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Shapeshifters: Global South scholars and their tensions in border-crossing to Global North journals
  1. Thirusha Naidu1,2,
  2. Carrie Cartmill3,
  3. Sunitha Swanepoel4,
  4. Cynthia Ruth Whitehead3,5,6
  1. 1Behavioural Medicine, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
  2. 2Public Health and Primary Care, University of Cambridge, UK
  3. 3The Wilson Centre, University Health Network, Toronto, Ontario, Canada
  4. 4University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
  5. 5Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  6. 6Women's College Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Thirusha Naidu; Naidut10{at}


Introduction Global South researchers struggle to publish in Global North journals, including journals dedicated to research on health professions education (HPE). As a consequence, Western perspectives and values dominate the international academic landscape of HPE. This study sought to understand Global South researchers’ motivations and experiences of publishing in Global North journals.

Methods This study used a hermeneutic phenomenological perspective. Unstructured interviews were conducted with 11 authors from 6 Global South countries. Interview transcripts were analysed through a process of familiarisation, identifying significant statements, formulating meanings, clustering themes, developing exhaustive descriptions, producing a fundamental structure and seeking verification.

Results Participants described being motivated by local institutional expectations, to improve reputation, to meet Global North perceptions of quality and to draw attention to their Global South context. Participants described experiences where their work was deemed irrelevant to Global North audiences, they were unable to interpret rejections and had learnt to play the publishing game by attending to both local and global imperatives. These motivations and experiences revealed several practical, academic and transformational tensions that Global South authors faced.

Conclusion The tensions and negotiations encountered by Global South authors who publish in HPE journals reflect a ‘border consciousness’ whereby authors must shift consciousness, or become ‘shapeshifters’, inhabiting two or more worlds as they cross borders between the Global South and Global North conventions. There is an added burden and risk in performing this shapeshifting, as Global South authors stand astride the borders of two worlds without belonging fully to either.

  • health education and promotion
  • health policies and all other topics
  • qualitative study

Data availability statement

Data are available on reasonable request.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • In health professions education (HPE), Global South authors struggle to publish in high-impact Global North journals.

  • Consequently, Global North perspectives dominate and Global South scholarly interests suffer.

  • Little is known about the detailed reasons for the this from authors’ perspectives.


  • This study amplifies Global South authors’ voices on specific reasons for this phenomenon.

  • We describe how authors encountered tensions in choosing high impact HPE journals, which reflects a border consciousness compelling authors to shift consciousness, or become ‘shapeshifters’, as they inhabit two worlds or remain border between the Global South and Global North conventions.

  • Global South authors may experience burdens and risks associated with shapeshifting, as they straddle the borders of two worlds while belonging fully to neither.


  • Findings should inspire journal editors to align Global South authors’ need to publish in high impact international Global North journals with the imperative for globally representative research in HPE.

  • Global South authors may be encouraged to recognise that their exclusion is a pervasive publication system failure and does not indicate personal inadequacy.

  • Journals must revise submission policies to invite more diverse representation of the global scholarly work in HPE.


For academics, publication means success. Knowledge production is a primary impetus, but scholars also aim to establish a research area, claim ideas, demonstrate collaborations, facilitate funding or comply with funder imperatives. Researchers may also have obligations to study participants or communities impacted by the research and fulfill academic promotion requirements. Limited research examines the motivations for publication across settings.1 2 Global South researchers struggle to publish across Global North settings3–5 and health professions education research (HPER) is no exception.6 7

Unsurprisingly, given higher education’s colonial legacy, Western perspectives and values dominate.8–11 Academic Medicine, started in 1926, as the first medical education journal with its early decades focused primarily on medical education in the USA.12 Medical Education started in the UK in 1966 and positioned itself as an international journal.13 Early issues assumed Western educational notions as worthy of international uptake.13 Global South contributions appeared as case reports on new medical schools established with the assistance of, and in the education traditions of, former colonisers.13 Medical education emerged as an academic field over the last 50 years, expanding to HPER in the last 30 years.14

Two publications by Norman a decade apart outlined the history and status of the field of HPER.15 16 Recurring controversies and the growth of specialised academic units in HPER became regarded globally as centres of excellence. Publications in HPER have since increased in diversity, specification of topics and research methods. Norman’s histories show what continues to be prominent in academic medical education research and reveals a history of what is persistently absent17; notably for this paper Global South and Global North-South perspectives.

Contemporary HPER is definitively shaped by epistemic roots founded in colonialism.18 19 This has resulted in Global North skewed developments in HPER. We explore what Global South scholars encountered when they ventured into the field. Emerging literature shows the under-representation of voices and perspectives in HPER from outside of English-speaking European and North American regions.5–7 20 21 Bibliometric studies indicate many publications (approximately 70%–80%) in HPER journals have authors from only five countries (the USA, Canada, the UK, the Netherlands and Australia).5 7 Yip and Rashid21 found that across 10 medical education journals, 92.6% of journal editors and editorial board members were from high-income countries, with 66% from only four countries (the USA, Canada, the UK and Australia).

Interest in authorship in the global context of North-South collaborations is growing.22

We use the term international in reference to the global reach of the journal. It is far more common for Global North journals to have international readership and influence in their field than Global South journals do. Many Global North journals also make claims of being international in scope and contributing to knowledge production that is relevant to an international audience. Researchers highlight the ‘middle author’ phenomenon where Global South authors are assigned the middle author role for credibility in Global South locations in global health or diversity and social equity issues in the Global North.23 First authors on larger bodies of work tend to be graduate students while last authors are generally project leaders. Project leaders and Global South authors are seldom the same individual. Global South authors, or those with marginalised identities, participate in the research because they may be unaware of the practice or intend to leverage the opportunity for future interests, be that for publication credit or a foothold in academia.24–26 North-South collaborations may involve Global North authors providing legitimacy through proficiency in academic English and preparing manuscripts for publication. Capturing the perspectives of Global South researchers contributes to redressing current global academic publishing inequity. The lack of Global South contribution to global discourse in health professions education (HPE) means that HPE continues to be shaped by Global North epistemology and methods. This deepens the Global North influence over Global South education, propagates health and healthcare in the Global South in the Global North image mimicking the coloniality of Global Health.

The purpose of the study

The study draws attention to the idea that beyond the important compulsion to publish to be heard, publishing in Global North journals is essential for academic promotion and career advancement in Global South contexts. This problem is increasingly highlighted across various disciplines such as molecular biology, global health and history. Consistent with a rationale of employing a qualitative research approach, this study aims to gather richer insight into authors’ experiences of having to publish in Global North journals to gain global visibility and local career advancement. We maintain that while this phenomenon is known for exploring rich data from the situated perspective of those who have lived experience of the phenomenon will offer deeper insights to influence change.


  1. To understand the motivations of Global South authors to publish in major Global North-based medical education journals.

  2. To explore Global South authors; experiences of publishing in Global North journals.


Research design

A hermeneutic phenomenological perspective was applied to understand Global South scholars’ motivations and experiences in international HPER journal publication. The hermeneutic perspective in phenomenology seeks to understand layers of experience below surface awareness, including prereflective means of sense-making.27 28 We chose a hermeneutic phenomenological perspective based on Heidegger’s views which centred on lived experience, whereby asking theoretical questions about Being (human existence) in the world, one is able to gain a deeper understanding of that experience of being human. Heidegger’s emphasis was on illuminating the everyday and taken-for-granted aspects of our lives. We focused on ontological perspectives or the individual lived experience through the concept of what it means to be human in our world. We explored the lived experience of authors who published in Global North journals in a world that is dominated by Global North epistemology (ways of being) shaped by a history of colonisation. Hermeneutic phenomenology was a particularly appropriate method as the aim of the study centred on the lived experiences of authors in a global context, specifically around the phenomenon of academic publishing in an exclusionary space.

Research participants and recruitment strategy

Participants were identified through a bibliometric study of Global South authors who published papers in five high-profile HPER journals between 2012 and 2021.7 First and last authors based at Global South universities who published in globally recognised HPE journals between 2017 and 2018 were contacted via the email address provided for the ‘corresponding author’ and invited to participate. We focused on authors who had published between 2017 and 2018 because the bibliometric study was in progress at the time of study recruitment and later years had not yet been coded for the geographic origins of first and last authors. We did not contact authors from earlier years since we wanted to ensure that they would be able to recollect their experiences of publishing within the HPE literature. First and last authors who were not corresponding authors, were traced via PubMed from papers published as corresponding author, and were contacted via corresponding email addresses.

We anticipated achieving sufficient information power with minimal interviews as our research question had a narrow aim, high specificity and strong focus on dialogical engagement.29 Forty-three potential interviewees were contacted and 11 agreed to participate (table 1). The study employed purposive sampling.

Table 1

Table of participants

Data collection

Instruments and procedure

A semi-structured phenomenological interview method was used. Participants were encouraged to relate illustrative stories about experiences. Hermeneutic and phenomenological interviewing involves the interviewer co-creating ideas with the participant through an engaged conversation. Participants were contacted by email invitation by the first author. Written informed consent was returned via email. Interviews were recorded and transcribed verbatim. Interviews lasted between 45 and 60 min and were conducted in English over Zoom and recorded. Zoom-generated transcripts were reviewed independently for clarity by two researchers. Recordings and transcripts were held in password-protected cloud storage accessible only to the research team.

Data analysis

Data were analysed in two stages comprising the following steps27:

  1. Familiarisation: three researchers read through all transcripts to familiarise themselves with the data.

  2. Identifying significant statements: all statements in the transcripts of direct relevance to motivations and experiences were identified.

  3. Formulating meanings: meanings relevant to motivations and experiences were identified from close consideration of significant statements.

  4. Clustering themes: meaning units were clustered into themes related across accounts.

  5. Developing an exhaustive description: inclusive descriptions of phenomenon, incorporating all the themes were written. Interpretive phenomenological analysis—stage 2.

  6. Producing the fundamental structure: exhaustive descriptions were condensed to dense statements capturing aspects essential to the phenomenon.

  7. Seeking verification of the fundamental structure: the researcher returned the fundamental structure statement to all participants to verify whether it captured their experience.


Our findings related to two main topics: Global South authors’ motivations and experiences publishing in top HPER journals, and tensions they experienced while doing so.


Local institutional expectations

External motivations included the higher value Global South institutions placed on international versus local or regional publication for academic promotions. Internal motivations included having their research widely known.

…you want your research to be known as broadly as possible. And so just going with a local journal…it kind of does stifle it. It’s only going to be known within that local context. (Interview 1)

While local university’s imperatives for international (Global North) publication was a criterion for advancement, it is also true that most high-profile journals are located in the Global North.

Universities don’t care about work that you publish that’s not in a North American or European (journal). Many of the high-profile journals just happen to be there. And if you’re not publishing in those journals then your progress for promotion is limited. (Interview 2)

Reputation within and beyond local context

International reputation was valued above local. Publishing in international journals allowed authors to improve personal standing in their contexts while securing global attention. Researchers submitted to local journals with topics of local interest.

[E]ven though it is a topic that is regionally oriented, if I know that if I can get it published in an international journal, that gives me two advantages. One is, of course, my own personal standing as an author improves because I have published it in a higher impact journal. And secondly, I know that the readership of that international journal would probably be wider than the readership of the regional journal to which I would be submitting. So, the same people who are likely to read the regional journal, … would be able to find it and read it from the international journal. (Interview 10)

Authors reasoned that local audiences would have access to international journals while regional journals were restricted to local audiences.

North-skewed perceptions of quality

Researchers considered the ‘quality’ of their manuscript before considering a submission to an international journal. International journals were seen as higher standard than Global South journals. Standards related to impact factor, editorial quality, quality of peer review, Western methodology and criteria for validity and rigour.

I would look at…what I believe is the quality of my paper. And if I believe that my paper is of such a quality to be able to be accepted in one of the Western journals, I would definitely try to do that first. And if I get rejected by them, then the second choice would fall on the good quality Indian journals. And you go down the list progressively like that. (Interview 10)

One interviewee speculated that researchers assume local journals held less rigorous standards and were more likely to accept submissions:

I wonder if there isn’t a perception that… therefore your work will get published more easily. But it, it’s not coming up to the standard of the journals from the Global North. (Interview 1)

Leveraging Global South experience

Researchers used currently trending Global South topics or terminology to leverage attention to the Global South location and content. They considered how to frame and draw attention to their ‘product’ based on Global South as a different context.

Well, in this case, I mean, we’ve got decolonization in the title. And global health in the title. […] So, I mean, it’s the perfect words to get Googled and it’s in Academic Medicine. So, people assume it must be good if it’s in Academic Medicine. So, that article’s got a lot going for it. But I’ll give you what […] I’ve learned over time. Young, emerging researchers don’t always pick up on this because they feel their research is so much part of them. But I say, it’s not about you and how you feel about your product. If we call it a product. It’s about what this can mean for the people out there. So, it’s about how you frame, what you’ve got. Even if your lab is in South Africa. How can you make what you’ve uncovered in your research relevant and appropriate for a global audience. (Interview 5)

Researchers working on specific topics, extensively researched in the Global North noted potential value in reanimating ‘Western’ interest by highlighting novel Global South contexts, especially with culturally loaded topics, for example, professionalism:

But I’ve seen my colleagues, also from Asian countries, have published something about professionalism. So, there’s quite a lot of professionalism from the Asian countries. So, maybe that’s something interesting for our colleagues in the West? So, maybe, something that is really culturally different. Professionalism with culture… topics that (are) sexy for the Western (audience). (Interview 6)


Global South concerns as irrelevant to the Global North

Researchers speculated whether acceptance of papers from the Global South were influenced by the relevance of topics to Global North audiences.

And so you are in a top journal in the US, you don’t want to publish things from Columbia that are local. Or who cares about your conflict? We have guns control here, out of control. We have opioid epidemic here. We have COVID-19 things. We have the greatest people to write for us and we don’t have the time for you either. (Interview 3)

One researcher noted that international journals were less likely to publish new work if it came from the Global South. Where definitions of ‘novel’ differed in the Global North and Global South, Global South definitions took precedence in publication.

Even though most of the research originated from the West. I found very limited studies on that area in my Asian settings. So, based on that, I realized that my definition of originality maybe differ with some of the high-rank journals. Because they want something that is completely new or exploring certain, new aspects that haven’t been explored in terms of the approach. (Interview 6)

Even with novel local work, the aim remains to publish in Global North journals and to ‘pitch’ local research for Global North relevance and interest.

[H]ow do we not duplicate what they’re doing, but how do we take what they’ve done and make it sort of more suitable for middle income or low-income countries. Which actually ironically has nothing to do with the high-income countries, the Global North. But yet we still publish there. (Interview 4)

Global South authors could offer the novelty of context to improve the possibility of publication.

So, I think there’s a tension between wanting to have your work read and wanting to have it facilitate your academic progress. But then also that sense of social accountability, you know. And I think that’s a difficult one. If you know that you’re doing local research for local people but you’re not publishing it in local journals, it is a real challenge. Because even though Global South reads Global North papers, you know you do also want to promote a story within a Global South journal. (Interview 4)

Global South research trajectories followed those in the Global North so Global South research was not published as topics may be outdated by Global North standards.

Like that has been done and implemented and researched and refined and reiterated so many times uhm, in the Global North. We are then using their research to implement those changes in our curricula here. And you know why would they care what challenges we face when we’re implementing project-based learning in some medical curricular in one university in South Africa. (Interview 2)

Learning to ‘play the game’ in publishing

Researchers needed to acquire strategies for career success in publication:

(we) have all the same concerns that other people have with peer review and … I, from early on, I think I paid close attention to this game. It’s a game and I, I know that there are certain boxes that I need to tick when I submit to certain kinds of journals. I, I try to make sure that I align.

These criteria were adopted and applied by institutions, so researchers understood and completed criteria, to improve local and international academic standing:

…the way I went from being a senior lecturer to an associate professor to a full professor, was premised on the extent to which I could demonstrate that my work was being taken up more broadly. And so, in the absence of other metrics, or in the absence of other criteria, people tend to use metrics. And metrics relate to citations. So I think that was probably one initial impetus. […] In that the moment I started publishing in one of the top journals, my work started getting recognized in other contexts. And that enabled me to do a lot for my centre. And for people in my environment. So, I suddenly realized that I could leverage the benefits that came from publishing in journals, where people got to know my name. (Interview 5)

Researchers conceded that strategy was imperative to improve publication status:

So, they have their own strategy to remain Q1 journals and to increase their impact factor and to be read, well-read, and so on. So, I’m fine. Because everyone has a strategy. We cannot not have a strategy. But we try to align strategies of the want, the people who want to publish with a journal that wants to publish. So, I personally, if you want, try to understand the strategy to know where I should publish. (Interview 7)

Interpreting rejection

When they experienced rejections in the past, authors found these difficult to interpret with feelings of uncertainty about whether rejections was due to outdated topics, lack of rigour, language or authors being from low-income and middle-income countries.

I think a lot of us have certain preconceived notions about other people, other cultures. We have those frames already built into us. So, editors, because they have seen examples of pretty rubbish papers coming out, let’s say from India or wherever, they will assume that, unless proven otherwise, that this paper that is being sent to us now is rubbish. And as a result, they tend to be much more strict in evaluating the paper. …. The second aspect is, of course, if it is somebody you can relate to culturally, socially, whatever it is, then you tend to be a little more lenient towards judging that article. As compared to, you know, an article coming from a total stranger. (Interview 10)

Authors experienced both patronising and respectful responses from journals.

She said it’s really, really hard to just reject the paper outright like this. But she said, please do learn from it. And some of the comments you may be able to use planning your research going forward. (Interview 1)

When participants were rejected in the past, authors experienced similar emotional reactions as authors everywhere. An added suspicion was that their paper may have been rejected simply because it was from the Global South. More than one author suspected the editor had not read the paper at all.

I had that flat-out rejection from Journal X which, which I was quite devastated about. Because, and I’ve since got to know (the editor). But he wrote back and he said, we don’t publish work of this nature. And my sense was that he hadn’t read the article. I might have been wrong. I don’t know. (Interview 5)

Some emerging or junior researchers supposed the status and experience of their coauthors influenced acceptance further linking to the notion that Global North journals may be interested in leveraging aspects of the Global South experience that have been established by more senior Global South authors.

I think one of the things is that it’s a far more competitive environment to get a publication out. Especially as a new researcher […] I submitted my paper twice and received it back twice. And then it was rejected. And so, I coauthored with a senior professor, who then just assisted me with some of the final editing really, and it was accepted immediately. […]And I wonder if the response of the editor doesn’t also depend on who the authors are, you know, and the coauthors. (Interview 4)

Tensions in crossing the North-South publication border

Participants’ accounts were characterised by tensions in publishing as Global South authors. We noted three types of tensions: practical, academic and transformational (figure 1).

Figure 1

Tensions Global South authors encounter when publishing in Global North journals.


Resources and international collaborations. Global South resource tensions involved prohibitive publication costs, lack of funding and available support personnel relative to the demands of publishing in major spaces while competing with international researchers who were context insiders. Global North researchers were seen as having appropriate funding and experienced personnel (administrators, doctoral and postdocs).

To give you an example, we frequently hire people from North America, with 100 publications each one, let’s say. And they come as full professors. But when they reach [my university] they do not develop or produce one work of scholarship. Why? It’s because they are used to a system whereby they are asked only to think of a research question. And just by thinking of a research question everything gets materialized. Because there are people who help in the grant writing. Or in writing a proposal. And there are people who adjust and refine the proposal, and do the statistical work. […] [H]ere in (country), the author would do everything. (Interview 7)

Participants considered international collaboration based on how much methodological and conceptual control they would have to concede in exchange for the financial benefits. Access to substantial international funding sources was contingent on having international collaborators.

For example, if we partner with you and you happen to have a statistician, this is easy. So, this brings me back to the question that you mentioned at the start. What does the collaboration make us or give us. Also, collaboration helps with regards to resources. Human resources or financial. (Interview 7)


Academic considerations included tensions over language and research epistemology. English at the academic level as a persistent publication requirement was pertinent. They noted having to contend with seemingly routine requests for Global South authors to secure costly professional language editing or comments about poor writing and language as cause for rejections. Conversely, publishing in English could make research inaccessible to local health educators and practitioners. Publishing locally, in local languages would exclude them from international competition, essentially ejecting them from ‘the game’.

We wrote it up and I sent the article …And it came back with comments like please get this article vetted by a native English speaker. Those are the words that were used. When I pride myself in English. I think my English is pretty good and I think it’s better than some of the English I’ve heard, even in England. I worked in England also, for that matter. So, when that came back all I did was I just changed a few phrases around here and there myself. And we sent it back saying that this has been looked at by a native English speaker, and they accepted it and published it. […] You know, so, obviously, there was a bias on the part of whoever was reviewing that article to suggest it in the first place. (Interview 10)

Regarding research epistemology, participants were aware of how they used Global North methodologies, theories and designs in their studies. Their tacit understanding was that Global South methods would not be understood or considered legitimate science. One participant described how her lack of confidence with the English language impacted her publication patterns:

I realize that our writing style, our writing ability, and perhaps our research ability, if compared to the colleagues from the West, perhaps are very low. I realized that we need to be able to publish to have like you said, a whole picture, a comprehensive picture of medical education from the West and from the East. But at the same time, I also realized that our writing ability, because English is not my first language. My writing ability, my analytical ability, maybe my research ability and so forth is lower compared to them. So, at the same time, I feel, sometimes I don’t have enough confidence to really try and really pursue publications. Because I realized that, at least in my mind, personally I realize I’m far below them. Yeah. So, maybe that’s one thing. I mean, it’s not about what I’m trying to say, it’s not because the journal maybe doesn’t want to give us space. But also, because at my end I cannot write satisfactory, maybe. (Interview 6)


Scholarship and developing new scholars

Participants had to make decisions about whether to conform to international normative scholarship conventions which would strengthen Global North research and advance their careers, or resist Global North conventions and introduce novel scholarly views from and about the Global South. They risked potential obscurity and possible academic failure from the Global North academic machinery misunderstanding and rejecting manuscripts. One participant described her strategy for playing the game of academic publishing:

I think if I was satisfied to just carry on playing the game, that would feel deeply unsatisfying. I think that as academics our main work is to push back against orthodoxy and established ideas, even if some of the work that we’re doing ends up being a dead end. Someone has to push forward into those spaces that are poorly understood. Someone has to try and breathe life into the professions that are dead and have been unchanged for 50 years. And I see that as being the work of academics. (Interview 2)

Hope for transformation came from Global South researchers encouraging their students to publish locally. While advising students on how to conform to enter and gain traction in global academia, many participants ensured and inspired academic rebellion in their students. Participants encouraged students to work in local contexts with local people and data and publish their work in local journals. While participants used the international space for personal and professional advancement, they nurtured emerging scholars to develop locally relevant scholarship in the Global South.

[W]e’re not trying to graduate PhD students who are going to work in other contexts. They may end up doing that but you know we’re working to try and build capacity in South Africa for South Africans, and for that to have utility for other countries that look and feel like us. […] I think a blend of different journals is also important. So, for example, if we talk about my PhD student, one of the things that he started off with was a scoping review […]. Now, that does have international interest. […] We designed that from the beginning for an international journal. But he’s also doing a series of interviews and focus groups amongst other African students. Now that may have less utility for an international journal. Having said that, we have the African Journal of Health Professions Education which is an accredited, really good publication. So, we’re going to aim for AJHPE with some of these data. (Interview 2)


Participants’ motivations to publish were similar to Global North researchers’ motivations. Divergent factors included that Global South institutions valued publications outside of their contexts more highly for promotion and Global North journals were perceived to have more merit and higher quality. Researchers weighed factors that would advance their reputations locally against those that would promote an international reputation and considered how Global North audiences who, they acknowledged, were not familiar with their contexts would consider and accept their submissions.

Global South authors were preoccupied with their best ‘quality’ being submitted to Global North journals. Quality described well-known yet implicit scholarly conventions set by Global North and complied with Global South universities. Global South authors felt compelled to negotiate practical, academic and transformational tensions to participate globally. Practical constraints included negotiating resource constraints and assessing the value of international collaboration. Academic tensions comprised dominance of English over other languages, and the tyranny of Global North epistemological frames. Transformational tensions authors encountered were deciding between conformity or dissent in dominant global scholarship, and whether to advise students to replicate or rebel against scholarly conventions.

Editors, and top medical educational journals were all based in Global North locations, implying that these journals had a Global North knowledge production perspective. Global North journals are local Global North publications yet hold global power in publication. Their focus on topics relevant to Global North authors implies they reflect Global North learning environments, academic exchange and knowledge production spaces. Global South authors were bound to additional publication-related work beyond coping with rejection, interpreting feedback from editors and managing publication strategy. Additional work included imagining and speculating how foreign gatekeepers would understand and evaluate their work, without the benefit of being part of those networks, having not trained and worked within them; and negotiating unfamiliar spaces and inferring how their research would be relevant in the Global North.

Tensions and negotiations encountered by Global South authors who publish in top HPE journals are reminiscent of tensions experienced by people who are compelled to exist simultaneously between two worlds. Migrants, immigrants, people of non-dominant sexual, gender, racial, ethnic, linguistic and ‘othered’ identities described in various contexts by many equity-seeking theorists have similar experiences.30–33 Such an existence demands that people stand astride the ‘borders’ of two or more worlds inhabiting a state of flux, ready to step into one world or the other as the situations call for, without belonging fully to either.34 Global South authors must invest additional emotion and intellectual labour to publish in the same journals as their Global North counterparts as they consider collaboration with Global North scholars and manage resource constraints. Intellectual labour incurred in understanding foreign epistemic frameworks and producing scholarly work in academic level English can create self-doubt and impact on researchers’ confidence, creativity, identity and emotional integrity. The imperative to publish in globally visible and impactful journals means Global South authors may miss opportunities to increase visibility for Global South journals. Global South authors are in the quandary of putting personal visibility tied to career advancement ahead of using global attention to their scholarship to advance awareness to scholarship in Global South regional journals.

Gloria Anzaldua’s work on border identities reflected through the lens of her own experiences as a Chicana, Lesbian Spanish-speaking migrant and scholar maps a plurality of self that comes with belonging to binary or multiple spaces. This plurality of self is most intense in cases where people have to create a ‘third space’ to present themselves in foreign contexts such as when Global South researchers must write in English or apply Global North epistemology and methods in research. This ‘border consciousness’ as Anzaldua describes it, is unsettling and destabilising. Here, the person is forced to confront aspects of their identity structured by multiple determinants all of which are ‘othered’ by dominant identity precepts. Border consciousness describes the experience of shifting consciousness where persons become ‘shapeshifters’ inhabiting two or more worlds as they cross borders between the Global South and Global North conventions. This identity is not a given and must be created.34 35 Added burden comes from performing this shapeshifting and border-crossing as the performer cannot be certain that they and their work will be recognised or that they will be allowed to cross over to legitimate territories and identities. When compared with Global North authors who are situated in contexts that defined and shape their identities reciprocally, Global South authors must manoeuvre across multiple internal and external contexts. Global North authors do not have to consider if it is their geolocation, language or topic which may influence rejection but primarily the quality and currency of their science. Indubitably Global North authors have challenges, however our point here is that seldom do these challenges concern their very identities and positions in the world.

Transformative tensions suggest that a new level of global consciousness created through negotiated spaces may emerge.34 The challenge of isolation and in-betweenness can give rise to assertions of empowerment in the gaps of what appear to be rigid borders.

Shapeshifter identity may have relative advantages which may emerge over time. The increasingly global nature of academia may benefit scholars who represent the Global South in the Global North in identity, geolocation, lived experience, ancestry and personal history—globally mobile, comfortably multilingual and proficient in English. Contextual factors have created a larger group of shapeshifters so these persons now make important contributions to dismantling of dominant structures. Global South to Global North migration is an important phenomenon, so there is space in Global North academic settings for persons with Global South-connected identities.

In HPE research, Global South authors’ motivations to publish in high-profile Global North journals in the field are influenced by their local institutional expectations, skewed perceptions that Global North journals are of higher quality, their intentions to leverage their Global South experience on the global platform and the need to extend their academic reputation beyond the Global South. In publishing the Global North, they experience apprehension that Global South concerns are irrelevant, they learn to play the ‘game of publishing’ and to interpret rejection outside of their context. These experiences result in tensions which pivot around practical, academic and transformation issues. Consequently, Global South authors are compelled to ‘shapeshift’ to constantly negotiate publication borders resulting in a high burden of intellectual labour and the personal quandary of considering international personal advancement against their contribution to local Global South scholarship.

Limitations and future directions

Our selection process resulted in only 11 interviews which illustrates the difficulty in finding Global South authors in HPER who successfully publish in Global North journals. Scholarly work describing how the global system is inherently exclusionary towards Global South scholars determined our focus on researchers who do successfully publish in globally visible spaces. We have not encountered studies that investigate Global North scholars being compelled to consider language, positionality and location in the submission process nor have we come across this in the HPER scholarly community to which all the authors belong. Future research may explore this phenomenon. Scholars who do eventually publish in Global North journals would have had the lived experience of being repeatedly rejected until they learnt to play the game. While it may appear that our study is silencing authors in low-income countries, it is in fact highlighting the world of global academic publishing that does this. We intentionally focus on high-profile or high-impact journals that shape discourse, thinking and future orientation in a field. These journals influence scholarship trends in HPER that shape teaching and learning of health professionals and ultimately impact health.

Future research should aim to include authors from more varied Global South countries. Regional variations are likely based on socio-economic conditions influenced by which Global North had colonised the Global South authors’ countries. Further research should explore colonial impacts on higher education institutions in Global South countries.

Data availability statement

Data are available on reasonable request.

Ethics statements

Patient consent for publication

Ethics approval

Ethics clearance was obtained from the University of KwaZulu-Natal Social Science Research Ethics committee (HSSREC/00002874/2021). Participants gave informed consent to participate in the study before taking part.


The authors would like to acknowledge the participants who are themselves authors and researchers in HPER for their time and willingness to participate in thinking deeply in our engagement with them.



  • Handling editor Seye Abimbola

  • X @NaiduThirusha, @cynthiarw29

  • Contributors TN and CRW conceptualised the study. TN liaised with participants, conducted the interviews and compiled the initial draft. CC and SS managed the project. CRW, TN, SS and CC participated in data analysis and reviewed successive drafts of the manuscript. TN acts as the guarantor for this work.

  • Funding A portion of the study was funded by Cynthia Whitehead’s BMO Financial Group Chair in Health Professions Education Research at University Health Network.

  • Competing interests CRW is the holder of the BMO Financial Group Chair in Health Professions Education Research at University Health Network. No other authors have any competing interests to declare.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.