<p>Histories of African medical education are typically narrated through a colonial-to-postcolonial sequence that does not fit Ethiopia. Ethiopia preserved its sovereignty. Yet its formal medical education has been heavily shaped by imported curricular models, expatriate faculty, and an ideal of ‘international acceptability’ / ‘modernization’ that has outlasted successive regimes. With close attention to the specific context of medical education in Ethiopia, this paper challenges broad, one-size-fits-all accounts of colonial influence. In this paper, we trace the history of medical education in Ethiopia, drawing on published historical scholarship and archival documents. Through attention to the specific historical context of Ethiopia, this case underscores that political sovereignty alone did not produce epistemological independence. In Ethiopia, across all periods, Ethiopian indigenous healing pedagogies have remained outside the ‘modern’ curricular frame. Foreign epistemic forms, introduced through invitation and emulation, persisted as mechanisms distinct from administrative colonization, yet still exerted a powerful influence. Historical scholarship with its call to be deeply attentive to context, continuity, and change over time offers a useful pathway to understand why colonial logics persist in contemporary medical education reform. This paper also presents models of international collaboration that have been developed in response to these historical insights. Efforts, such as the Toronto Addis Ababa Academic Collaboration and the African Hub for Innovation and Critical Scholarship in Health Professions Education, envision making ‘Ethiopianisation’ an epistemological project that replaces the imported model.</p>