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Abdalla ME, Taha MH, Onchonga D, Preston R, Barber C, Green-Thompson L, Taylor D, Cameron E, Woollard R, Boelen C. Instilling social accountability into the health professions education curriculum with international case studies: AMEE Guide No. 175. MEDICAL TEACHER 2024:1-14. [PMID: 39418524 DOI: 10.1080/0142159x.2024.2412098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 09/30/2024] [Indexed: 10/19/2024]
Abstract
This AMEE guide focuses on instilling social accountability (SA) concept and values into health professions education (HPE) curricula with the goal of producing competent, compassionate healthcare professionals who can act as change agents within the healthcare system. By incorporating SA, HPE schools will instil in their students a strong sense of accountability for addressing the health needs of the communities they serve. This AMEE guide presents a comprehensive framework for embedding SA into the HPE curriculum, covering various aspects in curriculum design, implementation, and evaluation. It also includes case studies of exemplary socially accountable curricula, highlighting the experiences of schools aspiring for SA. Acknowledging how curriculum is embedded in a larger institutional structure, and that SA requires institutional commitment in its governance structure and policies is also a critical component for consideration.
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Affiliation(s)
| | - Mohamed H Taha
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, United Arab Emirates
| | - David Onchonga
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Robyn Preston
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Cassandra Barber
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | | | - David Taylor
- College of Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Erin Cameron
- Human Sciences, NOSM University, Dr. Gilles Arcand Centre for Health Equity, Thunder Bay, Canada
| | - Robert Woollard
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Charles Boelen
- International Consultant in Health System and Personnel, Former Coordinator of the WHO Programme (Geneva) of Human Resources for Health, Sciez-sur-Léman, France
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Rault AE, Giard J, Ladner J, Kra O, Randrianarivo R, Chenault M, Leaune E. The experiences of medical and pharmacy students participating in a collaborative online international learning on social accountability and global health: a qualitative study. BMC MEDICAL EDUCATION 2024; 24:961. [PMID: 39227946 PMCID: PMC11373088 DOI: 10.1186/s12909-024-05895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 08/12/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Social accountability aims to promote a collective ethic that upholds the fundamental values of equity, efficiency, solidarity, and social justice in healthcare and is now considered as a critical mission of academic health centers. Collaborative Online International Learning (COIL) is a pedagogical approach that uses digital technology to provide experiential international learning, specifically for increasingly diverse and multicultural healthcare work environments. The SOLID'AIRS program is an innovative French-language COIL that aims to set up international exchanges and workshops on social accountability between health sciences students. The aim of our study was to assess the impact of participation in the SOLID'AIRS program on medical and pharmacy students. METHOD Five universities in four different countries were involved in SOLID'AIRS. We conducted a qualitative study by performing individual, semi-directed interviews with students who participated in the program from 2021 to 2022. A thematic analysis was conducted in five chronological phases: (1) reading, (2) descriptive coding, (3) conceptual coding, (4) identification of themes and (5) production of a coherent thematic structure. RESULTS After including sixteen student participants, 13 medical and 3 pharmacy students, we identified four main themes related to the impact of participation: (1) previous experiences in social accountability and international learning, (2) perception of the program, (3) perceived impacts of the program, and (4) difficulties encountered and avenues to improve the program. Overall, the program was well received by all participants who reported the advantages and limitations of the online learning format. The primary advantage of this format was its feasibility. The participants noted both professional and personal benefits of the program for their current and future practice, including greater reflexivity towards health sciences practice. Based on the challenges faced during the program, particularly in coordinating group work and communication, participants suggested increased supervision of group projects by collaborators, and organizing at least one in-person meeting for future editions. The participants reported encountering difficulties during the COIL and suggested ways of improvement. CONCLUSION Participating in a COIL on social accountability appears to be an effective way to adopt a reflective approach to medical practice and should be implemented and evaluated in other educational contexts.
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Affiliation(s)
| | | | - Joël Ladner
- Université Rouen Normandie, INSERM UMR 1073 ADEN, Rouen, France
- Department of Epidemiology and Health Promotion, CHU Rouen, Rouen, France
| | - Offoue Kra
- Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | | | - Marceau Chenault
- Faculté de médecine Lyon-Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Edouard Leaune
- Faculté de médecine Lyon-Est, Université Claude Bernard Lyon 1, Lyon, France.
- Centre Hospitalier le Vinatier, Bron, France.
- Research on Healthcare Performance, RESHAPE, Inserm U1290, Lyon, France.
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Towle A, Wang L, Ong K, Kline CC. Guiding Principles for Patient and Public Engagement in the Educational Missions of Medical Schools. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:1016-1023. [PMID: 38574203 DOI: 10.1097/acm.0000000000005728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
PURPOSE The purpose of this research was to cocreate with patients and the public a set of evidence-informed guiding principles for their authentic, responsive, ongoing, and sustainable engagement in the mission, goals, curriculum, and delivery of medical education. METHOD A set of guiding principles of relevance to medical education was identified from the literature. Eight focus groups with patients and community members representing a wide variety of perspectives were conducted in April and May 2022. Participants reviewed, prioritized, and discussed the principles and described successful engagement, resulting in 8 guiding principles in priority order. A summary report was circulated to participants for feedback. The principles were reviewed and endorsed by senior leaders in the medical school. RESULTS The 8 focus groups were attended by 38 people (age range, mid-20s to postretirement; 7 male, 27 female, and 4 unknown gender). Accountability (19%), inclusion (18%), reciprocity (17%), and partnership and shared decision-making (14%) were chosen as the most important principles. Participants want evidence that their contributions are valued and have made a difference. They want the medical school to include and support a diversity of perspectives that reflect the populations being served by the health care system. They want the medical school to invest in building trusting and respectful long-term relationships with patients and the public. CONCLUSIONS The guiding principles could be used by medical schools as a starting point to build relationships with their local communities to increase the authentic and sustainable engagement of patients and the public in the educational mission of the medical school.
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Gülpınar MA, Tanrıöver Ö. Integration of behavioral, social, and humanities sciences into healthcare and education and their alignment with medical education programs. MEDICAL TEACHER 2024:1-11. [PMID: 39087366 DOI: 10.1080/0142159x.2024.2377384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/03/2024] [Indexed: 08/02/2024]
Abstract
There has been an increasing acknowledgment of the intricacies inherent in health and healthcare processes, leading to a shift in medical education. This change underscores multidimensional, thorough, reflective, and contextual approaches characterized by mutual interaction and change. The perception of health/well-being and illness is transitioning toward acknowledging them as outcomes arising from the complex interplay of individual, social, and environmental/ecosystemic factors. This includes biological, genetic, behavioral, sociocultural, and environmental influences. In line with this changing perspective, the purpose of this article is to provide a general framework for the integration of behavioral, social, and human sciences into Medical Education Programs in Healthcare and Training Processes. The framework presented is based on the following three conceptual and theoretical basis: (1) Complex systems thinking and reflective, contextual healthcare and education practices, (2) Health systems and socio-economic-political framework, (3) Ecosystem framework in health and disease. Our aim in this article is to provide a guide for the integration of Behavioral, Social, and Humanity Sciences into medical education programs and to present examples from around the world.
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Affiliation(s)
- Mehmet Ali Gülpınar
- Department of Medical Education, Marmara University School of Medicine, Istanbul, Turkey
| | - Özlem Tanrıöver
- Department of Medical Education, Marmara University School of Medicine, Istanbul, Turkey
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Pfarrwaller E, Maisonneuve H, Laurent C, Abbiati M, Sommer J, Baroffio A, Haller DM. Dynamics of Students' Career Choice: a Conceptual Framework-Based Qualitative Analysis Focusing on Primary Care. J Gen Intern Med 2024; 39:1544-1555. [PMID: 38102409 PMCID: PMC11254893 DOI: 10.1007/s11606-023-08567-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Increasing primary care's attractiveness as a career choice is an important task of socially accountable medical schools. Research has broadly studied influences on medical students' career choice. However, a deeper understanding of the processes behind career decision-making could support medical schools in their efforts to promote primary care careers. OBJECTIVE To explore the dynamics of career choice during medical school with a focus on primary care, based on a previously developed conceptual framework. APPROACH Qualitative study using a phenomenological, inductive-deductive approach DESIGN AND PARTICIPANTS: Individual interviews were conducted from May 2019 to January 2020 with 14 first-year postgraduate trainee physicians, graduates of the Faculty of Medicine in Geneva, Switzerland, purposively sampled based on their interest in primary care during undergraduate studies. The interview guide was developed to elicit narratives about career-related decision-making. Two authors coded the transcripts. Thematic analysis alternated with data collection until thematic saturation was reached. Emerging themes were discussed and refined within the research team. KEY RESULTS Two main themes emerged: (1) developing professional identity, expressed as a changing professional image from unprecise and idealistic to concrete and realistic; priorities changed from content-based to lifestyle-based preferences; (2) individual trajectories of career-related decision-making, determined by different stages of refining professional interests; students navigated this process by employing various strategies, ranging from active exploration to passive behaviors. CONCLUSIONS This study's narrative approach illustrates the dynamic nature of career choice and refines elements of a conceptual framework previously developed by the authors. Its findings underline the importance of exploration, for which personal experiences and observations of physicians' work are crucial. To advance efforts to make primary care a more attractive career, students must be sufficiently exposed to primary care in a safe and individualized environment and should be supported in all stages of their career choice process.
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Affiliation(s)
- Eva Pfarrwaller
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Hubert Maisonneuve
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University College of General Medicine, Faculty of Medicine, University Claude Bernard Lyon 1, Lyon, France
| | - Camille Laurent
- University College of General Medicine, Faculty of Medicine, University Claude Bernard Lyon 1, Lyon, France
| | - Milena Abbiati
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Johanna Sommer
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anne Baroffio
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dagmar M Haller
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Weiss K, Di Gangi S, Inauen M, Senn O, Markun S. Changes in the attractiveness of medical careers and career determinants during the bachelor's program at Zurich medical schools. BMC MEDICAL EDUCATION 2024; 24:693. [PMID: 38926866 PMCID: PMC11210091 DOI: 10.1186/s12909-024-05693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Monitoring the career intentions of medical students during their undergraduate studies could help to address the shortage of physicians, particularly in general practice. This study aimed to investigate changes in medical students' career openness, attractiveness and determinants of medical career choice during their bachelor's studies. METHODS The design was cross-sectional, recruiting all medical students who started a bachelor's program in one of the four different educational tracks in Zurich, Switzerland, in the fall of 2019 (first survey) and completed it in the summer of 2022 (second survey). Students' perceptions of the attractiveness and determinants of different medical career options were assessed using a structured online questionnaire. Absolute changes between the two-time points were reported in percentage points overall and by educational track. Regression analysis was used to examine the association of student characteristics and determinants of career options with the attractiveness of each option. RESULTS We surveyed 354 medical students at the beginning and 433 at the end of the bachelor's program (participation rate: 71.1% and 86.9%, respectively). Overall, the proportion of students open to all proposed medical career options decreased (from 52.8% to 43.8%, p = 0.004). The attractiveness of outpatient gynecology or pediatrics increased (from 27.4% to 43.4%, p < 0.001), whereas the attractiveness of both general and specialized inpatient care decreased (from 47.8% to 40.3%, p = 0.05 and from 71.1% to 61.1%, p = 0.006 respectively). There was an increase in the proportion of students who perceived part-time work, autonomy and relationships with patients as important career determinants (from 47.3% to 64.7%, p < 0.001; from 63.3% to 77.8%, p < 0.001; from 80.8% to 89.3%, p = 0.002 respectively), while the importance of reputation and career opportunities decreased (from 42.6% to 26.2%, p < 0.001; from 79.2% to 63.6%, p < 0.001 respectively). The importance of part-time work and relationships with patients were positively associated with the attractiveness of general practice. CONCLUSIONS During the bachelor's program, the attractiveness of a career in general practice tended to decrease, but the importance of part-time work, autonomy and relationships with patients as career determinants increased. Helping students understand how these determinants relate to general practice may increase their interest in the profession. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Katja Weiss
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, Zurich, 8091, Switzerland
| | - Stefania Di Gangi
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, Zurich, 8091, Switzerland.
| | - Markus Inauen
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, Zurich, 8091, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, Zurich, 8091, Switzerland
| | - Stefan Markun
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, Zurich, 8091, Switzerland
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Choi EK, Yeo S. Medical students' professionalism attributes, knowledge, practices, and attitudes toward COVID-19 and attitudes toward care provision during pandemic amidst the COVID-19 outbreak according to their demographics and mental health. KOREAN JOURNAL OF MEDICAL EDUCATION 2024; 36:157-174. [PMID: 38835309 DOI: 10.3946/kjme.2024.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/29/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE This study examines various aspects related to medical professionalism in medical students during coronavirus disease 2019 (COVID-19) pandemic, focusing on their medical professionalism attributes, KPA (knowledge, practices, and attitudes) toward COVID-19 and attitudes toward provision of care in pandemic. We assessed whether these aspects related to medical professionalism were varied by their demographics and mental health level. METHODS Six questionnaires related to medical professionalism were distributed online to medical students in six grades at a single medical school. A one-way analysis of variance was used to examine differences in scores related to medical professionalism based on their demographics, for examples, gender, grade, residence, religion, as well as their mental health levels. Pearson correlation analysis was used to examine correlations between each variable. RESULTS Female students scored higher on medical professionalism attributes and attitudes toward duty-to-care than male students. Medical professionalism attribute scores were higher with higher relationship satisfaction and resilience levels but lower with higher anxiety levels. Furthermore, these scores were significantly associated with attitudes toward COVID-19 preparedness. However, COVID-19 knowledge and practice scores were negatively associated with attitudes toward COVID-19 preparedness and careers after graduation. Meanwhile, students who took the leave of absence related to 2020 doctors' strike had significantly lower scores on attitudes toward COVID-19 preparedness and duty to care than those who did not. CONCLUSION Our findings suggest that mental health of medical students is strongly related to their various aspects related to medical professionalism, especially their attitudes toward COVID-19 preparedness. Good mental health was positively linked to medical professionalism attributes and attitudes toward COVID-19 preparedness. However, knowledge and practice of COVID-19 were negatively associated with willingness to participate in the pandemic response. Additionally, the experience of the 2020 leave of absence impacted the attitudes of medical students toward COVID-19 preparedness (p=0.015) and their duty to care (p=0.012) negatively.
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Affiliation(s)
- Eun Kyung Choi
- Department of Medical Humanities and Medical Education, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sanghee Yeo
- Department of Medical Humanities and Medical Education, School of Medicine, Kyungpook National University, Daegu, Korea
- Kyungpook National University Hospital, Daegu, Korea
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Zondi PC, Patricios JS, Hendricks S. South African sport and exercise medicine: shaping health, fostering responsibility. Br J Sports Med 2024; 58:517-518. [PMID: 38569848 DOI: 10.1136/bjsports-2024-108374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Affiliation(s)
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sharief Hendricks
- Human Biology, University of Cape Town, Division of Exercise and Sports Medicine, Cape Town, South Africa
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Dubé TV, Cumyn A, Fourati M, Chamberland M, Hatcher S, Landry M. Pathways, journeys and experiences: Integrating curricular activities related to social accountability within an undergraduate medical curriculum. MEDICAL EDUCATION 2024; 58:556-565. [PMID: 37885341 DOI: 10.1111/medu.15260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/12/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Health professions education curricula are undergoing reform towards social accountability (SA), defined as an academic institution's obligation to orient its education, service and research to respond to societal needs. However, little is known about how or which educational experiences transform learners and the processes behind such action. For example, those responsible for the development and implementation of undergraduate medical education (UGME) programs can benefit from a deeper understanding of educational approaches that foster the development of competencies related to SA. The purpose of this paper was to learn from the perspectives of the various partners involved in a program's delivery about what curricular aspects related to SA are expressed in a UGME program. METHODS We undertook a qualitative descriptive study at a francophone Canadian university. Through purposive convenience and snowball sampling, we conducted 16 focus groups (virtual) with the following partners: (a) third- and fourth-year medical students, (b) medical teachers, (c) program administrators (e.g., program leadership), (d) community members (e.g., community organisations) and (e) patient partners. We used inductive thematic analysis to interpret the data. RESULTS The participants' perspectives organised around four key themes including (a) the definition of a future socially accountable physician, (b) socially accountable educational activities and experiences, (c) characteristics of a socially accountable MD program and (d) suggestions for curriculum improvement and implementation. CONCLUSIONS We extend scholarship about curricular activities related to SA from the perspectives of those involved in teaching and learning. We highlight the relevance of experiential learning, engagement with community members and patient partners and collaborative approaches to curriculum development. Our study provides a snapshot of what are the sequential pathways in fostering SA among medical students and therefore addresses a gap between knowledge and practice regarding what contributes to the implementation of educational approaches related to SA. We emphasise the need for educational innovation and research to develop and align assessment methods with teaching and learning related to SA.
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Affiliation(s)
- Tim V Dubé
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Annabelle Cumyn
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Mariem Fourati
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Martine Chamberland
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sharon Hatcher
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Michel Landry
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Université de Moncton, Moncton, New Brunswick, Canada
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Abdalla ME, Taha MH, Onchonga D, Magzoub ME, Au H, O'Donnell P, Neville S, Taylor D. Integrating the social determinants of health into curriculum: AMEE Guide No. 162. MEDICAL TEACHER 2024; 46:304-316. [PMID: 37677074 DOI: 10.1080/0142159x.2023.2254920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The World Health Organization (WHO) defines the Social Determinants of Health (SDOH) as the non-medical factors influencing health outcomes. SDOH is associated with conditions in which people are born, grow, work, and live. Medical schools and licensing bodies are increasingly recognizing the need for doctors and healthcare professionals to be aware of their patient's social context and how it impacts their states of health and disease. However, there is considerable variation in the approaches of different institutions and countries to incorporating SDOH into their curricula. In order to allow clinicians to adopt a holistic approach to patient health, equipping them with extensive knowledge of SDOH would give learners the confidence, skills, knowledge, and attitudes needed to effectively engage with patients and their families. This approach aids health professionals with knowledge of the influence of the social context and cultural factors that affect patients' behaviors in relation to health. Incorporating the SDOH in medical and health professional school curricula would contribute towards adequately preparing future healthcare practitioners to provide effective, comprehensive, and equitable care, especially to marginalized and underserved populations. The Guide will take an evidence-based approach grounded in the available contemporary literature and case studies. The focus will be on integrating SDOH into undergraduate and postgraduate medical curricula to promote an understanding of the social factors that influence patients' and communities' health. Ultimately, this guide seeks to contribute to the reduction of inequalities in health.
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Affiliation(s)
| | - Mohamed Hassan Taha
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, UAE
| | - David Onchonga
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Hosanna Au
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Siobhán Neville
- School of Medicine, University of Limerick, Limerick, Ireland
| | - David Taylor
- Gulf Medical University, Al Jurf, Ajman, United Arab Emirates
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Kang YJ, Lee S, Lee HJ, Kim DH. Analyzing the characteristics of mission statements in Korean medical schools based on the Korean Doctor's Role framework. KOREAN JOURNAL OF MEDICAL EDUCATION 2024; 36:99-104. [PMID: 38462245 PMCID: PMC10925805 DOI: 10.3946/kjme.2024.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE This study assessed the alignment between Korean medical schools' mission statements (MSs) and Korean Doctor's Role (KDR) domains, considering school characteristics. METHODS We analyzed the South Korean medical school's MS characteristics using a mixed-methods approach. Quantitative analysis preprocessed MS text data to identify concept words, while qualitative content analysis categorized information into predefined KDR domains and extracted themes from other parts. RESULTS At the KDR domain level, "social accountability" was the most frequent, followed by "education and research" and "patient care," while "professionalism" had the least frequency. At the competency level, the most frequent domains were "involvement in public and global health initiatives," while "self-regulation based on professional leadership" and "professionalism and self-management" were not present. CONCLUSION The study found that the majority of MSs had a homogeneous pattern and included traditional themes. Medical schools should evaluate and incorporate missing elements in their MSs to reflect the institution's own purpose and current societal needs.
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Affiliation(s)
- Ye Ji Kang
- Department of Medical Education, Hanyang University College of Medicine, Seoul, Korea
| | - Soomin Lee
- Hanyang University College of Medicine, Seoul, Korea
| | - Hyo Jeong Lee
- Department of Medical Education, Hanyang University College of Medicine, Seoul, Korea
| | - Do-Hwan Kim
- Department of Medical Education, Hanyang University College of Medicine, Seoul, Korea
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Reilly JB, Kim JG, Cooney R, DeWaters AL, Holmboe ES, Mazotti L, Gonzalo JD. Breaking Down Silos Between Medical Education and Health Systems: Creating an Integrated Multilevel Data Model to Advance the Systems-Based Practice Competency. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:146-152. [PMID: 37289829 DOI: 10.1097/acm.0000000000005294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
ABSTRACT The complexity of improving health in the United States and the rising call for outcomes-based physician training present unique challenges and opportunities for both graduate medical education (GME) and health systems. GME programs have been particularly challenged to implement systems-based practice (SBP) as a core physician competency and educational outcome. Disparate definitions and educational approaches to SBP, as well as limited understanding of the complex interactions between GME trainees, programs, and their health system settings, contribute to current suboptimal educational outcomes elated to SBP. To advance SBP competence at individual, program, and institutional levels, the authors present the rationale for an integrated multilevel systems approach to assess and evaluate SBP, propose a conceptual multilevel data model that integrates health system and educational SBP performance, and explore the opportunities and challenges of using multilevel data to promote an empirically driven approach to residency education. The development, study, and adoption of multilevel analytic approaches to GME are imperative to the successful operationalization of SBP and thereby imperative to GME's social accountability in meeting societal needs for improved health. The authors call for the continued collaboration of national leaders toward producing integrated and multilevel datasets that link health systems and their GME-sponsoring institutions to evolve SBP.
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Dubé TV. An imperative for transforming health professions education. MEDICAL EDUCATION 2024; 58:8-10. [PMID: 37963573 DOI: 10.1111/medu.15274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/16/2023]
Abstract
Transformations in health professions education are presented as a lever to achieve meaningful societal change and generate reforms that are more authentically aligned with evolving health needs.
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Affiliation(s)
- Tim V Dubé
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Amin Radwan RS, Ahmed GS. Perception of social accountability among medical students in Egypt. Int J Adolesc Med Health 2023; 35:467-473. [PMID: 38081588 DOI: 10.1515/ijamh-2023-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Assessment of the perceived SA for medical students in Beni-Suef University, Egypt. METHODS An analytical cross-sectional study was conducted over a period of 6 months among medical students at faculty of medicine, Beni-Suef University through an online survey using google form. For data collection, an English validated questionnaire developed in partnership by the International Federation of Medical Students Association (IFMSA) and the Training for Health Equity Network (THEnet) was used. RESULTS Students' mean SA score was 17.3±7.1. Perceived SA scores ranged from 18 to 26 for 40.9% of participants, while 38.9% of them had scores ranging from (9-17), indicating that the faculty is doing well, However, there is a need to identify areas of weakness and advocate for strategies to improve SA among students. Furthermore, there were statistically significant differences in age, gender, residence, and academic year across students with different scores. CONCLUSION Although half of the medical students of Beni-Suef university had acceptable SA, but there are areas for improvement and weakness to fix within the faculty.
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Affiliation(s)
| | - Gehad Sabry Ahmed
- Department of Public Health and Community Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Barber C, Chahine S, Leppink J, van der Vleuten C. Global Perceptions on Social Accountability and Outcomes: A Survey of Medical Schools. TEACHING AND LEARNING IN MEDICINE 2023; 35:527-536. [PMID: 35903923 DOI: 10.1080/10401334.2022.2103815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
Phenomenon: Social accountability has become a universal component in medical education. However, medical schools have little guidance for operationalizing and applying this concept in practice. This study explored institutional practices and administrative perceptions of social accountability in medical education. Approach: An online survey was distributed to a purposeful sample of English-speaking undergraduate medical school deans and program directors/leads from 245 institutions in 14 countries. The survey comprised of 38-items related to program mission statements, admission processes, curricular content, and educational outcomes. Survey items were developed using previous literature and categorized using a context-input-process-products (CIPP) evaluation model. Exploratory Factor Analysis (EFA) was used to assess the inter-relationship among survey items. Reliability and internal consistency of items were evaluated using McDonald's Omega. Findings: Results from 81 medical schools in 14 countries collected between February and June 2020 are presented. Institutional commonalities of social accountability were observed. However, our findings suggest programs focus predominately on educational inputs and processes, and not necessarily on outcomes. Findings from our EFA demonstrated excellent internal consistency and reliability. Four-factors were extracted: (1) selection and recruitment; (2) institutional mandates; (3) institutional activities; and (4) community awareness, accounting for 71% of the variance. McDonald's Omega reliability estimates for subscales ranged from 0.80-0.87. Insights: This study identified common practices of social accountability. While many medical schools expressed an institutional commitment to social accountability, their effects on the community remain unknown and not evaluated. Overall, this paper offers programs and educators a psychometrically supported tool to aid in the operationalization and reliability of evaluating social accountability.
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Affiliation(s)
- Cassandra Barber
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences. Maastricht University, Maastricht, The Netherlands
| | - Saad Chahine
- Associate professor, Faculty of Education, Queen's University, Kingston, Ontario, Canada
| | - Jimmie Leppink
- Research director, Hospital virtual Valdecilla (HvV), Santander, Cantabria, Spain
| | - Cees van der Vleuten
- Professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Burm S, Deagle S, Watling CJ, Wylie L, Alcock D. Navigating the burden of proof and responsibility: A narrative inquiry into Indigenous medical learners' experiences. MEDICAL EDUCATION 2023; 57:556-565. [PMID: 36495548 DOI: 10.1111/medu.15000] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Many medical schools have well-established admission pathways and programming to support Indigenous medical workforce development. Ideally, these efforts should contribute to attracting highly qualified Indigenous applicants which, in turn, may improve accessible, quality care for Indigenous people. However, it is difficult to evolve and tailor these approaches without a situated understanding of Indigenous learners' experiences. In this paper, we focus on the Canadian context, sharing Indigenous learners' stories about their journey towards and throughout medical training. METHODS The conceptual underpinnings of narrative inquiry and key principles from Indigenous methodologies were drawn upon throughout both data collection and analysis. Participants were Indigenous learners (medical students and residents) and a recently graduated physician (n = 5) from one Canadian medical school. Both spoken (formal recorded interviews) and visual (photographs) texts were used to make meaning of participants' experiences. RESULTS Participants' experiences during medical training showed a striking resemblance at three points in their transition to, and progression through, medical education: preparing for and applying to medical school, completing undergraduate medical training and determining specialty choice. Participants' stories revealed a tug-of-war between their identities as an Indigenous person and as a medical trainee, with these tensions sometimes compromising their perceived sense of belonging within both Indigenous and academic circles, creating, at times, a heavy burden to shoulder. CONCLUSION Meaningful representation of Indigenous people in the medical workforce is about more than training additional health care providers; it requires understanding Indigenous learners and recently graduated physicians' experiences as they enter and navigate the medical profession. By amplifying their voices, we stand to gain a more holistic representation of the factors that contribute to and potentially impede the recruitment and retention of Indigenous people into the medical profession.
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Affiliation(s)
- Sarah Burm
- Continuing Professional Development and Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Christopher J Watling
- Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lloy Wylie
- Departments of Pathology, Psychiatry, Anthropology and Health Sciences, Schulich Interfaculty Program in Public Health, Western Centre for Public Health and Family Medicine, Western University, London, Ontario, Canada
| | - Danielle Alcock
- Southwest Ontario Aboriginal Health Access Centre, London, Ontario, Canada
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Agarwal A, Rao AM, Alhazimi AM, Ismail MM, Fahmy EK. Integrating High-Impact Practices (HIPs) In Medical Curriculum At Northern Border University: Strengths, Challenges, and Examples. Cureus 2023; 15:e39938. [PMID: 37409202 PMCID: PMC10319360 DOI: 10.7759/cureus.39938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND High-Impact Practices (HIPs) are educational practices that have been shown to increase rates of student retention, engagement, and persistence to graduation which help them to become high achievers and lifelong learners. Universities strongly encourage faculty members to incorporate one or more of these HIPs in order to improve active learning among students. Students are met with a variety of experiences that are not entirely of their choice, including expectations for academic performance, interactions with faculty, staff, and peers, and extracurricular activities that may or may not match their expectations and skills. Higher retention and high-grade achievement rates are attributed to HIPs. The mechanism by which HIPs improve retention is poorly understood. AIMS AND OBJECTIVES There are numerous analyses of the objectives particular to undergraduate medical education in recent years. There have been proposed three major target categories. Undergraduate medical education has been positioned within a liberal education framework, where the main objective is to equip students with the critical thinking abilities, broad general education, and subject-specific knowledge they will need to be able to effectively problem-solve, adapt to new roles, and apply public health thinking and practices to a variety of situations. We tried to incorporate HIPs in a medical curriculum at the Faculty of Medicine, Northern Border University, by giving them topics that can be used to create public awareness about the selected objectives which may help the community greatly. METHODOLOGY Students were asked to make posters or videos on the topics and were asked to write reflections about their experience and give feedback to the coordinators for improvements and to make these HIPs better so that they can be included uniformly in the other courses as well. RESULTS AND CONCLUSIONS Based on results from a random sample of undergraduate students, we draw the conclusion that HIPs are correlated with engagement, which is the alignment of the student's critical thinking and ability to work in effective teams, group projects, learning communities, and sequence courses. HIPs have an impact on involvement among students across the world. HIPs are effective to the extent that they engage pupils, encouraging a greater commitment, which is one way to understand their success.
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Affiliation(s)
- Anshoo Agarwal
- Pathology, College of Medicine, Northern Border University, Arar, SAU
| | - Anil M Rao
- Pathology, Faculty of Medicine, Northern Border University, Arar, SAU
| | - Awdah M Alhazimi
- Physiology, Faculty of Medicine, Northern Border University, Arar, SAU
| | | | - Eslam K Fahmy
- Medical Education and Physiology, Faculty of Medicine Northern Border University, Arar, SAU
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Green S, Labine N, Luo OD, Vipond J, Moloo H, Bouka A, Thoma B. Planetary Health in CanMEDS 2025. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:46-49. [PMID: 36998490 PMCID: PMC10042797 DOI: 10.36834/cmej.75438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | | | | | | | | | - Aimee Bouka
- University of Toronto, Ontario, Canada
- University of Saskatchewan, Saskatchewan, Canada
- McGill University, Quebec, Canada
- University of Calgary, Alberta, Canada
- University of Ottawa, Ontario, Canada
| | - Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
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19
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Coşkun Ö, Timurçin U, Kıyak YS, Budakoğlu Iİ. Validation of IFMSA social accountability assessment tool: exploratory and confirmatory factor analysis. BMC MEDICAL EDUCATION 2023; 23:138. [PMID: 36859255 PMCID: PMC9977477 DOI: 10.1186/s12909-023-04121-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND IFMSA Social Accountability Assessment Tool has been developed for medical students by medical students to assess medical schools. However, its psychometric characteristics are unknown since it was developed without any analysis. We aimed to reveal its reliability and validity. METHODS 1122 undergraduate medical students from various years in Gazi University Faculty of Medicine have participated in the study. They have answered the Turkish version of IFMSA Social Accountability Assessment Tool created through a translation process by experts. Exploratory and confirmatory factor analyses were carried out. RESULTS Exploratory factor analysis showed that factor loadings were between 0.46 and 0.73 for Factor 1, 0.68 and 0.87 for Factor 2. The two-factor model, which consists of "Community Centeredness" and "Socio-Demographic Characteristics", was evaluated through confirmatory factor analysis. The goodness-of-fit statistics of the model showed well-fit: CMIN/df 4.46, GFI 0.96, CFI 0.95, RMSEA 0.05, SRMR 0.03. Standardized regression weights were between 0.43 and 0.77. CONCLUSION The tool has acceptable psychometric characteristics, with good reliability and validity. It could be considered as a point of departure for the change in the way of being socially accountable since it enables medical students to explore the weak areas of their medical schools in terms of social accountability.
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Affiliation(s)
- Özlem Coşkun
- Medical Education and Informatics, Gazi University Faculty of Medicine, Ankara, Turkey.
- Faculty of Medicine, Department of Medical Education and Informatics, Gazi University, Gazi Üniversitesi Hastanesi E Blok 9. Kat, Beşevler, Ankara, 06500, Turkey.
| | | | - Yavuz Selim Kıyak
- Medical Education and Informatics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Işıl İrem Budakoğlu
- Medical Education and Informatics, Gazi University Faculty of Medicine, Ankara, Turkey
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20
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Pfarrwaller E, Voirol L, Karemera M, Guerrier S, Baroffio A. Dynamics of career intentions in a medical student cohort: a four-year longitudinal study. BMC MEDICAL EDUCATION 2023; 23:131. [PMID: 36849901 PMCID: PMC9972700 DOI: 10.1186/s12909-023-04102-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Medical students' career intentions often change between matriculation and graduation, yet little is known about the precise timing and dynamics of individual students' career decisions. This study expands on previous research by exploring the stability of individual students' career intentions over four years and by analyzing associations between unstable career intentions and students' characteristics. METHODS Medical students from two classes were recruited into a cohort during their first academic year and completed a yearly survey over a four-year period (end of pre-clinical curriculum to graduation). Measures included career intention (specialty and practice type), personality, coping strategies, empathy, and motives for becoming a physician. The authors developed a score ranging from 0 to 10 quantifying instability of career intentions (0 = stable; 10 = unstable). The distribution of the score was analyzed descriptively, and the association between the score and other variables was quantified using a stepwise beta regression model. RESULTS The sample included 262 students (61% females). The mean score was 3.07 with a median of 3. 18% of students (N = 46) did not change their specialty intention over the four years, whereas 10% (N = 26) changed every year. No further subgroups were identified between these extremes. An intention to work in private practice in year 3 and the motive care for patients were significantly associated with more stable career intentions. CONCLUSION Most students are situated on a continuum between the two extremes of being firmly committed and undecided. Extrinsic factors may be more important drivers of these fluctuations than personal characteristics and should be explored in future research. This study's findings also provide avenues for supporting students in their career decision-making.
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Affiliation(s)
- Eva Pfarrwaller
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Genève 4, Geneva, Switzerland.
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Lionel Voirol
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Mucyo Karemera
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Stéphane Guerrier
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
- Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Anne Baroffio
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Irlam JH, Scheerens C, Mash B. Planetary health and environmental sustainability in African health professions education. Afr J Prim Health Care Fam Med 2023; 15:e1-e3. [PMID: 36861923 PMCID: PMC9982498 DOI: 10.4102/phcfm.v15i1.3925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 02/15/2023] Open
Abstract
CliMigHealth and the Education for Sustainable Healthcare (ESH) Special Interest Group of the Southern African Association of Health Educationalists (SAAHE) call for the urgent integration of planetary health (PH) and environmental sustainability into health professions curricula in Africa. Education on PH and sustainable healthcare develops much-needed health worker agency to address the connections between healthcare and PH. Faculties are urged to develop their own 'net zero' plans and to advocate for national and sub-national policies and practices that promote the Sustainable Development Goals (SDGs) and PH. National education bodies and health professional societies are urged to incentivise innovation in ESH and to provide discussion forums and resources to support the integration of PH into curricula.Contribution: This article provides a position statement for integrating planetary health and environmental sustainability into African health professions education curricula.
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Affiliation(s)
- James H. Irlam
- Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Charlotte Scheerens
- Department of Public Health and Primary Care, Faculty of Medicine, University of Ghent, Ghent, Belgium,Department of Economics, Faculty of Medicine, University of Ghent, Ghent, Belgium
| | - Bob Mash
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Wood B, Attema G, Ross B, Cameron E. A conceptual framework to describe and evaluate a socially accountable learning health system: Development and application in a northern, rural, and remote setting. Int J Health Plann Manage 2022; 37 Suppl 1:59-78. [PMID: 35986520 PMCID: PMC10087460 DOI: 10.1002/hpm.3555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/10/2022] [Accepted: 07/22/2022] [Indexed: 12/31/2022] Open
Abstract
Health care and academic institutions are increasingly committing to social accountability, a strategic shift that requires priorities, activities, and evaluations to be co-determined with all relevant partners. Consequently, governments, accreditors, funders, and communities are calling for these institutions to communicate their progress towards social accountability. The purpose of this study was to develop a conceptual framework around a socially accountable learning health system. This article presents an integrated analysis of two studies: (i) a narrative review of 11 prominent social accountability and health services conceptual frameworks and (ii) a reflexive thematic analysis of 18 key informant interviews. Using a systematic conceptual framework development and integrated theory of change/realist evaluation methodologies, we describe a synthesis of these findings to develop a conceptual framework for describing and evaluating socially accountable health professional education. The resulting framework describes assessment phases of social accountability, transitions between phases, learning cycles, and the actors and systems that collectively mobilise social accountability at multiple levels in health and education systems. The framework can be used to evaluate interventions or characterise progress towards social accountability in different settings, as illustrated in the example at the end of the paper. The framework emphasises the significance of designing, mobilising, and evaluating social accountability as part of a contextualised learning health system.
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Affiliation(s)
- Brianne Wood
- Northern Ontario School of Medicine (NOSM) University, Thunder Bay, Ontario, Canada.,Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada.,Lakehead University, Thunder Bay, Ontario, Canada
| | - Ghislaine Attema
- Northern Ontario School of Medicine (NOSM) University, Thunder Bay, Ontario, Canada.,Lakehead University, Thunder Bay, Ontario, Canada
| | - Brian Ross
- Northern Ontario School of Medicine (NOSM) University, Thunder Bay, Ontario, Canada
| | - Erin Cameron
- Northern Ontario School of Medicine (NOSM) University, Thunder Bay, Ontario, Canada.,Lakehead University, Thunder Bay, Ontario, Canada
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Lee ST, Yang EB. Factors affecting social accountability of medical schools in the Korean context: exploratory factor and multiple regression analyses. MEDICAL EDUCATION ONLINE 2022; 27:2054049. [PMID: 35313788 PMCID: PMC8942500 DOI: 10.1080/10872981.2022.2054049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/13/2022] [Accepted: 03/13/2022] [Indexed: 06/14/2023]
Abstract
The concept of social accountability of medical schools is becoming increasingly important worldwide, and numerous frameworks and evaluation tools have been developed. This study examined how global concepts work in a specific context by identifying the factors affecting medical schools' social accountability performance in the Korean context. A survey was conducted with 40 current deans of medical schools and 15 medical education experts in Korea to assess their opinions on the implementation of social accountability of medical schools. A questionnaire survey comprising five key factors, including 39 items, was developed based on a literature review. Exploratory factors were analyzed to derive factors affecting social accountability Multiple regression analysis was conducted to determine the importance of each factor in the implementation of social accountability of medical schools. The exploratory factor analysis revealed that eight factors in three areas influenced the implementation of social accountability by medical schools. The hardware (H) area included the declaration of social accountability and physicians, organizations and systems for implementing social accountability, and physical environment and finance. The software (S) area included curriculum design-related social accountability and monitoring and evaluation system. The partner (P) area included the proximity between partners, building partnerships among stakeholders, and interactions between partners. Multiple regression analysis revealed that 'interactions between partners' had the greatest impact on the implementation of social accountability of medical schools. It is a social accountability implementation model that reflects global principles within the Korean context. The HSP model is significant in that individual medical schools can be used in establishing mandated mechanisms for accreditation. Future studies could adapt this model to study standards and indicators in other contexts.
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Affiliation(s)
- Sangmi T. Lee
- Department of Medical Education, Yonsei University Wonju College of Medicine, Gangwon-do, South Korea
| | - Eunbae B. Yang
- Department of Medical Education, Yonsei University College of Medicine, Seoul, South Korea
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Schneider AR, Sharma T, Bhattacharya A, Brown A. Exploring the relationship between social accountability and competency-based medical education: A narrative review. MEDICAL TEACHER 2022; 44:1283-1289. [PMID: 35793268 DOI: 10.1080/0142159x.2022.2093702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Social accountability (SA), a quintessential goal of medical education, has been discussed as a precipitant for the transition toward competency-based medical education (CBME). However, the relationship between SA and CBME remains unclear. A narrative review was conducted to systematically explore the relationship between SA and CBME as described in the literature. METHODS Electronic databases, select journals, and medical education organizations were systematically searched. 363 titles and abstracts were screened and 147 full texts were reviewed. The salient text was extracted from 36 records, which were then inductively coded before narrative synthesis and interpretation. RESULTS The relationship between SA and CBME was described in three manners: (1) CBME as a natural driver of SA where CBME was perceived to be inherently socially accountable, (2) CBME as an opportunistic mechanism for actively changing medical training to better meet standards of SA, and (3) CBME as a tool to measure SA relating to measurable outcomes data provided by CBME. CONCLUSION CBME has theoretical potential to assist programs in becoming more socially accountable if the communities they serve are considered key stakeholders in the design, implementation, and evaluation. A paucity of evidence remains which provides empirical evidence of SA within programs that have implemented CBME.
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Affiliation(s)
| | - Tejeswin Sharma
- Cumming School of Medicine-Undergraduate Medical Education, University of Calgary, Calgary, Canada
| | - Anindita Bhattacharya
- Cumming School of Medicine-Undergraduate Medical Education, University of Calgary, Calgary, Canada
| | - Allison Brown
- Department of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Wood B, Bohonis H, Ross B, Cameron E. Comparing and using prominent social accountability frameworks in medical education: moving from theory to implementation in Northern Ontario, Canada. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:45-68. [PMID: 36310909 PMCID: PMC9588193 DOI: 10.36834/cmej.73051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Social accountability in medical education is conceptualized as a responsibility to respond to the needs of local populations and demonstrate impact of these activities. The objective of this study was to rigorously examine and compare social accountability theories, models, and frameworks to identify a theory-informed structure to understand and evaluate the impacts of medical education in Northern Ontario. METHODS Using a narrative review methodology, prominent social accountability theories, models, and frameworks were identified. The research team extracted important constructs and relationships from the selected frameworks. The Theory Comparison and Selection Tool was used to compare the frameworks for fit and relevance. RESULTS Eleven theories, models, and frameworks were identified for in-depth analysis and comparison. Two realist frameworks that considered community relationships in medical education and social accountability in health services received the highest scores. Frameworks focused on learning health systems, evaluating institutional social accountability, and implementing evidence-based practices also scored highly. CONCLUSION We used a systematic theory selection process to describe and compare social accountability constructs and frameworks to inform the development of a social accountability impact framework for the Northern Ontario School of Medicine. The research team examined important constructs, relationships, and outcomes, to select a framework that fits the aims of a specific project. Additional engagement will help determine how to combine, adapt, and implement framework components to use in a Northern Ontario framework.
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Affiliation(s)
- Brianne Wood
- Medical Education Research Lab in the North (MERLIN), Northern Ontario School of Medicine, Ontario, Canada
| | - Hafsa Bohonis
- Medical Education Research Lab in the North (MERLIN), Northern Ontario School of Medicine, Ontario, Canada
| | - Brian Ross
- Northern Ontario School of Medicine, Ontario, Canada
| | - Erin Cameron
- Medical Education Research Lab in the North (MERLIN), Northern Ontario School of Medicine, Ontario, Canada
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Falusi OO, Weisz J, Clarence I, Lichtenstein C, Coddington D, Avent G, Beers L, Ottolini M. Leveraging E-Learning and Community Assets to "TEACH" Residents to Address Child Poverty. Acad Pediatr 2022; 22:850-857. [PMID: 35182791 DOI: 10.1016/j.acap.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a multimodal child poverty curriculum for pediatric residents. METHODS The Trainee Education in Advocacy and Community Health (TEACH) curriculum trains residents to recognize and address the effects of child poverty, utilizing learning objectives modified from the US Child Poverty Curriculum, new interactive web-based modules, experiential learning, and reflection. This mixed-methods evaluation of the first component, "Epidemiology of Child Poverty," includes nearly 2 years of resident participation. Pre/post knowledge and attitudes regarding child poverty were assessed. Behavior change was evaluated in a subset of participants using an Objective Structured Clinical Examination (OSCE), comparing intervention and control groups of residents. Residents' experience with the curriculum was assessed using qualitative analysis of debrief sessions with faculty. RESULTS Fifty-two residents completed the curriculum between June 2018 and March 2020. Residents increased in knowledge (P < .001) and confidence (P < .0001) in recognizing and addressing poverty. They also self-reported greater preparedness (P < .001) and effectiveness (P < .001) in addressing social determinants of health. Early data from the OSCE have not shown a statistically significant change in skills compared with a control group. Qualitative themes included an increase in empathy for, understanding of, and responsibility to address the effects of poverty in caring for patients. CONCLUSIONS The multimodal "Epidemiology of Child Poverty" portion of the TEACH curriculum increased resident knowledge, confidence, and empathy. Given the ubiquitous nature of poverty and the generalizability of the online modules, the TEACH curriculum can be a resource for other residency programs.
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Affiliation(s)
- Olanrewaju O Falusi
- Division of General and Community Pediatrics (OO Falusi, J Weisz, D Coddington), Children's National Hospital, Washington, DC; Pediatric Residency Program (OO Falusi), Children's National Hospital, Washington, DC; Child Health Advocacy Institute (OO Falusi, I Clarence, L Beers), Children's National Hospital, Silver Spring, Md.
| | - Jessica Weisz
- Division of General and Community Pediatrics (OO Falusi, J Weisz, D Coddington), Children's National Hospital, Washington, DC
| | - Iana Clarence
- Child Health Advocacy Institute (OO Falusi, I Clarence, L Beers), Children's National Hospital, Silver Spring, Md
| | - Cara Lichtenstein
- Division of Graduate Medical Education (C Lichtenstein), Children's National Hospital, Washington, DC
| | - Dale Coddington
- Division of General and Community Pediatrics (OO Falusi, J Weisz, D Coddington), Children's National Hospital, Washington, DC
| | - Gail Avent
- Total Family Care Coalition (G Avent), Washington, DC
| | - Lee Beers
- Child Health Advocacy Institute (OO Falusi, I Clarence, L Beers), Children's National Hospital, Silver Spring, Md
| | - Mary Ottolini
- Department of Pediatrics (M Ottolini), The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
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Boone H, Snow NJ, Allison J, Sturge Sparkes C, Dawe R. Community engagement by faculties of medicine: A scoping review of current practices and practical recommendations. MEDICAL TEACHER 2022; 44:772-780. [PMID: 35166621 DOI: 10.1080/0142159x.2022.2035339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Social accountability (SA) is the responsibility of faculties of medicine (FoMs) to address the health priorities of the communities they serve. Community engagement (CE) is a vital, but often ambiguous, component of SA. Practical guidance on how to engage community partners (CPs) is key for meaningful CE. We conducted a systematic scoping review of CE involving FoMs to map out how FoMs engage their communities, to provide practical recommendations for FoMs to take part in CE, and to highlight gaps in the literature. MATERIALS AND METHODS We searched electronic databases for articles describing projects or programs involving FoMs and CPs. Descriptive information was analyzed thematically. RESULTS Thirty-eight of 1406 articles were included, revealing three themes: (1) Partners (Who to Engage)-deciding who to engage establishes the basis for responsibility and creates space for communities to engage FoMs; (2) Partnerships (How to Engage)-fostering creative and authentic collaboration, enabling meaningful community contributions; and (3) Projects and Programs (With What to Engage)-identifying opportunities for communities to have a voice in many spaces within FoMs. Under these themes emerged 32 practical recommendations. CONCLUSION Practical guidance facilitates meaningful commitments to communities. The literature is rich with examples of community-FoM partnerships. We provide recommendations for CE that are clear, evidence-based, and responsive.
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Affiliation(s)
- Hannah Boone
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Nicholas Jacob Snow
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Jill Allison
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | | | - Russell Dawe
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
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McLean M, Gibbs T. Addressing Code Red for humans and the planet: We are in this together. MEDICAL TEACHER 2022; 44:462-465. [PMID: 35259057 DOI: 10.1080/0142159x.2022.2040733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Climate change is one of the greatest threats to human health. It is not surprising that following one of the hottest years on record (2019) and wildfires on almost all continents that the 2021 Intergovernmental Panel on Climate Change and the 2021 Lancet Countdown on Climate Change identified a Code Red for humanity and for a healthy future. In addition, just prior to the November 2021 Conference of the Parties (COP26), the World Health Organization released its Special Report, The Health Argument for Climate Action, in which the global health community provided 10 recommendations for policymakers and governments for greener, cleaner and more sustainable action to ensure a healthy and just future. There is thus an urgent need for socially and environmentally accountable health professions education to pick up the pace in terms of climate change, planetary health and/or sustainable health care integration in curricula. Considerable work has already been undertaken by faculty and students. As we are in this together, students and faculty can collaborate and build upon the work already undertaken to ensure universities are social and environmentally accountable.
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Affiliation(s)
- Michelle McLean
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Trevor Gibbs
- Association for Medical Education in Europe (AMEE), Dundee, Scotland
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Pfarrwaller E, Voirol L, Piumatti G, Karemera M, Sommer J, Gerbase MW, Guerrier S, Baroffio A. Students' intentions to practice primary care are associated with their motives to become doctors: a longitudinal study. BMC MEDICAL EDUCATION 2022; 22:30. [PMID: 35016672 PMCID: PMC8750802 DOI: 10.1186/s12909-021-03091-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical schools can contribute to the insufficient primary care physician workforce by influencing students' career preferences. Primary care career choice evolves between matriculation and graduation and is influenced by several individual and contextual factors. This study explored the longitudinal dynamics of primary care career intentions and the association of students' motives for becoming doctors with these intentions in a cohort of undergraduate medical students followed over a four-year period. METHODS The sample consisted of medical students from two classes recruited into a cohort study during their first academic year, and who completed a yearly survey over a four-year period from their third (end of pre-clinical curriculum) to their sixth (before graduation) academic year. Main outcome measures were students' motives for becoming doctors (ten motives rated on a 6-point scale) and career intentions (categorized into primary care, non-primary care, and undecided). Population-level flows of career intentions were investigated descriptively. Changes in the rating of motives over time were analyzed using Wilcoxon tests. Two generalized linear mixed models were used to estimate which motives were associated with primary care career intentions. RESULTS The sample included 217 students (60% females). Career intentions mainly evolved during clinical training, with smaller changes at the end of pre-clinical training. The proportion of students intending to practice primary care increased over time from 12.8% (year 3) to 24% (year 6). Caring for patients was the most highly rated motive for becoming a doctor. The importance of the motives cure diseases, saving lives, and vocation decreased over time. Primary care career intentions were positively associated with the motives altruism and private practice, and negatively associated with the motives prestige, academic interest and cure diseases. CONCLUSION Our study indicates that career intentions are not fixed and change mainly during clinical training, supporting the influence of clinical experiences on career-related choices. The impact of students' motives on primary care career choice suggests strategies to increase the attractivity of this career, such as reinforcing students' altruistic values and increasing the academic recognition of primary care.
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Affiliation(s)
- Eva Pfarrwaller
- University Institute for Primary Care (IuMFE), Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Genève 4, Switzerland.
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Lionel Voirol
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Giovanni Piumatti
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Public Health, Faculty of BioMedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Mucyo Karemera
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Johanna Sommer
- University Institute for Primary Care (IuMFE), Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Genève 4, Switzerland
| | - Margaret W Gerbase
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Guerrier
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
- Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Anne Baroffio
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Abdalla ME, Dash NR, Shorbagi S, Taha MH. Development and validation of inventory tool to evaluate social accountability principles in case scenarios used in problem-based curriculum (Social accountability inventory for PBL). MEDICAL EDUCATION ONLINE 2021; 26:1847243. [PMID: 33200975 PMCID: PMC7737675 DOI: 10.1080/10872981.2020.1847243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
Social accountability (SA) is an obligation for medical schools in meeting the priority health concerns of the communities they serve. To measure the integration of SA principles into medical curricula, suitable tools are needed. This study developed and validated an inventory to assess SA values within the existing case scenarios used in problem-based learning (PBL) curricula. The Delphi technique was employed to develop and validate the new inventory. The validation used expert opinion and calculated the content validity using content validity indices (CVIs). The initial draft (Draft 0) was formulated with 25 open-ended questions. Following expert evaluation, Draft 1 had 22 closed-ended questions and the mean ratings, according to the experts, were as follows: relevance, 3.33-4.83; importance (3.5-4.8); clarity (3.33-4.83); and simplicity (3:00-4.67). Draft 2 had 19 questions. After a further round of rating and analysis, a final draft was prepared, consisting of 17 items, with CVI scores ≥ 0.8 and 100% overall satisfaction. Using this inventory tool will help health professions schools to translate SA indicators into curricular activities by identifying the gaps in their PBL curricula. Deficiencies can be either in the type of case scenarios used or the triggers embedded in the individual case scenarios, subsequently leading to the development of PBL case scenarios that address real health social needs. A revision and rewriting of the problem case scenarios to incorporate SA will be the next step.
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Affiliation(s)
- Mohamed Elhassan Abdalla
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, United Arab Emirates
| | - Nihar Ranjan Dash
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Sarra Shorbagi
- Department of Community and Family Medicine and Behavioural Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohamed H. Taha
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, United Arab Emirates
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Streeton AM, Kitsell F, Kung M, Oo M, Rowse V, Wadd V, Shere H. The Improving Global Health Programme - leadership development in the NHS through overseas placement. BMJ Glob Health 2021; 6:e004533. [PMID: 34853065 PMCID: PMC8633998 DOI: 10.1136/bmjgh-2020-004533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/06/2021] [Accepted: 03/12/2021] [Indexed: 11/03/2022] Open
Abstract
The Improving Global Health (IGH) programme develops leadership capacity within the National Health Service (NHS) in a novel way. NHS employees collaboratively run quality improvement projects within organisations in low-income and middle-income countries with whom long-standing healthcare partnerships have been built. Leadership behaviours are developed through theoretical and experiential learning, alongside induction and mentorship. The health systems of overseas partners are strengthened through projects that align with local priorities. This article develops solutions to two main problems: how reciprocal global health programmes can be designed and how global health programmes based in leadership can attract women and black and minority ethnic groups into leadership. The outcomes of both sides of the IGH programme are described here. The overseas perspective is described using the reflections of two current partners, highlighting improvements in the local healthcare system and demonstrating growth in local team members. The UK perspective is evaluated using two surveys sent to different groups of returned IGH participants. Leadership, global health and quality improvement skills improve, having a significant and long-lasting impact on career trajectory. The IGH programme is attracting women and black and minority ethnic groups into leadership. Through collaboration and reciprocity, the IGH programme is developing a new cadre of NHS leader that is diverse and inclusive. The use of long-standing healthcare partnerships ensures that learning is shared and growth is mutual, creating development within the overseas and UK partner alike.
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Affiliation(s)
- Ann-Marie Streeton
- Health Education England, Volunteer Global Engagement Directorate, UK
- General Practice Clinic, Clevedon Medical Centre, Clevedon, UK
| | - Fleur Kitsell
- Health Education England, Global Engagement Directorate, UK
| | | | - Myint Oo
- General Practitioners Society, Yangon, Myanmar
- Family Medicine, Win Family Health Clinic, Yangon, Myanmar
| | - Vicki Rowse
- Health Education England, Volunteer Global Engagement Directorate, UK
| | - Viki Wadd
- Health Education England, Volunteer Global Engagement Directorate, UK
- Transition Programme Director, Wiltshire, UK
| | - Harriet Shere
- Health Education England, Global Engagement Directorate, UK
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Berrington R, Condo N, Rubayita F, Cook K, Jalloh C. Community organization feedback about an undergraduate medical education service learning program Rétroaction d'un organisme communautaire sur apprentissage en milieu de travail d'un programme d'études médicales de premier cycle. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:70-78. [PMID: 34567307 PMCID: PMC8463225 DOI: 10.36834/cmej.71420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND In 2016, Service Learning (SL) became a curricular requirement for undergraduate medical education (UGME) students at the University of Manitoba. Students partner with a community-based organization for two years to engage in non-clinical activities in community settings. Significant feedback has been collected from students re: their SL experiences. This project specifically collected feedback from community organizations involved with SL. METHODS In June 2019, an electronic survey was distributed to the 36 community organizations involved with SL. RESULTS Twenty-seven organizations completed the survey. Feedback was grouped into two main themes: 1) Logistics and 2) The SL Experience. About half (52%) of respondents indicated it was "easy" to schedule students for SL; however, students' busy schedules and differences between hours of organization programming and students' availability were highlighted. Most respondents described students as "engaged" (70%); respondents indicated SL raised students' understanding of power and privilege (56%) and systemic oppression (63%). CONCLUSIONS Community organizations shared valuable insights to inform the SL program. Results identified specific aspects of the SL program to address moving forward, such as sharing learning objectives with community partners. Ensuring processes are in place to obtain feedback from community partners is an essential step to improve SL programs, and to strengthen reciprocal community-university partnerships.
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Affiliation(s)
| | - Nina Condo
- Elmwood Community Resource Centre, Manitoba, Canada
| | - Felicien Rubayita
- Manitoba Interfaith Immigration Council (Welcome Place), Manitoba, Canada
| | - Karen Cook
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Chelsea Jalloh
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
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Abdel-Wahab M, Gondhowiardjo SS, Rosa AA, Lievens Y, El-Haj N, Polo Rubio JA, Prajogi GB, Helgadottir H, Zubizarreta E, Meghzifene A, Ashraf V, Hahn S, Williams T, Gospodarowicz M. Global Radiotherapy: Current Status and Future Directions-White Paper. JCO Glob Oncol 2021; 7:827-842. [PMID: 34101482 PMCID: PMC8457786 DOI: 10.1200/go.21.00029] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Recognizing the increase in cancer incidence globally and the need for effective cancer control interventions, several organizations, professional bodies, and international institutions have proposed strategies to improve treatment options and reduce mortality along with minimizing overall incidence. Despite these efforts, an estimated 9.6 million deaths in 2018 was attributed to this noncommunicable disease, making it the second leading cause of death worldwide. Left unchecked, this will further increase in scale, with an estimated 29.5 million new cases and 16.3 million deaths occurring worldwide in 2040. Although it is known and generally accepted that cancer services must include radiotherapy, such access is still very limited in many parts of the world, especially in low- and middle-income countries. After thorough review of the current status of radiotherapy including programs worldwide, as well as achievements and challenges at the global level, the International Atomic Energy Agency convened an international group of experts representing various radiation oncology societies to take a closer look into the current status of radiotherapy and provide a road map for future directions in this field. It was concluded that the plethora of global and regional initiatives would benefit further from the existence of a central framework, including an easily accessible repository through which better coordination can be done. Supporting this framework, a practical inventory of competencies needs to be made available on a global level emphasizing the knowledge, skills, and behavior required for a safe, sustainable, and professional practice for various settings. This white paper presents the current status of global radiotherapy and future directions for the community. It forms the basis for an action plan to be developed with professional societies worldwide.
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Affiliation(s)
- May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Soehartati S Gondhowiardjo
- Radiotherapy Department, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas of Indonesia, Jakarta, Indonesia
| | - Arthur Accioly Rosa
- Radiation Oncology, Hospital Portugues, Hospital Sao Rafael, Salvador, Brazil
| | | | - Noura El-Haj
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | | | | | - Herdis Helgadottir
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Zubizarreta
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ahmed Meghzifene
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Varisha Ashraf
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Stephen Hahn
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Tim Williams
- South Florida Proton Therapy Institute, Delray Beach, FL
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Community-Engaged Curriculum Development in Sexual and Reproductive Health Equity: Structures and Self. Obstet Gynecol 2021; 137:723-727. [PMID: 33706348 PMCID: PMC7984752 DOI: 10.1097/aog.0000000000004324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inequitable outcomes in sexual and reproductive health disproportionately burden communities minoritized by systems of oppression. Although there is evidence linking structural determinants to these inequities, clinical learners have limited exposure to these topics in their training. We developed a curriculum aimed to teach clinical learners the structural determinants of sexual and reproductive health. METHOD We implemented Kern's six-step method for curriculum development. Through literature review, we identified structural competency as the foundational framework and explored community priorities for clinical training. We assessed learner needs regarding structural equity training, articulated goals and objectives, and chose video modules as the primary educational strategy. We collaboratively developed content with community scholars and reproductive justice advocates. For phase 1 of our curriculum, we created pillar videos with reflection questions, resources, and a visual glossary of key terms. All materials are available through an online educational platform offering open-access, evidence-based curricula. EXPERIENCE We launched our curriculum with a social media campaign and presented our videos at several national convenings. We implemented videos with clinical learners with positive preliminary evaluation results. CONCLUSION With rigorous development rooted in community engagement, our curriculum contributes to the tools promoting structural equity training in obstetrics and gynecology.
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Fitzgerald M, Shoemaker E, Ponka D, Walker M, Kendall C. Global health and social accountability: An essential synergy for the 21 st century medical school. J Glob Health 2021; 11:03045. [PMID: 33763215 PMCID: PMC7955959 DOI: 10.7189/jogh.11.03045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Michael Fitzgerald
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Esther Shoemaker
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada.,ICES, Toronto, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada.,Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - David Ponka
- Besrour Centre for Global Family Medicine, College of Family Physicians of Canada, Toronto, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Mark Walker
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Canada.,Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Claire Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada.,ICES, Toronto, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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Shaw E, Walpole S, McLean M, Alvarez-Nieto C, Barna S, Bazin K, Behrens G, Chase H, Duane B, El Omrani O, Elf M, Faerron Guzmán CA, Falceto de Barros E, Gibbs TJ, Groome J, Hackett F, Harden J, Hothersall EJ, Hourihane M, Huss NM, Ikiugu M, Joury E, Leedham-Green K, MacKenzie-Shalders K, Madden DL, McKimm J, Nayna Schwerdtle P, Peters S, Redvers N, Sheffield P, Singleton J, Tun S, Woollard R. AMEE Consensus Statement: Planetary health and education for sustainable healthcare. MEDICAL TEACHER 2021; 43:272-286. [PMID: 33602043 DOI: 10.1080/0142159x.2020.1860207] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.
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Affiliation(s)
- Emily Shaw
- Newcastle University, Newcastle Upon Tyne, UK
| | - Sarah Walpole
- Newcastle University, Newcastle Upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Centre for Sustainable Healthcare, Oxford, UK
| | - Michelle McLean
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | | | - Stefi Barna
- Centre for Sustainable Healthcare, Oxford, UK
| | - Kate Bazin
- Department of Physiotherapy, King's College London, London, UK
| | - Georgia Behrens
- School of Medicine Sydney, The University of Notre Dame Australia, Sydney, Australia
| | | | - Brett Duane
- School of Dentistry, Trinity College Dublin, Dublin, Ireland
| | - Omnia El Omrani
- International Federation of Medical Students' Associations, Copenhagen, Denmark
| | - Marie Elf
- School of Education, Health and Social Studies, Department of Nursing, Dalarna University, Falun, Sweden
| | - Carlos A Faerron Guzmán
- Planetary Health Alliance, Harvard University T H Chan School of Public Health, Boston, MA, USA
| | | | | | - Jonny Groome
- Greener Anaesthesia & Sustainability Project, Great Ormond Street Hospital for Children, London, UK
| | - Finola Hackett
- University of Calgary, CFMS Health and Environment, Lethbridge, Alberta, Canada
| | - Jeni Harden
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | - Maca Hourihane
- Irish Society of Chartered Physiotherapists Special Interest Group for Healthcare Professionals in International Health and Development and Irish Red Cross Society, Dublin, Ireland
| | | | - Moses Ikiugu
- Occupational Therapy, University of South Dakota School of Health Sciences, Vermillion, SD, USA
| | - Easter Joury
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kathleen Leedham-Green
- Medical Education Research Unit, Imperial College London Faculty of Medicine, London, UK
| | | | - Diana Lynne Madden
- School of Medicine Sydney, The University of Notre Dame Australia, Sydney, Australia
| | - Judy McKimm
- Medical School, Swansea University, Swansea, UK
| | | | | | - Nicole Redvers
- Department of Family & Community Medicine, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, USA
| | - Perry Sheffield
- Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Judith Singleton
- Pharmacy, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - SanYuMay Tun
- Imperial College London Centre for Environmental Policy, London, UK
| | - Robert Woollard
- Family Practice, The University of British Columbia, Vancouver, Canada
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Sayek I, Turan S, Batı AH, Demirören M, Baykan Z. Social accountability: A national framework for Turkish medical schools. MEDICAL TEACHER 2021; 43:223-231. [PMID: 33169641 DOI: 10.1080/0142159x.2020.1841889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To define recommendations to the medical schools in Turkey about social accountability which meets the local needs. METHODOLOGY OF THE STUDY The Association of Evaluation and Accreditation of Medical Education Programs (TEPDAD-Turkey) Social Accountability working group planned a study to determine national recommendations for social accountability of medical schools in two-stages. Delphi technique was used to develop the recommendations and finalize the recommendations in the first stage in which 61 members from 30 different institutions participated. Qualitative analysis was used for open questions in the first round and quantitative analysis for the data which is collected with a rating scale in the second and third rounds of the Delphi study. In the second stage, the recommendations were reviewed and finalized in a consensus workshop in which 68 members from 39 different institutions participated. RESULTS In the Delphi study 63 recommendations were classified under five themes: the health needs of the society, health service delivery, institutional structure and management, educational program and implementation and development and evaluation of social accountability. In the consensus workshop, the 63 recommendations were evaluated and of which 54 of 63 recommendations were agreed upon. CONCLUSION A national framework has been developed by including a wide range of experts from different institutions for the social accountability of medical schools in Turkey. Developing recommendations in a local context will enhance the conceptualization of the recommendations of social accountability in the medical schools. As an accreditation body embedding the principles in the national standards will have a further impact on this process.
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Affiliation(s)
- Iskender Sayek
- Department of Medical Education, Social Accountability Working Group TEPDAD *, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sevgi Turan
- Department of Medical Education, Social Accountability Working Group TEPDAD *, Hacettepe University School of Medicine, Ankara, Turkey
| | - A Hilal Batı
- Department of Medical Education, Social Accountability Working Group TEPDAD *, Ege University School of Medicine, Izmir, Turkey
| | - Meral Demirören
- Department of Medical Education, Social Accountability Working Group TEPDAD *, Hacettepe University School of Medicine, Ankara, Turkey
| | - Zeynep Baykan
- Department of Medical Education, Social Accountability Working Group TEPDAD *, Erciyes University School of Medicine, Kayseri, Turkey
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Barber C, van der Vleuten C, Leppink J, Chahine S. Social Accountability Frameworks and Their Implications for Medical Education and Program Evaluation: A Narrative Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1945-1954. [PMID: 32910000 DOI: 10.1097/acm.0000000000003731] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Medical schools face growing pressures to produce stronger evidence of their social accountability, but measuring social accountability remains a global challenge. This narrative review aimed to identify and document common themes and indicators across large-scale social accountability frameworks to facilitate development of initial operational constructs to evaluate social accountability in medical education. METHOD The authors searched 5 electronic databases and platforms and the World Wide Web to identify social accountability frameworks applicable to medical education, with a focus on medical schools. English-language, peer-reviewed documents published between 1990 and March 2019 were eligible for inclusion. Primary source social accountability frameworks that represented foundational values, principles, and parameters and were cited in subsequent papers to conceptualize social accountability were included in the analysis. Thematic synthesis was used to describe common elements across included frameworks. Descriptive themes were characterized using the context-input-process-product (CIPP) evaluation model as an organizational framework. RESULTS From the initial sample of 33 documents, 4 key social accountability frameworks were selected and analyzed. Six themes (with subthemes) emerged across frameworks, including shared values (core social values of relevance, quality, effectiveness, and equity; professionalism; academic freedom and clinical autonomy) and 5 indicators related to the CIPP model: context (mission statements, community partnerships, active contributions to health care policy); inputs (diversity/equity in recruitment/selection, community population health profiles); processes (curricular activities, community-based clinical training opportunities/learning exposures); products (physician resource planning, quality assurance, program evaluation and accreditation); and impacts (overall improvement in community health outcomes, reduction/prevention of health risks, morbidity/mortality of community diseases). CONCLUSIONS As more emphasis is placed on social accountability of medical schools, it is imperative to shift focus from educational inputs and processes to educational products and impacts. A way to begin to establish links between inputs, products, and impacts is by using the CIPP evaluation model.
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Affiliation(s)
- Cassandra Barber
- C. Barber is a PhD candidate, School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0003-3605-8485
| | - Cees van der Vleuten
- C. van der Vleuten is professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Jimmie Leppink
- J. Leppink is senior lecturer in medical education, Hull York Medical School, University of York, York, United Kingdom
| | - Saad Chahine
- S. Chahine is associate professor, Faculty of Education, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0488-773X
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Alrebish SA, Taha MH, Ahmed MH, Abdalla ME. Commitment towards a better future for medical education in Saudi Arabia: the efforts of the college of medicine at Qassim University to become socially accountable. MEDICAL EDUCATION ONLINE 2020; 25:1710328. [PMID: 31902316 PMCID: PMC7655075 DOI: 10.1080/10872981.2019.1710328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/18/2019] [Accepted: 11/24/2019] [Indexed: 06/10/2023]
Abstract
Background: The College of Medicine at Qassim University (COMQU) was founded in 2001 as a problem-based learning and community-oriented medical school in order to strengthen the health system not only in the Qassim region but also in the whole of Saudi Arabia. The aim of the current study was to assess whether the COMQU is a socially accountable medical school and the steps taken to achieve that target.Materials and methods: The study used the social accountability grid published by the World Health Organization (WHO) as a framework to assess the social accountability efforts in the context of three functions of medical schools: education, service and research. Data were collected through the analysis of college documents (2001-2017) and interviews with key informants.Results: The COMQU shows compliance towards social accountability in the three domains of the grid. The indicators related to the education domain demonstrate more compliance than those of research and community service in the grid.Conclusion: The COMQU is based on community-oriented medical education (COME) with strong commitment towards social accountability (socially responsible going towards social responsiveness). More research is needed in order to pave the way to achieve social accountability status.Abbreviations: COMQU: College of Medicine at Qassim University; COME: Community-oriented medical education; WHO: The World Health Organization; MOH: Ministry of Health; SCFHS: Saudi Commission of Health Specialties; PHC: Primary Health Care; HYMS: Hull York Medical School; WFME: World Federation for Medical Education; NCAAA: National Commission for Academic Accreditation and Assessment.
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Affiliation(s)
- Saleh A Alrebish
- Medical Education Department, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Mohamed H. Taha
- Medical Education Department, College of Medicine, Qassim University, Qassim, Saudi Arabia
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, UK
| | - Mohamed Elhassan Abdalla
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, United Arab Emirates
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Goez H, Lai H, Rodger J, Brett-MacLean P, Hillier T. The DISCuSS model: Creating connections between community and curriculum - A new lens for curricular development in support of social accountability. MEDICAL TEACHER 2020; 42:1058-1064. [PMID: 32608298 DOI: 10.1080/0142159x.2020.1779919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Medicine's social mandate recognizes the importance of introducing changes to systems and practices to meet the healthcare needs of marginalized populations. Social accountability efforts encompass a wide array of actions, including equity, diversity and inclusion initiatives, and adapting knowledge relevant to practice across education, research, and clinical domains. To influence change in education, ongoing structures and processes are needed to ensure adequacy, relevance, and effectiveness of curricular coverage. In support of this, we created an innovative and creative approach to developing curricular modules to prepare medical students to provide care that is responsive to the cultural, economic, and psychosocial realities of diverse patient populations. The DISCuSS model (Diversity, Identify, Search, Create module (with community engagement), Sustainability, Social accountability) provides a community-engaged, iterative approach to curriculum development relevant to social accountability. Over the past 5 years, we have created nine curricular modules focused on health-related inequities and social concerns, including modules on Indigenous and refugee health, sexual and gender minority health, human trafficking, and addiction. AFMC Graduation Questionnaire results have shown a statistically significant increase in our students 'preparedness to provide care to diverse populations.' The DISCuSS model, which continues to evolve, can be adapted and used in other settings.
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Affiliation(s)
- Helly Goez
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Hollis Lai
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Joanne Rodger
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | | | - Tracey Hillier
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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Ahmed MH, Abdalla ME, Taha MH. Why social accountability of medical schools in Sudan can lead to better primary healthcare and excellence in medical education? J Family Med Prim Care 2020; 9:3820-3825. [PMID: 33110774 PMCID: PMC7586598 DOI: 10.4103/jfmpc.jfmpc_498_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/25/2020] [Accepted: 05/21/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction: Medical education in Sudan continues to evolve and progress with proliferation in the number of medical schools after 1990. Social factors and the geographical location of Sudan will increase the opportunity of success of medical schools to be socially accountable. In this analysis, we explained why social accountability is needed in Sudan and how this can enhance both excellence in medical education and primary health care, especially in rural areas. Methodology: PubMed, scopus Medline, and Google Scholar were searched for published-English literature concerning social accountability of medical schools in Sudan and worldwide were reviewed regardless of the time limit. We have also included examples of medical schools from Sudan and the Middle East to reflect on their experience in social accountability. Results: In this critical review, we have shown that social accountability will come with benefits for medical schools and the community. Implementation of social accountability in medical schools in Sudan will increase the effectiveness of medical schools' productivity, research output, and health service in urban and rural areas. There is an urgent need for social accountability alliance in Sudan to increase collaboration between medical schools. This will increase the benefits of social accountability for all stakeholders and also increases the competency in social medicine within the medical school curriculum. Conclusion: Social accountability is regarded as a sign of excellence in medical education. Primary care physicians in Sudan are expected to be the leaders in the implementation of social accountability. This analysis answered two important questions about why medical schools in Sudan should be socially accountable? And do we need a special structure of social accountability in Sudan?
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Affiliation(s)
- Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Mohamed Elhassan Abdalla
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohamed H Taha
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, United Arab Emirates
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McKimm J, McLean M. Rethinking health professions' education leadership: Developing 'eco-ethical' leaders for a more sustainable world and future. MEDICAL TEACHER 2020; 42:855-860. [PMID: 32286110 DOI: 10.1080/0142159x.2020.1748877] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In this commentary, we discuss health professions' education (HPE) leadership in relation to planetary health emergencies, suggesting that an 'eco-ethical leadership' approach is highly relevant. Building on both traditional and more contemporary leadership approaches and the need for HPE to be socially and environmentally accountable, we define the key features of eco-ethical leadership and its underpinning beliefs and values, then expand on these features in terms of leadership at intrapersonal, interpersonal, team, organisational and system levels. Eco-ethical leadership is needed to tackle a range of 'wicked' problems - a changing climate, environmental pollution, deforestation, all of which threaten global biodiversity and human civilisation. Such leadership requires passionate individuals to role model the behaviours and actions that are required to bring people along with them, not least the learners, many of whom are already concerned about their future. Eco-ethical leadership (and followership) offers an integrated approach for HPE, centred around sustainability, values, collaboration, justice, advocacy and, if need be, activism. The environment cannot not wait. Eco-ethical leaders already exist but their numbers are small. They are required in key positions in academia and healthcare to drive the agenda in partnership with learners, many of whom are already environmental advocates and activists.
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Affiliation(s)
- Judy McKimm
- Strategic Educational Development, Swansea University Medical School, Swansea, UK
| | - Michelle McLean
- Medical Education and Planetary Health, Bond University, Gold Coast, Australia
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Hommes F, Drees S, Geffert K, von Philipsborn P, Stratil JM. How are social determinants of health represented in German medical education?: a qualitative content analysis of key-curricular documents. BMJ Open 2020; 10:e036026. [PMID: 32713848 PMCID: PMC7383947 DOI: 10.1136/bmjopen-2019-036026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The WHO Commission on Social Determinants of Health (SDH) has called for a health workforce trained in recognising, understanding and acting on the SDH. However, little is known about how current medical education prepares graduates for this challenge. This study analyses the extent to which the German medical education incorporates content on SDH. DESIGN Following a published protocol, in 2018, we conducted a qualitative and quantitative content analysis of three key document groups, defining and guiding what medical schools are expected to teach and what medical students are expected to know when graduating in Germany. We developed the coding system in a mixed inductive and deductive approach based on key WHO documents. SETTING Medical schools and the medical education system in Germany. RESULTS Important gaps exist in the representation of SDH in medical education in Germany. Between 3% and 27% of the analysed document-elements made reference to SDH and only 0%-3% of those document elements made explicit references to SDH. While some aspects were covered widely (eg, topics of occupational health, early childhood development and hygiene), other topics such as health inequalities or determinants outside of the healthcare system were not or hardly represented. CONCLUSIONS A stronger and more explicit representation of SDH in German medical education is needed to prepare the new health workforce for current and future challenges in our globalised world and for medical schools to be socially accountable.
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Affiliation(s)
- Franziska Hommes
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Tropical Medicine and International Health, Berlin, Germany
| | - Simon Drees
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Peter von Philipsborn
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jan M Stratil
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Assessment of Diversity Outcomes in American Medical School Admissions: Applying the Grutter Legitimacy Principles. SUSTAINABILITY 2020. [DOI: 10.3390/su12125211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the last 30 years, except for female participation, the enrollment of Latinx, African Americans, Native Americans, Alaskan natives, and disadvantaged students in medical school has been constant; however, increasing enrollment of these minority populations is feasible, if admissions committees make two changes in approach. First, the traditional belief that matriculation merit is a linear function of past academic performance must be rejected. Second, once the threshold needed to complete medical school in four years and to pass licensing examinations at the first attempt has been met, all candidates are equally qualified, and matriculation decisions must be based, in part, on societal interests. In Grutter vs. Bollinger, the United States Supreme Court determined that graduate admission committees can and should consider societal interests. Each admission decision represents a substantial government investment in each student, as the Medicare Act directly subsidizes much of the cost of medical education. As Grutter explained, there is a societal interest in the public having confidence in, and access to, the medical school training that will prepare tomorrow’s medical, professional, and political leaders. Our analysis suggests that medical school admissions are biased towards academic achievement in matriculants, beyond acceptable thresholds for graduation and licensure. We believe medical schools must shift their admissions strategies and consider noncognitive factors in all candidates as determinative once minimum acceptable academic standards have been met.
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Witter S, Hamza MM, Alazemi N, Alluhidan M, Alghaith T, Herbst CH. Human resources for health interventions in high- and middle-income countries: findings of an evidence review. HUMAN RESOURCES FOR HEALTH 2020; 18:43. [PMID: 32513184 PMCID: PMC7281920 DOI: 10.1186/s12960-020-00484-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/28/2020] [Indexed: 05/28/2023]
Abstract
Many high- and middle-income countries face challenges in developing and maintaining a health workforce which can address changing population health needs. They have experimented with interventions which overlap with but have differences to those documented in low- and middle-income countries, where many of the recent literature reviews were undertaken. The aim of this paper is to fill that gap. It examines published and grey evidence on interventions to train, recruit, retain, distribute, and manage an effective health workforce, focusing on physicians, nurses, and allied health professionals in high- and middle-income countries. A search of databases, websites, and relevant references was carried out in March 2019. One hundred thirty-one reports or papers were selected for extraction, using a template which followed a health labor market structure. Many studies were cross-cutting; however, the largest number of country studies was focused on Canada, Australia, and the United States of America. The studies were relatively balanced across occupational groups. The largest number focused on availability, followed by performance and then distribution. Study numbers peaked in 2013-2016. A range of study types was included, with a high number of descriptive studies. Some topics were more deeply documented than others-there is, for example, a large number of studies on human resources for health (HRH) planning, educational interventions, and policies to reduce in-migration, but much less on topics such as HRH financing and task shifting. It is also evident that some policy actions may address more than one area of challenge, but equally that some policy actions may have conflicting results for different challenges. Although some of the interventions have been more used and documented in relation to specific cadres, many of the lessons appear to apply across them, with tailoring required to reflect individuals' characteristics, such as age, location, and preferences. Useful lessons can be learned from these higher-income settings for low- and middle-income settings. Much of the literature is descriptive, rather than evaluative, reflecting the organic way in which many HRH reforms are introduced. A more rigorous approach to testing HRH interventions is recommended to improve the evidence in this area of health systems strengthening.
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Affiliation(s)
- Sophie Witter
- Queen Margaret University, Edinburgh, United Kingdom
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Hays RB, Strasser RP, Sen Gupta TK. Twelve tips for establishing a new medical school. MEDICAL TEACHER 2020; 42:398-402. [PMID: 31030588 DOI: 10.1080/0142159x.2019.1571570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Many new medical programs have been established during the last 20 years, and this trend seems set to continue as the health care needs of the world's populations become more complex and demand increases for more physicians to provide the necessary health care. In this paper, we address how best to establish a new medical school, based on our experiences in new ventures in several countries. Success requires a combination of boldness of vision, support from many stakeholder groups, adequate financial and human resources, educational expertise, confidence, patience, and persistence.
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Affiliation(s)
- R B Hays
- Centre for Rural and Remote Health, James Cook University and Rural Clinical School, University of Tasmania, Townsville, Australia
| | - R P Strasser
- Northern Ontario School of Medicine, Thunder Bay, Canada
| | - T K Sen Gupta
- Centre for Rural and Remote Health, James Cook University and Rural Clinical School, University of Tasmania, Townsville, Australia
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Pitama S, Beckert L, Huria T, Palmer S, Melbourne-Wilcox M, Patu M, Lacey C, Wilkinson TJ. The role of social accountable medical education in addressing health inequity in Aotearoa New Zealand. J R Soc N Z 2019. [DOI: 10.1080/03036758.2019.1659379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Suzanne Pitama
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Lutz Beckert
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tania Huria
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Suetonia Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Maira Patu
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Tim J. Wilkinson
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Mian O, Hogenbirk JC, Marsh DC, Prowse O, Cain M, Warry W. Tracking Indigenous Applicants Through the Admissions Process of a Socially Accountable Medical School. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1211-1219. [PMID: 30730368 DOI: 10.1097/acm.0000000000002636] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE To describe the admissions process and outcomes for Indigenous applicants to the Northern Ontario School of Medicine (NOSM), a Canadian medical school with the mandate to recruit students whose demographics reflect the service region's population. METHOD The authors examined 10-year trends (2006-2015) for self-identified Indigenous applicants through major admission stages. Demographics (age, sex, northern and rural backgrounds) and admission scores (grade point average [GPA], preinterview, multiple mini-interview [MMI], final), along with score-based ranks, of Indigenous and non-Indigenous applicants were compared using Pearson chi-square and Mann-Whitney tests. Binary logistic regression was used to assess the relationship between Indigenous status and likelihood of admission outcomes (interviewed, received offer, admitted). RESULTS Indigenous qualified applicants (338/17,060; 2.0%) were more likely to be female, mature (25 or older), or of northern or rural background than non-Indigenous applicants. They had lower GPA-based ranks than non-Indigenous applicants (P < .001) but had comparable preinterview-, MMI-, and final-score-based ranks across all admission stages. Indigenous applicants were 2.4 times more likely to be interviewed and 2.5 times more likely to receive an admission offer, but 3 times less likely to accept an offer than non-Indigenous applicants. Overall, 41/338 (12.1%) Indigenous qualified applicants were admitted compared with 569/16,722 (3.4%) non-Indigenous qualified applicants. CONCLUSIONS Increased representation of Indigenous peoples among applicants admitted to medical school can be achieved through the use of socially accountable admissions. Further tracking of Indigenous students through medical education and practice may help assess the effectiveness of NOSM's social accountability admissions process.
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Affiliation(s)
- Oxana Mian
- O. Mian is research associate, Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada. J.C. Hogenbirk is senior research associate, Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada; ORCID: http://orcid.org/0000-0003-0841-4657. D.C. Marsh is professor of clinical sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada; ORCID: https://orcid.org/0000-0002-8769-1785. O. Prowse is assistant dean for admissions, Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada. M. Cain is director of admissions and recruitment, Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada. W. Warry is currently director, Rural Health Initiatives, Memory Keepers Medical Discovery Team, and professor of family medicine and biobehavioral health, University of Minnesota, Duluth, Minnesota. At the time of writing, he was director, Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
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Smitherman HC, Baker RS, Wilson MR. Socially Accountable Academic Health Centers: Pursuing a Quadripartite Mission. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:176-181. [PMID: 30303815 DOI: 10.1097/acm.0000000000002486] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Academic health centers (AHCs) in the United States have had a leading role in educating the medical workforce, generating new biomedical knowledge, and providing tertiary and quaternary clinical care. Yet the health status of the U.S. population lags behind almost every other developed world economy. One reason is that the health care system is not organized optimally to address the major driver of health status, the social determinants of health (SDOH). The United States' overall poor health status is a reflection of dramatic disparities in health that exist between communities and population groups, and these are associated with variations in the underlying SDOH. Improving health status in the United States thus requires a fundamental reengineering of the health delivery system to address SDOH more explicitly and systematically. AHCs' tripartite mission, which has served so well in the past, is no longer sufficient to position AHCs to lead and resolve the intractable drivers of poor health status, such as unfair and unjust health disparities, health inequities, or differences in a population's SDOH.AHCs enjoy broad public support and have an opportunity-and an obligation-to lead in improving the nation's health. This Perspective proposes a new framework for AHCs to expand on their traditional tripartite mission of education, research, and clinical care to include explicitly a fourth mission of social accountability. Through this fourth mission, comprehensive community engagement can be undertaken, addressing SDOH and measuring the health impact of interventions by using a deliberate structure and process, yielding defined outcomes.
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Affiliation(s)
- Herbert C Smitherman
- H.C. Smitherman Jr is vice dean of diversity and community affairs, Wayne State University School of Medicine, Detroit, Michigan. R.S. Baker is vice dean of medical education, Wayne State University School of Medicine, Detroit, Michigan. M.R. Wilson is president, Wayne State University, Detroit, Michigan
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Ventres W, Boelen C, Haq C. Time for action: key considerations for implementing social accountability in the education of health professionals. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:853-862. [PMID: 28900801 DOI: 10.1007/s10459-017-9792-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 08/17/2017] [Indexed: 06/07/2023]
Abstract
Within health professional education around the world, there exists a growing awareness of the professional duty to be socially responsible, being attentive to the needs of all members of communities, regions, and nations, especially those who disproportionately suffer from the adverse influence of social determinants. However, much work still remains to progress beyond such good intentions. Moving from contemplation to action means embracing social accountability as a key guiding principle for change. Social accountability means that health institutions attend to improving the performance of individual practitioners and health systems by directing educational and practice interventions to promote the health of all the public and assessing the systemic effects of these interventions. In this Reflection, the authors (1) review the reasons why health professional schools and their governing bodies should codify, in both curricular and accreditation standards, norms of excellence in social accountability, (2) present four considerations crucial to successfully implementing this codification, and (3) discuss the challenges such changes might entail. The authors conclude by noting that in adopting socially accountable criteria, schools will need to expand their philosophical scope to recognize social accountability as a vitally important part of their institutional professional identity.
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Affiliation(s)
- William Ventres
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for the Medical Sciences, 4301 W. Markham Street, #530, Little Rock, AR, 72205-7199, USA.
- Institute for Studies in History, Anthropology and Archeology, University of El Salvador, San Salvador, El Salvador.
| | - Charles Boelen
- Independent International Consultant, Sciez, France
- Program of Human Resources for Health, World Health Organization, Geneva, Switzerland
| | - Cynthia Haq
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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