Social Accountability in Medical Education

A century after the seminal Flexner report redefined medical education, its institutions face new challenges to demonstrate their alignment with the needs of patients and populations, their relevance to societal priorities, and their measurable impact on health.

Social Accountability in Medical Education

A century after the seminal Flexner report redefined medical education, its institutions face new challenges to demonstrate their alignment with the needs of patients and populations, their relevance to societal priorities, and their measurable impact on health.

The CPV is not only focused on clinician professionalism but on the factors that enable clinician professionalism. Organizational professionalism is a concept developed and championed by the Foundation for Medical Excellence which developed a Charter for Organizational Professionalism because “physicians indicated that they were unable to fully live up to the principles in the 2002 [Physician Charter on Medical Professionalism]partly because of their employing or affiliated health care organizations.” Many physicians lack autonomy, organizational support, or both making it difficult to do what is right for patients and the public. Whether or how health care organizations support the social contract for health care is seriously in need of transparency.

One facet of this is how academic training programs and their sponsoring institutions spend more than $16 Billion of public benefit funding from Medicare. When Congress created this funding stream more than 50 years ago, it was presumed that teaching hospitals would act in the best interest of the public as they produced clinical workforce. Efforts by the Institute of Medicine in 1989 and 2014 to create accountability and governance in order to better serve the public have been routinely blocked.

Social accountability in health education is a relatively new term here in the United States, building on foundations of work lead by Dr. Charles Boelen at the World Health Organization in the 1990s. Senior leaders at the Center for Professionalism and Value have spent considerable time and energy working with collaborators at George Washington University and the Robert Graham Center advancing the concept of Social Accountability over the past decade.Their efforts have helped to

  1. Spawn a movement and organizations dedicated to this social mission in health professional education led by Dr. Fitzhugh Mullan and called the Beyond Flexner Alliance
  2. Help to create and inform a movement dedicated to social accountability in Graduate Medical Education (GME), the GME Initiative
  3. Produce original research and analyses presented in numerous presentations, policy forums, and publications fueling these movements and national policy discussions.Some examples include
    Spending Patterns in Region of Residency Training and Subsequent Expenditures for Care Provided by Practicing Physicians for Medicare Beneficiaries 
  4. The Effects of Training Institution Practice Costs,Quality, and Other Characteristics on Future Practice
  5. Toward Defining and Measuring SocialAccountability in Graduate Medical Education: A Stakeholder Study
  6. The social mission in medical school mission statements: associations with graduate outcomes.
  7. Graduates of Teaching Health Centers Are More Likely to Enter Practice in the Primary Care Safety Net 
  8. Develop novel tools such as the Medical School Mapper, Virgin Hospital Explorer, GME for Teaching Hospitals Tables and more to help planners, policymakers, and advocates better understand the data and outputs of medical education.
As part of our portfolio of work focused on organizational professionalism, we will continue to advance the data-driven metrics of accountability for public funds that are supposed to produce the health care workforce that the US needs. We plan to collaborate broadly to develop these metrics and shine a light on those institutions who are serving the nation’s needs—and those that could do better. We believe that these can help Congress and other funders make better decisions about the return on their investment, and can create opportunities for teaching hospitals to learn from each other for improvement.