Tomlin Paul | Building social accountability in medical education

An international meeting of medical education experts in 1994, called by the World Health Organisation (WHO) and the Educational Commission for Foreign Medical Graduates, affirmed that serving the specific needs of populations and individuals is an essential part of the definition of quality of medical education and should be an important goal of all medical schools.

Social accountability of medical schools was defined in 1995 by the WHO as: "The obligation to direct their education, research, and service activities towards addressing the priority health concerns of the community, the region, or nation they have a mandate to serve."

The UWI's experience

After nearly 70 years of operation, the medical school at the University of the West Indies, (UWI) Mona, remains at the forefront of crafting and renewing a socially accountable agenda for its students and graduates.

One of the best examples of social mission in medical education in the region is seen in the pioneering work of the late Sir Kenneth Standard, who was the first professor and head of the Department of Social and Preventive Medicine at the UWI in Jamaica.

'Sir Ken' pioneered the development of the primary health care team and started programmes for training community health aides and nurse practitioners. He also established rural training sites for medical students with the aim of increasing their willingness to work in rural underserved communities.

The social obligation gradient

There are three different gradients in social obligation, from social responsibility to social responsiveness and social accountability.

Under 'social responsibility', the aim of the education programme is to produce a 'good' practitioner, leaving it mainly to the school to define which competences are the most appropriate to meet the health needs of patients.

In contrast, under 'social responsiveness', the education programme aims to attain clearly defined competences derived from an objective analysis of people's health needs and grouped under the generic concept of professionalism.

Meanwhile, under 'social accountability', the ambition of the educational programme is to produce health-system change agents who would have a greater impact on heath-system performance and ultimately on people's health status.

The programme is contextualised, so that it takes into account essential factors and challenges to improve health in that setting.

The value of social accountability in medical education

Social accountability, while expanding the scope of medical education to include community as true partners, calls for a deeper understanding of disease occurrence within the context of social determinants or the system and structures, impacting health in the broadest sense.

For the medical student, it can be seen as enriching the experience of becoming a doctor and creating a more exhaustive understanding of the role of the physician.

What it does more directly for the medical education endeavour is to increase its relevance. Clinical medicine in the advent of technology and innovation has made great impacts on individual health.

Social accountability, as a movement, has the potential to provide medical schools with a quantum leap in relevance and impact as it prods for addressing priority health problems through a more fundamental framework.

Increasingly, excellence in medical education is being linked to the notion of usefulness and impact and the notion of making the greatest possible difference on people's health.

Focusing curriculum on social determinants

Our medical school at UWI, Mona, has a curriculum in which students are exposed to the conditions in which people live and work.

Students have a community-oriented, service-learning experience and are able to conduct research and analyse community health problems.

A deeper focus of the curriculum on the forces and systems shaping the conditions of daily life is taking place to foster critical analysis around the social determinants and the role they play in shaping the lives of the people being served by the graduates of the medical school.

This engagement will allow for ways to address the impact of economic policies and systems, development agendas, social norms, social policies, and political systems on health outcomes.

Student outreach

In addition to formal curriculum opportunities, the programme has recently stepped up its outreach activities to communities. This is done under faculty supervision while, at the same time, having medical students work within a team setting with their counterpart health-professional students. Our students play a key role in leadership for social outreach within the academy.

At the country level, the school has continued to work closely with the Ministry of Health to achieve meaningful integration of our students and graduates into the country's health system, inclusive of partnering in relevant research.

- Dr Tomlin Paul is the recently appointed Dean of the Faculty of Medical Sciences, UWI, Mona. Feedback: editorial@gleanerjm.com