Assessing social accountability in health professions education: bridging the gap between interest and implementation

Abstract

BACKGROUND
Social accountability (SA), defined as aligning health professional education, research, and service with community needs, remains inconsistently implemented across institutions. The Individualized Social Accountability Tool (ISAT) provides a structured framework for assessing and benchmarking SA across institutions. However, low adoption rates limit its full potential, and barriers to implementation remain poorly understood.

METHODS
We conducted a cross-sectional study using two surveys distributed via REDCap to current ISAT users (N = 50) and interested adopters (N = 62). Descriptive statistics were used to characterize responses. Open-ended responses were analyzed using a thematic qualitative approach with frequency counts to contextualize key themes.

RESULTS
Response rates were 24% for both surveys (12/50 users; 15/62 interested). Respondents represented diverse global regions, including North America, Sub-Saharan Africa, and the Middle East. While 79% (N = 11) agreed that SA is important, only 40% reported it as a high institutional priority. Faculty development was limited: 43% reported no SA training, and 29% offered training only upon request. Despite this, 86% of institutions expressed interest in using ISAT. Identified barriers included limited resources, unfamiliarity with the tool, and financial constraints.

CONCLUSION
There is a clear gap between the perceived importance of SA and institutional prioritization and implementation. ISAT use appears promising in increasing awareness, particularly in identifying discrepancies between perceived and actual SA performance. However, structural and resource-related barriers limit adoption. Addressing these gaps may require shifts in institutional culture, targeted faculty development, policy adjustments, and stronger evidence demonstrating ISAT’s impact to fully realize its potential.