Key drivers of social accountability in nine Canadian medical schools

Proposing the Community Triad Model to action social accountability in medical schools

This article is the third in a series exploring drivers of social accountability (SA) in medical schools across Canada. Findings from the two previous articles have highlighted a central relationship between community, students, and faculty at medical schools, and led to the emergence of a new social accountability model- the Community Triad Model (CTM). The CTM proposes an interconnectedness between community, students, faculty, and the broader institution, and the pathways through which community-based learning directly and indirectly influences decision-making in medical institutions. This article explores the relationships between the three arms of the CTM by examining the literature on community engagement and SA, as well as by revisiting popular models and foundational SA reports to garner insights into authentic community engagement in health professions education. While there is an abundance of literature demonstrating the impact of community placements on students, there are limited studies describing the influence of communities on faculty and the broader institution either directly, or indirectly via students. The authors recommend that institutions be more intentional in engaging students and faculty, and learn from their experiences with community to shape curriculum, practices, policies, and culture of the broader institution. This study offers an operational model of SA that is easy to adopt and implement. It intends to demonstrate how the components of the triad (students, faculty/leadership, community) function together in the community engagement and social accountability of medical schools.

Social accountability in a medical school: is it sufficient? A regional medical school curriculum and approaches to equip graduates for rural and remote medical services

BACKGROUND

Social accountability is increasingly integral to medical education, aligning health systems with community needs. Universitas Pattimura's Faculty of Medicine (FMUP) enhances this through a curriculum that prepares graduates for rural and remote (RR) medical practice, exceeding national standards. The impact of this curriculum on graduate readiness in actual work settings remains unassessed.

OBJECTIVE

This study was conducted to capture the perspectives of FMUP medical graduates in a rural-centric curriculum, focusing on the teaching and learning opportunities afforded to them during their medical education. These insights are crucial for evaluating the accountability of regional medical schools in delivering quality service, particularly in underserved areas.

METHODS

Semistructured interviews were conducted with nine FMUP graduates employed in the RR areas of Maluku Province. A qualitative analysis was employed to examine graduates' views on the curriculum concerning medical school accountability.

RESULTS

The FMUP curriculum, informed by social accountability principles, partially prepares graduates to work under Maluku's RR conditions. However, it was reported by participants that their skills and preparedness often fall short in the face of substandard working environments.

CONCLUSIONS

The FMUP curriculum supports the government's aim to develop an RR medical workforce. However, the curriculum's social accountability and rural emphasis fall short of addressing community health needs amid inadequate practice conditions. Political investment in standardizing medical facilities and equipment is essential for enhancing graduates' effectiveness and health outcomes in RR communities.

Community-based learning in medical education: A starting guide and lessons learned

Community-based medical education (CBME) addresses real-world health problems and is characterized by its emphasis on reciprocity and collaboration with community stakeholders. Limited evidence shows that CBME is an effective learning strategy to care for underserved communities. However, medical schools and nursing schools struggle to implement CBME in their curriculum. In this article, we present four practical examples of CBME from medical and nursing schools in Belgium and the Netherlands. By taking the lessons learned derived from these practical examples into account, all students can have an authentic learning experience within the community, which empowers community members and increases their health.

Accountability as a virtue in medicine: from theory to practice

Accountability is a norm basic to several aspects of medical practice. We explore here the benefits of a more explicit focus on the virtue of accountability, which as distinct from the state of being held accountable, entails both welcoming responsibility to others and welcoming input from others. Practicing accountably can limit moral distress caused by institutional pressures on the doctor patient relationship. Fostering a mindset that is welcoming rather than resistant to feedback is critical to enhancing a culture of learning. Analysis of failures of accountable practice offers opportunities for improving the delivery of clinical care.

Validation of IFMSA social accountability assessment tool: exploratory and confirmatory factor analysis

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.

A conceptual framework to describe and evaluate a socially accountable learning health system: Development and application in a northern, rural, and remote setting

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.

Evaluation of the integration of social accountability values into medical education using a problem-based learning curriculum

BACKGROUND

Medical schools have the obligation to direct their education toward addressing the priority health concerns of the societies that they serve. The purpose of this study was to evaluate the integration of the concepts and values of social accountability into the case scenarios that are used in a problem-based learning (PBL) curriculum at a medical school in the United Arab Emirates (UAE).

METHODS

A validated "social accountability inventory for PBL" was used for examining 70 case scenarios in a problem-based learning (PBL) medical curriculum.

RESULTS

The findings of the study showed that patient gender and age were included in all the 70 case scenarios. Vast majority of the case scenarios had successfully integrated the social accountably values in addressing the following: the major health problems or social health concerns of the UAE (73%), the social determinants of health (70%), the contextual integration of medical professionalism (87%), the evolving roles of doctors in the health system (79%), the healthcare referral system based on the case complexity (73%), the involvement of different stakeholders in healthcare (87%), psychosocial issues rather than only the disease-oriented issues (80%) and the values of health promotion/prevention (59%) cases. On the other hand, the case scenarios were deficient in integrating other social accountability values that related to the importance of treatment cost-effectiveness (91%), consideration of the underserved, disadvantaged or vulnerable populations in the society (89%), patient's ethnicity (77%), multidisciplinary approach to patient management (67%), the socioeconomic statuses of patients (53%), the issues regarding the management of the health system (39%) respectively. There was variability in integrating the social accountability values in case scenarios across different units which are based on organ system.

CONCLUSION

Medical educators and healthcare leaders can use this valuable data to calibrate the curriculum content, especially when using a problem-based learning curriculum to integrate the values of social accountability such as relevance, quality, equity and cost-effectiveness to train the future generation of healthcare providers to be ready to address the ever-changing and diverse needs of the societies.