Simone Ross

Measuring social accountability in health professional education: Development and international pilot testing of an evaluation framework

Background: Health professional schools are responsible for producing graduates with competencies and attitudes to address health inequities and respond to priority health needs. Health professional schools striving towards social accountability founded the Training for Health Equity Network (THEnet). Aim: This article describes the development of THEnet evaluation framework for socially accountable health professional education, presents the framework to be used as a tool by other schools and discusses the findings of pilot implementation at five schools. Methods: The framework was designed collaboratively and built on Boelen and Woollards conceptualization, production and usability model. It includes key components, linked to aspirational statements, indicators and suggested measurement tools. Five schools completed pilot implementation, involving workshops, document/data review and focus group discussions with faculty, students and community members. Results: Three sections of the framework consider: How does our school work?; What do we do? and What difference do we make? Pilot testing proved that the evaluation framework was acceptable and feasible across contexts and produced findings useful at school level and to compare schools. The framework is designed as a formative exercise to help schools take a critical look at their performance and progress towards social accountability. Initiatives to implement the framework more widely are underway. The framework effectively aids in identifying strengths, weaknesses and gaps, with a view to schools striving for continuous self-improvement. Conclusion: THEnet evaluation framework is applicable and useful across contexts. It is possible and desirable to assess progress towards social accountability in health professional schools and this is an important step in producing health professionals with knowledge, attitudes, and skills to meet the challenges of priority health needs of underserved populations.

Impact of selection strategies on representation of underserved populations and intention to practise: international findings

Socially accountable medical schools aim to reduce health inequalities by training workforces responsive to the priority health needs of underserved communities. One key strategy involves recruiting students from underserved and unequally represented communities on the basis that they may be more likely to return and address local health priorities. This study describes the impacts of different selection strategies of medical schools that aspire to social accountability on the presence of students from underserved communities in their medical education programmes and on student practice intentions.

The training for health equity network evaluation framework: A pilot study at five health professional schools

Background: The Training for Health Equity Network (THEnet), a group of diverse health professional schools aspiring toward social accountability, developed and pilot tested a comprehensive evaluation framework to assess progress toward socially accountable health professions education. The evaluation framework provides criteria for schools to assess their level of social accountability within their organization and planning; education, research and service delivery; and the direct and indirect impacts of the school and its graduates, on the community and health system. This paper describes the pilot implementation of testing the evaluation framework across five THEnet schools, and examines whether the evaluation framework was practical and feasible across contexts for the purposes of critical reflection and continuous improvement in terms of progress towards social accountability. Methods: In this pilot study, schools utilized the evaluation framework using a mixed method approach of data collection comprising of workshops, qualitative interviews and focus group discussions, document review and collation and analysis of existing quantitative data. Results: The evaluation framework allowed each school to contextually gather evidence on how it was meeting the aspirational goals of social accountability across a range of school activities, and to identify strengths and areas for improvement and development. Discussion: The evaluation framework pilot study demonstrated how social accountability can be assessed through a critically reflective and comprehensive process. As social accountability focuses on the relationship between health professions schools and health system and health population outcomes, each school was able to demonstrate to students, health professionals, governments, accrediting bodies, communities and other stakeholders how current and future health care needs of populations are addressed in terms of education, research, and service learning.

The impact of socially-accountable health professional education: A systematic review of the literature

Abstract This literature review describes the impact of health professional schools with a social accountability mandate by identifying characteristics of medical education found to impact positively on medical students, health workforce, and health outcomes of disadvantaged communities. A critical appraisal tool was used to identify the strengths and weaknesses of the published articles. Data are presented as a narrative synthesis due to the variety of methodologies in the studies, and characterized using a logic model. Health professional schools aiming to improve health outcomes for their disadvantaged local communities described collaborative partnerships with communities, equitable selection criteria, and community-engaged placements in underserved areas as positively impacting the learning and attitudes of students. Students of socially accountable schools were more likely to stay in rural areas and serve disadvantaged communities, and were often more skilled than students from more traditional schools to meet the needs of underserved communities. However, published literature on the impact of socially accountable health professional education on communities and health outcomes is limited, with only one study investigating health outcomes. The findings of this literature review guide schools on the inputs likely to maximize their socially accountability outputs and increase their impact on students, local health workforce and local communities.

The impact of socially-accountable, community-engaged medical education on graduates in the Central Philippines: Implications for the global rural medical workforce

Abstract Introduction: Developing and retaining a high quality medical workforce, especially within low-resource countries has been a world-wide challenge exacerbated by a lack of medical schools, the maldistribution of doctors towards urban practice, health system inequities, and training doctors in tertiary centers rather than in rural communities. Aim: To describe the impact of socially-accountable health professional education on graduates; specifically: their motivation towards community-based service, preparation for addressing local priority health issues, career choices, and practice location. Methods: Cross-sectional survey of graduates from two medical schools in the Philippines: the University of Manila-School of Health Sciences (SHS-Palo) and a medical school with a more conventional curriculum. Results: SHS-Palo graduates had significantly (p < 0.05) more positive attitudes to community service. SHS-Palo graduates were also more likely to work in rural and remote areas (p < 0.001) either at district or provincial hospitals (p = 0.032) or in rural government health services (p < 0.001) as Municipal or Public Health Officers (p < 0.001). Graduates also stayed longer in both their first medical position (p = 0.028) and their current position (p < 0.001). Conclusions: SHS-Palo medical graduates fulfilled a key aim of their socially-accountable institution to develop a health professional workforce willing and able, and have a commitment to work in underserved rural communties.

Addressing health workforce inequities in the Mindanao regions of the Philippines: Tracer study of graduates from a socially-accountable, community-engaged medical school and graduates from a conventional medical school

Abstract Developing and retaining a high-quality medical workforce in low-resource countries is a worldwide challenge. The Filipino Ateneo de Zamboanga University–School of Medicine (ADZU-SOM) has adopted a strong focus on socially accountable health professional education (SAHPE) in order to address the shortage of physicians across rural and urban communities in the Western Mindanao region. A cross-sectional survey of graduates from two Philippines medical schools: ADZU-SOM in the Mindanao region and a medical school with a more conventional curriculum, found ADZU-SOM graduates were more likely to have joined the medical profession due to a desire to help others (p = 0.002), came from lower socioeconomic strata (p = 0.001) and had significantly (p < 0.05) more positive attitudes to community service. ADZU graduates were also more likely to currently work in Government Rural Health Units (p < 0.001) or be generalist Medical Officers (p < 0.001) or Rural/Municipal Health Officers (p = 0.003). ADZU graduates were also less likely to work in private or specialist Government hospitals (p = 0.033 and p = 0.040, respectively) and be surgical or medical specialists (p = 0.010 and p < 0.001, respectively). The findings suggest ADZU-SOM’s SAHPE philosophy manifests in the practice choices of its graduates and that the ADZU-SOM can meet the rural and urban health workforce needs of the Western Mindanao region.

Leadership skills for medical student clubs and societies

The Australian Medical Council, the national standards body for basic medical education, recommends that all medical students develop leadership skills. There is often little formal teaching of leadership skills in the core medical curriculum. Medical student clubs and societies (societies) offer one mechanism through which to develop leadership skills during higher education.

Socially accountable medical education strengthens community health services

Socially accountable health professional education (SAHPE) is committed to achieving health equity through training health professionals to meet local health needs and serve disadvantaged populations. This Philippines study investigates the impact of SAHPE students and graduates on child and maternal health services and outcomes.

Improving Community Health Using an Outcome-Oriented CQI Approach to Community-Engaged Health Professions Education

Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement.