Social Accountability in Medical Education


A DIFFERENT DRUM

Dr. Malaya Santos

Dr. Malaya Pimentel-Santos is a long-time community health advocate, having worked with several non-government health organizations. She is a fellow of the Philippine Dermatological Society and a professor of microbiology at the St. Luke’s College of Medicine.

For comments, msantosmd@hotmail.com


The World Health Organization has defined social accountability for 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 needs are to be identified jointly by governments, healthcare organizations, health professionals and the public” (Boelen and Heck, 1995)

Over the past two decades, the importance of social accountability has slowly but surely gained recognition. In 2010, Drs. Julio Frenk and Lincoln Chen published an article in The Lancet entitled Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. This paper– considered by many as a milestone in medical education reform – helped to highlight the changing global landscape and the next great challenge amidst the scientific advances of the 21st century: to ensure the just and equitable distribution of progress in healthcare.

In that same year (2010), over a hundred organizations and individuals working in health education, professional regulation and policy-making came together to formulate the first Global Consensus for Social Accountability in Medical Schools (GCSA). This document outlined the greater responsibility facing educators in this millennium: to help respond to current and future health needs and improve quality, equity, relevance and effectiveness in health care delivery.

Transformative education in the Philippine context

The Philippines is classified as a lower middle-income country (World Bank data). Despite improving economic indicators, there is significant inequality in income distribution (Gini Index of 40.10 in 2015), the majority of health care expenditure is still paid out of pocket (Philippine Statistics Authority, 2018), and access to health and other basic services remains inadequate for many populations. In what is known as the global information age, the lamentable state of our country’s digital infrastructure placed us 101st in the world on the information and communications technology (ICT) Development Index (2017).

On the upside, the ongoing government-mandated transition to outcome-based education (OBE) has helped to emphasize the role of medical schools in producing graduates equipped to meet current challenges in healthcare in multi-faceted roles as clinicians, researchers, decision-makers, communicators, leaders and managers. This shift to OBE has compelled educators to realign medical pedagogy to not only develop clinical competency, but also outcomes like professionalism, the systems-based approach to healthcare, nationalism, internationalism, and social accountability.

Given this reality and recognizing the impact of the social determinants of health, how then does the academe help to promote social accountability within the framework of local and global health systems? More importantly, against what parameters can we measure the success of such programs and projects?

Private sector initiatives

Social accountability – like ethics and professionalism which is the subject of earlier articles – is not an easy subject matter to teach. Auspiciously, a search of the literature will reveal guiding frameworks such as the Global Consensus for Social Accountability (GCSA, 2010) and the Association for Medical Education in Europe (AMEE) Guide to Producing a Socially Accountable Medical School (Boelen et al, 2016).

These and other related literature serve as a reminder that social accountability must be approached intentionally and proactively through instruction, role modeling, training and assessment, and integrated at all levels of the medical curriculum. Furthermore, the principles and practice of social accountability must also be apparent in areas such as research and organizational service, outreach and extension programs.

I teach at a local private non-stock, non-profit institution for higher learning that offers postgraduate degrees in medicine and molecular medicine. Guided by the principles of transformative education and aligned with our vision, mission and core values, it is our goal to leverage educational strategies and tools to promote the core values of stewardship, professionalism, integrity, compassion, and excellence towards producing graduates adequately prepared to address the national and global health agenda and tackle contemporary challenges in healthcare. In support of this, we recognize the value of providing venues to engage in critical discourse, obtain inspiration, and leverage multisectoral partnership and collaboration towards developing professionalism, social accountability and evidence-based innovation in medical education.

Serving the people

As a member of my school’s admissions committee, I have been conducting interviews for aspiring medical students for a little over a decade. One question I always ask is ‘why do you want to be a doctor?’ and in earnest reply I invariably get some form of ‘because I want to serve’. On one hand, perhaps hopeful applicants give this answer because they feel it is what interview panels want to hear. On the other hand, the more idealistic part of me would like to believe that the majority of would-be physicians begin their journey with a sincere and simple dream to one day make a difference and be of service to mankind.

The World Medical Association’s 2017 version of the Hippocratic oath begins with the declaration: “I SOLEMNLY PLEDGE to dedicate my life to the service of humanity. This further underscores the noble task of the academe, which is to deliberately and purposefully strive to keep this spark alive and nurture the dream into a concrete experience of ethical service, compassion and social accountability.

January 2019 Health and Lifestyle

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