“I Don’t Want to Read About It; I Want to Do It”: Perspectives on Being and Doing Social Accountability in Medical Education

Abstract

Purpose: Medical schools and healthcare institutions are increasingly committing to social accountability, the reorientation and prioritization of addressing local community health needs. Now, as part of this commitment, schools and institutions are called upon to demonstrate evidence of their progress towards social accountability to governments, accreditors, funders, and communities. This study aimed to understand what social accountability means to diverse interest holders, particularly with regard to demonstrating local evidence, to provide contextual insight for the development of an “impact framework” for one Canadian medical school. Methods: One-on-one semi-structured key informant interviews were conducted with three diverse groups: academic, health services, and community interest holders to understand multiple perspectives on social accountability in health professional education. Respondents were asked how they perceive, actualize, and measure social accountability at different levels (societal, school, individual). Interviews were transcribed and thematically analyzed. Results: Eighteen interviews were conducted, with eight academic representatives, six health care professionals, and four community leaders. The researchers identified three high-level themes in their analysis: the definition of social accountability, enacting and embodying social accountability, and measuring social accountability. There were distinct differences in terms of defining, executing, and evaluating being socially accountable and doing social accountability. Conclusion: Respondents emphasized that defining what social accountability means for a specific context is critical to advancing the movement. Acknowledging that there are similarities and differences between being socially accountable and doing social accountability is important for evaluating an individual’s or a group’s accountability to society in health care, health professional education, and research. While the actual indicators and outcomes used to assess the progress toward social accountability are likely geographically bound; meaningful engagement, shared governance and power structures, and integrated data and analytic capacities are important enablers to move social accountability measurement forward.