Exploring social accountability in Canadian medical schools: broader perspectives.

Kira Koepke,Erin Walling,Robert Woollard,Eric Lachance,Lisa Yeo

doi:10.15694/mep.2020.000283.1

Abstract

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.

Highlights

Canadian medical schools have a major role and accountability for improving the health of their communities and ensuring their activities align with the needs and priorities of the population they serve (Boelen et al, 2019)
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
Focus group discussions 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 in organizational structure, and organizational culture, to foster real, lasting change

Summary

Introduction

Canadian medical schools have a major role and accountability for improving the health of their communities and ensuring their activities align with the needs and priorities of the population they serve (Boelen et al, 2019). Little is known about how Canadian medical schools are putting social accountability into action, the factors and elements that support social accountability, and the successes had to date. This article is the second in a two-part series that presents the results of a study that applied an appreciative inquiry approach in order to better understand how some of Canada’s medical schools are putting social accountability into action. That article uncovered emerging themes driving social accountability including visionary leadership, accreditation standards, champions, authentic community engagement (including community-based learning opportunities), a supportive organizational and governance structure, diversity within medical schools and measurement of social accountability progress and outcomes. In recognizing that action around social accountability occurs at various levels in institutions, this second paper broadens our understanding by capturing the perspectives of faculty, staff and students (n=32) through focus groups conducted at four Canadian medical schools. The focus groups included an intentional mix of perspectives from those involved directly in student education, program design, community outreach and patient care

Methods

Discussion

Conclusion