Educational approaches for social accountability in health professions training: a scoping review protocol

Introduction

The World Health Organization emphasizes the importance of socially accountable education in training health professionals to address health inequities and serve community needs.¹ Health professions education (HPE) programs across professions like medicine, nursing, physiotherapy and occupational therapy are progressively adapting their curricula to align with this mandate.^2,3 This involves integrating elements such as service learning, clinical placements in underserviced areas, and cultural immersion to sensitize students to social determinants of health.^4-6 These educational approaches aim to develop advocacy, social justice engagement, and community service integration skills in future health professionals.

Despite these efforts, the literature lacks clarity on identifying which specific educational approaches promote social accountability. This is an important focus for research, as it will guide educational institutions in designing curricula that not only fulfill accreditation standards^7,8 but also truly prepare students to become agents of change in addressing health disparities and improving health outcomes.

Our research aims to map the breadth and depth of the existing literature regarding educational approaches in HPE underpinned by the concept of social accountability. A preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports was conducted and no current or underway scoping or systematic reviews on social accountability educational practices were identified. No similar review protocol is registered in PROSPERO.

Methods

We will use the six-stage methodological framework developed by Arksey and O’Malley,⁹ further refined by Levac and colleagues¹⁰ and the Joanna Briggs Institute.¹¹ We chose to conduct a scoping review to a) identify the types of available evidence in a given field, b) clarify key concepts/definitions in the literature, c) examine how research is conducted on a certain topic or field, and d) identify key characteristics or factors related to a concept.¹² The full protocol details are registered with the Open Science Framework.¹³ Next, we describe the six stages for this scoping review.

Stage 1 - Formulating the research question

What educational approaches in health professions training promote social accountability?

Stage 2 - Identifying the relevant literature

Collaborating with an academic librarian, we developed a search strategy using keywords related to social accountability in HPE. The strategy was piloted and refined to ensure comprehensive literature coverage (Table 1). We plan to repeat the search strategy to incorporate any new evidence that has been published since the original search, ensuring an up-to-date mapping of the literature.¹⁴

Table 1.

Search strategy and databases

Concepts	Social accountability	Teaching and learning	Health professions education
Search terms	"social* accountab*" OR “social* responsib*” OR “change agent” OR “health advoca*” OR “social contract*” OR “social determin*” OR “social justice”)	“learn*” OR “education” OR “teach*” OR “experiential*” OR “situated*” OR “service*” OR “work*” OR “transform*” OR “critical*” OR “praxis*” OR “community*” OR “curricul*” OR “place*”)	“medical” OR “medicine” OR “nurs*” OR “occupational therap*” OR “physical therap*” OR “physiotherap*” OR “residen*” OR “health profession*”

Interface - EBSCOhost Research Databases

Date range – 2000-2023

Databases - CINAHL Plus with Full Text; ERIC; MEDLINE with Full Text; APA PsycInfo; Education Source

Stage 3 - Selecting the literature

We will determine relevance to our research question using the Population (learners in medicine, nursing, physical, and occupational therapy), Concept (social accountability¹), and Context (HPE programs) framework for inclusion and exclusion criteria.¹⁵ We will include empirical research papers based on consensus-built inclusion and exclusion criteria. We will exclude grey literature from our study due to its ambiguous nature, difficulty in systematic identification, and scarce inclusion in formal sources, acknowledging this as a potential limitation.¹⁶ The review process will involve two independent screening phases by two reviewers: firstly, reviewing titles and abstracts, and subsequently, full texts, to apply inclusion and exclusion criteria.This process will be piloted on 5% of the papers, aiming for 90% agreement,¹⁷ with iterative discussions to resolve discrepancies.

Stage 4 - Data charting

Our data extraction will include publication year, country of origin, discipline, conceptualizations of social accountability, contextual settings, educational approaches, and key discussions. This process will be independently conducted on 20% of the papers, aiming for 90% agreement,¹⁷ with iterative discussions to resolve discrepancies.

Stage 5 - Collating and reporting the results

Reasons for exclusion of full text will be recorded and reported in the final scoping review according to the PRISMA extension for scoping reviews (PRISMA-ScR).¹⁸ Data analysis will be conducted in two stages: first, a numerical (bibliometric) analysis to detail the scope and characteristics of included papers. Second, a thematic analysis to explore socially accountable educational approaches.¹⁹

Stage 6 - Consultation with knowledge users

To complete the scoping study, we will use the Harvard Macy “step-back” method to gather knowledge user group feedback.²⁰ We plan to conduct three focus groups at three HPE faculties in Canada, each comprising six to eight participants purposively recruited²¹ from various partner groups (e.g., learners, community members, faculty, and leaders in social accountability). Our objective is to present our findings and intentionally withdraw (i.e., “step-back”) from the discussion, enabling the group members to engage in open deliberation and discuss implications. Toward the conclusion, the lead author returns to the conversation (i.e., “steps back in”) and facilitates an interactive group discussion to promote the exploration of new ideas and perspectives. Ethics approval will be obtained by the appropriate ethics committees.

Summary

The widespread adoption of social accountability principles in accreditation processes for HPE programs in multiple countries could indicate a global movement towards prioritizing these principles in educational paradigms. This scoping review aims to enrich our understanding of educational approaches, offering guideposts for HPE programs to incorporate socially accountable education. Such efforts are poised to play a supportive role in preparing health professionals who are both skilled and committed to meeting the health needs of their communities.

Funding Statement

Funding

This article draws on research supported by the Social Sciences and Humanities Research Council.

Conflicts of interest

TD and MZ are on the editorial board for the Canadian Medical Education Journal. Neither were involved in any decision regarding this manuscript. All other authors report no conflicts of interest.

Edited by

Marcel D’Eon (editor-in-chief)