Assessing the Integration of Social Accountability Values ​​into Medical Education Using a Problem-Based Learning Program | BMC medical training

In this study, we examined the integration of social accountability values ​​such as relevance, quality, fairness, and cost-effectiveness in the case scenarios (70 in total) used in the medical problem-based learning program. Overall, we observed that significant amounts of these social responsibility values ​​were embedded by appropriate triggers in the case scenarios. However, their consistency between the different units remained variable.


In terms of relevance, we observed that the majority of case scenarios (73%) dealt with the country’s main health problems or social health concerns. It is vital for the medical school to understand and frame its education, training and research focused on the major health issues of the community, region and/or nation it is mandated to serve. . [1, 3]. Similarly, 70% of case scenarios had triggers for one or more social determinants of health. Improve our understanding of the social determinants of health such as the environments in which people are born, grow up, live, work and age, factors such as socio-economic status, education, employment and access to care is essential to provide targeted health care and shape people’s health [21,22,23].

The majority of PBL case scenarios (87%) reflected the contextual integration of medical professionalism, the changing roles of physicians in the healthcare system (79%), and reflected a healthcare referral system based on the complexity of the case (73%). We believe these traits are essential for providing good clinical care, maintaining good medical practice, patient relations, working with colleagues, probity and health. [24]. The medical profession now recognizes the importance of introducing professionalism early in the medical curriculum to provide learning opportunities, gain experience and reflect on the values ​​of medical professionalism for better patient care. . [25].

In the same note, the role of the doctor underwent quantum shifts from person who knew medicine to a manger, social worker, teacher, advocate, and leader to name a few. 21st century physicians should have the skills to work as a team, use resources efficiently, provide patient-centered care, advocate for health systems, and increase accessibility for patients. Therefore, knowledge and understanding of the social determinants of health will provide the information and framework needed to understand patient needs and societal factors that are closely linked to health outcomes. [26] .

Highlighting the importance of the multidisciplinary approach in patient care, we observed that only 29% of case scenarios had successfully integrated it; similarly, approximately 49% of cases had integrated health system management issues into their content and 59% of cases had triggers applying the values ​​of health promotion/prevention measures in patient care. We believe that the lack of triggers in the initiation of learning outcomes, especially in the areas mentioned above, needs improvement. It is well known that the multidisciplinary care model that brings together different providers such as doctors, nurses, social workers and other specialists not only improves healthcare outcomes but also reduces the risk of errors. [27]. Given the need for doctors to actively collaborate with several professionals, it becomes essential to introduce such learning modules early in the medical curriculum. Similarly, medical students should be made aware of the structure of the health system they wish to join, from the start of their course. This will help them integrate into the country’s health system and improve their understanding of health legislations, concerns, and issues within the health system. [28].


In the area of ​​social accountability equity, the case scenarios used in our problem-based learning program showed full integration in consideration of the patient’s gender and age group. In comparison, the case scenarios did not include underserved, disadvantaged, or vulnerable populations in society (89%), the ethnicity of patients (77%), and did not address the socioeconomic status of patients in 53% of cases. The socio-economic status (SES) of an individual made up of his education, his profession and his income has a significant impact on health and access to care. Low SES is an important determinant of access to health care. People with low SES are at greater risk of poor health, are more likely to be uninsured, seek health care less often, and may receive poor quality care. SES can also affect a person’s lifestyle and life expectancy. Thus, SES is a good predictor of an individual’s health outcomes. [29, 30]. Similarly, ethnicity plays an important role in health and access to health care. Racial and ethnic disparities exist in health care and are important determinants of social accountability [31]. In order to make students aware of the importance of SES, ethnicity, and vulnerable population identification, PBL case scenarios should include this information in the patient profile to trigger appropriate discussion and emphasize its importance. [32].


The majority of case scenarios (91%) need to be improved to trigger a discussion about the cost of treatment and offer alternatives to their patients. While most medical programs are good at training students to discuss diagnosis, treatment, and drug side effects with their patients, they don’t share financial issues with them. Empowering the patient in their own healthcare decision-making, especially financial matters such as the cost of treatment and the treatment alternatives available, has become an important responsibility of the physician. [33]. In order to instill these traits, students must commit to learning how to disclose financial consequences and appropriate alternatives with their patients through the modeled case scenarios.


Finally, 78% of the PBL case scenarios used in our program include the concept of person-centered healthcare, ensuring that both patient and physician consult with the patient about their health needs and values ​​when making decisions. clinics. [34].

About Michael G. Walter

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