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

Reflections

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.

Keywords

Global health Health equity Health professional education Humans Interprofessional relations Social accountability Social responsibility 

References

  1. 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.
  2. Armstrong, S., & Rispel, L. (2015). Social accountability and nursing education in South Africa. Global Health Action, 8, 27879. doi:10.3402/gha.v8.27879.CrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. Bloom, J. R. (1990). The relationship of social support and health. Social Science and Medicine, 30, 635–637.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. Boelen, C., & Heck, J. (1995). Defining and measuring the social accountability of medical schools. Geneva: World Health Organization.Google Scholar
  8. 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.CrossRefGoogle Scholar
  9. Boelen, C., & Woollard, R. F. (2009). Social accountability and accreditations: A new frontier for educational institutions. Medical Education, 43, 888–894.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. Buchman, S., Woollard, R., Meili, R., & Goel, R. (2016). Practising social accountability. From theory to action. Canadian Family Physician, 62, 15–18.Google Scholar
  14. 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
  15. Dawson, A., & Jennings, B. (2012). The place of solidarity in public health ethics. Public Health Review, 34, 65–79.CrossRefGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. Eisenberg, L. (1995). Medicine: Molecular, monetary, or more than both? Journal of the American Medical Association, 274, 331–334.CrossRefGoogle Scholar
  19. 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
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. Frank, A. (2004). The renewal of generosity: Illness, medicine, and how to live. Chicago, IL: University of Chicago Press.CrossRefGoogle Scholar
  23. 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
  24. 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.CrossRefGoogle Scholar
  25. Global Consensus for Social Accountability of Medical Schools. (2010). (East London, South Africa). Retrieved May 11, 2017 from http://www.healthsocialaccountability.org.
  26. 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
  27. 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
  28. 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.CrossRefGoogle Scholar
  29. 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.CrossRefGoogle Scholar
  30. 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.CrossRefGoogle Scholar
  31. 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.CrossRefGoogle Scholar
  32. 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.CrossRefGoogle Scholar
  33. 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
  34. 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.CrossRefGoogle Scholar
  35. 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.CrossRefGoogle Scholar
  36. Leinster, S. (2011). Evaluation and assessment of social accountability in medical schools. Medical Teacher, 33, 673–676. doi:10.3109/0142159X.2011.590253.CrossRefGoogle Scholar
  37. 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.CrossRefGoogle Scholar
  38. 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.CrossRefGoogle Scholar
  39. Marmot, M. (2005). Social determinants of health inequalities. Lancet, 365, 1095–1104.Google Scholar
  40. 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.CrossRefGoogle Scholar
  41. 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.CrossRefGoogle Scholar
  42. 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.CrossRefGoogle Scholar
  43. 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
  44. 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.CrossRefGoogle Scholar
  45. 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
  46. 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
  47. 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.CrossRefGoogle Scholar
  48. 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.
  49. 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.CrossRefGoogle Scholar
  50. 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.CrossRefGoogle Scholar
  51. 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.CrossRefGoogle Scholar
  52. 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
  53. 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.CrossRefGoogle Scholar
  54. Porter, D. (2006). How did social medicine evolve, and where is it heading? PLoS Medicine, 3, e399. doi:10.1371/journal.pmed.0030399.CrossRefGoogle Scholar
  55. 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.CrossRefGoogle Scholar
  56. 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.CrossRefGoogle Scholar
  57. 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.CrossRefGoogle Scholar
  58. 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.
  59. 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.CrossRefGoogle Scholar
  60. 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
  61. 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.CrossRefGoogle Scholar
  62. 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.CrossRefGoogle Scholar
  63. 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.CrossRefGoogle Scholar
  64. Starfield, B. (2006). State of the art in research on equity in health. Journal of Health Politics, Policy and Law, 31, 11–32.CrossRefGoogle Scholar
  65. 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.CrossRefGoogle Scholar
  66. 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.CrossRefGoogle Scholar
  67. 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.CrossRefGoogle Scholar
  68. 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.CrossRefGoogle Scholar
  69. 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.
  70. 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.CrossRefGoogle Scholar
  71. 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.
  72. 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.CrossRefGoogle Scholar
  73. 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.CrossRefGoogle Scholar
  74. Ventres, W., & Dharamsi, S. (2015). Socially accountable medical education: The REVOLUTIONS framework. Academic Medicine, 90, 1728. doi:10.1097/ACM.0000000000000872.CrossRefGoogle Scholar
  75. 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
  76. 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.CrossRefGoogle Scholar
  77. 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
  78. 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.CrossRefGoogle Scholar
  79. 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.CrossRefGoogle Scholar
  80. 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.CrossRefGoogle Scholar
  81. 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
  82. 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.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • William Ventres
    • 1
    • 2
  • Charles Boelen
    • 3
    • 4
  • Cynthia Haq
    • 5
  1. 1.Department of Family and Preventive Medicine, College of MedicineUniversity of Arkansas for the Medical SciencesLittle RockUSA
  2. 2.Institute for Studies in History, Anthropology and ArcheologyUniversity of El SalvadorSan SalvadorEl Salvador
  3. 3.Independent International ConsultantSciezFrance
  4. 4.Program of Human Resources for HealthWorld Health OrganizationGenevaSwitzerland
  5. 5.Department of Family Medicine and Community HealthUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

Personalised recommendations