Evaluation and assessment of social accountability in medical schools

Social accountability as an outcome must be measured at institutional (evaluation) and individual (assessment) level. The definitions used in the measurement will be dependent on the social setting of the medical school being scrutinised. A formal framework is needed so that comparisons can be made and progress measured. The World Health Organisation suggests that there are four principles that delineate social accountability--relevance, quality, cost-effectiveness and equity. Medical schools are evaluated according to their planning, doing and impact in relation to these principles. Boelen and Woollard have clarified the ideas of planning, doing and impact into Conceptualisation, Production and Usability. THEnet group of medical schools use a shortened version of Boelen and Woollard's framework with 20 criteria to evaluate their programmes. At the individual level, there is considerable overlap between the concepts of 'social accountability' and 'professionalism'. Attempts are being made to define and measure professionalism, however, if the behaviour and attitudes of individual graduates is a significant component in defining social responsibility new methods of assessment need to be developed. Factors such as the available resources and the structure of the health services have a very large effect on doctors' attitudes and behaviour. As a result, the task of evaluating and assessing the extent to which medical schools are socially accountable is complex. Judgments on how well a school is meeting the standards will have to make allowance for the local political and economic environment.