Social Accountability in Medical Student Scholarly Projects: A Call for Intentional Integration

Abstract

Background

While social accountability is integrated into clinical training at many institutions, its role in medical scholarly projects remains unexplored. While much has been studied on social accountability in medical education and service, little is known about how it is approached in research. Therefore, we examined whether community partnerships were included in student plans, the community’s role in the research process, and health equity outcomes as measures of social accountability.

Methods

We approached this observational study in two stages. In stage 1, we reviewed medical student research proposals. In stage 2, students self-identified where their projects fell on a social accountability spectrum.

Results

In stage 1, we reviewed all 75 proposals submitted by the graduating class of 2025, which revealed that most student project plans lacked community involvement and that most scholarly work did not contribute to improving health equity or was not expected to. We determined that 84% (N = 63) of medical scholarly work fell outside the realm of social accountability. Fifty-seven students (N=57 of 414 total students, 14%) responded to the voluntary survey in Stage 2, recruited via a QR code embedded in the mandatory final project form. There was a shift in project self-classification after definitions of social responsiveness, social responsibility, and social accountability were provided. Respondents identified strategies to enhance accountability; however, the majority did not plan to implement these changes.

Conclusion

Most scholarly projects by medical students reviewed lacked meaningful community engagement and measurable contributions to health equity. Students demonstrated improved understanding of social accountability when definitions were explicitly provided, yet the majority did not plan to act on identified strategies. These findings reveal a critical gap between institutional commitment to social accountability and its integration into student research, underscoring the need for intentional curricular interventions and structured mentorship in socially accountable research practices.

Introduction

The World Health Organization (WHO) defines social accountability (SA) as “the obligation to orient education, research, and service activities towards priority health concerns of the local community, the region and/or nation one has a mandate to serve. These priorities are jointly defined by the government, health service organizations, and the public”.¹ The WHO is not alone in recognizing SA as a critical mandate. The Global Consensus on Social Accountability for Medical Schools is a landmark document, created in 2010 by 130 organizations and individuals, that outlines four key components that medical schools should address to ensure accountability and transparency. One component highlights schools’ need to “reorient their education, research, and service priorities”.² While much has been studied on SA in medical education and service,^1,3–14 little is known about how SA is approached in research, particularly by medical students. More specifically, it remains unclear how SA is conceptualized, operationalized, and implemented within medical student research training.

A gradient of social obligations begins with recognizing social responsibility, an implicit acknowledgment that community issues exist.^2,6 The next step within the progression is social responsiveness, whereby an organization acts on the problems. SA—the highest level of social obligation—culminates in a demonstration of impact. SA is a competency-based value best demonstrated by physicians acting as change agents in partnership with their communities.¹⁵ Socially responsible schools are “committed to what their faculty intuitively considers the welfare of society”. Socially responsive schools respond “to societal welfare by directing education, research and service activities towards explicitly identified health priorities”.⁶ What, then, is socially accountable research (SAR)? SA schools must work collaboratively with local communities to effectively address community health priorities and reduce health inequities, leading to a shared understanding and mutual goals. This collaboration enables schools to move beyond merely addressing health priorities to incorporate accountability by demonstrating tangible impact. To illustrate, Public and Patient Involvement (PPI) and community-engaged research frameworks provide a critical extension of SA, particularly in research. PPI emphasizes the active partnership of patients and communities in shaping research priorities, design, implementation, and dissemination, rather than positioning them solely as subjects.^16,17 Within SAR, this partnership is essential to ensuring that research addresses locally defined health priorities and produces meaningful, equitable impact.

Recent frameworks for SAR highlight the importance of co-creation, shared governance, and the translation of findings into community benefit, moving beyond traditional academic outputs.¹⁸ Despite growing recognition of these approaches, their application within undergraduate medical research training remains limited. This gap is particularly important given that early research experiences shape how future physicians conceptualize knowledge production, community partnership, and their role in advancing health equity. This study is part of an international project: Community-Engaged Research in Education, Advocacy, and System Transformation for Advancing Health Equity (CREATE), which aims to explore the transformative potential of SAR networks, locally and globally.¹⁹

The positionality of our study is that the University of New Mexico School of Medicine (UNM SOM) is internationally recognized for its SA.^20,21 The UNM SOM demonstrates SA by graduating students who are strongly committed to health equity.²² These recognitions were primarily measured through clinical and educational activities and did not focus on SA in research, particularly in research education for medical students. Although all medical students at the UNM SOM are required to complete a scholarly project before graduation, the curriculum provides no formal instruction in research. Students begin medical school with a project proposal in the first year and have the remaining three to four years to complete their scholarly project, presenting their findings orally and/or in a written manuscript. Projects are research-based and can be basic, clinical, population health, or implementation science. During this time, students must find a mentor and either participate in an ongoing study or design their own project. Mentors must have a faculty appointment as an MD or PhD. Mentors do not receive any explicit training in social accountability, although they may have a background in community engagement or community-based practice-research (CBPR). This leaves an educational gap for many medical students regarding best practices for partnering with communities, acknowledging the valuable role of community members in conducting research, and, at a basic level, how SA differs from social responsiveness and social responsibility. While this study is specific to medical students at UNM, a medical school internationally recognized as socially accountable, the results are applicable to other medical institutions that can use them as lessons for developing their own SA mandates and research curricula.

Using community engagement theory as our construct, we aimed to determine what our students understand about SA and whether it is considered during the conception, conduct, and finalization of their projects. The lack of formal instruction on community partnership in research reflects a common challenge in community engagement theory: institutions often assume that good intentions translate to effective practice without explicit training. Our primary research question was to determine whether SA is considered in medical student research at our medical school and, if so, how. Our secondary research question was to assess how students self-identified their projects on a SA spectrum. The results of this study have the potential to help mentors of health professions student researchers guide students in conducting SAR.

Importantly, awareness of SA does not automatically translate into action. Medical students face contextual barriers to implementing socially accountable practices in research, including the time constraints of a demanding curriculum, the absence of formal academic credit or incentives for community engagement, limited access to established community partners, and reliance on mentors whose own training may not include SA. As a result, even students who can identify ways to make their projects more accountable may not feel positioned to enact those changes; this knowledge-to-action gap is examined further in the discussion.

Methods

Study Design

The current study used an observational study design and was conducted in two stages. We defined SA using three variables foundational to community-engaged research: partnerships with communities, the role of communities in the research process, and the project’s achievement of health equity outcomes.²³ For the purposes of this study, a “tangible health equity outcome” was defined as a measurable change in health access, behavior, or disparity directly attributable to the student project and benefiting an underserved or priority population (examples: distributing naloxone to at-risk youth, implementing process changes to reduce hospital readmissions).

Participants

Study participants consisted of UNM medical students who had completed their final research reports. This often occurred between the end of the third year and the beginning of the fourth year, but was not limited to any particular year of study. In stage 1 of the study, n=75 reports that were completed by the end of 2025 were evaluated. In stage 2 of the study, n=57 Surveys completed between May 1st, 2025, and November 7th, 2025, were evaluated. This time period was selected because it captures when most reports are submitted in a year.

Stage 1: Review of Project Proposals

To determine whether SA in research was a focus among our students, we reviewed all medical student research proposals from students graduating in 2025 (n=75). All students must complete a final project form to receive credit for their work. Our team developed a survey to assess the social accountability of the research, drawing on existing frameworks for social accountability and community-engaged research.^18,24 The survey was verified by two independent SA researchers in Canada and Australia to ensure face validity, comprehension, and usability Figure 1.

Figure 1.

Stage 1 survey instrument used to assess social accountability in medical student scholarly projects. Questions assessed whether students conducted research or a community project (or both), the focus of the scholarly abstract, the presence and level of community involvement (ranging from none to maximum, with maximum defined as community involvement at every stage and a demonstrated impact on health equity), whether the project improved health equity (with examples requested if applicable), and who assessed or would assess the work (internal faculty, external reviewer, peer reviewers, or community members). Community involvement was coded on a four-level scale: none (project was set in the community but without community involvement), minimal (community was engaged but had no substantive role), moderate (some community involvement), or maximum (community involved at every stage, with demonstrated health equity impact).

Stage 2: Introspective Student Review

Stage 2 used the final written report detailing the students’ completed research. Building on themes from Stage 1, a new survey was developed. A QR code for the survey was embedded in the mandatory final project plan form (distributed through the medical school curriculum) as a voluntary survey. From May 1, 2025, to November 1, 2025, students used the survey to self-identify their projects’ positions on the social accountability spectrum Figure 2.

Figure 2.

Stage 2 survey instrument used to facilitate medical students’ self-classification of their scholarly projects on the social accountability spectrum. Students first self-classified their project as socially responsive, socially responsible, socially accountable, or none of the above, without reference to formal definitions. They were then provided standardized definitions of each term—adapted from the World Health Organization’s framework for social accountability in medical education—and asked to reclassify their project. Students who identified strategies to increase their project’s social accountability were asked whether they intended to implement those changes. The survey concluded with an item assessing interest in learning more about social accountability in research.

Data Analysis

Data from both stages were collected and housed in the UNM RedCap database.²⁵ We created an Excel spreadsheet, made the research questions in Stage 1 as the categories, entered the responses, and then determined frequencies. We used a consensus approach to resolve any disagreements. RedCap provided frequencies for Stage 2. For open-ended questions, we used thematic analysis as our qualitative analytic approach.²⁶ No additional qualitative software was used beyond REDCap for data management. The data were inductively coded by four independent researchers using thematic analysis. When coding disagreements arose, researchers discussed differing interpretations until consensus was reached Figure 3.

Figure 3.

Two-stage study design for an observational study of social accountability in medical student scholarly projects at the University of New Mexico School of Medicine. Stage 1 (left, blue) involved a retrospective review of all 75 scholarly project proposals submitted by the graduating Class of 2025. A research team applied a social accountability review survey, verified by two international social accountability researchers, and coded projects for community partnership, community role in research, and health equity outcomes. The primary finding was that 84% (63/75) of projects fell outside the scope of social accountability. Stage 2 (right, Orange) was a prospective, introspective student self-review conducted via voluntary survey (May 1–November 7, 2025). Of 414 students, 57 (14%) self-classified their projects on the social accountability spectrum. Following provision of standardized definitions, students reclassified their projects and identified strategies to increase social accountability; 83% (24/29) of students who identified such strategies indicated they would not implement them. Findings from both stages converge on a gap between the institution’s stated social accountability commitment and its integration into student research, signaling the need for curricular intervention.

Abbreviation: SA, social accountability.

Ethics

The University of New Mexico Human Research and Review Committee approved this study (HRRC #24-449 and #24-449). For stage 1, no consent was necessary as it was a retrospective review of existing data. In stage 2, a statement of consent was provided before the survey, and participants marked “I Consent” or “I do NOT consent”. The survey process immediately ended if consent was not given.

Results

Stage 1: Proposal Review

We analyzed all 75 project proposals that were submitted by medical students in the Class of 2025. These 75 proposals represent the complete graduating cohort; Approximately 26 (35%) were research proposals, 1 (1%) was a community project, 3 (4%) were categorized as both, and 45 (60%) were categorized as other (Table 1). Other proposals included chart reviews, literature reviews, and case reports. Research activities were classified into one or more of the following four categories: health education (N = 46, 61%), advocacy (N = 9, 12%), system transformation (N = 45, 60%), and other (N = 1, 1%) (Table 1).

Table 1.

Research Proposal Review

Scale	Definition	Number of Proposals (N), Percentage of Proposals (%)
Area of Focus	Research proposal	26 (35%)
	Community project	1 (1%)
	Research proposal and community project	3 (4%)
	Other (chart review, literature review, case report)	45 (60%)
Category	Health education	46 (61%)
	Advocacy	9 (12%)
	System transformation	45 (60%)
	Other	1 (1%)
Community Partnership	Partnered with the community	12 (16%)
	Did not partner with the community	59 (79%)
	Unclear whether a partnership exists	4 (5%)
If yes to community partnership	Community partners assisted with data collection	5 (42%)
	Community partners participated as research subjects	12 (100%)
	Community partners were part of the initial research idea	0 (0%)
Level of community involvement	None	63 (84%)
	Minimal	7 (9%)
	Moderate	5 (17%)
	Maximum	0 (0%)
Health equity contribution	Contributed to health equity	8 (11%)
	Did not contribute to health equity	66 (88%)
	Failed to explain the health equity impact	1 (1%)
Final evaluation	Internal faculty	74 (99%)
	External person	1 (1%)

Across the proposals, N=12/75 (16%) partnered with a community, whereas the majority (N=59/75, 79%) did not (Table 1). In the remaining 5% (N = 4/75), it was unclear whether a partnership with the community existed. Among projects that partnered with the community, 42% (N = 5/12) assisted with data collection, and 100% (N = 12/12) of participants served as research subjects. None (N=0/75) of the research proposals mentioned including community members in the initial research idea.

Most research (N = 63/75, 84%) had no community involvement (defined as community members playing no role in study design, data collection, or dissemination). Approximately N=7/75 (9%) had minimal community involvement, meaning community members participated only as research subjects or passive data sources without active engagement in research decisions. Some (N = 5/75, 7%) had moderate community involvement, defined as community members contributing to data collection or providing feedback on findings. None of the proposals were classified as having maximum community involvement, in which community members were engaged as partners in all aspects of the research from conception through dissemination and the research explicitly aimed to improve health equity (Table 1).

The majority (N = 66/75, 88%) of the scholarly work either did not contribute to improving health equity or will not do so. For those who did or will improve health equity (N = 8/75, 11%), examples of improvement are summarized below:

• Distributing Naloxone to youth (ages 16–24) at local music venues

• Creating and evaluating a tool to reduce patient spending in healthcare settings

• Post-patient interviews, implemented process changes to reduce readmissions

• Reducing adverse glycemic events by addressing delays in insulin transition and improving access to long-acting insulin in ICU patients

• Creating a literature review to provide recommendations on the management of patients with comorbid diabetes and viral illness

• Improving recognition of pediatric stroke symptoms in the postoperative setting to reduce diagnostic delays

• Delivering fall prevention education to older adults

Only one of the proposals failed to explain its impact on health equity. Final research evaluations were conducted primarily internally (N = 74/75, 99%), with only one proposal being evaluated externally. Internal assessments include a pass/fail grade and an optional narrative component. Based on this review, we determined that 84% (N = 63/75) of medical scholarly work fell outside the scope of social accountability, whereas only 16% (N = 12/75) partnered with the community.

Stage 2: Introspective Student Review

Of the N=57 respondents to the Stage 2 survey, the majority were from the Class of 2028 (44%, N=25/57). Only 2% (N = 1/57) were from the Class of 2025. The Class of 2026 (28%, N = 16/57) and the Class of 2027 (26%, N = 15/57) had similar representation. Most respondents reported familiarity with the concepts of social responsibility (77%, N = 44/57) and social accountability (60%, N = 34/57), whereas fewer recognized social responsiveness (26%, N = 15/57). Some reported being unfamiliar with all three terms (14%, N = 8/57). When initially asked to classify their research projects along the social accountability spectrum, 46% (N = 26/57) identified their work as socially responsible, 21% (N = 12/57) as socially responsive, 9% (N = 5/57) as socially accountable, and 25% (N = 14/57) as not on the social accountability spectrum. However, after receiving clear definitions of these terms, students reclassified their projects: social responsibility responses decreased to 21% (N = 12/57), whereas social responsiveness and social accountability increased to 46% (N = 26/57) and 26% (N = 15/57), respectively. Only 7% (N = 4/57) classified their projects as not on the social accountability spectrum (Table 2). Table 2 and Figure 4.

Table 2.

Self-Labeling of Projects Pre/Post Definitions

	Pre-Definition	Post-Definition
Socially Responsible	46% (N = 26/57)	21% (N = 12/57)
Socially Responsive	21% (N = 12/57)	46% (N = 26/57)
Socially Accountable	9% (N = 5/57)	26% (N = 15/57)
Not on the Social Accountability Spectrum	25% (N = 14/57)	7% (N = 4/57)

Figure 4.

Student self-classification of scholarly projects on the social accountability spectrum before and after definitions were provided (N = 57). Grouped bar chart displaying the percentage of respondents who classified their project as socially responsible, socially responsive, socially accountable, or not on the social accountability spectrum, at two time points: before (blue bars) and after (Orange bars) standardized definitions were provided. Before receiving definitions, students most frequently classified their projects as socially responsible (46%, n=26) or not on the social accountability spectrum (25%, n=14), with fewer selecting socially responsive (21%, n=12) or socially accountable (9%, n=5). After definitions were provided, classifications shifted markedly: socially responsive increased to 46% (n=26), socially accountable increased to 26% (n=15), socially responsible decreased to 21% (n=12), and those classified as not on the spectrum decreased to 7% (n=4), suggesting that definitional clarity meaningfully influenced students’ self-assessment of their work. Data correspond to Table 2.

When asked how they might modify their research projects to make them more socially accountable, almost half (49%, N = 28/57) of the respondents reported that their projects already met that standard. The other half (51%, N=29/57) outlined potential strategies to achieve greater accountability. Thematic analysis of these responses revealed common approaches, including engaging patients or community stakeholders for feedback, translating research findings into practical applications or educational improvements, disseminating research outcomes to broader audiences, and collaborating with health systems, academic institutions, or government agencies. Despite this insight, 83% (N = 24/29) reported that they would not implement those changes.

Respondents were also asked if they would be interested in learning more about social accountability in research. Interest in learning more was high: 67% (N = 38/57) expressed interest. Preferred methods of education included seminars (32%, N = 12/38), one-on-one project consultations (32%, N = 12/38), and receiving emailed information (58%, N = 22/38).

Discussion

To build a healthcare system that improves health equity, medical students must possess a comprehensive understanding of social accountability and related concepts and be able to apply these principles effectively. Our study aimed to determine whether social accountability is considered in medical student research at UNM SOM and, if so, how. Additionally, we sought to know how students self-identified their projects on a SA spectrum. Our findings revealed that most student proposals did not consider aspects of SA. The way students characterized their project on the SA spectrum also differed before and after the definitions were shared. In the same survey, students report knowing how to increase SA in their projects, but the majority say they will not take action. These findings suggest that the gap is not solely a lack of awareness but reflects a broader structural issue in how research training is conceptualized within medical education. Prior literature demonstrates that without explicit curricular integration, social accountability remains aspirational rather than operationalized.^7,24 The discrepancy between knowledge and action observed in our study may therefore reflect institutional signals regarding what is valued in research, particularly the prioritization of traditional academic outputs over community impact. Our findings yield valuable insights into the state of education in SA at UNM and offer vital lessons for other medical schools seeking to advance health equity.

Social accountability is not explicitly taught in the UNM SOM curriculum, and there is no instruction for students on integrating SA effectively into their research projects. Rather, SA is implicit in the mission statement and via role modeling from faculty who work in and with communities, early exposure to communities, community-based clinical placements, student-run clinics, and policy and advocacy training. These experiences are the usual markers of a socially accountable curriculum.¹³ However, in research, unless a student has a mentor who practices social accountability, students are often given little guidance in formulating research plans and, as a result, may overlook SA, equity, and other relevant factors, such as working with communities and reporting results back to the community. Results from our study show that students want education on SA. These findings suggest both receptivity to the concept of social accountability and an opportunity to provide structured, accessible educational interventions that support the deeper integration of these principles into student research. These findings are consistent with studies in community-engaged research, which show that without structured mentorship and institutional expectations, community engagement remains superficial or absent.^8,14 Furthermore, socially accountable research frameworks emphasize that accountability is demonstrated through measurable impact, equitable partnerships, and responsiveness to community-defined priorities.¹⁸ The predominance of projects lacking community engagement in this study suggests that most student work remains at the level of social responsibility rather than achieving true accountability.

Social accountability is not universally understood, and good intentions alone do not translate into effective SA practice without explicit training.^27,28 Our findings indicate that, although UNM is a socially accountable school, it lacks education on SA research; therefore, SA is not being used by students in their research projects. These shifts suggest that students may initially underestimate the depth of their projects’ societal engagement and that greater clarity of terminology encourages a more nuanced self-assessment. Our curriculum lacks explicit discussion of social accountability (SA) activities as they occur, including within the research realm. Our results, as reflected in the pre- and post-definitions of SA, show that knowledge changes when an explicit definition is provided. This also provides students with a basic understanding of how to conduct SA, as reflected in their responses on how they could improve SA in their project. Students want more education on the topic, and some medical schools are responding.^8,29,30 Our results demonstrate that explicit education on social accountability in research is needed, as students often overlook the importance of SA, including the implications of their research results for health equity. Thus, community input, involvement, and acceptance of findings are necessary. This is reflected in our students’ reluctance to incorporate SA into their existing project plans. We recognize there are structural and individual barriers to implementing SA into research, particularly for students. These include time constraints inherent to a demanding medical curriculum, limited motivation due to a lack of “rewards” or academic credit for integrating social accountability, a knowledge gap regarding how to operationalize SA in practice, limited access to community partners, and dependence on mentor values and practices. The degree to which mentors themselves prioritize SA may significantly shape student behavior. If a mentor does not model or encourage communication engagement, students are unlikely to pursue it regardless of personal interest. Additionally, not all forms of medical research, such as laboratory-based studies and retrospective chart reviews, may be equally amenable to SA frameworks. Acknowledging these distinctions, rather than applying a uniform expectation, may help institutions develop more contextually appropriate SA training. A hidden curriculum can be either positive or negative, but if it is hidden, it is not explicit.³¹ Future steps include hosting information sessions for students on SA and informing research mentors of these preliminary results, reminding them to consider and emphasize the community’s role in their research plans and how they might achieve SA in future endeavors.

Limitations

Our study is the first to examine medical students’ understanding of SA through their research projects. Our study has several strengths and notable limitations. The authors acknowledge that the study would be stronger if we had longitudinal data on students before and after the projects. However, having point-in-time information will enable UNM faculty to adjust their mentorship more promptly. Additionally, the sample size for prospective proposals was small within this single-site study, limiting the generalizability of our study. While the sample size still provides information on students’ awareness and their ability to incorporate SA into their research, there may be bias in self-reported classifications. The review of student proposals required the researchers to interpret the findings based on the available information, which was often incomplete and lacked detail. However, we still identified that students frequently overlook SA as a critical aspect of their research plans, even when their research is centered on the community. Lastly, some students may have felt obligated to indicate that their project was socially accountable because they attend an internationally recognized socially accountable school. It is not possible for us to say how many students selected that their work was socially accountable due to their perceptions or out of obligation.

Future Directions

Future work should aim to conduct similar analyses in other medical schools, particularly those with a social accountability mandate. Moreover, students were generally interested in learning more about SA and in integrating these practices into their research. Educational materials on SA should be developed to suit a range of learning styles and fit busy medical students’ schedules. The implementation and evaluation of these educational materials should be monitored to determine their effectiveness.

Conclusion

This study highlights a critical gap between institutional commitments to social accountability and its practical integration into medical student research at UNM SOM. Despite strong student interest and an improved understanding of social accountability when explicitly defined, most projects lacked meaningful community engagement and measurable contributions to health equity. The majority of students who identified strategies to enhance their projects’ social accountability did not plan to implement those changes, pointing to a structural barriers beyond mere awareness. These findings underscore the need for intentional curricular interventions, structured mentorship, and clearer expectations to help students translate awareness into action. Concrete next steps should include developing curricular modules on SA research within the scholarly project curriculum, creating mentor development programs that explicitly address SA principles and community engagement practices, and establishing structured community partnership frameworks that connect students with local organizations at project inception. Future efforts should also explore scaling similar assessments to other medical schools, particularly those with an SE mandate, to build a comparative evidence base for best practices.

Funding Statement

No funding to declare.

Disclosure

Dr Amy Clithero-Eridon reports leadership or fiduciary roles from HRSA, The Network Towards Unity for Health, outside the submitted work. Dr Erin Cameron reports meeting/travel support from SSHRC Partnership Grant; leadership or fiduciary roles from Thunder Bay Health Sciences Research Institute Board of Directors, TUFH Board of Directors, outside the submitted work. The authors have no other conflicts of interest to disclose in relation to the work presented in this paper.