PS017 - Social Accountability and Accreditation of Medical Schools: Are New Norms Needed?

Nelson Sewankambo,   shared his experiences of fostering social accountability as Dean of Makerere University Medical School, Uganda, including stakeholder participation in curriculum review, community-based education throughout the country, and research amongst vulnerable populations. Key learning points that emerged from these experiences were:

• There is a need to change the center of gravity - looking outside in rather than always inside out, and using the views of the beneficiaries to contribute to change;
• Old institutions can change;
• Change can be a win-win situation for all: the institution, the graduate and the community;
• In order to maintain change, staff need to be motivated and engaged;

Like many rural and remote regions around the world, Northern Ontario has a chronic shortage of doctors and health care providers. Recognizing that medical graduates who have grown up in a rural area are more likely to practice in a rural setting, in 2001 a new medical school was founded in the region. Roger Strasser, founding Dean of the Northern Ontario School of Medicine, pointed to the social accountability mandate of the school, an obligation to contribute to improving the health of the peoples and communities of Northern Ontario. To do so, the school actively recruits students from the region and relies heavily on broad band electronic communication to support distributed community engaged learning in a diversity of communities.

Philippe Chastonay, from the Institute of Social and Preventive Medicine at University of Geneva, reflected on the commitment of his medical students to the community. Switching from traditional frontal teaching to problem-based learning offered students at the University of Geneva the opportunity to take part in a community immersion programme. Students had to select, research and tackle a priority health problem, considering its bio-psycho-social complexity. The students' involvement exceeded the expectations of the Faculty: many students remained deeply involved after the end of the programme, truly becoming actors of change, equal partners among other health professionals and strong advocates of a participatory approach to health. In doing so they strengthened both public health and the position of the medical school in the community.

The discussion highlighted the need for inclusion of social accountability standards in accreditation of medical schools, and the need for a timescale and mechanism for such inclusion. The need to extend the community-based focus of the training into the 'internship' or 'residency' placements was also discussed, and the opportunities for students to have practical experience in different parts of the world. Finally, the enthusiasm of students for community involvement was underlined, and the transformative power of such experiences was appreciated.