The implementation of social accountability in undergraduate medical education at Makerere University School of Medicine

Abstract

Background: Social accountability for medical schools is the obligation to direct core activities toward the community's most important needs. The understanding, adaptation, and implementation of social accountability in medical education in Uganda is limited. Objectives: 1) To explore the implementation of social accountability in undergraduate medical education at Makerere University School of Medicine. 2) To explore medical students' perceptions, attitudes, and experiences regarding social accountability in undergraduate medical education at Makerere University School of Medicine. 3) To develop a framework for social accountability in undergraduate medical education at Makerere University School of Medicine. 4) To explore the readiness to adopt the framework for social accountability in undergraduate medical education at Makerere University School of Medicine. Methods: This was a multi-method cross-sectional study. Sub-study one was a qualitative study involving a desktop curriculum review and key informant interviews. Sub-study two was a parallel convergent mixed-methods study involving undergraduate medical students. Sub-study three was an online modified Delphi survey involving stakeholders. Sub-study four was a parallel convergent mixed methods study exploring the educators’ readiness to adopt the framework. Ethical approval was obtained from the School of Medicine Higher Degrees Research Ethics Committee (Mak-SOMREC-2021-77) and the Uganda National Council for Science and Technology (HS2203ES). Results: Social accountability was expressed within the curriculum and stakeholders’ views. Students evaluated the medical school as doing well in social accountability. However, the students had varied experiences of social accountability. Most students faced challenges in planning to be socially accountable practitioners. The framework has twenty recommendations in five domains. The framework was described as relevant, and educators were willing to implement the framework. Conclusion: Social accountability is expressed in the curriculum and stakeholders’ views. Students evaluated the medical school as doing well in social accountability and valued social accountability; however, they expressed difficulty in planning to be socially accountable. The framework has five domains with twenty recommendations. Educators expressed willingness to adopt the framework. The key limitation of the study was the low response rate to the substudy four survey. Utility of findings: These findings may guide stakeholders in improving the implementation of social accountability.