to Design and Implementation (Wiley, 2015). [ Google Scholar ] 23. Nieuwenhuis J., “Qualitative Research Designs and Data‐Gathering Techniques.” in First Steps in Research, eds. Maree K.. Van Schaik, 2016), 72–103). [ Google Scholar ] 24. Sekayi D. and Kennedy A., “Qualitative Delphi Method: A Four‐Round Process With a Worked Example,” Qualitative Report 22, no. 10 (2017): 2755–2763, 10.46743/2160-3715/2017.2974. [ DOI ] [ Google Scholar ] 25. Von der Gracht H. A., “Consensus Measurement in Delphi Studies: Review and Implications for Future Quality Assurance,” Technological Forecasting and Social Change 79, no. 8 (2012): 1525–1536, 10.1016/j.techfore.2012.04.013. [ DOI ] [ Google Scholar ] 26. Johnson E., Morwane R., Dada S., Pretorius G., and Lotriet M., “Adult Learners' Perspectives on Their Engagement in a Hybrid Learning Postgraduate Programme,” Journal of Continuing Higher Education 66, no. 2 (2018): 88–105, 10.1080/07377363.2018.1469071. [ DOI ] [ Google Scholar ] 27. Hamdoun W. M. A., “Constructive Alignment Approach: Enhancing Learning and Teaching,” British Journal of Multidisciplinary and Advanced Studies 4, no. 2 (2023): 162–170, 10.37745/bjmas.2022.0173. [ DOI ] [ Google Scholar ] 28. Keddie A., Educating for Diversity and Social Justice (Routledge, 2012). [ Google Scholar ] 29. Loeng S., “Self‐Directed Learning: A Core Concept in Adult Education,” Education Research International 2020 (2020): 3816132, 10.1155/2020/3816132. [ DOI ] [ Google Scholar ] 30. Duran M. and Dökme İ., “The Effect of the Inquiry‐Based Learning Approach on Student's Critical Thinking Skills,” EURASIA Journal of Mathematics, Science and Technology Education 12, no. 12 (2016): 2887–2908, 10.12973/eurasia.2016.02311a. [ DOI ] [ Google Scholar ] 31. Mngomezulu S., Dhunpath R., and Munro N., “Does Financial Assistance Undermine Academic Success? Experiences of ‘At Risk’ Students in a South African University,” Journal of Education 68 (2024): 131–148. [ Google Scholar ] 32. Tinto V., Access Without Support Is not Opportunity (2008), https://www.researchgate.net/publication/237752117_Access_Without_Support_is_not_Opportunity . 33. Chetty L. and Kepkey B., “Access to and Effectiveness of Support Services for Students in Extended Curriculum Programmes at a South African University,” Journal of Student Affairs in Africa 11, no. 2 (2023). [ Google Scholar ] 34. Mothokoa N. B. and Maritz J., “Recognition of Prior Learning Candidates' Experiences in a Nurse Training Programme,” Health South Africa Gesondheid 23 (2018): a1080. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 35. Aryani F., Rais M., and Wirawan H., “Reflective Learning Model in Improving Student Critical Thinking Skills,” Global Journal of Engineering Education 19, no. 1 (2017): 19–23. [ Google Scholar ] 36. Council on Higher Education (CHE), Report on the Teaching Effectiveness Workshop (Council on Higher Education, 2014). 37. Redder L. A., Quality Assurance in Professional Higher Education Institutions: The Structure of Internal Quality Assurance Systems and the Experienced Costs (University of Twente, 2010). [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement Data are available from the corresponding author upon reasonable request. Articles from Health Science Reports are provided here courtesy of Wiley ACTIONS View on publisher site PDF (515.2 KB) Cite Collections Permalink PERMALINK Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM Add to Collections Create a new collection Add to an existing collection Name your collection * Choose a collection Unable to load your collection due to an error Please try again Add Cancel Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top