By: William Ventres, MD, MA, research professor, Institute for Studies in History, Anthropology, and Archeology, University of El Salvador, and Shafik Dharamsi, PhD, professor and associate dean, School of Osteopathic Medicine, University of the Incarnate Word
Several new medical schools are underway in the United States, with more on the horizon. Many more are sprouting up around the world, especially in areas of extreme need, such as Africa.
Commonly, the founding deans and administrators of these new institutions indicate that they are starting their medical schools to help address local disparities in health outcomes. Yet, most of these new schools continue to overemphasize the same basic biomedically-focused model that has dominated undergraduate medical education for over 100 years. For all our understanding of how social determinants of health (like poverty, racism, and the lack of universal access to health care) contribute to illness, few medical schools have stepped up to adequately address these issues through significant curricular reform. Nothing changes in the quest to prepare future generations of physicians to be socially responsive.
We wrote our AM Last Page, “Socially Accountable Medical Education: The REVOLUTIONS Framework,” to provide medical educators in emerging medical schools with a curricular blueprint to help them realize their vision of creating socially accountable institutions. Social accountability means attending to the priority health needs of the surrounding community, giving special attention to those who live on the economic and social margins—those who bear the highest burden of disease. We created this blueprint by adapting ideas from innovative programs around North America. (A review of any one of these programs is beyond the scope of either our AM Last Page or this blog post; we can, however, recommend for interested readers an Academic Medicine article highlighting three medical schools’ specific efforts to integrate social accountability into all their curricular endeavors.¹) We put together these ideas in what we hope is an engaging format—REVOLUTIONS—that speaks to the need for promoting organizational cultures aimed at addressing the social determinants of health. Our goal is to encourage the formation of socially responsive physicians who will be master adaptive learners and work with their local and global communities in novel ways, as exemplified in the curricular case studies we cite on the website accompanying our AM Last Page.
We admit that there are many challenges to the implementation of such a model (potential resource constraints, the pull to maintain the status quo, and the fear of challenging conventional academic approaches among them). While our framework is not designed to eliminate those barriers, it does provide practical and innovative suggestions for changing how we prepare our next generation of physicians.
Clinicians, educators, administrators, community activists, and politicians working to create new medical schools have an incredible opportunity to improve health outcomes. When it comes to health, ignorance is not bliss. We simply cannot afford to ignore how social injustices relate to health outcomes, and the want of creativity in developing appropriate curricula can no longer be reason to reproduce programs in medical education that do not speak to the needs of the most vulnerable around us.
We know there are many other programs in existence that complement our REVOLUTIONS framework. We encourage their sponsors to add to the conversation about developing socially accountable curricula. Please share your experiences and comments on AM Rounds or in other media. (See, for example, Dr. Christina Gonzalez’s recent blog post “On the Journey to Achieve Health Equity: Teaching the Next Generation of Physicians“). Let us all evolve the REVOLUTIONS framework in socially accountable medical education together, whether in the United States or elsewhere around the world.
NOTE/NOTA: Readers interested in a Spanish language version of the framework—SOLIDARIDAD—please contact the authors by electronic mail/Los lectores interesados en una versión en español del enfoque—SOLIDARIDAD—pónganse en contacto con los autores por correo electrónico. Author contacts: firstname.lastname@example.org, email@example.com.