Development and evaluation of an online course about the social accountability of medical schools.

OBJECTIVES: The objective of this communication is to describe the development, implementation, and evaluation of a pioneering online course about the social accountability of medical schools intended to develop the skills of academic staff at medical schools in the eastern Mediterranean region. METHODS: This four-module course was developed using a six-step approach for curriculum development. Three faculty members with vast experience in social accountability delivered the course online through the MOODLE platform to participants. The content and appropriateness of the course were evaluated using Kirkpatrick's evaluation model, by offering a self-administered questionnaire that assesses the participants' opinions and feedback besides the analysis of the responses of the participants to the discussion points. RESULTS: Sixteen participants from four countries were admitted to the course. An overall 75% of the participants completed four modules. The mean number of online discussion threads was reported to be 36 responses per module. All participants regarded the course as having a clear take-home message. The majority agreed that the course introduced new concepts and corrected some of their misunderstandings about social accountability in medical schools. The main problems that participants experienced were time constraints and technical Internet problems. CONCLUSION: The application of the concept of social accountability in the day-to-day work of medical schools requires faculty to be informed and trained. The online course provides a flexible way to conduct faculty development programmes.

Time for action: key considerations for implementing social accountability in the education of health professionals.

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.

Coordinating medical education and health care systems: the power of the social accountability approach.

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.

Producing a socially accountable medical school: AMEE Guide No. 109.

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.

Is our medical school socially accountable? The case of Faculty of Medicine, Suez Canal University.

BACKGROUND: Faculty of Medicine, Suez Canal University (FOM/SCU) was established as community oriented school with innovative educational strategies. Social accountability represents the commitment of the medical school towards the community it serves. AIMS: To assess FOM/SCU compliance to social accountability using the "Conceptualization, Production, Usability" (CPU) model. METHODS: FOM/SCU's practice was reviewed against CPU model parameters. CPU consists of three domains, 11 sections and 31 parameters. Data were collected through unstructured interviews with the main stakeholders and documents review since 2005 to 2013. RESULTS: FOM/SCU shows general compliance to the three domains of the CPU. Very good compliance was shown to the "P" domain of the model through FOM/SCU's innovative educational system, students and faculty members. More work is needed on the "C" and "U" domains. CONCLUSION: FOM/SCU complies with many parameters of the CPU model; however, more work should be accomplished to comply with some items in the C and U domains so that FOM/SCU can be recognized as a proactive socially accountable school.

The social accountability of medical schools and its indicators.

CONTEXT: There is growing interest worldwide in social accountability for medical and other health professional schools. Attempts have been made to apply the concept primarily to educational reform initiatives with limited concern towards transforming an entire institution to commit and assess its education, research and service delivery missions to better meet priority health needs in society for an efficient, equitable an sustainable health system. METHODS: In this paper, we clarify the concept of social accountability in relation to responsibility and responsiveness by providing practical examples of its application; and we expand on a previously described conceptual model of social accountability (the CPU model), by further delineating the parameters composing the model and providing examples on how to translate them into meaningful indicators. DISCUSSION: The clarification of concepts of social responsibility, responsiveness and accountability and the examples provided in designing indicators may help medical schools and other health professional schools in crafting their own benchmarks to assess progress towards social accountability within the context of their particular environment.

Seeking impact of medical schools on health: meeting the challenges of social accountability.

CONTEXT: The acquisition of sums of knowledge and mastery of sophisticated technologies by medical graduates is insufficient for their responsibilities to recognise and adapt to people's evolving needs. RESPONSE: A Global Consensus on Social Accountability for Medical Schools brought together 130 organisations and individuals from around the world with responsibility for health education, professional regulation and policy making to participate for 8 months in a three-round Delphi process leading to a 3-day consensus development conference which included weighted representation from all regions of the world. The resulting Consensus reflects agreement on 10 strategic directions to enable a medical school to be socially accountable. RESULTS: The list of 10 directions embraces a system-wide scope from identification of health needs to verification of the effects of medical schools on those needs, all driven by the quest for positive impact on peoples' health status. This includes an understanding of the social context, an identification of health challenges and needs and the creation of relationships to act efficiently (directions 1 and 2). Within the spectrum of the health workforce required to address health needs, the anticipated role and competences of the doctor are described (direction 3) serving as a guide to the education strategy (direction 4), which the medical school is called to implement along with consistent research and service strategies (direction 5). Standards are required to steer the institution towards a high level of excellence (directions 6 and 7), which national authorities need to recognise (direction 8). While social accountability is a universal value (direction 9), local societies will be the ultimate appraisers of the achievements of the school and its graduates (direction 10).

[Global consensus on social accountability of medical schools]. / Consensus Mondial sur la Responsabilité Sociale des Facultés de Médecine.

A collaborative research project on the social accountability of medical schools based on the Delphi method was conducted by an international reference group composed of 130 representatives of the main associations of medical schools and medical education organizations throughout the world, in addition to experts invited to take part in a personal capacity. The project ended with a conference held in South Africa overseen by an independent adjudicator who was not an expert in the field. The event resulted in the unanimous adoption of a document entitled ?Global consensus on social accountability of medical schools'. The document emphases the importance of improving the capacity of medical schools to respond to the needs and challenges of health care for citizens and society in general, in line with the core values of quality, equity, relevance and effectiveness. The implications for reconsidering quality practices and for reviewing accreditation and evaluation criteria are presented.

Social accountability: the extra leap to excellence for educational institutions.

More than ever are we facing the challenge of providing evidence that what we do responds to priority health needs and challenges of the ones we intend to serve: patients, citizens, families, communities and the nation at large. Which are those health needs and challenges? Who defines them? How do medical schools organize themselves to address them through their education, research and service delivery functions? Principles of social accountability call for an explicit three-tier engagement: identification of current and prospective social needs and challenges, adaptation of school's programmes to meet them and verification that anticipated effects have benefited society. Measurement tools need to be designed and tested to steer development in this direction, particularly to establish a meaningful relationship between inputs, processes, outputs and impact on health. The Global Consensus on Social Accountability of Medical Schools provides a unique opportunity to foster collaborative research and development in an area of great significance for the future of medical education.

Medical schools in sub-Saharan Africa.

Small numbers of graduates from few medical schools, and emigration of graduates to other countries, contribute to low physician presence in sub-Saharan Africa. The Sub-Saharan African Medical School Study examined the challenges, innovations, and emerging trends in medical education in the region. We identified 168 medical schools; of the 146 surveyed, 105 (72%) responded. Findings from the study showed that countries are prioritising medical education scale-up as part of health-system strengthening, and we identified many innovations in premedical preparation, team-based education, and creative use of scarce research support. The study also drew attention to ubiquitous faculty shortages in basic and clinical sciences, weak physical infrastructure, and little use of external accreditation. Patterns recorded include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development. Ten recommendations provide guidance for efforts to strengthen medical education in sub-Saharan Africa.

Social accountability and accreditation: a new frontier for educational institutions.

CONTEXT: An association with excellence should be reserved for educational institutions which verify that their actions make a difference to people's well-being. The graduates they produce should not only possess all of the competencies desirable to improve the health of citizens and society, but should also use them in their professional practice. Four principles enunciated by the World Health Organization refer to the type of health care to which people have a right, from both an individual and a collective standpoint: quality, equity, relevance and effectiveness. Therefore, social, economic, cultural and environmental determinants of health must guide the strategic development of an educational institution. DISCUSSION: Social responsibility implies accountability to society for actions intended to serve it. In the health field, social accountability involves a commitment to respond as best as possible to the priority health needs of citizens and society. An educational institution should verify its impact on society by following basic principles of quality, equity, relevance and effectiveness, and by active participation in health system development. Its social accountability should be measured in three interdependent domains concerning health personnel: conceptualisation, production and utilisability. An educational institution that fully assumes the position of a responsible partner in the health care system and is dedicated to the public interest deserves a label of excellence. CONCLUSIONS: As globalisation is reassessed for its social impact, societies will seek to justify their investments with more solid evidence of their impact on the public good. Medical schools should be prepared to be judged accordingly. There is an urgent need to foster the adaptation of accreditation standards and norms that reflect social accountability. Only then can educational institutions be measured and rewarded for their real capacity to meet the pressing health care needs of society.

Social Accountability: Medical Education's Boldest Challenge.

In this century, medical schools will be gauged by their capacity to anticipate the kind of doctors required by evolving health systems. They will need to consider the challenges these health systems face as they grapple with critical health concerns in society. In this context, two things immediately become apparent: one, the roots of ill health lie in poverty, discrimination, lack of education, maldistribution and misuse of often scarce resources; and two, in any given country, those who identify health issues, act on health determinants, decide on the use of resources, deliver health services, or train health manpower are usually different groups that may not share the same value system and priorities. Thus, fragmentation is a serious threat to the efficiency and effectiveness of health systems everywhere. These observations set the table for some tough questions: What readjustments do health systems need to make? What roles should doctors play? Which responsibilities should medical schools shoulder to contribute to the development of healthier societies? I like to think that being aware of these overarching issues is a first step towards social accountability.