Answering important questions about social accountability

A recent U of A Faculty of Medicine & Dentistry survey shows a desire to increase knowledge of social accountability.

Shelby Soke - 09 November 2017

In October 2016, the Working Group on Social Accountability surveyed Faculty of Medicine & Dentistry faculty members and staff. With social accountability as a key expectation of medical education and Canada's health-care system, understanding the faculty's perceptions of it was crucial.

"At its core, social accountability is about meeting the priority health issues of the communities which we serve," said Jill Konkin, associate dean, community engagement and co-lead of the social accountability group. "Our priorities are to be determined in partnership with the community."

What were the results?

A total of 395 respondents completed the survey. The majority of respondents believe that social accountability is important and a majority identified that it was important in education, service and research.

While most faculty members and staff believe social accountability is important, many do not feel they are knowledgeable on the subject. An initial question about knowledge of social accountability as a concept had a small majority of respondents (55 per cent) report that they felt knowledgeable. This number decreased significantly when answering a similar question later in the survey after the definition was introduced.

Most respondents reported being aware of social accountability, but less than half said they were personally involved in social accountability initiatives or activities. Most respondents want to increase their knowledge, with two-thirds reporting that they wanted more information on social accountability.

"I was heartened that the survey established that many faculty members felt that social accountability was important, though many of them realized they didn't know as much about it as they thought they did and wanted more information," said Michael Walter, professor and chair of the Department of Medical Genetics and co-lead of the social accountability group.

What is social accountability?

Social accountability has been a movement in medical education since 1995 when the World Health Organization (WHO) called on medical schools to orient their education and research to meeting the priority health concerns of the communities they serve.

The WHO has defined the Social Accountability of Medical Schools as "the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve. The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public."

Health Canada took on the WHO's mandate in 2001 and, more recently, social accountability has become an accreditation standard for undergraduate medical education.

What are we doing to be socially accountable?

"A lot of people think that social accountability is just something that we do, but there is actually a pedagogy of social accountability, there is a lot of work being done," said Konkin. "It isn't just in medical schools, but many health professions are starting to take this up."

Konkin says that the Faculty of Medicine & Dentistry's curriculum is changing to include more about social determinants of health and populations facing health inequities, in an effort to help our learners begin to understand the issues faced by many of the populations they will serve.

There are a number of community-engaged researchers at the U of A doing work that includes people from the community they are working in and inquiring into things that are important to that community.

There are also basic scientists that are engaged with knowledge translation with clinicians. Konkin says lab scientists are getting more engaged in sharing their cutting-edge research with colleagues to help them make evidence-based decisions for their patients and their communities.

"The intent of being socially accountable isn't having the community tell researchers what to look into," said Konkin. "If the whole faculty is more oriented to the communities we serve, then for those who are doing inquiry-driven research, our communities will see how the faculty serves and is connected to the community, even if they can't understand or connect to that specific research."

Walter says that since researchers are accountable to the Canadian public that funds much of their research, they stay accountable by reporting their findings and advancing and sharing knowledge in useful ways.

The Rural Integrated Community Clerkship program is another example of socially accountable actions. Recently recognized with a David Cook award for medical curriculum innovation, the Rural Integrated Community Clerkship is a partnership with rural physicians and health professionals. It is intended to strengthen the relationships between the communities and the medical school and create the possibility for rural physicians who do not want to leave their communities to have academic careers.

Konkin stresses that social accountability is about more than just medical schools, though they play an important role. The "big picture" of social accountability includes partnerships with government, the health service, the faculty and academics, professional organizations and the communities we serve, all of the pentagram partners. Currently, the biggest gap in relationships is with our communities.

What is next?

Konkin,Walter and the social accountability working group want to engage the faculty to determine what success would look like. Currently, the working group is developing some possible outcome measures that they will bring forward to see what resonates with the faculty. Ultimately, this will also need to be developed with our communities and other pentagram partners.

According to Konkin, an example of a specific area of social accountability that needs to be tackled is health inequities.

"The Indigenous population in Alberta has a lifespan 12 years shorter than non-Indigenous populations and their infant mortality rates are where the non-Indigenous population was in the 1970s. Similarly, immigrant populations often have higher burden of disease," said Konkin.

Part of being socially accountable is examining how we have engaged with those communities to sort through what their strengths are and how we can build on them with the community.

"Discovery scientists are used to the concept that we are accountable," said Walter. "The social aspect means we need to think about it a little more broadly and ask ourselves 'are we doing enough, are we serving all of the communities we should be serving?'"

Walter also believes that researchers need to find ways to make their data more accessible and find ways to interact with the community and explain the work they do and why it is important.

What can you do right now?

Konkin recommends that if you would like to incorporate social accountability on a personal level, think about how you can be part of facilitating a culture change in our health system that will be more inclusive and culturally safe.

"There's a significant amount of individual work we can do both with ourselves and others to make culturally safe environments," said Konkin. "We need to push ourselves into looking at our power and privilege, you norm to what you are used to and we need to see beyond that."

To get involved further in social accountability planning in the Faculty of Medicine & Dentistry, or for a full copy of the survey results, please contact