Skip to main content

Advertisement

SpringerLink
Log in

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

  • Reflections
  • Published:
Advances in Health Sciences Education Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Adler, N. E., Cutler, D. M., Fielding, J. E., Galea, S., Glymour, M. M., Koh, H. K., et al. (2016). Addressing social determinants of health and health disparities: A vital direction for health and health care. Retreived May 11, 2017 from https://nam.edu/wp-content/uploads/2016/09/Addressing-Social-Determinants-of-Health-and-Health-Disparities.pdf.

  • Armstrong, S., & Rispel, L. (2015). Social accountability and nursing education in South Africa. Global Health Action, 8, 27879. doi:10.3402/gha.v8.27879.

    Article  Google Scholar 

  • Bezruchka, S. (2012). The hurrider I go the behinder I get: The deteriorating international ranking of US health status. Annual Review of Public Health, 33, 157–173. doi:10.1146/annurev-publhealth-031811-124649.

    Article  Google Scholar 

  • Bloom, J. R. (1990). The relationship of social support and health. Social Science and Medicine, 30, 635–637.

    Article  Google Scholar 

  • Bloom, S. W. (1989). Structure and ideology in medical education: An analysis of resistance to change. Journal of Health and Social Behavior, 29, 294–306.

    Article  Google Scholar 

  • Boelen, C., Dharamsi, S., & Gibbs, T. (2012). The social accountability of medical schools and its indicators. Education for Health (Abingdon), 25, 180–194. doi:10.4103/1357-6283.109785.

    Article  Google Scholar 

  • Boelen, C., & Heck, J. (1995). Defining and measuring the social accountability of medical schools. Geneva: World Health Organization.

    Google Scholar 

  • Boelen, C., Pearson, D., Kaufman, A., Rourke, J., Woollard, R., Marsh, D. C., et al. (2016). Producing a socially accountable medical school: AMEE Guide No. 109. Medical Teacher, 38, 1078–1091. doi:10.1080/0142159X.2016.1219029.

    Article  Google Scholar 

  • Boelen, C., & Woollard, R. F. (2009). Social accountability and accreditations: A new frontier for educational institutions. Medical Education, 43, 888–894.

    Article  Google Scholar 

  • Boelen, C., & Woollard, R. (2011). Social accountability: The extra leap to excellence for educational institutions. Medical Teacher, 33, 614–619. doi:10.3109/0142159X.2011.59024.

    Article  Google Scholar 

  • Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010). Socioeconomic disparities in health in the United States: What the patterns tell us. American Journal of Public Health, 100(suppl 1), S186–S196. doi:10.2105/AJPH.2009.166082.

    Article  Google Scholar 

  • Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports, 129(suppl 2), 19–31. doi:10.1177/00333549141291S206.

    Article  Google Scholar 

  • Buchman, S., Woollard, R., Meili, R., & Goel, R. (2016). Practising social accountability. From theory to action. Canadian Family Physician, 62, 15–18.

    Google Scholar 

  • Cooke, M., Irby, D., & O’Brien, B. (2010). Educating physicians: A call for reform of medical school and residency. San Francisco, CA: Jossey-Bass.

    Google Scholar 

  • Dawson, A., & Jennings, B. (2012). The place of solidarity in public health ethics. Public Health Review, 34, 65–79.

    Article  Google Scholar 

  • Dharamsi, S., Ho, A., Spadafora, S. M., & Woollard, R. (2011). The physician as health advocate: Translating the quest for social responsibility into medical education and practice. Academic Medicine, 86, 1108–1113. doi:10.1097/ACM.0b013e318226b43b.

    Article  Google Scholar 

  • Eichbaum, Q. (2017). Acquired and participatory competencies in health professions education: Definition and assessment in global health. Academic Medicine, 92, 468–474. doi:10.1097/ACM.0000000000001382.

    Article  Google Scholar 

  • Eisenberg, L. (1995). Medicine: Molecular, monetary, or more than both? Journal of the American Medical Association, 274, 331–334.

    Article  Google Scholar 

  • Engel, G. L. (1988). How much longer must medicine’s science be bounded by a seventeenth century world view? In K. L. White (Ed.), The task of medicine: Dialogue at Wickenburg (pp. 113–136). Menlo Park, CA: The Henry Kaiser Family Foundation.

    Google Scholar 

  • Fleet, L. J., Kirby, F., Cutler, S., Dunikowski, L., Nasmith, L., & Shaughnessy, R. (2008). Continuing professional development and social accountability: A review of the literature. Journal of Interprofessional Care, 22(Suppl 1), 15–29. doi:10.1080/13561820802028360.

    Article  Google Scholar 

  • Flinkenflögel, M., Ogunbanjo, G., Cubaka, V. K., & De Maeseneer, J. (2015). Rwandan family medicine residents expanding their training into South Africa: The use of south-south medical electives in enhancing learning experiences. BMC Medical Education, 15, 124. doi:10.1186/s12909-015-0405-3.

    Article  Google Scholar 

  • Frank, A. (2004). The renewal of generosity: Illness, medicine, and how to live. Chicago, IL: University of Chicago Press.

    Book  Google Scholar 

  • Frank, J. R., Snell, L., & Sherbino, J. (Eds.). (2015). CanMEDS 2015 physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada.

    Google Scholar 

  • Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., et al. (2010). Health professionals for a new century: Transforming education to strengthen health professions in an interdependent world. Lancet, 376, 1923–1938. doi:10.1016/S0140-6736(10)61854-5.

    Article  Google Scholar 

  • Global Consensus for Social Accountability of Medical Schools. (2010). (East London, South Africa). Retrieved May 11, 2017 from http://www.healthsocialaccountability.org.

  • Goel, R., Buchman, S., Meili, R., & Woollard, R. (2016). Social accountability at the micro level: One patient at a time. Canadian Family Physician, 62(287–290), 299–302.

    Google Scholar 

  • Haq, C., Rothenberg, D., Gjerde, C., Bobula, J., Wilson, C., Bickley, L., et al. (2000). New world views: Preparing physicians in training for global health work. Family Medicine, 32, 566–572.

    Google Scholar 

  • Haq, C., Stearns, M., Brill, J., Crouse, B., Foertsch, J., Knox, K., et al. (2013). Training in urban medicine and public health: TRIUMPH. Academic Medicine, 88, 352–363. doi:10.1097/ACM.0b013e3182811a75.

    Article  Google Scholar 

  • Ho, K., Buote, D., Jarvis-Selinger, S., Lauscher, H. N., Ferdinands, L., Parboosingh, J., et al. (2008). Achieving social accountability through interprofessional collaboration: The Canadian medical schools experience. Journal of Interprofessional Care, 22(suppl 1), 4–14. doi:10.1080/13561820802028410.

    Article  Google Scholar 

  • Hosny, S., Ghaly, M., & Boelen, C. (2015). Is our medical school socially accountable? The case of Faculty of Medicine, Suez Canal University. Medical Teacher, 37(Suppl 1), S47–S55. doi:10.3109/0142159X.2015.1006600.

    Article  Google Scholar 

  • Kaprielian, V. S., Silberberg, M., McDonald, M. A., Koo, D., Hull, S. K., Murphy, G., et al. (2013). Teaching population health: A competency map approach to education. Academic Medicine, 88, 626–637. doi:10.1097/ACM.0b013e31828acf27.

    Article  Google Scholar 

  • Kasper, J., Greene, J. A., Farmer, P. E., & Jones, D. S. (2016). All health is global health, all medicine is social medicine: Integrating the social sciences into the preclinical curriculum. Academic Medicine, 91, 628–632. doi:10.1097/ACM.0000000000001054.

    Article  Google Scholar 

  • Kaye, D. K., Mwanika, A., & Sewankambo, N. (2010). Influence of the training experience of Makerere University medical and nursing graduates on willingness and competence to work in rural health facilities. Rural and Remote Health, 10, 1372.

    Google Scholar 

  • Kumagai, A. K., & Lypson, M. L. (2009). Beyond cultural competence: Critical consciousness, social justice, and multicultural education. Academic Medicine, 84, 782–787. doi:10.1097/ACM.0b013e3181a42398.

    Article  Google Scholar 

  • Larkins, S. L., Preston, R., Matte, M. C., Lindemann, I. C., Samson, R., Tandinco, F. D., et al. (2013). Measuring social accountability in health professional education: Development and international pilot testing of an evaluation framework. Medical Teacher, 35, 32–45. doi:10.3109/0142159X.2012.731106.

    Article  Google Scholar 

  • Leinster, S. (2011). Evaluation and assessment of social accountability in medical schools. Medical Teacher, 33, 673–676. doi:10.3109/0142159X.2011.590253.

    Article  Google Scholar 

  • Lodenstein, E., Dieleman, M., Gerretsen, B., & Broerse, J. E. (2017). Health provider responsiveness to social accountability initiatives in low- and middle-income countries: A realist review. Health Policy and Planning, 32, 125–140. doi:10.1093/heapol/czw089.

    Article  Google Scholar 

  • Maeshiro, R., Johnson, I., Koo, D., Parboosingh, J., Carney, J. K., Gesundheit, N., et al. (2010). Medical education for a healthier population: Reflections on the Flexner Report from a public health perspective. Academic Medicine, 85, 211–219. doi:10.1097/ACM.0b013e3181c885d8.

    Article  Google Scholar 

  • Marmot, M. (2005). Social determinants of health inequalities. Lancet, 365, 1095–1104.

    Google Scholar 

  • Meili, R., Ganem-Cuenca, A., Leung, J. W., & Zaleschuk, D. (2011). The CARE model of social accountability: Promoting cultural change. Academic Medicine, 86, 1114–1119. doi:10.1097/ACM.0b013e318226adf6.

    Article  Google Scholar 

  • Meurer, L. N., Young, S. A., Meurer, J. R., Johnson, S. L., Gilbert, I. A., & Diehr, S. (2011). The urban and community health pathway. American Journal of Preventive Medicine, 41(suppl 4), S228–S236. doi:10.1016/j.amepre.2011.06.005.

    Article  Google Scholar 

  • Michaels, D. C., Reid, S. J., & Naidu, C. S. (2014). Peer review for social accountability of health sciences education: A model from South Africa. Education for Health (Abingdon), 27, 127–131. doi:10.4103/1357-6283.143728.

    Article  Google Scholar 

  • Morley, C. P., Mader, E. M., Smilnak, T., Bazemore, A., Petterson, S., Rodriguez, J. E., et al. (2015). The social mission in medical school mission statements: Associations with graduate outcomes. Family Medicine, 47, 427–434.

    Google Scholar 

  • Mullan, F., Chen, C., Petterson, S., Kolsky, G., & Spagnola, M. (2010). The social mission of medical education: Ranking the schools. Annals of Internal Medicine, 152, 804–811. doi:10.7326/0003-4819-152-12-201006150-00009.

    Article  Google Scholar 

  • Murray, R. B., Larkins, S., & Russell, H. (2012). Medical schools as agents of change: Socially accountable medical education. Medical Journal of Australia, 196(1–5), 51.

    Google Scholar 

  • National Academies of Sciences, Engineering, and Medicine. (2016). A framework for educating health professionals to address the social determinants of health. Washington, DC: The National Academies Press. doi:10.17226/21923.

    Google Scholar 

  • O’Brien, M. J., Garland, J. M., Murphy, K. M., Shuman, S. J., Whitaker, R. C., & Larson, S. C. (2014). Training medical students in the social determinants of health: The Health Scholars Program at Puentes de Salud. Advances in Medical Education and Practice, 5, 307–314. doi:10.2147/AMEP.S67480.

    Article  Google Scholar 

  • Pan American Health Organization. (2007). Renewing Primary Health Care in the Americas: A position paper of the Pan American Health Organization/World Health Organization (PAHO/WHO). Washington DC: PAHO. Retrieved May 11, 2017 from http://apps.who.int/medicinedocs/documents/s19055en/s19055en.pdf.

  • Panosian, C., & Coates, T. J. (2006). The new medical “missionaries”: Grooming the next generation of global health workers. New England Journal of Medicine, 354, 1771–1773.

    Article  Google Scholar 

  • Papp, S. A., Gogoi, A., & Campbell, C. (2013). Improving maternal health through social accountability: A case study from Orissa, India. Global Public Health, 8, 449–464. doi:10.1080/17441692.2012.748085.

    Article  Google Scholar 

  • Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., et al. (2015). Racism as a determinant of health: A systematic review and meta-analysis. PLoS ONE, 10, e0138511. doi:10.1371/journal.pone.0138511.

    Article  Google Scholar 

  • Parsi, K., & List, J. (2008). Preparing medical students for the world: Service learning and global health justice. Medscape Journal of Medicine, 10, 268.

    Google Scholar 

  • Pickett, K., & Wilkinson, R. (2014). Income inequality and health: A causal review. Social Science and Medicine, 128, 316–326. doi:10.1016/j.socscimed.2014.12.031.

    Article  Google Scholar 

  • Porter, D. (2006). How did social medicine evolve, and where is it heading? PLoS Medicine, 3, e399. doi:10.1371/journal.pmed.0030399.

    Article  Google Scholar 

  • Puschel, K., Rojas, P., Erazo, A., Thompson, B., Lopez, J., & Barros, J. (2014). Social accountability of medical schools and academic primary care training in Latin America: Principles but not practice. Family Practice, 31, 399–408. doi:10.1093/fampra/cmu010.

    Article  Google Scholar 

  • Quintana, F., Sarasa, N. L., Canizares, O., & Huguet, Y. (2012). Assessment of a complementary curricular strategy for training South African physicians in a Cuban medical university. MEDICC Review, 14, 19–24.

    Article  Google Scholar 

  • Reddy, A. T., Lazreg, S. A., Phillips, R. L., Jr., Bazemore, A. W., & Lucan, S. C. (2013). Toward defining and measuring social accountability in graduate medical education: A stakeholder study. Journal of Graduate Medical Education, 5, 439–445. doi:10.4300/JGME-D-12-00274.1.

    Article  Google Scholar 

  • Robert Wood Johnson Foundation. (2016). How we work: Building a culture of health. Retrieved May 11, 2017 from http://www.rwjf.org/en/how-we-work/building-a-culture-of-health.html.

  • Schroeder, S. A., Zones, J. S., & Showstack, J. A. (1989). Academic medicine as a public trust. Journal of the American Medical Association, 262, 803–812.

    Article  Google Scholar 

  • Sharma, M., Pinto, A. D., & Kumagai, A. K. (2017). Teaching the social determinants of health: A path to equity or a road to nowhere? Academic Medicine. doi:10.1097/ACM.0000000000001689. [Epub ahead of print].

    Google Scholar 

  • Shaw, E. K., Howard, J., West, D. R., Crabtree, B. F., Nease, D. E., Jr., Tutt, B., et al. (2012). The role of the champion in primary care change efforts. Journal of the American Board of Family Medicine, 25, 676–685. doi:10.3122/jabfm.2012.05.110281.

    Article  Google Scholar 

  • Showstack, J., Fein, O., Ford, D., Kaufman, A., Cross, A., Madoff, M., et al. (1992). Health of the public. The academic response. Health of the Public Mission Statement Working Group. Journal of the American Medical Association, 267, 2497–2502.

    Article  Google Scholar 

  • South, J., & Phillips, G. (2014). Evaluating community engagement as part of the public health system. Journal of Epidemiology and Community Health, 68, 692–696. doi:10.1136/jech-2013-203742.

    Article  Google Scholar 

  • Starfield, B. (2006). State of the art in research on equity in health. Journal of Health Politics, Policy and Law, 31, 11–32.

    Article  Google Scholar 

  • Strasser, R., Hogenbirk, J. C., Minore, B., Marsh, D. C., Berry, S., McCready, W. G., et al. (2013). Transforming health professional education through social accountability: Canada’s Northern Ontario School of Medicine. Medical Teacher, 13, 490–496. doi:10.3109/0142159X.2013.774334.

    Article  Google Scholar 

  • Strasser, R., Worley, P., Cristobal, F., Marsh, D. C., Berry, S., Strasser, S., et al. (2015). Putting communities in the driver’s seat: The realities of community-engaged medical education. Academic Medicine, 90, 1466–1470. doi:10.1097/ACM.0000000000000765.

    Article  Google Scholar 

  • Strelnick, A. H., Swiderski, D., Fornari, A., Gorski, V., Korin, E., Ozuah, P., et al. (2008). The residency program in social medicine of Montefiore Medical Center: 37 years of mission-driven, interdisciplinary training in primary care, population health, and social medicine. Academic Medicine, 83, 378–389. doi:10.1097/ACM.0b013e31816684a4.

    Article  Google Scholar 

  • Stringhini, S., Sabia, S., Shipley, M., Brunner, E., Nabi, H., Kivimaki, M., et al. (2010). Association of socioeconomic position with health behaviors and mortality. Journal of the American Medical Association, 303, 1159–1166. doi:10.1001/jama.2010.297.

    Article  Google Scholar 

  • Training for Health Equity Network. (2011). THEnet’s social accountability evaluation framework, Version 1, Monograph I (1st ed.). Retrieved May 11, 2017 from http://thenetcommunity.org/wp-content/uploads/2013/05/The-Monograph.pdf.

  • Tyer-Viola, L., Nicholas, P. K., Corless, I. B., Barry, D. M., Hoyt, P., Fitzpatrick, J. J., et al. (2009). Social responsibility of nursing: A global perspective. Policy, Politics, and Nursing Practice, 10, 110–118. doi:10.1177/1527154409339528.

    Article  Google Scholar 

  • US Centers for Disease Control and Prevention. (2013). Community health assessment for population health improvement: Resource of most frequently recommended health outcomes and determinants. Atlanta, GA: Office of Surveillance, Epidemiology, and Laboratory Services. Retrieved May 11, 2017 from https://wwwn.cdc.gov/CommunityHealth/PDF/Final_CHAforPHI_508.pdf.

  • Vanderbilt, A. A., Baugh, R. F., Hogue, P. A., Brennan, P. A., & Imran, I. (2016). Curricular integration of social medicine: A prospective for medical educators. Medical Education Online, 21, 30586. doi:10.3402/meo.v21.30586.

    Article  Google Scholar 

  • Ventres, W. B. (2017). Global family medicine: A ‘UNIVERSAL’ mnemonic. Journal of the American Board of Family Medicine, 30, 104–108. doi:10.3122/jabfm.2017.01.160074.

    Article  Google Scholar 

  • Ventres, W., & Dharamsi, S. (2015). Socially accountable medical education: The REVOLUTIONS framework. Academic Medicine, 90, 1728. doi:10.1097/ACM.0000000000000872.

    Article  Google Scholar 

  • Ventres, W., Dharamsi, S., & Ferrer, R. (2016). From social determinants to social interdependency: Theory, reflection, and engagement. Social Medicine, 11(2), 84–89.

    Google Scholar 

  • Ventres, W. B., & Fort, M. P. (2014). Eyes wide open: An essay on engaged awareness in global medicine and public health. BMC International Health and Human Rights, 14, 29. doi:10.1186/s12914-014-0029-4.

    Article  Google Scholar 

  • Ventres, W., & Haq, C. (2014). Toward a cultural consciousness of self-in-relationship: From “us and them” to “we”. Family Medicine, 46, 691–695.

    Google Scholar 

  • Ventres, W. B., & Wilson, C. L. (2015). Beyond ethical and curricular guidelines in global health: Attitudinal development on international service-learning trips. BMC Medical Educaton, 15, 68. doi:10.1186/s12909-015-0357-7.

    Article  Google Scholar 

  • Weiler, A. M., Hergesheimer, C., Brisbois, B., Wittman, H., Yassi, A., & Spiegel, J. M. (2015). Food sovereignty, food security and health equity: A meta-narrative mapping exercise. Health Policy and Planning, 30, 1078–1092. doi:10.1093/heapol/czu109.

    Article  Google Scholar 

  • Woolf, S. H., & Braveman, P. (2011). Where health disparities begin: The role of social and economic determinants—and why current policies may make matters worse. Health Affairs (Millwood), 30, 1852–1859. doi:10.1377/hlthaff.2011.0685.

    Article  Google Scholar 

  • Woollard, R., Buchman, S., Meili, R., Strasser, R., Alexander, I., & Goel, R. (2016). Social accountability at the meso level: Into the community. Canadian Family Physician, 62, 538–540.

    Google Scholar 

  • Zink, T., Halaas, G. W., Finstad, D., & Brooks, K. D. (2008). The rural physician associate program: The value of immersion learning for third-year medical students. Journal of Rural Health, 24, 353–359. doi:10.1111/j.1748-0361.2008.00181.x.

    Article  Google Scholar 

Download references

Acknowledgements

Dr. Ventres thanks the Brocher Foundation, Geneva, Switzerland; the Faculty of Health Sciences, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa; and the Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, Texas, for supporting him with residential fellowships during which this essay was designed, written, and revised.

Author information

Authors and Affiliations

  1. 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

    William Ventres

  2. Institute for Studies in History, Anthropology and Archeology, University of El Salvador, San Salvador, El Salvador

    William Ventres

  3. Independent International Consultant, Sciez, France

    Charles Boelen

  4. Program of Human Resources for Health, World Health Organization, Geneva, Switzerland

    Charles Boelen

  5. Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Cynthia Haq

Authors
  1. William Ventres
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charles Boelen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cynthia Haq
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William Ventres.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

The author Charles Boelen is retired from the Program of Human Resources for Health, World Health Organization, Geneva, Switzerland.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ventres, W., Boelen, C. & Haq, C. Time for action: key considerations for implementing social accountability in the education of health professionals. Adv in Health Sci Educ 23, 853–862 (2018). https://doi.org/10.1007/s10459-017-9792-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10459-017-9792-z

Keywords

Search

Navigation