Comparing and using prominent social accountability frameworks in medical education: moving from theory to implementation in Northern Ontario, Canada


  • Brianne Wood Northern Ontario School of Medicine
  • Hafsa Bohonis Northern Ontario School of Medicine
  • Brian Ross Northern Ontario School of Medicine
  • Erin Cameron Northern Ontario School of Medicine



Background: Social accountability in medical education is conceptualized as a responsibility to respond to the needs of local populations and demonstrate the impact of these activities. The objective of this study was to rigorously examine and compare social accountability theories, models, and frameworks to identify a theory-informed structure to understand and evaluate the impacts of medical education in Northern Ontario.

Methods: Using a narrative review methodology, prominent social accountability theories, models, and frameworks were identified. The research team extracted important constructs and relationships from the selected frameworks. The Theory Comparison and Selection Tool was used to compare the frameworks for fit and relevance.

Results: Eleven theories, models, and frameworks were identified for in-depth analysis and comparison. Two realist frameworks that considered community relationships in medical education and social accountability in health services received the highest scores. Frameworks focused on learning health systems, evaluating institutional social accountability, and implementing evidence-based practices also scored highly.

Conclusion: We used a systematic theory selection process to describe and compare social accountability constructs and frameworks to inform the development of a social accountability impact framework for the Northern Ontario School of Medicine. The research team examined important constructs, relationships, and outcomes, to select a framework that fits the aims of a specific project. Additional engagement will help determine how to combine, adapt and implement framework components to use in a Northern Ontario framework.


Boelen C, Heck JE, Health WHOD of D of HR for. Defining and measuring the social accountability of medical schools. 1995 Available from: [Accessed Aug 27, 2020].

Boelen C, Dharamsi S, Gibbs T. The social accountability of medical schools and its indicators. Educ Health. 2012;25:180.

Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet. 2010;376:1923–58.

Rourke J. Social accountability in theory and practice. Ann Fam Med. 2006;4:S45–8.

Woollard RF. Caring for a common future: medical schools’ social accountability. Med Educ. 2006;40:301–13.

Smitherman HC, Baker RS, Wilson MR. Socially accountable academic health centers: pursuing a quadripartite mission. Acad Med. 2019;94:176–81.

Malena C, Forster R, Singh J. Social accountability: an introduction to the concept and emerging practice [Internet]. World Bank: World Bank; 2004 Dec. (Social Development Papers). Report No.: 76. Available from: [Accessed Jun 24, 2020].

Boelen C, Blouin D, Gibbs T, Woollard R. Accrediting excellence for a medical school’s impact on population health. Educ Health. 2019;32:41.

Hunt D, Klamen D, Harden RM, Ali F. The ASPIRE-to-Excellence Program: a global effort to improve the quality of medical education. Acad Med. 2018;93:1117–9.

Larkins SL, Preston R, Matte MC, et al. Measuring social accountability in health professional education: development and international pilot testing of an evaluation framework. Med Teach. 2013;35:32–45.

Meili R, Ganem-Cuenca A, Leung JW, Zaleschuk D. The CARE model of social accountability: promoting cultural change: Acad Med. 2011;86:1114–9.

Reeve C, Woolley T, Ross SJ, et al. The impact of socially-accountable health professional education: a systematic review of the literature. Med Teach. 2017;39:67–73.

Rourke J. Social Accountability: A framework for medical schools to improve the health of the populations they serve. Acad Med. 2018;93:1120–4.

Sandhu G, Garcha I, Sleeth J, Yeates K, Walker GR. AIDER: a model for social accountability in medical education and practice. Med Teach. 2013;35:e1403-8.

Beckman TJ, Cook DA. Educational epidemiology. JAMA. 2004;292:2969–71.

Ritz SA, Beatty K, Ellaway RH. Accounting for social accountability: developing critiques of social accountability within medical education. Educ Health Abingdon Engl. 2014;27:152–7.

Jayal NG. New directions in theorising social accountability? IDS Bull. 2007;38:105–12.

Fox JA. Social accountability: what does the evidence really say? World Dev. 2015;72:346–61.

Joshi A. Do they work? Assessing the impact of transparency and accountability initiatives in service delivery. Dev Policy Rev. 2013;31:s29–48.

Boelen, Pearson D, Kaufman A, et al. Producing a socially accountable medical school: AMEE Guide No. 109. Med Teach. 2016;38:1078–91.

Ventres W, Boelen C, Haq C. Time for action: key considerations for implementing social accountability in the education of health professionals. Adv Health Sci Educ. 2018;23:853–62.

Birken SA, Rohweder CL, Powell BJ, Shea CM, Scott J, Leeman J, et al. T-CaST: an implementation theory comparison and selection tool. Implement Sci. 2018;13:143.

Strifler L, Cardoso R, McGowan J, Cogo E, Nincic V, Khan PA, et al. Scoping review identifies significant number of knowledge translation theories, models, and frameworks with limited use. J Clin Epidemiol. 2018;100:92–102.

Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Inf Libr J. 2009;26:91–108.

Ross B, Cameron E. Socially accountable medical education: our story might not be yours. High Educ Stud. 11.

Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:53.

Implementation Science Exchange. Theory, Model, and Framework Comparison and Selection Tool (T-CaST) [Internet]. Available from: [Accessed Jan 19, 2022].

Esmail R, Hanson HM, Holroyd-Leduc J, et al. A scoping review of full-spectrum knowledge translation theories, models, and frameworks Implement Sci. 2020.

Emadzadeh A, Mousavi Bazaz SM, Noras M, Karimi S. Social Accountability of the curriculum in medical education: a review on the available models. Future Med Educ J. 2016;6:31–7.

Lodenstein E, Dieleman M, Gerretsen B, Broerse JE. A realist synthesis of the effect of social accountability interventions on health service providers’ and policymakers’ responsiveness. Syst Rev. 2013;2:98.

Lodenstein E, Dieleman M, Gerretsen B, Broerse JEW. Health provider responsiveness to social accountability initiatives in low- and middle-income countries: a realist review. Health Policy Plan. 2017;32:125–40.

Ellaway RH, O’Gorman L, Strasser R, Marsh DC, Graves L, Fink P, et al. A critical hybrid realist-outcomes systematic review of relationships between medical education programmes and communities: BEME Guide No. 35. Med Teach. 2016;38:229–45.

Boelen C, Woollard B. Social accountability and accreditation: a new frontier for educational institutions. Med Educ. 2009;43:887–94.

Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011;38:4–23.

Lavis J, Gauvin F, Mattison C, Moat K, Waddell K, Reid R. Research literature about rapid-learning health systems. Hamilton, Canada: McMaster Health Forum; 2018 Dec p. 34. (Creating rapid-learning health systems in Canada).

Menear M, Blanchette M-A, Demers-Payette O, Roy D. A framework for value-creating learning health systems. Health Res Policy Syst. 2019;17:79.

Levesque J-F, Sutherland K. Combining patient, clinical and system perspectives in assessing performance in healthcare: an integrated measurement framework. BMC Health Serv Res. 2020;20:23.

Kirby J, O’Hearn S, Latham L, Harris B, Davis-Murdoch S, Paul K. Introducing a collaborative e2 (evaluation & enhancement) social accountability framework for medical schools. Int J High Educ. 2016;5:216–21.

Ellaway RH, Kehoe A, Illing J. critical realism and realist inquiry in medical education. Acad Med [Internet]. 2020 [cited 2020 Jun 11];Publish Ahead of Print. Available from: [Accessed Jun 11, 2020].

Damschroder LJ. Clarity out of chaos: use of theory in implementation research. Psychiatry Res 2020;283.

Wong G, Greenhalgh T, Westhorp G, Pawson R. Realist methods in medical education research: what are they and what can they contribute? Med Educ. 2012;46:89–96.

Barber C, van der Vleuten C, Leppink J, Chahine S. Social accountability frameworks and their implications for medical education and program evaluation: a narrative review. Acad Med J Assoc Am Med Coll. 2020;95:1945–54.

Birken SA, Powell BJ, Presseau J et al. Combined use of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF): a systematic review. Implement Sci. 2017;12:2.




How to Cite

Wood B, Bohonis H, Ross B, Cameron E. Comparing and using prominent social accountability frameworks in medical education: moving from theory to implementation in Northern Ontario, Canada. Can. Med. Ed. J [Internet]. 2022 Jun. 7 [cited 2022 Sep. 29];13(5):45-68. Available from:



Original Research