Symposium #2 - Learn About Social Accountability Standards

A Conceptual Framework to Generate Standards for Assessing and Accrediting Progress Towards Social Accountability


Somaya Hosny is a board member of the National Authority of quality assurance and accreditation and education in Egypt and a professor in histology and cell biology at the Faculty of Medicine at the Suez Canal University.

Paul Grand’Maison is a family doctor and professor emeritus at the Faculty of Medicine and Health Sciences at the University of Sherbrooke—member of ISAASC, RIFRESS steering committee, and the Accreditation Committee for worldwide francophone medical schools.

Charles Boelen is an international consultant in health systems and workforce. Former coordinator of WHO headquarters program of human resources for health. President of RIFRESS - International francophone network for social accountability in health

Robert Woollard is a Professor of Medicine at the University of British Columbia. He has chaired Canada’s accreditation systems for UGE and continuing professional development. Has been working on the issue of social accountability for more than three decades.


Conceptual Framework

ISAATT’s main objective revolves around understanding how medical schools contribute to societal health needs. It employs a five-box framework (see powerpoint, linked to above), the first box examines an institution’s considerations regarding health in society(ex., the population profile, health system, and health workforce), and the second box examines the function and structures of a medical school (ex., the mission statement, curriculum, faculty, and research efforts). The goal is to determine if we can measure the strength of the relationship between “health in society” and “function and structures of a medical school. This raises a dual challenge: how do we assess progress towards social accountability, and what does global relevance imply?

To address this dual challenge, a three-level gradient assessment is suggested that emphasizes progress toward social accountability, moving from mere awareness to transformation and finally to impact. This approach promotes continuous quality improvement within medical schools rather than viewing accreditation as a one-time audit process. Additionally, the project emphasizes the need for global relevance and outlines requirements such as practicality, clarity, universality, flexibility, and transferability. In the accreditation process, the institutions will receive a general assessment, a specific assessment, and a spectrum of indicators.

Box 3 to 5 within the conceptual framework relates to the evaluation and accreditation of the institutions. For Box 3, a general assessment is conducted, which grades the institution on a scale of 0-3 based on whether the institution is responding optimally to the needs of society. To conduct this assessment, each of the structures and functions listed in box 2 are examined and provided a grade. A grade of “1” indicates that the institution is aware of the needs of society, a grade of “2” indicates that the institution is willing to transform due to its awareness, and a grade of “3” indicates the institution’s transformation has had an impact on society.

Box 4 is designed to provide a narrative description of the observations made through the evaluation process of boxes 1-3. This is referred to as a specific assessment and provides a more precise outline of the grade the institution has received. Finally, box 5 is referred to as a spectrum of indicators that helps institutions to improve their processes. It provides a collection of standards that illustrate levels 1(awareness), 2 (transformation), and 3 (impact) for each function and structure of the institution. Suggestions for levels 1, 2, and 3 are created based on the availability of literature and if not available, will encourage research and development in the area to understand different indicators.


Example of Progress towards Social Accountability: How to Proceed from Box 1 to Box 5

To exemplify how to proceed from Box 1 to Box 5, one issue regarding health in society was examined. This example will consider the strong policy for universal health coverage (UHC) and how this is linked to social accountability in medical schools. Starting at Box1 (health system), we can examine the underlying issues for UHC, such as accessibility of services and community-based primary care. Moving to Box 2(function/ structure of a medical school), we can examine the relevant elements for UHC. This involves the mission, curriculum, contribution to health services, and partnership of the medical school and how this is linked to UHC and increasing accessibility and improving community-based primary care. For the general assessment in Box 3, one would evaluate to what extent the medical school contributes to UHC. Evaluation would look at what kind of contributions members of the medical school are making towards health services with the view of accessibility and community-based primary care. This would result in a grade for the medical school based on their contributions, for example, Level 1 which would indicate the school is aware of some elements linked to UHC in their structures and functions. Box 4 would expand upon Box 3 to provide a narrative on the evidence that would justify the mark given at Box 3. Lastly, Box 5involves identifying a spectrum of indicators with consideration of the context of awareness (level 1), transformation (level 2), and impact (level 3). There should be examples of indicators suggested for levels 1, 2, and 3 which allow the medical school to build upon their current structure. This can include suggestions for improving the mission statement, MD curriculum, partnership, and health services.


Group Discussion

In terms of implementation, the group discussion touches on the challenges and potential strategies, highlighting the need for a comprehensive approach that involves both top-down and bottom-up measures. It underscores the importance of ensuring that social accountability is integrated into the core of medical school activities and is not just limited to mission statements. The discussion also suggests using a fractional gradient system, with descriptors and rubrics to guide implementation and track progress effectively over time. The aim is to foster adynamic and continuously improving healthcare education system that remains responsive to evolving societal needs.


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