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Social accountability of medical schools. T he primary goal of undergraduate medical education (UME) : to create a doctor who is broadly educated across the key competencies of medicine and who has the knowledge and clinical skills to enter graduate training.

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Social accountability of medical schools

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The primary goal of undergraduate medical education (UME) :

  • to create a doctor who is broadly educated across the key competencies of medicine and who has the knowledge and clinicalskills to enter graduate training

It is difficult to accomplish this goal :

In traditional fragmented and highly specialized clinical environments in which medical student education competes with:


Over the years, the WHO and other organizations have advocated that doctors consciously adopt new roles to become more active in health development, particularly through primary health care

  • They have insisted on the need for new physicians to acquire
  • new competencies:?????

However, too few medical schools have acted to recast their educational programs accordingly

  • As a result, a mismatch has persisted between what is being taught and learned in medical schools and what is expected from future doctors in their health systems
  • Traditional medical education in high- and low-income countries emphasize :
  • Biomedical disease-oriented model
  • alone does not fully address today’s public health need, and often lacks firm social mandates

Criteria to determine the social accountability of a medical school

  • The extent to which the school’s guiding principles are community orientated
  • The emphasis placed in the curriculum on concepts and knowledge of what constitutes a community and a population, how to measure and cope with health needs and how to take proper account of the cultural and social background
  • The extent to which community-based learning forms part of the curriculum
  • The degree of community involvement in the training program
  • The organizational linkages between the school or program and the health services system

What major initiatives should a medical school take to be recognized as “socially accountable”?



  • The school must :
  • provide ample and appropriate learning opportunities for medical students to grasp the complexity of socio-economic determinants in health
  • integrate the biomedical aspects of diseases into a holistic approach to health


  • The school must :
  • Share responsibility for ensuring equitable and quality health services delivery to an entire population within a well defined geographical area
  • In this context, public health and health service research should be declared priority investments to experiment and develop best health practices for involving future graduates.


  • the school must :
  • Recognize social accountability as a mark of academic excellence, promoting relevant evaluation and accreditation standards and mechanisms
  • New standards should be adopted highlighting the school’s capacity to anticipate the profile, mix, and number of health professionals needed to meet society’s present and future priority health concerns, and its ability to help create relevant work environments for its graduates
  • Moreover, the school’s performance should be assessed by a group composed partly by academic staff and partly by representatives of the society the school intends to serve.

A number of innovative medical education programs, building on social accountability principles, have been established to address priority health needs of their communities and health systems


In 2007, the Global Health Education Consortium (GHEC) received funding to facilitate the development of a network of socially accountable medical schools whose express mandate is to train physicians for addressing health needs in resource-constrained settings.

  • GHEC identified eight medical education programs of varying sizes and operating in high- and low-income countries, whose mission is to train doctors for service in underserved areas

These schools are:

  • The Latin American School of Medicine in Cuba (ELAM)
  • The Comprehensive Community Physician Training Program in Venezuela (CCPTP)
  • The Northern Ontario School of Medicine in Canada (NOSM)
  • The Faculty of Health Sciences at Walter Sisulu University in SouthAfrica (WSU)
  • Flinders University School of Medicine (FLINDERS) and James Cook Faculty of Medicine, Health and Molecular Sciences (JCU) in Australia
  • Ateneode Zamboanga University School of Medicine (ADZU) and the University of Philippines School of Health Sciences (SHS) in the Philippines

In late 2008 : THE net was created:

  • To increase understanding globally of how schools can produce health and health workforce outcomes that improve health equity and health system performance and how to measure progress towards these goals

It is a global network of socially accountable schools sharing a core commitment to achieving equity in health care and health outcomes through quality education, service and action-oriented research responsive to the needs ofcommunities and health care systems.



  • Established in 1975
  • Parallel Rural Community Curriculum established in 1997
  • PRCC students are placed in rural general practice, with medicine, surgery, pediatrics, obstetrics and gynecology and specialties integrated throughout the year
  • Program has government support with university- local service provider and community partnerships


  • Established in 1985 as a rural medical school, reformed curriculum in 1992
  • Leading problem-based learning and community-based medical education program in Africa
  • Learning activities occur in rural provincial health system and through community partnerships program


  • Established in 1994
  • Problem- and competency-based learning model with strong locally oriented public health and behavioral perspectives; includes working on clinical problems and on the method of problem analysis itself
  • Service learning model—students provide services from the 1st year, including implementing inter sectorial health development programs.
  • Students spend close to 50% of their time in the community


  • Established in 1999
  • Large scale, currently training 9,000 students with 6000 graduates
  • Recruit students from underserved communities in Latin America-Africa-North America
  • Scholarships offered for study in Cuba, including training in Cuban communities
  • Last year of six-year curriculum in internship in country (community) of origin


  • Established in 2000
  • Innovative medical curriculum with a focus on rural & remote health, indigenous health & tropical medicine
  • Clinical experience in the rural and remote context at an early stage


  • Established in 2005
  • Large scale, currently training 23,000
  • All learning takes place in the communities students are from or in close proximity
  • Faculty are community-based physicians, most with masters degree in medical education
  • The faculty in collaboration with underserved communities is simultaneously developing and integrating medical education program into primary care infrastructure


  • Established in 2005
  • Smaller scale and rural
  • Up 40% of distributed learning takes places in urban, rural and aboriginal communities in the North, facilitated by trained practitioners and faculties miles away from students
  • Highly integrated curriculum with no courses by discipline, instead organized around five themes
  • e-curriculum allows students posted in different communities to work as teams and participate in virtual academic rounds


  • Community- and competency-based step ladder curriculum Integrates training of health workers, midwives, nurses and physicians in a single, sequential, and continuous curriculum

In conclusion:

  • Simply placing students in a community setting as part of the curriculum is not a sufficient response to the challenge of social accountability in medical education.
  • A comprehensive strategy would include education, clinical service and research.
  • The education component would include a continuum of community-related activities throughout undergraduate education
  • The services component would include clinical outreach activities as well as a commitment to producing the appropriate mix of generalists and specialists to serve the whole community.
  • Finally, the research component would involve university faculty, members of the community and program funders in addressing research questions formulated in consultation with the community

community-based education: (WHO , 1987)

  • learning activities that take place within the community in which not only students but also teachers and patients are actively engaged throughout the educational experience
  • Community-based education can be implemented wherever people live, in rural, suburban or urban areas

rationale behind community-oriented medical education (Habbick & Leeder) :

  • creating more appropriate knowledge, skills and attitudes
  • Deeper understanding of range of health, illness, and the workings of health and social services
  • Deeper understanding of the contribution of social and environmental factors to the causation and prevention of illness
  • A more patient-oriented perspective
  • making better use of the expertise and availability of staff and patients who are in primary care settings
  • enhancing multidisciplinary working
  • Broader range of learning opportunities
  • Increasing recruitment into primary care and generalist specialties.

Collectively, THE net enables sharing, peer support and collaboration while working with stakeholders to develop and disseminate evidence, challenge assumptions, set standards and promote socially accountable medical education