What is social accountability, and how does it translate into the activities of the College of Medicine?
Written by Lisa Yeo, Division of Social Accountability Strategist, U of S

The Division of Social Accountability, CoM was established in 2011 to promote and support the college’s social accountability promise – a promise to direct its Clinical, Advocacy, Research and Education (CARE Model) activities towards the priority health needs of the communities we serve. We see this promise reflected in the 2017-2022 College of Medicine Strategic Plan and mission statement of our college. It’s a promise to address community health needs, but it’s also much more than that.

The definition of social accountability came out of the World Health Organization in 1995 and states that social accountability is “the obligation [of medical schools] 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.” But what does that really mean and how does it translate into the activities of the CoM? What values and philosophy are we upholding by being socially accountable?

For us, social accountability is about health equity. It’s about access to quality healthcare for all people and it’s about meeting the unique needs of underserved populations. It’s about engaging with and being responsive to the issues our communities face and recognizing that we—as a College of Medicine, as current and future clinicians, researchers, health educators and administrators—are but one part of the complex condition that is health. Improving health is tantamount to working together in partnership with policy makers, health care organizations, health professionals and communities to create a sustainable and equitable health care system. It’s about humbly acknowledging the limitations of our clinical work, and appreciating that major and pervasive factors that contribute to the wellness and ill-health of Canadians  often lie far beyond the walls of the hospital or the clinic.

Translated into our world of medical education, social accountability is about ensuring that our graduates are adequately prepared to respond to the diverse and ever-changing health needs of the population. It is producing a physician workforce that is diverse in dimensions such as ethnicity and religion, gender and sexual orientation, geographic origin, socioeconomic status, etc., by attracting an applicant base (both student and faculty) that is more representative of the Canadian population. Medical schools demonstrate their social accountability through a commitment to producing the right mix of professionals (i.e., specialists and generalists) and ensuring their graduates go on to practice in areas where they are needed most.

Social accountability means the content and context of the learning environment reflects the diversity of geographic, socioeconomic and cultural practice settings. It’s about supporting and promoting community-engaged teaching and learning that is of mutual benefit to partnering organizations, students and the university. It emphasizes a philosophy that values health promotion, disease prevention (“thinking upstream”) and cultural safety as key components of medical care. It’s preparing graduates to work in multidisciplinary, inter-professional teams that can work together to tackle all the determinants of health—including the social determinants—to reduce health inequities. It emphasizes our role in instilling a culture of health advocacy where physicians are accountable to society and recognize their duty to improve the health and well-being of their patients, their communities and the broader populations they serve. It’s about preparing future physicians to be leaders who engage in the evolution of the health care system and contribute to sustainability through health system reform.

In the world of research, social accountability translates into investigation inspired by and responsive to the needs of the community, especially the needs of our underserved communities; it is about supporting and promoting high-quality community-engaged research related to expressed needs. It is often research that is collaborative, participatory and action-focused from the onset, with the research agenda, questions, methodology and knowledge translation components being developed in partnership with key stakeholders. In socially accountable research, mechanisms are put into ensure direct community impact: investigators take initiative to develop and implement interventions in collaboration with the community. It is research that emphasizes population health and has a role in identifying and anticipating the health status and health care needs of the community.  It is basic biomedical research that creates new understanding of the biological pathways to the determinants of health and applied clinical research that evaluates the safety and efficacy of drugs, treatments and procedures and contributes to the quality of care provided. It is health services research that evaluates new delivery models and their impact from the level of individual patients to the health system.

And at the structural level of our college, social accountability is partnership and engagement: engagement with our community, health system and health provider partners. It’s a genuine commitment to meaningfully engage in a manner that is mutually beneficial with recognition of the local and regional community as primary stakeholders. In redefining who is “expert,” we strengthen the CoM’s reputation for engaging in respectful and trusting partnerships. Partnership in designing, implementing and evaluating our education, research and service programs to meet the priority health needs of the communities we serve is key. Partnering with health regions and health organizations to helps to ensure graduates are properly deployed, supported and retained where they are most needed. Partnerships for social accountability is understanding the integrity of relationships and working from a collaborative leadership perspective that will have the best possible impact on socially marginalized and medically underserved people and communities.

We recognize that it can be difficult to wrap one’s head around the concept of social accountability and that it is often at the application stage, where theory is translated into practice, that things become a little clearer. The four-part series of papers Practising Social Accountability outlines how clinicians can actualize social accountability in their practice, from the micro to the macro levels.  The division will be releasing a series of resources outlining how social accountability may be actualised through curriculum, admissions, research, etc. in the coming months. Stay tuned!

Written by the Division of Social Accountability

Guest blog on “Preston’s Page” (Dean of Medicine, U of S)

Social accountability is not a new concept here at the College of Medicine. It continues to be a principle and lens that guides our actions. It permeates discourse in medical schools both nationally and internationally. Much has changed in the past year in terms of social accountability within our college.

Every student, every faculty and staff can support social accountability in the college. We are doing a great deal already.  Among our national and international colleagues working in this area, our college is looked upon as a leader in the area of social accountability, and we aspire to continue to measure up to our reputation. At the same time, we recognize that there is still much more to do. The division continues to collaborate and support college-wide strategies for building a culture of engagement and social accountability, working in partnership with our internal and external stakeholders towards integrating social accountability into the four areas of CARE. An overview of activities supported by the Social Accountability Committee was shared at the college’s May 2017 Faculty Council meeting.

Much work has been put into assisting the college through the accreditation process, particularly in light of the new CACMS accreditation element 1.1.1. Social Accountability. We have been working closely with the accreditation team to identify sources of information and outline processes for 1.1.1. (as well as other accreditation elements with social accountability components) and began the process of drafting measures of social accountability to capture progress to date and long-term impact. We look forward to sharing progress on those measures at the upcoming September 2017 Faculty Council meeting.

This past year, the team has been working closely with various internal units in the College of Medicine to advance social accountability. We were excited to see the college approve implementation of a Diversity and Social Accountability Admissions Program, put forward by the Admissions Committee after consultation with the division and the Social Accountability Committee. We received valuable feedback at the pilot of the Social Accountability Lens at the December Curriculum Retreat and continue to work with the UGME Curriculum Committee and its subcommittees to build social accountability into the foundation of the curriculum. We drafted an annual communique identifying priority health needs rooted in social issues, which was distributed to course chairs for integration into curriculum planned. A masters of public health practicum research project that began last summer is continuing into phase 2 this year with an appreciative inquiry of how Canadian medical schools are putting social accountability into action. The division continues to engage internally to expand capacity and understanding of social accountability in theory and in practice, co-presenting at grand rounds with various departments. Further, the division was fully engaged on many of the working groups and full-day sessions for CoM strategic planning and was enthused to hear such a strong emphasis on social accountability from numerous attendees.

Other areas of focus and activity have included global and Indigenous health opportunities in partnership with the Global Health Committee and the Indigenous Health Committee. We continue to manage the Making the Links global health certificate program with fifteen positions for first-year medical students each year. The two-year program was recently expanded to support students interested in an Indigenous Health Stream. With the help of the college’s Aboriginal Admissions Coordinator, Val Arnault-Pelletier, we expanded our community partnerships last year to include Kawacatoose First Nation in southeast Saskatchewan and rural and remote Indigenous communities in Townsville, Australia. We also partnered with various internal and external committees to put on numerous global health events this year, including our fifth annual student-led Global Health Conference: Sustain the Gains, a documentary screening of On the Bride’s Side, and community and on-campus conversations with speakers Dr. Ted Schreker and Dr. Eric Lachance. The Global Health Travel Awards Subcommittee updated the award program this year to better align with learner, faculty and college needs and now runs two award cycles per year. We have also been working to identify opportunities for mutually beneficial community-university partnerships and collaborations (e.g., SPRP/Health Region Poverty Reduction Strategy Consultation; YXE Connects).

On the people side of the division, in December, we welcomed back Carlyn Seguin, who had previously been away on maternity leave. We said goodbye to division head, Dr. Ryan Meili, and welcomed Dr. Eddie Rooke as acting director.  Erin Wolfson, Lisa Yeo and Joanna Winichuk all celebrated their one-year anniversaries with the division.

We continue to build a greater understanding of the ever-changing needs of the college and the larger community it serves. Reflecting our commitment to being responsive, relevant and accountable to our communities locally and globally, we expanded the roles within the Division of Social Accountability. This will allow the college to build on its existing strengths, programs and commitment to meaningful engagement, locally and globally. Some of the DSA staff roles and responsibilities have changed to reflect this commitment, and we share our staff information here to ensure you can connect effectively with us (contact information):

• Carlyn Seguin continues to lead the management of the Making the Links – Certificate in Global Health (MTL-CGH) Program amongst various global health activities, in the position of Global Health Manager.
• Lisa Yeo continues to provide strategic leadership, planning and project support in the Social Accountability Strategist position, serving as a resource to many areas of the college with a keen focus on measurement and evaluation.
• Erin Wolfson has recently moved into the role of Community Engagement Specialist, expanding the college’s capacity and commitment to ethical collaboration and authentic engagement with communities. This involves enhancing and building community-university relationships and interdisciplinary collaborations that build health equity and respond to priority health concerns of partners and communities.
• Joanna Winichuk, as Clerical Assistant, continues to provide invaluable administrative support to the team and to the MTL-CGH program, with an expanded focus on communications in the upcoming year.
• Eddie Rooke has taken on the role of Acting Director, promoting and expanding capacity in social accountability throughout the college, teaching undergraduate and postgraduate students, and liaising with internal and external partners to advance the vision of health equity.

Our division was established in 2011 to promote and support the college’s social accountability promise – a promise to direct its Clinical, Advocacy, Research and Education (CARE Model) activities towards the priority health needs of the communities we serve. We see this promise reflected in the 2017-2022 College of Medicine Strategic Plan and mission statement of our college. It’s a promise to address community health needs, but it’s also much more than that.

There is still much more to be done. With a focus on accreditation in preparation for our college’s full accreditation visit in the fall, the team continues to respond to incoming requests. We continue to engage with our partners internationally and some of the team recently attended the Social Accountability World Summit (check out the social accountability blog page in the coming weeks for learnings and invaluable resources from the summit).

We are excited for all that is to come and look forward to continuing to support the CoM in meeting the needs of the people of Saskatchewan and achieving health equity. We thank Dr. Ryan Meili, our former division head, who helped advance social accountability here for more than 10 years.

For more on the division, visit our webpage!