Developing an Accreditation Framework for Postgraduate Medical Speciality Education in Low-Resource Settings: A Qualitative Study from Sudan.

INTRODUCTION: Postgraduate medical education (PGME) is essential for producing competent specialists and strengthening health systems. Although Sudan has an established undergraduate accreditation system through the Sudan Medical Council (SMC), PGME accreditation under the Sudan Medical Specialization Board (SMSB) remains fragmented and inconsistently aligned with international standards. This study assessed the status of PGME accreditation in Sudan, examined the SMSB experience, and developed a framework to strengthen accreditation practices. METHODS: A qualitative case study design was employed between 2023 and 2025. Data were collected through a structured review of international literature, accreditation-related documents, and semi-structured interviews with 16 purposively selected stakeholders, including accreditation experts, SMSB leaders, trainers, specialty council representatives, and policymakers. Data were analyzed using the Framework Approach, involving familiarization, thematic framework development, indexing, charting, and interpretation. RESULTS: The findings revealed a substantial gap between the mature undergraduate accreditation system of the SMC and the evolving PGME accreditation system of the SMSB. Strengths included SMSB's legal mandate, national reach, experienced specialists, and emerging WFME-informed standards. Challenges included the absence of a dedicated accreditation department, inadequate surveyor training, unpublished standards, weak stakeholder coordination, limited monitoring and evaluation, financial constraints, and political instability. These findings informed a multi-level framework focused on governance reform, role separation, capacity building, stronger monitoring systems, accreditation standards and processes, and continuous quality improvement. CONCLUSION: Sudan has substantial experience in PGME but lacks a coherent and standardized accreditation system. This study proposes a context-sensitive accreditation framework that emphasizes governance strengthening, role separation, capacity building, and continuous quality improvement. Its implementation may enhance training quality, institutional accountability, and the credibility of postgraduate medical education programs, while also providing guidance for other countries facing similar challenges.