Global Perceptions on Social Accountability and Outcomes: A Survey of Medical Schools

Phenomenon: Social accountability has become a universal component in medical education. However, medical schools have little guidance for operationalizing and applying this concept in practice. This study explored institutional practices and administrative perceptions of social accountability in medical education. Approach: An online survey was distributed to a purposeful sample of English-speaking undergraduate medical school deans and program directors/leads from 245 institutions in 14 countries. The survey comprised of 38-items related to program mission statements, admission processes, curricular content, and educational outcomes. Survey items were developed using previous literature and categorized using a context-input-process-products (CIPP) evaluation model. Exploratory Factor Analysis (EFA) was used to assess the inter-relationship among survey items. Reliability and internal consistency of items were evaluated using McDonald's Omega. Findings: Results from 81 medical schools in 14 countries collected between February and June 2020 are presented. Institutional commonalities of social accountability were observed. However, our findings suggest programs focus predominately on educational inputs and processes, and not necessarily on outcomes. Findings from our EFA demonstrated excellent internal consistency and reliability. Four-factors were extracted: (1) selection and recruitment; (2) institutional mandates; (3) institutional activities; and (4) community awareness, accounting for 71% of the variance. McDonald's Omega reliability estimates for subscales ranged from 0.80-0.87. Insights: This study identified common practices of social accountability. While many medical schools expressed an institutional commitment to social accountability, their effects on the community remain unknown and not evaluated. Overall, this paper offers programs and educators a psychometrically supported tool to aid in the operationalization and reliability of evaluating social accountability.