Since 2015, the Committee on Accreditation of Canadian Medical Schools (CACMS) supported by the Association of Faculties of Medicine in Canada (AFMC) and the Canadian Medical Association (CMA) has an accreditation standard on Social Accountability, which states:
A medical school is committed to address the priority health concerns of the populations it has a responsibility to serve. The medical school’s social accountability is: a) articulated in its mission statement; b) fulfilled in its educational program through admissions, curricular content, and types and locations of educational experiences; c) evidenced by specific outcome measures.
ACMS did not stop there. This fundamental principle of social accountability is now part of several other elements of standards.
One CACMS element clearly indicates the need to respond to the most important societal issues of the day.[jf1]
7.5 Societal Problems: The faculty of a medical school ensure that the medical curriculum includes instruction in the diagnosis, prevention, appropriate reporting, and treatment of the medical consequences of common societal problems.
In Canada, currently, this would include the epidemic of Opioid related deaths, for example.
As well, our accountability to underserved populations and our responsibility to provide culturally competent care are being addressed in a newly revised proposed standard element.
7.6 Culture and Health Care Disparities: The faculty of a medical school ensure that the medical curriculum provides opportunities for medical students to learn to recognize and appropriately address the unique needs of people of diverse cultures, genders, races and belief systems, in particular the Indigenous peoples of Canada.
The medical curriculum prepares medical students to:
- a) recognize and appropriately address the manner in which people of diverse cultures, genders, races and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. b) recognize and appropriately address personal biases (cultural, gender, racial, belief) and how these biases influence clinical decision-making and the care provided to patients. c) develop the basic skills needed to provide culturally competent health care. d) identify health care disparities and participate in developing solutions to address them.
And a final example of a requirement under curricular content and design that requires student thoughtful involvement in community needs in the form of Service Learning.
6.6 Service-Learning: The faculty of a medical school ensure that the medical education program provides sufficient opportunities for, encourages, and supports medical student participation in a service-learning activity.
Service learning is defined as a structured learning experience that combines community service with preparation and reflection.
Still much to do[jf2]
Canada may be seen to be leading the pack in social accountability and accreditation but we are not there yet. Most of our schools have yet to be tested against the elements of the standards as they have only been in place in the last few years or are still in the process of being approved. As we train our next generation of physicians, we need to be vigilant to ensure that our schools continue to focus on our most important health issues and our most vulnerable populations. Not until we can demonstrate that our schools are producing physicians who care for our populations in greatest need, and that we are providing good care to all Canadians, can we start speaking about a job well done.