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

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

Key drivers of social accountability in nine Canadian medical schools.

A social accountability mandate for Canadian medical schools formally emerged in Canada with changes to accreditation standards in 2015. However, how social accountability is defined and operationalized within medical schools has transpired independently. Key enablers of social accountability in Canadian medical schools have been largely unexplored. This paper is the first of a two part series that seeks to explore drivers of social accountability in a sample of Canadian medical schools. Nine key drivers of social accountability emerged from the data including a unified vision, committed leadership, accreditation standards, champions of social accountability, authentic community engagement, community-based learning opportunities, a supportive organizational and governance structure, diversity within medical schools, and measurement of progress and outcomes. This is the first study of its kind to examine what is driving social accountability across Canadian medical schools. An appreciative inquiry approach highlights areas of progress for future work to focus and build upon. This paper presents the findings from part one of the study - exploring the themes emerging from key informant interviews with senior leaders. A second paper will dive into the broader perspectives of faculty, staff and students, to explore more fully the varying perspectives of social accountability within colleges.

Possible link of Interleukin-6 and Interleukin-2 with psychiatric diagnosis, ethnicity, disaster or BMI.

BACKGROUND: Cytokines are of increasing interest as markers for stress responses, mental disorders and general health. We assessed associations of two cytokines with several factors among relocated hurricane survivors and controls. METHODS: We examined 40 relocated hurricane survivors and 40 demographically matched (frequency matching) Oklahoma controls to assess relationships of Interleukin-2 (IL-2) and Interleukin-6 (IL-6) with psychiatric diagnoses (SCID-IV), demographic variables, hurricane exposure and body mass index (BMI). Participants were predominantly African American (n=70, 87.5%). RESULTS: Relocated Katrina survivors had higher proportions of current PTSD, major depression and psychiatric diagnoses than controls. Unexpectedly, exposure to Katrina with relocation was not by itself associated with differences in IL-2 or IL-6 levels. The mean IL-2 level was significantly higher in African American participants than other ethnicities (8 Caucasians, 2 Asians) and in those with a current psychiatric disorder. The mean IL-6 level was higher in females than males and in participants with any current psychiatric diagnosis. IL-6 level also correlated positively with participants' BMI. CONCLUSIONS: Results suggest that cytokines studied were influenced non-specifically by the presence of a mental disorder, and by demographic variables of gender, ethnicity and BMI. Implications of these findings are discussed, as well as possible long-term impact of the identified interleukin differences on immunologic, inflammatory, neuropsychiatric and other systems.

Exploring social accountability in Canadian medical schools: broader perspectives.

This article was migrated. The article was marked as recommended. This article is the second of a two-part series in a study that explores key drivers of social accountability in Canada's medical schools and offers examples of social accountability in action. The study gathered perspectives from medical school staff, students and faculty through focus group discussions, using an appreciative inquiry approach. Drivers of social accountability emerging from the focus groups largely corroborate what was discovered in the first part of the series during key informant interviews with senior leaders. These include the importance of accreditation, leadership, vision and mandate, and community engagement among others, and highlight the key role champions play in driving social accountability. This study builds on the first article in the series by recognizing leadership as an important driver for social accountability, but highlighting how leadership alone is not enough. The broader range of perspectives gathered through the focus group discussions uncovered the importance of social accountability 'champions' at all levels: formal leadership, faculty, student and staff. Focus group discussions also uncovered an additional key driver that was not found in key informant interviews - cultural humility, with participants noting that action towards social accountability requires shifts not only in organizational structure, but also organizational culture, to foster real, lasting change. This study demonstrates the utility of an appreciative inquiry approach for understanding how complex systems like medical education institutions are innovatively tackling challenges around health equity. The richness of the themes that emerged consistently across focus group sessions and key informant interviews support the utility of the approach in furthering our understanding as to what is working to drive social accountability in some Canadian medical schools.

Neuropsychological Outcomes of Exposure to Hurricane Katrina and Relocation.

OBJECTIVE: Survivors of natural disasters are at risk for mental health sequela, including deficits in neurocognitive functioning. This study explores links between hurricane exposure and resulting psychiatric symptoms and deficits in cognitive processing, attention, learning, and memory. METHODS: Relocated Katrina survivors and demographically matched controls completed neurocognitive tests assessing processing speed (Trail Making Test, Part A), mental flexibility (Trail Making Test, Part B), sustained attention (Conner's Continuous Performance Test), and learning and memory (Rey Auditory-Verbal Learning Test). PTSD (Clinician-Administered PTSD Scale) and depressive symptoms (BDI- II) were also measured. RESULTS: Survivors had more PTSD and depression symptoms and weaker performance in cognitive processing, mental flexibility, and sustained attention, but not memory and learning compared to controls. When controlling for depression and PTSD symptoms (analysis of covariances), only CPT-II response time remained significantly different for survivors, so that sustained attention deficits were independent of emotional symptoms. CONCLUSION: Survivors had more psychiatric symptoms and neurocognitive dysfunctions than controls in most assessed measures. Our study had mixed results in identifying cognitive deficits related to psychopathology. Results suggest that disaster survivors, even those without psychopathology, should be assessed for cognitive issues that may affect their ability to process post-disaster instructions and access assistance in recovery efforts.

Evaluating the implementation and outcomes of the Saskatchewan Pressure Ulcer Guidelines in long-term care facilities.

The Health Quality Council and the Saskatchewan Association of Health Organizations convened a committee to develop evidence-based best practice guidelines for pressure ulcer prevention and management in the province of Saskatchewan, Canada. The Health Quality Council designed a pilot project to 1) implement these guidelines in long-term care facilities using an evidence-based strategy and 2) evaluate the impact of the guidelines on the incidence and prevalence of residents with pressure ulcers. Seven long-term care facilities in Saskatchewan participated in the project, which ran from November 2004 to September 2005. Data from 753 patients were collected and analyzed. Following guideline implementation, the incidence of residents with pressure ulcers decreased from 6.0% to 0.2% and the prevalence rate decreased from 8.8% to 3.7%. The greater decline in incidence compared to prevalence suggests that process improvements occurred primarily in the prevention of new pressure ulcers. These results suggest that organizational commitment to improving skin and wound care followed by the facilitated implementation of evidence-based guidelines can result in improved clinical outcomes for long-term care residents.