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

Figures & data

Table 1. Type and length of medical degree program included in the survey sample by county.

Country	Degree Awarded	Length of Program
Australia	Bachelor of Medicine and Bachelor of Surgery (M.B.B.S.) Medicinae Baccalaureus, Baccalaureus Chirurgiae (M.B., Ch.B.) Doctor of Medicine (M.D.)	3 to 7 years
Canada	Doctor of Medicine (M.D.)	3 to 4 years
Caribbean Countries	Bachelor of Medicine, Bachelor of Surgery (M.B.B.S.) Doctor of Medicine (M.D.)	4 to 5 years
New Zealand	Bachelor of Medicine and Bachelor of Surgery (M.B.B.S.) Medicinae Baccalaureus, Baccalaureus Chirurgiae (M.B., Ch.B.)	4 to 6 years
South Africa	Bachelor of Medicine, Bachelor of Surgery (M.B., Ch.B.)	5 to 6 years
United Kingdom & Ireland	Bachelor of Medicine, Bachelor of Surgery (M.B., Ch.B.)	4 to 5 years
United States of America	Doctor of Medicine (M.D.)	4 years

Note: The information presented in this table was obtained using the World Directory of Medical Schools website.

Table 2. Social Accountability Survey Response Rates by Country and Medical School.

Country	No. of Medical Schools	Response Rate No. (%) by Medical Schools
Australia & New Zealand	23	9 (39.1)
Canada	14*	14 (100.0)
Caribbean Countries	36	9 (25.0)
South Africa	9	4 (44.4)
United Kingdom & Ireland	42	9 (21.4)
United States	141	36 (25.5)
Total	265	81 (30.6)

*Excluding French-language medical schools.

Table 3. Descriptive Statistics: Mean (M), Standard Deviation (SD), and Range of Possible Scores for Social Accountability Survey Demographic and Medical School Characteristics Item Responses.

	No. (%) out of 81 responses	M (SD)	Range of possible scores
Demographics
Country
Australia/New Zealand	9 (11.1)
Canada	14 (17.3)
Caribbean	9 (11.1)
South Africa	4 (4.9)
United Kingdom/Ireland	9 (11.1)
United States	36 (44.4)
Gender
Male	43 (53.1)
Female	38 (46.9)
Medical Practitioner	65 (80.2)
Number of years practicing as a medical practitioner	61 (75.3)	24.85 (9.73)	5-43
Number of years working at current institution	79 (97.5)	13.14 (8.83)	1-35
Medical School Characteristics
Explicit social accountability mandate	71 (87.7)
Primary care or family medicine/general practitioner department or facility/discipline group	74 (91.4)
Educational experiences:
Hospitals (secondary and tertiary health care)	79 (97.5)
Outpatient clinics	78 (96.3)
Emergency clinics	72 (88.9)
Community health centers or clinics	75 (92.6)
General Practice (Physician’s office; consultation room/clinic)	73 (90.1)
Patient Homes	37 (45.7)
Homes for the elderly (retirement homes or aging care facilities)	46 (56.8)
Chronic-care facilities	51 (63.0)
Institutional importance of social accountability (10-point scale 1 = not at all important and 10 = extremely important)	80 (98.8)	8.36 (1.79)	1-10
Publicly posted mission statement	77 (95.1)

Table 4. Mean (M), and Standard Deviation (SD) for the 28 Likert Scale Survey Item Responses (1 = strongly disagree, 5 = strongly agree).

	No. (%) out of 81 responses	M (SD)
Missions Statement
Improve the quality of future graduates	79 (97.5)	4.46 (0.93)
Enhance the health status of the local population	79 (97.5)	4.52 (0.85)
Respond to priority health needs of the local population	79 (97.5)	4.42 (0.96)
Coordinate with local organizations to promote health care	79 (97.5)	3.77 (1.29)
Population Profile
Responsible to serve a specific geographic region(s)	79 (97.5)	4.29 (1.09)
Actively conducts community-based health outcomes research	79 (97.5)	4.11 (1.01)
Aware of the epidemiological disease profile of the local population	79 (97.5)	4.44 (0.84)
Access to data containing a community profile of the local population (e.g., socio-demographic composition, priority health needs, health risks and health determinants)	79 (97.5)	4.29 (1.03)
Community Engagement
Collaborates with local community agencies to provide health care in the community	79 (97.5)	4.11 (1.10)
Works with local partners to identify population health needs	79 (97.5)	4.20 (1.03)
Collaborates with government agencies responsible for health care	78 (96.3)	4.24 (0.94)
Contributes to health care policy in my region	78 (96.3)	4.23 (1.07)
Involves community members to serve on internal committees	78 (96.3)	3.62 (1.20)
Selection & Recruitment
Rural geographic areas	80 (98.8)	4.21 (1.14)
Local geographic regions	80 (98.8)	4.25 (1.12)
Indigenous populations	80 (98.8)	4.15 (1.20)
Traditional marginalized groups	80 (98.8)	4.17 (1.22)
Low socio-economic status	80 (98.8)	4.15 (1.29)
Attempting to create a student profile reflective of the socio-demographic composition of the local population	80 (98.8)	4.04 (1.25)
Attempting to create a faculty profile reflective of the socio-demographic composition of the local population	80 (98.8)	3.61 (1.31)
Curriculum
Teaches health care that is responsive to the needs of the local population	80 (98.8)	4.34 (0.83)
Provides community-based learning opportunities	80 (98.8)	4.53 (0.84)
Offers longitudinal community-based learning opportunities	80 (98.8)	3.97 (1.25)
Provides learning opportunities that expose students to vulnerable populations within the community	79 (97.5)	4.42 (0.93)
Provides opportunities for local community agencies to educate students on health human resources needs in the local community/region(s)	79 (97.5)	3.86 (1.08)
Educational Products
Actively tracks graduate mobility (where graduates pursue residency and professional practice)	79 (97.5)	3.96 (1.25)
Produces the right number of specialists needed to serve the local health workforce needs	79 (97.5)	3.30 (1.18)
Collects data on the impact of graduates on patient outcomes	79 (97.5)	2.52 (1.25)

Table 5. Results from Exploratory Factor Analysis with Oblique Rotation (Promax; ∂ = 0) on 28 Social Accountability Likert Scale Survey Items.

		Factor Loadings, Names and CIPP Domain Alignment
Item	Communalities	1	2	3	4
		Selection & Recruitment (Inputs)	Institutional Mandate (Context)	Institutional Activities (Processes)	Community Awareness (Context)
Selection: Attempting to create a student profile reflective of the socio-demographic composition of the local population.	0.780	0.751
Selection: Select students from rural geographic areas	0.323	0.738
Selection: Select students with low socio-economic status	0.606	0.734
Selection: Select students from traditionally marginalized groups	0.640	0.725
Selection: Select students from local regions	0.460	0.693
Selection: Attempting to create a faculty profile reflective of the socio-demographic composition of the local population.	0.606	0.612
Mission Statement: Respond to priority health needs of the local population	0.902		0.935
Mission Statement: Improve the quality of future graduates	0.501		0.765
Mission Statement: Enhance the health status of the local population	0.742		0.743
Mission Statement: Coordinate with local organizations to promote health care	0.469		0.651
Curriculum: Provides community-based learning opportunities	0.660			0.873
Curriculum: Provides learning opportunities that expose students to vulnerable populations within the community	0.719			0.786
Curriculum: Offers longitudinal community-based learning opportunities	0.517			0.534
Population Profile: Aware of the epidemiological disease profile of the local population	0.843				0.903
Population Profile: Access to data containing a community profile of the local population (e.g., socio-demographic composition, priority health needs, health risks and health determinants)	0.496				0.604
Population Profile: Actively conducts community-based health outcomes research	0.571				0.593
Eigenvalue		7.07	1.74	1.38	1.13
% of Variance		44.19	10.85	8.63	7.08
Cumulative %		44.19	55.05	63.68	70.76
M (SD)		4.07 (0.95)	4.29 (0.84)	4.30 (0.86)	4.28 (0.81)
McDonald’s ω		0.870	0.848	0.803	0.799

Principal Axis Factoring. Promax rotation with Kaiser Normalization. Rotation converged in 7 iterations.

Pattern coefficients are presented. Entries in bold indicate pattern coefficients (absolute values) >0.50 on at least one factor.