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Barber C, van der Vleuten C, Chahine S. Validity evidence and psychometric evaluation of a socially accountable health index for health professions schools. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:147-172. [PMID: 37347458 DOI: 10.1007/s10459-023-10248-5] [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: 12/28/2021] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
There is an expectation that health professions schools respond to priority societal health needs. This expectation is largely based on the underlying assumption that schools are aware of the priority needs in their communities. This paper demonstrates how open-access, pan-national health data can be used to create a reliable health index to assist schools in identifying societal needs and advance social accountability in health professions education. Using open-access data, a psychometric evaluation was conducted to examine the reliability and validity of the Canadian Health Indicators Framework (CHIF) conceptual model. A non-linear confirmatory factor analysis (CFA) on 67 health indicators, at the health-region level (n = 97) was used to assess the model fit of the hypothesized 10-factor model. Reliability analysis using McDonald's Omega were conducted, followed by Pearson's correlation coefficients. Findings from the non-linear CFA rejected the original conceptual model structure of the CHIF. Exploratory post hoc analyses were conducted using modification indices and parameter constraints to improve model fit. A final 5-factor multidimensional model demonstrated superior fit, reducing the number of indicators from 67 to 32. The 5-factors included: Health Conditions (8-indicators); Health Functions (6-indicators); Deaths (5-indicators); Non-Medical Health Determinants (7-indicators); and Community & Health System Characteristics (6-indicators). All factor loadings were statistically significant (p < 0.001) and demonstrated excellent internal consistency ( ω >0.95). Many schools struggle to identify and measure socially accountable outcomes. The process highlighted in this paper and the indices developed serve as starting points to allow schools to leverage open-access data as an initial step in identifying societal needs.
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Affiliation(s)
- Cassandra Barber
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Cees van der Vleuten
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Saad Chahine
- Faculty of Education, Queen's University, Kingston, ON, Canada
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Cleland J, Zachariah A, David S, Pulimood A, Poobalan A. A qualitative study of social accountability translation: from mission to living it. BMC MEDICAL EDUCATION 2024; 24:145. [PMID: 38355545 PMCID: PMC10868042 DOI: 10.1186/s12909-024-05093-y] [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: 05/08/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Medical schools are increasingly adopting socially accountable mission and curricula, the realisation of which are dependent on engaging individuals to embody the mission's principles in their everyday activities as doctors. However, little is known about how graduates perceive the efforts taken by their medical school to sensitise them to social accountability values, and how they translate this into their working lives. Our aim was to explore and understand graduate perceptions of how their medical school influenced them to embody a social accountability mission in their working lives. METHODS This was a qualitative interview study carried out with graduates/alumni [n = 51] of Christian Medical College, Vellore [CMCV], India, a school with a long-established and explicit social-accountability mission. Data coding and analysis were initially inductive and thematic using Braun and Clarke's six step framework. MacIntyre's virtue ethics theory framed secondary analysis, allowing us to consider the relationships between individual and contextual factors. RESULTS Our participants perceived that CMCV invested heavily in selecting personal qualities aligned with the CMCV mission. They saw that these qualities were reinforced through various practices: [e.g., placements in resource limited and/or remote and rural settings]; community engagement and expectations [e.g., student self-governance]; role modelling [staff and more senior students]. Much emphasis was placed on sustaining these traditions and practices over time, creating a strong sense of identity and belonging among participants, traditions which were fostered further by the alumni network and continued engagement with CMCV post-graduation. CONCLUSIONS Ensuring social accountable medical education depends on alignment and interactions over time between context and structures, systems and human agents. Further studies are needed to extend understanding of how students from diverse contexts experience socially accountable medical education and translate their educational experience into their thinking and practice after graduation.
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Affiliation(s)
- Jennifer Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore.
| | - Anand Zachariah
- Christian Medical College, M.G.R Medical University, Vellore, India
| | - Sarah David
- Christian Medical College, M.G.R Medical University, Vellore, India
| | - Anna Pulimood
- Christian Medical College, M.G.R Medical University, Vellore, India
| | - Amudha Poobalan
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Rispel LC, Ditlopo P, White J, Blaauw D. Perspectives of the cohort of health professionals in the WiSDOM study on the learning environment, transformation, and social accountability at a South African University. MEDICAL EDUCATION ONLINE 2023; 28:2185121. [PMID: 36880804 PMCID: PMC10013394 DOI: 10.1080/10872981.2023.2185121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/01/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The dearth of empirical research on transformative health professions education informed this study to examine the factors that influence the perspectives of the cohort of health professionals in the WiSDOM study on the learning environment, transformation, and social accountability at a South African university. METHODS WiSDOM, a prospective longitudinal cohort study, consists of eight health professional groups: clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists, and physiotherapists. At study inception in 2017, participants completed a self-administered questionnaire that included four domains of selection criteria (6 items); the learning environment (5 items); redress and transformation (8 items); and social accountability (5 items). In the analysis, we, rescaled the original Likert scoring of 1 (strongly disagree) to 7 (strongly agree) to a new scale ranging from 0-10. We calculated the mean scores for each item and across items for the four domains, with low scores (0.00-1.99) classified as poor and high scores (8.00-10.00) as excellent. We used multiple linear regression analysis to compare the mean scores, while adjusting for different socio-demographiccharacteristics. RESULTS The mean age of the 501 eligible participants was 24.1 years; the majority female (72.9%), 45.3% self-identified as Black African; and 12.2% were born in a rural area. The domains of selection criteria and redress and transformation obtained mean scores of 5.4 and 5.3 out of 10 respectively, while social accountability and the learning environment obtained mean scores of 6.1 and 7.4 out of 10 respectively. Self-identified race influenced the overall mean scores of selection criteria, redress and transformation, and social accountability (p < 0.001). Rural birth influenced the perceptions on selection criteria, redress and transformation (p < 0.01). CONCLUSION The results suggest the need to create inclusive learning environments that foreground redress, transformation, and social accountability, while advancing the discourse on decolonised health sciences education.
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Affiliation(s)
- Laetitia C. Rispel
- Centre for Health Policy & South African Research Chairs Initiative (SARChI), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Prudence Ditlopo
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janine White
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Duane Blaauw
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Anawati A, Cameron E, Harvey J. Exploring the development of a framework of social accountability standards for healthcare service delivery: a qualitative multipart, multimethods process. BMJ Open 2023; 13:e073064. [PMID: 37709334 PMCID: PMC10503373 DOI: 10.1136/bmjopen-2023-073064] [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: 02/23/2023] [Accepted: 08/23/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Social accountability is an equity-oriented health policy strategy that requires institutions to focus on local population needs. This strategy is well established in health professional education, but there is limited understanding of its application in healthcare service delivery. Building on what is known in the education setting, this study aimed to explore the development of a framework of comprehensive, evidence-based social accountability standards for healthcare service delivery institutions. DESIGN This qualitative, multipart, multimethods study consisted of a modified Delphi process guided by an evidence-based social accountability tool for health professional education and complementary methods including developmental evaluation and a review of select literature to capture emerging evidence and contextual relevance. SETTING The study took place in Northern Ontario, Canada at a medical school and a tertiary, regional academic health sciences centre that are both grounded in social accountability. PARTICIPANTS Eight expert participants from diverse, multidisciplinary backgrounds, including a patient advocate, were purposefully recruited from both institutions, enrolled and seven completed the study. MAIN OUTCOME The resulting framework of social accountability standards is organised into 4 major sections that capture broad and critical concepts; 17 key component reflective questions that address key themes; 39 aspirations that describe objective standards and 197 indicators linked to specific expectations. RESULTS Three modified Delphi rounds were completed producing a framework of consensus derived standards. Developmental evaluation helped identify facilitators, barriers and provided real-time feedback to the study's processes and content. The literature reviewed identified 10 new concepts and 43 amendments. CONCLUSION This study highlights the development of a comprehensive, evidence-based framework of social accountability standards for healthcare service delivery institutions. Future studies will aim to evaluate the application of these standards to guide equity-oriented social accountability health policy strategies in healthcare service delivery.
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Affiliation(s)
- Alex Anawati
- Clinical Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Emergency Department, Health Sciences North, Sudbury, Ontario, Canada
| | - Erin Cameron
- Human Sciences, Northern Ontario School of Medicine University, Thunder Bay, Ontario, Canada
| | - Jacqueline Harvey
- Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
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Larkins SL, Cristobal F, Hogenbirk J, Tandinco F, Othman AB, Mbokazi J, Van Roy K, Upadhyay S, Johnston K, Neusy AJ. Mission and role modelling in producing a fit-for-purpose rural health workforce: perspectives from an international community of practice. Med J Aust 2023; 219 Suppl 3:S20-S26. [PMID: 37544007 DOI: 10.5694/mja2.52020] [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] [Received: 11/01/2022] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Sarah L Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD
| | - Fortunato Cristobal
- School of Medicine, Ateneo de Zamboanga University, Zamboanga City, the Philippines
| | - John Hogenbirk
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Canada
| | - Filedito Tandinco
- School of Health Sciences, University of the Philippines Manila, Leyte, the Philippines
| | - Abu-Bakr Othman
- Faculty of Medicine, University of Gezira, Wad Madani, Sudan
| | - Jabu Mbokazi
- Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Kaatje Van Roy
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Karen Johnston
- College of Medicine and Dentistry, James Cook University, Townsville, QLD
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Laudone TW, Prisco JL, Keuler NL, Coetzee R. A call for social accountability within pharmacy education: Partnership, competency, and leadership. CURRENTS IN PHARMACY TEACHING & LEARNING 2023; 15:234-237. [PMID: 37024354 DOI: 10.1016/j.cptl.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 11/04/2022] [Accepted: 03/28/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION To address the needs of the community, social accountability (SA) needs to be integrated in health education, especially pharmacy education. This is part one of a two-part commentary that focuses specifically on partnership, competency, and leadership as it relates to SA within pharmacy education. COMMENTARY Here the need for partnership in SA, competency of SA in pharmacy education, and leadership in SA is discussed. IMPLICATIONS Integration of SA in pharmacy education can be challenging, however good leadership, a competency framework, and partnership with change agents can assist with this transformation.
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Affiliation(s)
- Thomas W Laudone
- University of Maryland School of Pharmacy, 20 N Pine Street, Baltimore, MD 21201, United States.
| | - Jennifer L Prisco
- MCPHS University School of Pharmacy, 179 Longwood Avenue, Boston, MA 02115, United States.
| | - Nicole L Keuler
- University of Western Cape School of Pharmacy, Robert Sobukwe Rd, Belville, 7535, South Africa.
| | - Renier Coetzee
- University of Western Cape School of Pharmacy, Robert Sobukwe Rd, Belville, 7535, South Africa.
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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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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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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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Taha MH, Abdalla ME, Saleh Wadi MM, Khalafalla HE, Akbarilakeh M. The implementation of social accountability in medical schools in Eastern Mediterranean region: A scoping review. J Taibah Univ Med Sci 2022; 18:84-97. [DOI: 10.1016/j.jtumed.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/15/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022] Open
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Dash NR, Taha MH, Shorbagi S, Abdalla ME. Evaluation of the integration of social accountability values into medical education using a problem-based learning curriculum. BMC MEDICAL EDUCATION 2022; 22:181. [PMID: 35291999 PMCID: PMC8925153 DOI: 10.1186/s12909-022-03245-6] [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] [Received: 10/07/2021] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Nihar Ranjan Dash
- Clinical Sciences Department, College of Medicine, University of Sharjah, 27272 Sharjah, United Arab Emirates
| | - Mohamed H. Taha
- College of Medicine and Medical Education Center, 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
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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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Herzog LS, Wright SR, Pennington JJ, Richardson L. The KAIROS Blanket Exercise: Engaging Indigenous ways of knowing to foster critical consciousness in medical education. MEDICAL TEACHER 2021; 43:1437-1443. [PMID: 34369238 DOI: 10.1080/0142159x.2021.1956679] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Indigenous Peoples across Turtle Island (North America) experience ongoing health disparities tied to the effects of colonization and persistent racism toward Indigenous Peoples. Educating future clinicians to develop a critical consciousness is an important way to work toward cultural safety and improve the health care experiences of Indigenous patients. The present study evaluated the ability of the KAIROS Blanket Exercise (KBE) to foster critical consciousness. METHODS Two hundred thirteen medical students at the University of Toronto participated in the KBE. Subsequently, 174 students completed a paper evaluation, designed to capture concepts of cultural safety and critical consciousness. Data were analyzed using quantitative and qualitative methods to identify shifts in perspectives. RESULTS The majority of students reported the exercise altered the way they viewed those from backgrounds different from their own, and comments regarding bias, power and privilege were highlighted throughout the responses. Engaging in critical reflection through dialogue and revealing the complex sociopolitical context of Indigenous Peoples' history were emphasized as central to this transformation. CONCLUSIONS Following participation in the KBE, medical students demonstrated a shift in their perspectives. This suggests that creating curricular space for critical pedagogy may be effective in fostering critical consciousness, ultimately encouraging reflexive practice and social action.
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Affiliation(s)
- Lindsay S Herzog
- Mount Sinai Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Sarah R Wright
- Michael Garron Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Wilson Centre for Research in Education, University Health Network, University of Toronto, Toronto, Canada
| | | | - Lisa Richardson
- Wilson Centre for Research in Education, University Health Network, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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McGrail MR, O’Sullivan BG. Increasing doctors working in specific rural regions through selection from and training in the same region: national evidence from Australia. HUMAN RESOURCES FOR HEALTH 2021; 19:132. [PMID: 34715868 PMCID: PMC8555311 DOI: 10.1186/s12960-021-00678-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/15/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND 'Grow your own' strategies are considered important for developing rural workforce capacity. They involve selecting health students from specific rural regions and training them for extended periods in the same regions, to improve local retention. However, most research about these strategies is limited to single institution studies that lack granularity as to whether the specific regions of origin, training and work are related. This national study aims to explore whether doctors working in specific rural regions also entered medicine from that region and/or trained in the same region, compared with those without these connections to the region. A secondary aim is to explore these associations with duration of rural training. METHODS Utilising a cross-sectional survey of Australian doctors in 2017 (n = 6627), rural region of work was defined as the doctor's main work location geocoded to one of 42 rural regions. This was matched to both (1) Rural region of undergraduate training (< 12 weeks, 3-12 months, > 1 university year) and (2) Rural region of childhood origin (6+ years), to test association with returning to work in communities of the same rural region. RESULTS Multinomial logistic regression, which adjusted for specialty, career stage and gender, showed those with > 1 year (RRR 5.2, 4.0-6.9) and 3-12 month rural training (RRR 1.4, 1.1-1.9) were more likely to work in the same rural region compared with < 12 week rural training. Those selected from a specific region and having > 1-year rural training there related to 17.4 times increased chance of working in the same rural region compared with < 12 week rural training and metropolitan origin. CONCLUSION This study provides the first national-scale empirical evidence supporting that 'grow your own' may be a key workforce capacity building strategy. It supports underserviced rural areas selecting and training more doctors, which may be preferable over policies that select from or train doctors in 'any' rural location. Longer training in the same region enhances these outcomes. Reorienting medical training to selecting and training in specific rural regions where doctors are needed is likely to be an efficient means to correcting healthcare access inequalities.
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Affiliation(s)
- Matthew R. McGrail
- The University of Queensland Rural Clinical School, 78 on Canning St, Rockhampton, QLD 4700 Australia
| | - Belinda G. O’Sullivan
- The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba, QLD DC 4350 Australia
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Nuuyoma V, Makhene A. The use of clinical practice to facilitate community engagement in the Faculty of Health Science. Nurse Educ Pract 2021; 54:103102. [PMID: 34089973 DOI: 10.1016/j.nepr.2021.103102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 04/15/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022]
Abstract
AIM This article seeks to describe how clinical practice can be used to facilitate community engagement in the Faculty of Health Science. DESIGN The study followed a qualitative exploratory, descriptive and contextual design. METHODS The study was conducted in the Faculty of Health Science at a public university in Namibia, Southern Africa. A total of 19 academic staff were purposively selected to participate in the focus group interviews. Thereafter, Giorgi's method of phenomenological data analysis was used to analyse data. Lincoln and Guba's strategies were used to establish trustworthiness. The ethical considerations followed Dhai and McQuoid-Mason's four principles. RESULTS The three themes that emerged as findings were: facilitation of community engagement through home visits as part of clinical practice; facilitation of community engagement through clinical rural placements; and facilitation of community engagement through interprofessional education and practice. CONCLUSIONS It is concluded that health science students and academic staff should conduct home visits, students' placement should also include rural based facilities and allow inter-professional education and practice in clinical practice. However, there remains an overall need to explore for community engagement projects that may be conducted in rural settings. Additionally, a generic service-learning course for all undergraduate health science students may help facilitate community engagement through interprofessional education and practice.
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Affiliation(s)
- Vistolina Nuuyoma
- Department of Nursing Science, University of Johannesburg, South Africa.
| | - Agnes Makhene
- Department of Nursing Science, University of Johannesburg, South Africa
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Guignona M, Halili S, Cristobal F, Woolley T, Reeve C, Ross SJ, Neusy AJ. A Curriculum for Achieving Universal Health Care: A Case Study of Ateneo de Zamboanga University School of Medicine. Front Public Health 2021; 9:612035. [PMID: 34026703 PMCID: PMC8132581 DOI: 10.3389/fpubh.2021.612035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Universal Health Care requires equal distribution of a health workforce equipped with competencies appropriate for local population needs. While health inequities persist in the Philippines, the Ateneo de Zamboanga University School of Medicine (ADZU-SOM) in Zamboanga Peninsula – an impoverished and underserved region – has demonstrated significant success retaining graduates and improving local health statistics. This study describes the qualitative evidence of ADZU-SOM students and graduates having positive impacts on local health services and communities, and the contextual factors associated with the school's socially-accountable mission and curriculum that contribute to these impacts. Methods: This qualitative study involved 41 one-on-one or group interviews conducted across seven participant groups (faculty, graduates, final-year students, health professionals, health workers, community members, community leaders). Gale et al's method for analyzing qualitative data in multi-disciplinary health research, WHO's “6 Building Blocks for quality health systems” framework and THEnet's social-accountability framework were used to organize and interpret data. Results: Local community members, community leaders, and health staff consistently reported examples of ADZU-SOM students and graduate doctors developing health infrastructure and providing health education, health promotion, and disease prevention activities accessible to all population groups. Students and graduates suggested these impacts were due to a number of factors, including how ADZU-SOM's sandwich model of longitudinal community-engagement culminating in 10-months continuous community placement in the final year helped them develop a strong motivation for community service, the teachings and curriculum activities that focused on public health and the social determinants of health, and faculty's commitment and ability to operationalize ADZU-SOM's mission and values. Staff also reported impacts were driven by integration of regional and national health priorities as core curriculum, and involving local stakeholders in curriculum development. Conclusions: This study provides qualitative evidence that ADZU-SOM's curriculum content and immersive community placements are training a medical workforce that is strengthening local health systems and health infrastructure across all 6 WHO “Building Blocks for quality health systems.” These findings suggest ADZU-SOM has managed to evolve a consciousness toward community service among final year students and graduates, adding evidence to the assertion it is a fully socially-accountable health professions institution.
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Affiliation(s)
- Monserrat Guignona
- School of Medicine, Ateneo de Zamboanga University, Zamboanga, Philippines
| | - Servando Halili
- School of Medicine, Ateneo de Zamboanga University, Zamboanga, Philippines.,Research and Extension, Zamboanga State College of Marine Sciences and Technology, Zamboanga, Philippines
| | | | - Torres Woolley
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Carole Reeve
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,School of Medicine, Flinders University, Alice Springs, NT, Australia
| | - Simone Jacquelyn Ross
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,The Training for Health Equity Network, New York, NY, United States
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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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Woolley T, Ross S, Larkins S, Sen Gupta T, Whaleboat D. "We learnt it, then we lived it": Influencing medical students' intentions toward rural practice and generalist careers via a socially-accountable curriculum. MEDICAL TEACHER 2021; 43:93-100. [PMID: 33016806 DOI: 10.1080/0142159x.2020.1817879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The James Cook University (JCU) medical school has a mission to produce graduates committed to practising with underserved populations. This study explores the views of final-year students regarding the influence of the JCU medical curriculum on their self-reported commitment to socially-accountable practice, intentions for rural practice, and desired postgraduate training pathway. METHODS Cross-sectional survey of final year JCU medical students (n = 113; response rate = 65%) to determine whether their future career directions (intentions for future practice rurality and postgraduate specialty training pathway) are driven more by altruism (commitment to socially accountable practice/community service) or by financial reward and/or prestige. RESULTS Overall, 96% of responding students reported their JCU medical course experiences had cultivated a greater commitment towards 'socially-accountable' practice. A commitment to socially-accountable practice over financial reward and/or prestige was also significantly associated with preferring to practise Medicine in non-metropolitan areas (p = 0.036) and intending to choose a 'generalist' medical discipline (p = 0.003). CONCLUSIONS The findings suggest the JCU medical curriculum has positively influenced the commitment of its graduating students towards more socially accountable practice. This influence is a likely result of pre-clinical teachings around health inequalities and socially-accountable medical practice in combination with real-world, immersive experiences on rural and international placements.
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Affiliation(s)
- Torres Woolley
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Simone Ross
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Donald Whaleboat
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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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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Johnston K, Guingona M, Elsanousi S, Mbokazi J, Labarda C, Cristobal FL, Upadhyay S, Othman AB, Woolley T, Acharya B, Hogenbirk JC, Ketheesan S, Craig JC, Neusy AJ, Larkins S. Training a Fit-For-Purpose Rural Health Workforce for Low- and Middle-Income Countries (LMICs): How Do Drivers and Enablers of Rural Practice Intention Differ Between Learners From LMICs and High Income Countries? Front Public Health 2020; 8:582464. [PMID: 33194989 PMCID: PMC7604342 DOI: 10.3389/fpubh.2020.582464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 11/13/2022] Open
Abstract
Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points-entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multi-national study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway.
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Affiliation(s)
- Karen Johnston
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Monsie Guingona
- Ateneo de Zamboanga University School of Medicine, Zamboanga City, Philippines
| | | | - Jabu Mbokazi
- School of Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Charlie Labarda
- School of Health Sciences, University of the Philippines, Manila, Philippines
| | | | | | | | - Torres Woolley
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | | | - John C Hogenbirk
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, ON, Canada
| | - Sarangan Ketheesan
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Sarah Larkins
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
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Clithero-Eridon A, Crandall C, Ross A. Future medical student practice intentions: the South Africa experience. BMC MEDICAL EDUCATION 2020; 20:434. [PMID: 33198729 PMCID: PMC7670592 DOI: 10.1186/s12909-020-02361-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/06/2020] [Indexed: 05/22/2023]
Abstract
BACKGROUND Primary care is a broad spectrum specialty that can serve both urban and rural populations. It is important to examine the specialties students are selecting to enter, future community size they intend to practice in as well as whether they intend to remain in the communities in which they trained. AIM The goals of this study were to characterize the background and career aspirations of medical students. Objectives were to (1) explore whether there are points in time during training that may affect career goals and (2) assess how students' background and stated motivations for choosing medicine as a career related to intended professional practice. SETTING The setting for this study was the Nelson R. Mandela School of Medicine, located in Durban, South Africa. METHODS We conducted a cross-sectional survey of 597 NRMSM medical students in their first, fourth, or sixth-year studies during the 2017 academic year. RESULTS Our findings show a noticeable lack of interest in primary care, and in particular, family medicine amongst graduating students. Altruism is not as motivating a factor for practicing medicine as it was among students beginning their education. CONCLUSION Selection of students into medical school should consider personal characteristics such as background and career motivation. Once students are selected, local context matters for training to sustain motivation. Selection of students most likely to practice primary care, then emphasizing family medicine and community immersion with underserved populations, can assist in building health workforce capacity. There are institutional, legislative, and market pressures influencing career choice either toward or away from primary care. In this paper, we will discuss only the institutional aspects.
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Affiliation(s)
- Amy Clithero-Eridon
- Department of Family & Community Medicine, University of New Mexico, MSC 09-5040, 1 UNM, Albuquerque, NM 87131-0001 USA
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico, MSC 11-6025, 1 UNM, Albuquerque, NM 87131-0001 USA
| | - Andrew Ross
- Department of Family Medicine, University of KwaZulu-Natal, 24 Jupiter Rd, Westville, Durban, 3629 South Africa
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Dunbar W, Alcide C, Raccurt C, Pape JW, Coppieters Y. Attitudes of medical students towards men who have sex with men living with HIV: implications for social accountability. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:233-239. [PMID: 33099520 PMCID: PMC7882130 DOI: 10.5116/ijme.5f87.39c2] [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: 11/24/2019] [Accepted: 10/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the attitudes that medical students in Haiti harbour toward Men who have Sex with Men living with HIV in order to better understand how stigma and other factors may impair healthcare, and to explore suggestions of opportunities in line with the values of social accountability. METHODS This study employed a qualitative design by using a grounded theory approach regarding the context of Haiti. We used purposive sampling to select the 22 research participants. In-depth interviews were conducted, audio-recorded, transcribed and analyzed using an inductive content analysis approach. RESULTS Although stigmatizing attitudes emerged through the findings, medical students expressed willingness to provide Men who have Sex with Men with adequate health services in relation to HIV care. Their expressions were based on the Men who have Sex with Men's comprehensive right to receive equitable care, the moral responsibility of healthcare professionals, their perception of health disparities and the HIV global risk reduction. Participants pointed out that the medical education curriculum did not consider sexual health and specificities of sexual minorities and suggested a more inclusive and socially accountable training based on equity and quality. CONCLUSIONS The students expressed favourable attitudes regarding health services to Men who have Sex with Men even though some layered stigmatizing attitudes emerged through the discussions. They all lacked skills on how to handle health specificities of sexual minorities. These findings recommend a revision of the medical education curriculum in regard to social accountability principles.
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Affiliation(s)
- Willy Dunbar
- Health Systems and Policies, International Health, School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Colette Alcide
- Faculty of Health Sciences, Quisqueya University, Port-au-Prince, Haiti
| | - Christian Raccurt
- Faculty of Health Sciences, Quisqueya University, Port-au-Prince, Haiti
| | - Jean W. Pape
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Yves Coppieters
- Health Systems and Policies, International Health, School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium
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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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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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Ramsay R, Stanyon M, Takahashi N. Social accountability across cultures, does the concept translate? An explorative discussion with primary care colleagues in Japan. EDUCATION FOR PRIMARY CARE 2020; 31:66-70. [PMID: 32049599 DOI: 10.1080/14739879.2020.1727780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article sets out to explore and clarify the concept of social accountability in a global health context. It examines some of the cross-cultural challenges when translating social accountability across healthcare systems with specific reference to Japanese primary care. Finally, the role of social accountability in postgraduate education and medical professionalism will be considered with practical recommendations focusing on education and training in primary care.
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Affiliation(s)
- Robin Ramsay
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Maham Stanyon
- Department of Community and Family Medicine, Centre for Medical Education and Career Development, Fukushima University, Fukushima, Japan
| | - Noryiuki Takahashi
- Department of Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, Showaku, Japan
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Sandhu VK, Jose DM, Feldman CH. Underserved Communities: Enhancing Care with Graduate Medical Education. Rheum Dis Clin North Am 2020; 46:167-178. [PMID: 31757283 PMCID: PMC8486350 DOI: 10.1016/j.rdc.2019.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The shortage of health care professionals is projected to worsen in the coming years. This is particularly concerning in underserved areas that are fraught with disparities in disease outcomes and life expectancy, quality of life, and health care access. The onus is on medical education institutions to train students to serve vulnerable communities to improve both health care access and the quality of medical school education. When health disparities are formally included in medical education curricula and the culture of medical education shifts to a community-based learning approach, patients and health care providers alike will reap the benefits.
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Affiliation(s)
- Vaneet K Sandhu
- Department of Internal Medicine, Division of Rheumatology, Loma Linda University, Loma Linda University Medical Center, 11234 Anderson Street, Suite 1521, Loma Linda, CA 92354, USA.
| | - Donna M Jose
- Department of Internal Medicine, Loma Linda University, 11234 Anderson Street, Loma Linda, CA 92354, USA
| | - Candace H Feldman
- Department of Medicine, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Office 6016P, Boston, MA 02115, USA
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Woolley T, Clithero-Eridon A, Elsanousi S, Othman AB. Does a socially-accountable curriculum transform health professional students into competent, work-ready graduates? A cross-sectional study of three medical schools across three countries. MEDICAL TEACHER 2019; 41:1427-1433. [PMID: 31407932 DOI: 10.1080/0142159x.2019.1646417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Socially-accountable health professional education (SAHPE) is committed to achieving health equity through training health-workers to meet local health needs and serve disadvantaged populations. This research assesses the biomedical and socially-accountable competencies and work-readiness of first year graduates from socially-accountable medical schools in Australia, the United States and Sudan.Method: A self-administered survey to hospital and community health facility staff closely associated with the training and/or supervision of first year medical graduates from three SAHPE medical schools.Main outcome measure: Likert scale ratings of key competencies of SAHPE graduates (as a group) employed as first-year doctors, compared to first year doctors from other medical schools in that country (as a group).Findings: Supervisors rated medical graduates from the 3 SAHPE schools highly for socially-accountable competencies ('communication skills', 'teamwork', 'professionalism', 'work-readiness', 'commitment to practise in rural communities', 'commitment to practise with underserved ethnic and cultural populations'), as well as 'overall performance' and 'overall clinical skills'.Interpretation: These findings suggest SAHPE medical graduates are well regarded by their immediate hospital supervisors, and SAHPE can produce a medical workforce as competent as from more traditional medical schools, but with greater commitment to health equity, working with underserved populations, and addressing local health needs.
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Affiliation(s)
- Torres Woolley
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Amy Clithero-Eridon
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Salwa Elsanousi
- Department of Family and Community Medicine, University of Gezira, Gezira, Sudan
| | - Abu-Bakr Othman
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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Sandhu VK, Hojjati M, Blanco I. Healthcare disparities in rheumatology: the role of education at a global level. Clin Rheumatol 2019; 39:659-666. [PMID: 31602534 DOI: 10.1007/s10067-019-04777-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 01/12/2023]
Abstract
All fields of medicine are victim to health inequity worldwide, including rheumatology. While the health system is a key proponent to health access for all, other social determinants of health also impact world health. We describe herein the current state of global healthcare disparities in rheumatology and attempts at optimizing graduate medical education and resources for optimized healthcare, international research collaborations and a future of universal health equity. We performed a comprehensive search through Pubmed using the following keywords: healthcare disparities, medical education, access to care, community health.Key Points• Healthcare disparities are ubiquitous globally, including the field of rheumatology.• The heterogeneity of global healthcare disparities emphasizes the importance of addressing unmet needs at a regional level.• A standardized approach to incorporating healthcare disparities education in the medical field is lacking. Intervening at this level provides a foundation of increasing provider awareness of regional healthcare disparities so as to establish a framework of addressing such disparities in a culturally competent manner.
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Affiliation(s)
- Vaneet Kaur Sandhu
- Division of Rheumatology, Department of Medicine, Loma Linda University, 11234 Anderson Street, MC-1516, Loma Linda, CA, 92354, USA.
| | - Mehrnaz Hojjati
- Division of Rheumatology, Department of Medicine, Loma Linda University, 11234 Anderson Street, MC-1516, Loma Linda, CA, 92354, USA
| | - Irene Blanco
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
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Exploring the Implications of a Needs-Based Pharmacy Education Framework Modelled on Population Health: Perspective from a Developing Country. PHARMACY 2019; 7:pharmacy7030116. [PMID: 31416114 PMCID: PMC6789758 DOI: 10.3390/pharmacy7030116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022] Open
Abstract
Globally, health education reform is directing efforts to strengthen the health system through collaboration between health education and health services. However, collaborative efforts vary between developed and developing countries as the health needs, economic constraints, and resource availability differs. In developing countries, resource allocation is weighed in favor of interventions that will benefit the majority of the population. The question that emerges is: How could health education, service, and research activities be (re-)aligned to optimize return on investment for the health system and society at large? This paper proposes a needs-based pharmacy educational approach by centralizing population health for a developing country like South Africa. Literature on systems-based approaches to health professional education reform and the global pharmacy education framework was reviewed. A needs-based pharmacy educational approach, the population health model which underpins health outcome measurements to gauge an educational institution’s effectiveness, was contextualized. An evaluation framework to determine the pharmacy school’s effectiveness in strengthening the health system could be applied. A needs-based pharmacy educational approach modeled on population health could: Integrate resources from education, service, and research activities; follow a monitoring and evaluation framework that tracks educational outcomes; and engage with external stakeholders in curricular development and assessment.
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Clithero-Eridon A, Albright D, Crandall C, Ross A. Contribution of the Nelson R. Mandela School of Medicine to a socially accountable health workforce. Afr J Prim Health Care Fam Med 2019; 11:e1-e7. [PMID: 31038340 PMCID: PMC6489146 DOI: 10.4102/phcfm.v11i1.1962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND A socially accountable health professional education curriculum aims to produce fit-for-purpose graduates to work in areas of need. 'Fit-for-purpose' can be assessed by monitoring graduate practice attributes. AIM The aim of this article was to identify whether graduates of 'fit-for-purpose' programmes are socially accountable. SETTING The setting for this project was all 37 district hospitals in the KwaZulu-Natal province in Durban, South Africa. METHODS We surveyed healthcare professionals working at district hospitals in the KwaZulu-Natal province. We compared four social accountability indicators identified by the Training for Health Network Framework, comparing medical doctors educated at the Nelson R. Mandela School of Medicine (NRMSM) with medical doctors educated at other South African and non-South African medical schools. In addition, we explored medical doctors' characteristics and reasons for leaving or staying at district hospitals. RESULTS The pursuit of specialisation or skills development were identified as reasons for leaving in the next 5 years. Although one-third of all medical doctors reported an intention to stay, graduates from non-South African schools remained working at a district hospital longer than graduates of NRMSM or other South African schools and they held a majority of leadership positions. Across all schools, graduates who worked at the district hospital longer than 5 years cited remaining close to family and enjoyment of the work and lifestyle as motivating factors. CONCLUSION Using a social accountability approach, this research assists in identifying areas of improvement in workforce development. Tracking what medical doctors do and where they work after graduation is important to ensure that medical schools are meeting their social accountability mandate to meet community needs.
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Affiliation(s)
- Amy Clithero-Eridon
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico.
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Jones R, Crowshoe L, Reid P, Calam B, Curtis E, Green M, Huria T, Jacklin K, Kamaka M, Lacey C, Milroy J, Paul D, Pitama S, Walker L, Webb G, Ewen S. Educating for Indigenous Health Equity: An International Consensus Statement. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:512-519. [PMID: 30277958 PMCID: PMC6445615 DOI: 10.1097/acm.0000000000002476] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education's influence-for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role and, in fact, may be complicit in perpetuating inequities.This article seeks to examine the factors underpinning medical education's role in Indigenous health inequity, to inform interventions to address these factors. The authors developed a consensus statement that synthesizes evidence from research, evaluation, and the collective experience of an international research collaboration including experts in Indigenous medical education. The statement describes foundational processes that limit Indigenous health development in medical education and articulates key principles that can be applied at multiple levels to advance Indigenous health equity.The authors recognize colonization, racism, and privilege as fundamental determinants of Indigenous health that are also deeply embedded in Western medical education. To contribute effectively to Indigenous health development, medical education institutions must engage in decolonization processes and address racism and privilege at curricular and institutional levels. Indigenous health curricula must be formalized and comprehensive, and must be consistently reinforced in all educational environments. Institutions' responsibilities extend to advocacy for health system and broader societal reform to reduce and eliminate health inequities. These activities must be adequately resourced and underpinned by investment in infrastructure and Indigenous leadership.
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Affiliation(s)
- Rhys Jones
- R. Jones is senior lecturer, Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand
| | - Lynden Crowshoe
- L. Crowshoe is associate professor, Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Papaarangi Reid
- P. Reid is professor and Tumuaki, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Betty Calam
- B. Calam is associate professor, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elana Curtis
- E. Curtis is associate professor, Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand
| | - Michael Green
- M. Green is professor and head, Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Tania Huria
- T. Huria is senior lecturer, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Kristen Jacklin
- K. Jacklin is professor, Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minnesota, and professor, Human Sciences Division, Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
| | - Martina Kamaka
- M. Kamaka is associate professor, Department of Native Hawaiian Health, University of Hawai‘i at Manoa John A. Burns School of Medicine, Honolulu, Hawai‘i
| | - Cameron Lacey
- C. Lacey is senior lecturer, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Jill Milroy
- J. Milroy is professor, School of Indigenous Studies, University of Western Australia, Perth, Western Australia, Australia
| | - David Paul
- D. Paul is professor, School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Suzanne Pitama
- S. Pitama is associate professor, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Leah Walker
- L. Walker is associate director, Centre for Excellence in Indigenous Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gillian Webb
- G. Webb is associate professor, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Shaun Ewen
- S. Ewen is professor and director, Melbourne Poche Centre for Indigenous Health, and pro vice chancellor (Indigenous), University of Melbourne, Melbourne, Victoria, Australia
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Larkins S, Johnston K, Hogenbirk JC, Willems S, Elsanousi S, Mammen M, Van Roy K, Iputo J, Cristobal FL, Greenhill J, Labarda C, Neusy AJ. Practice intentions at entry to and exit from medical schools aspiring to social accountability: findings from the Training for Health Equity Network Graduate Outcome Study. BMC MEDICAL EDUCATION 2018; 18:261. [PMID: 30424760 PMCID: PMC6234627 DOI: 10.1186/s12909-018-1360-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/25/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions. METHODS The Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet's Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent. RESULTS Findings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds. CONCLUSIONS These findings, from a diverse range of schools with social accountability mandates in different settings, provide preliminary evidence for the selection and training of a medical workforce motivated to meet the needs of underserved populations. These respondents are being followed longitudinally to determine the degree to which these intentions translate into actual practice.
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Affiliation(s)
- Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland Australia
- James Cook Drive, James Cook University, Townsville, 4810 Australia
| | - Karen Johnston
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland Australia
- Training for Health Equity Network, New York, NY USA
| | - John C. Hogenbirk
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario Canada
| | - Sara Willems
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Salwa Elsanousi
- Community Medicine, Department of Family and Community Medicine, University of Gezira, Gezira, Sudan
| | - Marykutty Mammen
- Teaching and Learning Centre, University of Fort Hare, East London, Eastern Cape South Africa
| | - Kaatje Van Roy
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Jehu Iputo
- Department of Medical Education, Walter Sisulu University, Mthatha, South Africa
| | | | | | - Charlie Labarda
- School of Health Sciences at the University of the Philippines, Manila, Philippines
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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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Woolley T, Sen Gupta T, Larkins S. Work settings of the first seven cohorts of James Cook University Bachelor of Medicine, Bachelor of Surgery graduates: Meeting a social accountability mandate through contribution to the public sector and Indigenous health services. Aust J Rural Health 2018; 26:258-264. [PMID: 29799145 DOI: 10.1111/ajr.12418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The James Cook University medical school's mission is to produce a workforce appropriate for the health needs of northern Australia. DESIGN, SETTING AND PARTICIPANTS James Cook University medical graduate data were obtained via cross-sectional survey of 180 early-career James Cook University medical graduates from 2005-2011 (response rate of 180/298 contactable graduates = 60%). Australian medical practitioner data for 2005-2009 graduates were obtained via the 2015 'Medicine in Australia: Balancing Employment and Life' wave 8 dataset. MAIN OUTCOME MEASURE Comparison of the range of work settings and hours worked by James Cook University medical graduates to Australian medical graduates. RESULTS Compared to a similar group of Australian medical graduates, James Cook University Bachelor of Medicine, Bachelor of Surgery graduates are significantly more likely to work in government-funded 'public' organisations (hospitals, community health centres, Aboriginal Community Controlled Health Services, government departments, agencies or defence forces). In particular, James Cook University medical graduates were more likely to work in Aboriginal Community Controlled Health Services and community health centres and other state-run primary health care organisations than other Australian medical graduates. CONCLUSION James Cook University medical graduates appear to work in a higher proportion of public settings; in particular, primary care settings, than Australian medical graduates. This is an appropriate mix for the predominantly rural and remote geography of Queensland and its associated medical workforce priorities. Reporting medical graduate outcomes by their nature of practice could be an important adjunct to other measures, such as geographic location and choice of specialty.
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Affiliation(s)
- Torres Woolley
- College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Tarun Sen Gupta
- College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sarah Larkins
- College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
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Woolley T, Halili SD, Siega-Sur JL, Cristobal FL, Reeve C, Ross SJ, Neusy AJ. Socially accountable medical education strengthens community health services. MEDICAL EDUCATION 2018; 52:391-403. [PMID: 29266421 DOI: 10.1111/medu.13489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/02/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Socially accountable health professional education (SAHPE) is committed to achieving health equity through training health professionals to meet local health needs and serve disadvantaged populations. This Philippines study investigates the impact of SAHPE students and graduates on child and maternal health services and outcomes. METHODS This is a non-randomised, controlled study involving a researcher-administered survey to 827 recent mothers (≥1 child aged 0-5 years). Five communities were serviced by SAHPE medical graduates or final-year medical students (interns) in Eastern Visayas and the Zamboanga Peninsula, and five communities in the same regions were serviced by conventionally trained (non-SAHPE) graduates. FINDINGS Mothers in communities serviced by SAHPE-trained medical graduates and interns were more likely than their counterpart mothers in communities serviced by non-SAPHE trained graduates to: have lower gross family income (p < 0.001); have laboratory results of blood and urine samples taken during pregnancy discussed (p < 0.001, respectively); have first pre-natal check-up before 4th month of pregnancy (p = 0.003); receive their first postnatal check-up <7 days of birth (p < 0.001); and have a youngest child with normal (>2500 g) birthweight (p = 0.003). In addition, mothers from SAHPE-serviced communities were more likely to have a youngest child that: was still breastfed at 6 months of age (p = 0.045); received a vitamin K injection soon after birth (p = 0.026); and was fully immunised against polio (p < 0.001), hepatitis B (p < 0.001), measles (p = 0.008) and diphtheria/pertussis/tetanus (p < 0.001). In communities serviced by conventional medical graduates, mothers from lower socio-economic quartiles (<20 000 Php) were less likely (p < 0.05) than higher socio-economic mothers to: report that their youngest child's delivery was assisted by a doctor; have their weight measured during pregnancy; and receive iron syrups or tablets. CONCLUSIONS The presence of SAHPE medical graduates or interns in Philippine communities significantly strengthens many recommended core elements of child and maternal health services irrespective of existing income constraints, and is associated with positive child health outcomes.
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Affiliation(s)
- Torres Woolley
- College of Medicine & Dentistry, James Cook University, Townsville, Qld, Australia
| | - Servando D Halili
- School of Medicine, Ateneo de Zamboanga University, Zamboanga City, Mindanao, Philippines
- Zamboanga State College of Marine Sciences and Technology, Zamboanga City, Mindanao, Philippines
| | | | - Fortunato L Cristobal
- School of Medicine, Ateneo de Zamboanga University, Zamboanga City, Mindanao, Philippines
| | - Carole Reeve
- College of Medicine & Dentistry, James Cook University, Townsville, Qld, Australia
- School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Simone J Ross
- College of Medicine & Dentistry, James Cook University, Townsville, Qld, Australia
- The Training for Health Equity Network, New York City, New York, USA
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Ellaway RH, Van Roy K, Preston R, Greenhill J, Clithero A, Elsanousi S, Richards J, Labarda C, Graves L, Mammen M, Assayed AA, Willems S. Translating medical school social missions to student experiences. MEDICAL EDUCATION 2018; 52:171-181. [PMID: 28949033 DOI: 10.1111/medu.13417] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/05/2017] [Accepted: 07/11/2017] [Indexed: 05/17/2023]
Abstract
CONTEXT There is a growing focus on the social missions of medical schools as a way of expressing an institutional commitment to service, responsibility and accountability. However, there has been little exploration of how a social mission translates to student experiences. METHODS This multicentre study explored how the social missions of eight medical schools (from Australia, Belgium, Canada, the Philippines, South Africa, Sudan and the USA) translated to their medical education programmes, and how their students perceived the mission. The study used a nested case study design involving interviews with final-year medical students. Constructivist grounded theory techniques were used to analyse the data. Cultural-historical activity theory concepts of externalisation and internalisation were used to structure the analyses. RESULTS The study identified substantial variation in the form, focus and depth of expression of each school's social mission, significant variation in how and to what extent the mission was externalised in the design of each school's undergraduate medical education programme, and significant variation in how students perceived the social mission and its translation to their training experiences. The translation of a social mission to educational outcomes depended on a cascade of externalisation and internalisation processes, each of which could alter or reinterpret the mission. Translation depended to a great extent on sensitising learners to the mission's values and issues and subsequently activating this knowledge in the context of direct clinical encounters that embodied the issues the mission was seeking to address. CONCLUSION Whether a medical school's social mission is focused on equity of access to the medical profession or on its graduates serving particular community needs, the mission principles need to be translated into practice. This translation process involves a series of externalisation and internalisation steps, each of which determines how much and what aspects of the mission are translated.
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Affiliation(s)
- Rachel H Ellaway
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Human Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Kaatje Van Roy
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Robyn Preston
- General Practice and Rural Medicine, James Cook University, Townsville, Queensland, Australia
| | - Jennene Greenhill
- Flinders University Rural Clinical School, Renmark, South Australia, Australia
| | - Amy Clithero
- Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | | | - Janet Richards
- Flinders University Rural Clinical School, Renmark, South Australia, Australia
| | - Charlie Labarda
- School of Health Sciences, University of the Philippines-Manila, Manila, Philippines
| | - Lisa Graves
- Human Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Department of Family and Community Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Marykutty Mammen
- Department of Human Biology, Walter Sisulu University, Mthatha, South Africa
| | | | - Sara Willems
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
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Brooker R, Hu W, Reath J, Abbott P. Medical student experiences in prison health services and social cognitive career choice: a qualitative study. BMC MEDICAL EDUCATION 2018; 18:3. [PMID: 29291725 PMCID: PMC5748951 DOI: 10.1186/s12909-017-1109-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/17/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND One of the purposes of undergraduate medical education is to assist students to consider their future career paths in medicine, alongside the needs of the societies in which they will serve. Amongst the most medically underserved groups of society are people in prison and those with a history of incarceration. In this study we examined the experiences of medical students undertaking General Practice placements in a prison health service. We used the theoretical framework of the Social Cognitive Career Theory (SCCT) to explore the potential of these placements to influence the career choices of medical students. METHODS Questionnaire and interview data were collected from final year students, comprising pre and post placement questionnaire free text responses and post placement semi-structured interviews. Data were analysed using inductive thematic analysis, with reference to concepts from the SCCT Interest Model to further develop the findings. RESULTS Clinical education delivered in a prison setting can provide learning that includes exposure to a wide variety of physical and mental health conditions and also has the potential to stimulate career interest in an under-served area. While students identified many challenges in the work of a prison doctor, increased confidence (SCCT- Self-Efficacy) occurred through performance success within challenging consultations and growth in a professional approach to prisoners and people with a history of incarceration. Positive expectations (SCCT- Outcome Expectations) of fulfilling personal values and social justice aims and of achieving public health outcomes, and a greater awareness of work as a prison doctor, including stereotype rejection, promoted student interest in working with people in contact with the criminal justice system. CONCLUSION Placements in prison health services can stimulate student interest in working with prisoners and ex-prisoners by either consolidating pre-existing interest or expanding interest into a field they had not previously considered. An important aspect of such learning is the opportunity to overcome negative preconceptions of consultations with prisoners.
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Affiliation(s)
- Ron Brooker
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Boelen C. Coordinating medical education and health care systems: the power of the social accountability approach. MEDICAL EDUCATION 2018; 52:96-102. [PMID: 28884465 DOI: 10.1111/medu.13394] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/24/2017] [Accepted: 06/06/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT As the purpose of medical education is to produce graduates able to most effectively address people's health concerns, there is general agreement that coordination with the health care system is essential. For too long, coordination has been dealt with in a subjective manner with only few landmarks to ensure objective and measurable achievements. Over the last 30 years, since the Edinburgh Declaration on medical education, progress has been made, namely with the concept of social accountability. METHODS The social accountability approach provides a way to plan, deliver and assess medical education with the explicit aim to contribute to effective, equitable and sustainable health system development. It is based on a system-wide scope exploring issues from identification of people's and society's health needs to verification of the effects of medical education in meeting those needs. A wide international consultation among medical education leaders led to the adoption of the Global Consensus on Social Accountability of Medical Schools. EXPERIENCES Benchmarks of social accountability are in the process of being conceived and tested, enabling medical schools to steer medical education in a more purposeful way in relation to determinants of health. A sample of schools using the social accountability approach claims to have had a positive influence on health care system performance and people's health status. CONCLUSION Improved coordination of medical education and other key stakeholders in the health system is an important challenge for medical schools as well as for countries confronted with an urgent need for optimal use of their health workforce. There is growing interest worldwide in defining policies and strategies and supporting experiences in this regard.
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Affiliation(s)
- Charles Boelen
- Programme of Human Resources for Health, Sciez-sur-Léman, France
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Lillo-Crespo M, Sierras-Davó MC, MacRae R, Rooney K. Developing a framework for evaluating the impact of Healthcare Improvement Science Education across Europe: a qualitative study. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2017; 14:28. [PMID: 29203760 PMCID: PMC5801324 DOI: 10.3352/jeehp.2017.14.28] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/29/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Frontline healthcare professionals are well positioned to improve the systems in which they work. Educational curricula, however, have not always equipped healthcare professionals with the skills or knowledge to implement and evaluate improvements. It is important to have a robust and standardized framework in order to evaluate the impact of such education in terms of improvement, both within and across European countries. The results of such evaluations will enhance the further development and delivery of healthcare improvement science (HIS) education. We aimed to describe the development and piloting of a framework for prospectively evaluating the impact of HIS education and learning. METHODS The evaluation framework was designed collaboratively and piloted in 7 European countries following a qualitative methodology. The present study used mixed methods to gather data from students and educators. The framework took the Kirkpatrick model of evaluation as a theoretical reference. RESULTS The framework was found to be feasible and acceptable for use across differing European higher education contexts according to the pilot study and the participants' consensus. It can be used effectively to evaluate and develop HIS education across European higher education institutions. CONCLUSION We offer a new evaluation framework to capture the impact of HIS education. The implementation of this tool has the potential to facilitate the continuous development of HIS education.
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Affiliation(s)
- Manuel Lillo-Crespo
- Nursing Department, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | | | - Rhoda MacRae
- Institute for Healthcare Policy and Practice, School of Health Nursing and Midwifery, The University of the West of Scotland, Hamilton, UK
| | - Kevin Rooney
- Department of Anaesthesia and Intensive Care Medicine, Royal Alexandra Hospital, Paisley, UK
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Siega-Sur JL, Woolley T, Ross SJ, Reeve C, Neusy AJ. The impact of socially-accountable, community-engaged medical education on graduates in the Central Philippines: Implications for the global rural medical workforce. MEDICAL TEACHER 2017; 39:1084-1091. [PMID: 28754058 DOI: 10.1080/0142159x.2017.1354126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Developing and retaining a high quality medical workforce, especially within low-resource countries has been a world-wide challenge exacerbated by a lack of medical schools, the maldistribution of doctors towards urban practice, health system inequities, and training doctors in tertiary centers rather than in rural communities. AIM To describe the impact of socially-accountable health professional education on graduates; specifically: their motivation towards community-based service, preparation for addressing local priority health issues, career choices, and practice location. METHODS Cross-sectional survey of graduates from two medical schools in the Philippines: the University of Manila-School of Health Sciences (SHS-Palo) and a medical school with a more conventional curriculum. RESULTS SHS-Palo graduates had significantly (p < 0.05) more positive attitudes to community service. SHS-Palo graduates were also more likely to work in rural and remote areas (p < 0.001) either at district or provincial hospitals (p = 0.032) or in rural government health services (p < 0.001) as Municipal or Public Health Officers (p < 0.001). Graduates also stayed longer in both their first medical position (p = 0.028) and their current position (p < 0.001). CONCLUSIONS SHS-Palo medical graduates fulfilled a key aim of their socially-accountable institution to develop a health professional workforce willing and able, and have a commitment to work in underserved rural communties.
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Affiliation(s)
- J L Siega-Sur
- a School of Health Sciences , University of the Philippines Manila , Palo , Leyte , Philippines
| | - T Woolley
- b College of Medicine and Dentistry , James Cook University , Townsville , Australia
| | - S J Ross
- b College of Medicine and Dentistry , James Cook University , Townsville , Australia
- c The Training for Health Equity Network , Brussels , Belgium
| | - C Reeve
- d School of Medicine , Flinders University , Alice Springs , Australia
| | - A-J Neusy
- c The Training for Health Equity Network , Brussels , Belgium
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Halili S'B, Cristobal F, Woolley T, Ross SJ, Reeve C, Neusy AJ. Addressing health workforce inequities in the Mindanao regions of the Philippines: Tracer study of graduates from a socially-accountable, community-engaged medical school and graduates from a conventional medical school. MEDICAL TEACHER 2017; 39:859-865. [PMID: 28580824 DOI: 10.1080/0142159x.2017.1331035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Developing and retaining a high-quality medical workforce in low-resource countries is a worldwide challenge. The Filipino Ateneo de Zamboanga University-School of Medicine (ADZU-SOM) has adopted a strong focus on socially accountable health professional education (SAHPE) in order to address the shortage of physicians across rural and urban communities in the Western Mindanao region. A cross-sectional survey of graduates from two Philippines medical schools: ADZU-SOM in the Mindanao region and a medical school with a more conventional curriculum, found ADZU-SOM graduates were more likely to have joined the medical profession due to a desire to help others (p = 0.002), came from lower socioeconomic strata (p = 0.001) and had significantly (p < 0.05) more positive attitudes to community service. ADZU graduates were also more likely to currently work in Government Rural Health Units (p < 0.001) or be generalist Medical Officers (p < 0.001) or Rural/Municipal Health Officers (p = 0.003). ADZU graduates were also less likely to work in private or specialist Government hospitals (p = 0.033 and p = 0.040, respectively) and be surgical or medical specialists (p = 0.010 and p < 0.001, respectively). The findings suggest ADZU-SOM's SAHPE philosophy manifests in the practice choices of its graduates and that the ADZU-SOM can meet the rural and urban health workforce needs of the Western Mindanao region.
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Affiliation(s)
| | - Fortunato Cristobal
- a School of Medicine , Ateneo de Zamboanga University , Zamboanga , Philippines
| | - Torres Woolley
- b College of Medicine and Dentistry , James Cook University , Townsville , Australia
| | - Simone J Ross
- b College of Medicine and Dentistry , James Cook University , Townsville , Australia
- c The Training for Health Equity Network , Brussels , Belgium
| | - Carole Reeve
- d School of Medicine , Flinders University , Alice Springs , Australia
| | - A-J Neusy
- c The Training for Health Equity Network , Brussels , Belgium
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Khoshhal KI, Guraya SY. Leaders produce leaders and managers produce followers. A systematic review of the desired competencies and standard settings for physicians' leadership. Saudi Med J 2017; 37:1061-7. [PMID: 27652355 PMCID: PMC5075368 DOI: 10.15537/smj.2016.10.15620] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objectives: To elaborate the desired qualities, traits, and styles of physician’s leadership with a deep insight into the recommended measures to inculcate leadership skills in physicians. Methods: The databases of MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched for the full-text English-language articles published during the period 2000-2015. Further search, including manual search of grey literature, was conducted from the bibliographic list of all included articles. Medical Subject Headings (MeSH) keywords “Leadership” AND “Leadership traits” AND “Leadership styles” AND “Physicians’ leadership” AND “Tomorrow’s doctors” were used for the literature search. This search followed a step-wise approach defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The retrieved bibliographic list was analyzed and non-relevant material such as abstracts, conference proceedings, letters to editor, and short communications were excluded. Finally, 21 articles were selected for this review. Results: The literature search showed a number of leadership courses and formal training programs that can transform doctors to physician leaders. Leaders can inculcate confidence by integrating diverse views and listening; supporting skillful conversations through dialogue and helping others assess their influence and expertise. In addition to their clinical competence, physician leaders need to acquire the industry knowledge (clinical processes, health-care trends, budget), problem-solving skills, and emotional intelligence. Conclusion: This review emphasizes the need for embedding formal leadership courses in the medical curricula for fostering tomorrow doctors’ leadership and organizational skills. The in-house and off-campus training programs and workshops should be arranged for grooming the potential candidates for effective leadership.
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Affiliation(s)
- Khaid I Khoshhal
- Department of Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia. E-mail.
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Clithero A, Ross SJ, Middleton L, Reeve C, Neusy AJ. Improving Community Health Using an Outcome-Oriented CQI Approach to Community-Engaged Health Professions Education. Front Public Health 2017; 5:26. [PMID: 28289678 PMCID: PMC5326770 DOI: 10.3389/fpubh.2017.00026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/09/2017] [Indexed: 11/14/2022] Open
Abstract
Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement.
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Affiliation(s)
- Amy Clithero
- Family and Community Medicine, University of New Mexico School of Medicine , Albuquerque, NM , USA
| | - Simone Jacquelyn Ross
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia; Training for Health Equity Network, New York City, NY, USA
| | - Lyn Middleton
- Training for Health Equity Network, New York City, NY, USA; School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Carole Reeve
- School of Medicine, Flinders University , Alice Springs, NT , Australia
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Ellaway RH. Moral agency and the medical education researcher. MEDICAL EDUCATION 2017; 51:3-5. [PMID: 27040491 DOI: 10.1111/medu.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Reeve C, Woolley T, Ross SJ, Mohammadi L, Halili SB, Cristobal F, Siega-Sur JLJ, Neusy AJ. The impact of socially-accountable health professional education: A systematic review of the literature. MEDICAL TEACHER 2017; 39:67-73. [PMID: 27797293 DOI: 10.1080/0142159x.2016.1231914] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This literature review describes the impact of health professional schools with a social accountability mandate by identifying characteristics of medical education found to impact positively on medical students, health workforce, and health outcomes of disadvantaged communities. A critical appraisal tool was used to identify the strengths and weaknesses of the published articles. Data are presented as a narrative synthesis due to the variety of methodologies in the studies, and characterized using a logic model. Health professional schools aiming to improve health outcomes for their disadvantaged local communities described collaborative partnerships with communities, equitable selection criteria, and community-engaged placements in underserved areas as positively impacting the learning and attitudes of students. Students of socially accountable schools were more likely to stay in rural areas and serve disadvantaged communities, and were often more skilled than students from more traditional schools to meet the needs of underserved communities. However, published literature on the impact of socially accountable health professional education on communities and health outcomes is limited, with only one study investigating health outcomes. The findings of this literature review guide schools on the inputs likely to maximize their socially accountability outputs and increase their impact on students, local health workforce and local communities.
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Affiliation(s)
- Carole Reeve
- a School of Medicine, Flinders University , Alice Springs , Australia
| | - Torres Woolley
- b College of Medicine , James Cook University , Townsville , Australia
| | - Simone J Ross
- b College of Medicine , James Cook University , Townsville , Australia
- c The Training for Health Equity Network , Brussels , Belgium
| | - Leila Mohammadi
- a School of Medicine, Flinders University , Alice Springs , Australia
| | - Servando Ben Halili
- d School of Medicine , Ateneo de Zamboanga University , Zamboanga , Philippines
| | - Fortunato Cristobal
- d School of Medicine , Ateneo de Zamboanga University , Zamboanga , Philippines
| | - Jusie Lydia J Siega-Sur
- e School of Health Sciences , University of the Philippines Manila , Palo , Leyte , The Philippines
| | - A-J Neusy
- c The Training for Health Equity Network , Brussels , Belgium
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Boelen C, Pearson D, Kaufman A, Rourke J, Woollard R, Marsh DC, Gibbs T. Producing a socially accountable medical school: AMEE Guide No. 109. MEDICAL TEACHER 2016; 38:1078-1091. [PMID: 27608933 DOI: 10.1080/0142159x.2016.1219029] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Health systems worldwide are confronted with challenges due to increased demand from their citizens, an aging population, a variety of health risks and limited resources. Key health stakeholders, including academic institutions and medical schools, are urged to develop a common vision for a more efficient and equitable health sector. It is in this environment that Boelen and Heck defined the concept of the "Social Accountability of Medical Schools" - a concept that encourages schools to produce not just highly competent professionals, but professionals who are equipped to respond to the changing challenges of healthcare through re-orientation of their education, research and service commitments, and be capable of demonstrating a positive effect upon the communities they serve. Social Accountability calls on the academic institution to demonstrate an impact on the communities served and thus make a contribution for a just and efficient health service, through mutually beneficial partnerships with other healthcare stakeholders. The purpose of this Guide is to explore the concept of Social Accountability, to explain it in more detail through examples and to identify ways to overcome obstacles to its development. Although in the Guide reference is frequently made to medical schools, the concept is equally applicable to all forms of education allied to healthcare.
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Affiliation(s)
| | | | | | - James Rourke
- d Memorial University of Newfoundland , St. John's , NL , Canada
| | | | - David C Marsh
- f Northern Ontario School of Medicine , Sudbury , ON , Canada
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Preston R, Larkins S, Taylor J, Judd J. From personal to global: Understandings of social accountability from stakeholders at four medical schools. MEDICAL TEACHER 2016; 38:987-994. [PMID: 26751185 DOI: 10.3109/0142159x.2015.1114596] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM This paper addresses the question of how social accountability is conceptualised by staff, students and community members associated with four medical schools aspiring to be socially accountable in two countries. METHODS Using a multiple case study approach this research explored how contextual issues have influenced social accountability at four medical schools: two in Australia and two in the Philippines. This paper reports on how research participants understood social accountability. Seventy-five participants were interviewed including staff, students, health sector representatives and community members. Field notes were taken and a documentary analysis was completed. RESULTS Overall there were three common understandings. Socially accountable medical education was about meeting workforce, community and health needs. Social accountability was also determined by the nature and content of programs the school implemented or how it operated. Finally, social accountability was deemed a personal responsibility. The broad consensus masked the divergent perspectives people held within each school. CONCLUSION The assumption that social accountability is universally understood could not be confirmed from these data. To strengthen social accountability it is useful to learn from these institutions' experiences to contribute to the development of the theory and practice of activities within socially accountable medical schools.
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Pálsdóttir B, Barry J, Bruno A, Barr H, Clithero A, Cobb N, De Maeseneer J, Kiguli-Malwadde E, Neusy AJ, Reeves S, Strasser R, Worley P. Training for impact: the socio-economic impact of a fit for purpose health workforce on communities. HUMAN RESOURCES FOR HEALTH 2016; 14:49. [PMID: 27523088 PMCID: PMC4983779 DOI: 10.1186/s12960-016-0143-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 07/28/2016] [Indexed: 05/04/2023]
Abstract
Across the globe, a "fit for purpose" health professional workforce is needed to meet health needs and challenges while capitalizing on existing resources and strengths of communities. However, the socio-economic impact of educating and deploying a fit for purpose health workforce can be challenging to evaluate. In this paper, we provide a brief overview of six promising strategies and interventions that provide context-relevant health professional education within the health system. The strategies focused on in the paper are:1. Distributed community-engaged learning: Education occurs in or near underserved communities using a variety of educational modalities including distance learning. Communities served provide input into and actively participate in the education process.2. Curriculum aligned with health needs: The health and social needs of targeted communities guide education, research and service programmes.3. Fit for purpose workers: Education and career tracks are designed to meet the needs of the communities served. This includes cadres such as community health workers, accelerated medically trained clinicians and extended generalists.4. Gender and social empowerment: Ensuring a diverse workforce that includes women having equal opportunity in education and are supported in their delivery of health services.5. Interprofessional training: Teaching the knowledge, skills and attitudes for working in effective teams across professions.6. South-south and north-south partnerships: Sharing of best practices and resources within and between countries.In sum, the sharing of resources, the development of a diverse and interprofessional workforce, the advancement of primary care and a strong community focus all contribute to a world where transformational education improves community health and maximizes the social and economic return on investment.
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Affiliation(s)
- Björg Pálsdóttir
- Training for Health Equity Network, New York, United States of America
| | - Jean Barry
- Consultant Nursing and Health Policy, International Council of Nurses, Geneva, Switzerland
| | - Andreia Bruno
- International Pharmaceutical Federation, The Hague, Netherlands
| | - Hugh Barr
- Centre for the Advancement of Interprofessional Education (CAIPE), London, United Kingdom
| | - Amy Clithero
- Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico United States of America
| | - Nadia Cobb
- Office for the Promotion of Global Healthcare Equity, Division of Physician Assistant Studies, University of Utah School of Medicine, Salt Lake City, Utah United States of America
| | - Jan De Maeseneer
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
- The Network: Towards Unity for Health, Ghent, Belgium
| | - Elsie Kiguli-Malwadde
- African Center for Global Health and Social Transformation (ACHEST), Kampala, Uganda
| | | | - Scott Reeves
- Interprofessional Research, Centre for Health and Social Care Research, Kingston University and St George’s, University of London, London, United Kingdom
| | - Roger Strasser
- Northern Ontario School of Medicine, Lakehead and Laurentian Universities, Sudbury and Thunder Bay, Canada
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Chen V, Foster Page L, McMillan J, Lyons K, Gibson B. Measuring the attitudes of dental students towards social accountability following dental education - Qualitative findings. MEDICAL TEACHER 2016; 38:599-606. [PMID: 26176203 DOI: 10.3109/0142159x.2015.1060303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The term social accountability has gained increased interest in medical education, but is relatively unexplored in dentistry. AIMS The aim of this study is to explore dental students' attitudes towards social accountability. METHODS A qualitative study utilizing focus groups with University of Otago final year (5th year) Bachelor of Dental Surgery (BDS) students was carried out. A questionnaire designed to measure medical students' attitudes towards social responsibility was used as a guide. Following data collection, framework analysis was used to analyze each of the three focus groups, and repeating themes were noted. RESULTS Analysis of the focus groups discovered recurring themes, such that participants believed that dentists should be accountable to society in a professional context and that they are responsible for patients who present at their clinic but that there is no professional obligation to help reduce oral health inequalities by working with populations facing inequalities. There was strong agreement that there needs to be change to the dental health care system from a structural and political level to address oral health inequalities, rather than individual dentists assuming greater responsibility. CONCLUSION Our findings show that dental education may not be accountable to society in the sense that it is not producing graduates who believe that they have an obligation to address the priority oral health concerns of society.
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