Crossing the Bridge from the Education Campus Island to the Community: Will we Walk or do we Learn to Swim?

Abstract

As we move through the second decade of the twenty-first century, health professional education is increasingly being evaluated through a social accountability lens [1]. The WHO defines social accountability in medical education as “the obligation to orient education, research, and service activities towards priority health concerns of the local communities, the region and/or nation one has a mandate to serve. These priorities are jointly defined by government, health service organisations, and the public” [2]. This lens is evident in position statements by organisations such as the Training for Health Equity Network (THEnet) [3], the World Federation for Medical Education [4], and the Global Consensus on Social Accountability in Medical Education [5], and by the Association for Medical Education in Europe including social accountability as one of only three categories for their awards for excellence in medical education (the ASPIRE initiative [6]). As an example, I see social accountability being played out in our school through a team of paediatric medical scientists and clinicians who are educating our MD students in an environment bathed by research that is impacting our community, in this case, a group focused on discovering and implementing new approaches to the basic scientific understanding and treatment of bronchiolitis, the most common reason in our community for infants to be separated from their homes and families. These scientists and clinicians are inspirational mentors to MD students eager to adopt positive role models. In clinical education, this social accountability lens has resulted in a sometimes radical shift of clinical teaching out of the traditional single tertiary hospital campus and into multiple community settings, particularly in underserved regions [7, 8]. This has been supported by the disruptive technology of longitudinal integrated clerkships (LICs), a relationship-based pedagogy where medical students undertake an entire academic year of clinical study based in community settings, often with an emphasis on primary care teachers, rather than undertaking tertiary hospital rotations through the traditional specialist disciplines [9]. Many medical schools base LICs in multiple dispersed sites and use blended eLearning approaches to assist students to be able to access core learning materials and library resources. Schools have developed LICs based in underserved communities because of the known association with an increased likelihood that graduates of these programs will choose careers based in these community settings [10, 11]. Additional research has demonstrated that the academic results [12] achieved by students in these settings are at least equivalent to their traditional campus peers and, in the areas of professionalism, there appear to be significant additional benefits [13]. With some notable exceptions [14, 15], however, the basic science teaching in health profession courses has remained * Paul Worley paul.worley@flinders.edu.au