Year : 2014 | Volume
: 27 | Issue : 2 | Page : 148--151
How social accountability can be incorporated into an urban community-based medical education program: An Australian initiative
Sarah Mahoney1, Linnea Boileau2, John Floridis3, Christina Abi-Abdallah3, Bernard Lee3,
1 Flinders University School of Medicine, Flinders University, Bedford Park, South Australia, Australia
2 School of Medicine, Flinders University, Bedford Park, South Australia, Australia
3 Flinders University, Bedford Park, South Australia, Australia
Dr. Sarah Mahoney
MBBS Academic Coordinator Onkaparinga Clinical Education program, School of Medicine, Flinders University, Bedford Park, South Australia
Background: Medical schools play a role in ensuring that their outcomes ultimately have positive effects on the health status of communities. We describe an initiative that translates this broad intent into meaningful activities that foster positive attitudes to social accountability among medical students in the context of an already full curriculum. Methods: Faculty members from an urban community-based medical education program undertook broad consultation with its community groups. Medical students then undertook activities designed to assist in the well-being of socio-economically disadvantaged adolescents through near-peer counselling and health education. Results: Early evaluation from medical students, secondary students, community organisations and faculty indicates that the activities undertaken to-date have been of value to stakeholders. Discussion: This initiative is intended to develop one model for incorporating social accountability into the medical curriculum with sustainable activities that benefit the community and medical students. Further research and evaluation of the impact of this initiative on both the community group involved and on medical students is essential.
|How to cite this article:|
Mahoney S, Boileau L, Floridis J, Abi-Abdallah C, Lee B. How social accountability can be incorporated into an urban community-based medical education program: An Australian initiative.Educ Health 2014;27:148-151
|How to cite this URL:|
Mahoney S, Boileau L, Floridis J, Abi-Abdallah C, Lee B. How social accountability can be incorporated into an urban community-based medical education program: An Australian initiative. Educ Health [serial online] 2014 [cited 2021 Oct 20 ];27:148-151
Available from: https://www.educationforhealth.net/text.asp?2014/27/2/148/143746
Social accountability and medical education
Social accountability is increasingly recognised as a necessary role for medical schools, gauged by '…their capacity to anticipate the kind of doctors required by evolving health systems….Medical schools must make explicit contributions to improving health and demonstrate that their "products" - graduates, research findings and service models - have tangible positive effects on health status in local communities'. 
We describe an initiative of Flinders University in South Australia aimed at enhancing medical student understanding of the social determinants of health, while providing useful services for at-risk adolescents in the local community. Medical students provide advice and support (with appropriate supervision) within their own limitations to facilitate adolescents' use of mainstream community health services; they apply their knowledge, empathy, communication and leadership skills in a setting outside the usual healthcare context and develop an awareness of the inequities and challenges some adolescents face. Concurrently, the project provides adolescents with access to healthcare guidance in a safe and supportive setting.
The Australian healthcare system is a mixture of publicly funded-services and private fee-for-service care. , Medical education occurs predominantly in publicly funded tertiary hospitals, with a smaller proportion in rural community settings. The Flinders medical school is a graduate-entry program in which third-year students learn in a range of settings from traditional rotations to longitudinal rural programs. In 2009, an urban longitudinal community-based program, the Onkaparinga Clinical Education Program (OCEP) was established. It is based in an underserved area of relative socio-economic disadvantage in the outer suburbs of Adelaide, South Australia, and provides a year-long clinical program for 24 medical students. 
As part of the program's commitment to social accountability, staff and students explored opportunities for meaningful engagement with the community  and decided to focus efforts on adolescent health. Christies Beach High School (CBHS) is a secondary school that targets approximately 1200 adolescent students based in the same area of relative socio-economic disadvantage as OCEP. CBHS staff identified the health and well-being needs of the school's students, and discussions between OCEP and CBHS resulted in development of an initiative called 'The Cube'.
Issues and educational strategies
The aims of The Cube address factors described by Boelen  as necessary for a medical school to be 'socially accountable'. It provides 'ample and appropriate learning opportunities for medical students to grasp the complexity of socio-economic determinants in health', and its approach is to integrate 'the biomedical aspects of diseases into a holistic approach to health and well-being' by enabling medical students to understand adolescent health in the real world of adolescents, rather than solely in the health clinic setting. The program also attempts to address, in a local context, some of the 10 actionable areas developed at the Global Consensus for Social Accountability of Medical Schools in December 2010. 
There are two separate educational strategies incorporated in this initiative, those of the medical school and those of the secondary school. The OCEP program aims to address several specific needs including: Medical workforce development strategy by enabling medical students to learn in an underserved region; immediate workforce retention and quality by recognising the community hospital and general and specialist private practices as teaching practices affiliated with the medical school; having a visible local university presence and being active contributors to local health needs; and maintaining social accountability as a core principle of the program.
For CBHS, the strategies address the understanding that education, socio-economic status and health outcomes are interrelated, and that effective learning improves when mental and physical well-being are optimal. In this context, the broad outcomes identified by CBHS staff were: Improved physical, emotional and social well-being for school students; improved student engagement, achievement and success in learning; capacity to effect behavioural change; and enhanced partnerships between school, family and community.
'We would welcome a partnership with OCEP … where medical students could support the function and operations of a Wellbeing Centre. The medical students could provide advice, counselling, mentorship, guidance and a referral service to our students. This would give our school a much needed and highly valued service to support student well-being. We understand that at the same time this would give medical students a valuable learning role in adolescent health'. Paul Wilson, former Principal, Christies Beach High School.
In this initiative, medical students attend a Wellbeing Centre ('The Cube') located within the grounds of Christies Beach High School to provide advice and support for at-risk adolescents, and to facilitate their use of mainstream community health services. Issues affecting adolescent health identified by school staff include: The desire to express independence and experiment; concern about self-image; interpersonal relationships; emerging sexual identity; and mental health. Medical students may facilitate appropriate referrals to general practitioners (family physicians), sexual health services, counselling, substance abuse and mental health services. Through its location within the school itself, The Cube enhances the support already available to adolescents at the school.
Essential groundwork for medical schools intending to develop such initiatives includes building relationships between the organisations, clarifying areas of interest and need in the community, identification and involvement of key stakeholders, and determination of financial requirements. For The Cube, relationship-building included regular meetings between OCEP and CBHS staff and student groups, a survey of secondary students, advice from school staff based on existing information and research, and presentations and interactive health workshops (health 'Expo') for adolescents by medical students.
Stakeholders for The Cube include Flinders University, the South Australian Department of Education and Child Development, OCEP, CBHS, adolescent health organisations, adolescent mental health organisations, sexual health organisations, medico-legal representation and medical professional organisations. A steering group with representation from these key stakeholders was established. The Cube required funding for infrastructure and ongoing funding for administration support.
Identified risks for The Cube's future include lack of funding, loss of clinical and academic support, medico-legal issues, and defining professional boundaries and responsibilities of medical students. The medico-legal risks are mitigated by providing medical students with training in consent and mandatory reporting, by ensuring support from clinicians with expertise in adolescent health, and having clear protocols for referrals. Teacher-counsellors from the secondary school provide support and training for medical students. Guidance in managing professional boundaries is provided, and the intermediary (rather than treating) role of the medical student is made clear to all participants. Clinical and academic support is provided by university staff and affiliated general practitioners, and through liaison with the key stakeholders. The initiative is a core component of OCEP and is sustained by the continuity of the program, rather than solely by individuals.
Early evaluation shows that the activities undertaken to date have been of value to both medical and secondary students. Results from a survey conducted by senior secondary students about the health Expo were positive, with 93% of respondents agreeing the Expo was worthwhile and 100% agreeing that it should be an annual event. CBHS staff provided positive feedback and a continuing willingness to participate in The Cube.
Medical students have been enthusiastic, with several students giving presentations to local, national and international audiences.
OCEP 2012 medical students' presentations included aims to:
'…empower and educate the high school students, inspiring confidence to make positive decisions to … look after their health, and aspire to further study. The long term outcomes for this project aim to build strong relationships between the school and the medical students ….'
'engage high school students in identifying major academic and medical issues, foster concepts of student learning, personal development and self-care, develop a "pre-doctor" service … with a focus to peer counselling … to equip students with basic medical or referral information, and to set up partnerships with local support groups for the development of the student wellbeing centre'. 
The aim of the initiative is for a long-term partnership, and research and evaluation of its impact on both student groups is essential. The outcomes will be published as the initiative develops further and consolidates its strengths. While formal evaluation is yet to be completed, its potential can be inferred from the level of interest and support received. Since the pilot work on The Cube, another secondary school has worked with OCEP to develop a similar program, and two rural schools wish to adopt the model. The initiative has had strong support from its key stakeholders, and interest from national and international audiences as evidenced by the responses at several medical education conferences.
Considerations for medical schools looking to establish similar initiatives include: Taking a long-term view and avoiding a short-term project mentality, avoiding creation of expectations that cannot be fulfilled; establishing a solid core of stakeholder support and trust; determining where priorities lie for the community partner and for the medical school; and understanding and minimising potential risks. The needs of the community partner should drive the initiative, and if the medical school cannot meet those needs, the initiative should not proceed on the medical school agenda alone. Persistence and commitment from the organisations involved is essential, rather than reliance on one or two enthusiastic participants.
In summary, we describe a model for incorporating social accountability into the medical curriculum with sustainable activities that benefit the community and medical students. Further research and evaluation of the impact on both the community group involved and on medical students is essential.
Current and former staff and students of Christies Beach High School: OCEP 2011-2013 medical students.
Acknowledgements - key stakeholders
Youth Friendly Doctor Program, Australian Medical Association (SA)
South Australian Department of Education and Child Development
Sexual Health information networking and information SA
Southern Adelaide Fleurieu Kangaroo Island Medicare Local
Second Story Youth Health Service
Flinders University INSPIRE mentorship program
Drug and Alcohol Services South Australia
|1||Boelen C. Social accountability: Medical Education′s Boldest Challenge. MEDICC Rev 2008;10:52.|
|2||Leeder SR. Achieving equity in the Australian healthcare system. Med J Aust 2003;179:475-8.|
|3||Biggs A. Health in Australia: A quick guide. Australian Parliamentary Library 2013. Available from: http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1314/QG/HealthAust [Last accessed on 2014 Apr 9].|
|4||Mahoney S, Walters L, Ash J. Urban community based medical education: General practice at the core of a new approach to teaching medical students. Aust Fam Physician 2012;41:631-6.|
|5||Mahoney S, Campbell S, Garner S. Community Engagement in an Urban Community Based Medical Education program: A case study. Australas J Univ Community Engagem 2011 Volume 6, No 2 Spring.|
|6||Global Consensus for Social Accountability of Medical Schools in December 2010. Available from: http://sedem.org/GlobalConsensus.pdf [Last accessed on 2014 Apr 9].|
|7||Abi-Abdallah C. The Cube: A Community Engagement Initiative Flinders School of Medicine. Poster presentation AUCEA international conference ′Next Steps: Community Engaged Learning′ Australia July 2012.|
|8||Lee B. Does an Apple a Day Really Keep the Doctor Away? Engaging the Students of Christies Beach High School. Poster presentation AUCEA international conference ′Next Steps: Community Engaged Learning′ Australia July 2012.|