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

Brianne Wood; Hafsa Bohonis; Brian Ross; Erin Cameron

doi:10.36834/cmej.73051

Auteurs-es

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

DOI :

https://doi.org/10.36834/cmej.73051

Résumé

Contexte : La responsabilité sociale dans l’éducation médicale est conceptualisée comme étant la responsabilité de répondre aux besoins des populations locales et de démontrer l’impact de ces activités. L’objectif de cette étude était d’examiner rigoureusement et de comparer les théories, les modèles et les cadres de la responsabilité sociale afin d’élaborer un dispositif ayant des fondements théoriques qui servirait à cerner et à évaluer les retombées de l’éducation médicale dans le Nord de l’Ontario.

Méthodes : Suivant une méthodologie de revue narrative, les théories, modèles et cadres principaux de la responsabilité sociale ont été recensés. L’équipe de recherche a extrait les concepts et les relations importants des cadres sélectionnés. Les cadres ont ensuite été comparés sur le plan de l’adéquation et de la pertinence à l’aide d’un outil de comparaison et de sélection des théories (le Theory Comparison and Selection Tool).

Résultats : Onze théories, modèles et cadres ont été retenus pour une analyse et une comparaison approfondies. Deux cadres réalistes prenant en considération les relations communautaires dans l’éducation médicale et la responsabilité sociale dans les services de soins de santé ont reçu les scores les plus élevés. Les cadres axés sur l’apprentissage des systèmes de santé e, sur l’évaluation de la responsabilité sociale des institutions et sur la mise en œuvre de pratiques fondées sur les données probantes ont également obtenu des scores élevés.

Conclusion : Nous avons utilisé un processus systématique de sélection des théories pour décrire et comparer les construits et les cadres de responsabilité sociale afin d’éclairer le développement d’un cadre de référence sur les retombées de la responsabilité sociale pour l’École de médecine du Nord de l’Ontario. L’équipe de recherche a examiné les construits importants, les liens entre ces derniers et les retombées afin de choisir un cadre pouvant répondre aux objectifs d’un projet spécifique. Des travaux ultérieurs permettront de déterminer de quelle manière il sera possible de combiner, d’adapter et de mettre en oeuvre les composantes de ce cadre qui sera utilisé dans le Nord de l’Ontario.

Références

Boelen C, Heck JE, Health WHOD of D of HR for. Defining and measuring the social accountability of medical schools. 1995 Available from: https://apps.who.int/iris/handle/10665/59441 [Accessed Aug 27, 2020].

Boelen C, Dharamsi S, Gibbs T. The social accountability of medical schools and its indicators. Educ Health. 2012;25:180. https://doi.org/10.4103/1357-6283.109785

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. https://doi.org/10.1016/S0140-6736(10)61854-5

Rourke J. Social accountability in theory and practice. Ann Fam Med. 2006;4:S45–8. https://doi.org/10.1370/afm.559

Woollard RF. Caring for a common future: medical schools’ social accountability. Med Educ. 2006;40:301–13. https://doi.org/10.1111/j.1365-2929.2006.02416.x

Smitherman HC, Baker RS, Wilson MR. Socially accountable academic health centers: pursuing a quadripartite mission. Acad Med. 2019;94:176–81. https://doi.org/10.1097/ACM.0000000000002486

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: http://documents.worldbank.org/curated/en/327691468779445304/pdf/310420PAPER0So1ity0SDP0Civic0no1076.pdf [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. https://doi.org/10.4103/efh.efh_204_19

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. https://doi.org/10.1097/ACM.0000000000002099

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. https://doi.org/10.3109/0142159X.2012.731106

Meili R, Ganem-Cuenca A, Leung JW, Zaleschuk D. The CARE model of social accountability: promoting cultural change: Acad Med. 2011;86:1114–9. https://doi.org/10.1097/ACM.0b013e318226adf6

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. https://doi.org/10.1080/0142159X.2016.1231914

Rourke J. Social Accountability: A framework for medical schools to improve the health of the populations they serve. Acad Med. 2018;93:1120–4. https://doi.org/10.1097/ACM.0000000000002239

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. https://doi.org/10.3109/0142159X.2013.770134

Beckman TJ, Cook DA. Educational epidemiology. JAMA. 2004;292:2969–71. https://doi.org/10.1001/jama.292.24.2969-c

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. https://doi.org/10.4103/1357-6283.143747

Jayal NG. New directions in theorising social accountability? IDS Bull. 2007;38:105–12. https://doi.org/10.1111/j.1759-5436.2007.tb00425.x

Fox JA. Social accountability: what does the evidence really say? World Dev. 2015;72:346–61. https://doi.org/10.1016/j.worlddev.2015.03.011

Joshi A. Do they work? Assessing the impact of transparency and accountability initiatives in service delivery. Dev Policy Rev. 2013;31:s29–48. https://doi.org/10.1111/dpr.12018

Boelen, Pearson D, Kaufman A, et al. Producing a socially accountable medical school: AMEE Guide No. 109. Med Teach. 2016;38:1078–91. https://doi.org/10.1080/0142159X.2016.1219029

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. https://doi.org/10.1007/s10459-017-9792-z

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. https://doi.org/10.1186/s13012-018-0836-4

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. https://doi.org/10.1016/j.jclinepi.2018.04.008

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. https://doi.org/10.1111/j.1471-1842.2009.00848.x

Ross B, Cameron E. Socially accountable medical education: our story might not be yours. High Educ Stud. 11. https://doi.org/10.5539/hes.v11n1p114

Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:53. https://doi.org/10.1186/s13012-015-0242-0

Implementation Science Exchange. Theory, Model, and Framework Comparison and Selection Tool (T-CaST) [Internet]. Available from: https://impsci.tracs.unc.edu/tcast/ [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. https://doi.org/10.1186/s13012-020-0964-5

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. https://doi.org/10.1186/2046-4053-2-98

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. https://doi.org/10.1093/heapol/czw089

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. https://doi.org/10.3109/0142159X.2015.1112894

Boelen C, Woollard B. Social accountability and accreditation: a new frontier for educational institutions. Med Educ. 2009;43:887–94. https://doi.org/10.1111/j.1365-2923.2009.03413.x

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. https://doi.org/10.1007/s10488-010-0327-7

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. https://doi.org/10.1186/s12961-019-0477-3

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. https://doi.org/10.1186/s12913-019-4807-5

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. https://doi.org/10.5430/ijhe.v5n4p216

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: https://journals.lww.com/academicmedicine/pages/articleviewer.aspx?year=9000&issue=00000&article=97261&type=Abstract [Accessed Jun 11, 2020].

Damschroder LJ. Clarity out of chaos: use of theory in implementation research. Psychiatry Res 2020;283. https://doi.org/10.1016/j.psychres.2019.06.036

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. https://doi.org/10.1111/j.1365-2923.2011.04045.x

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. https://doi.org/10.1097/ACM.0000000000003731

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. https://doi.org/10.1186/s13012-016-0534-z