Providing socially accountable medical education: Student perceptions from two Australian medical schools

Background: Flinders University (FU) and James Cook University (JCU) are founding members of the Training for Health Equity Network (THEnet), an international community of practice involving twelve socially accountable health professional schools that align their training, research and service with the needs of underserved populations. Aims: This study aims to describe how medical students perceive and engage with the social mission of their school. Developing a robust understanding of learners’ perceptions may inform curricular development. Methods: This qualitative study draws on the results from two Australian medical schools that participated in the international study Accounting for Learners’ Perceptions of Social Accountability in THEnet Schools. A mixed convenience and purposive sample of domestic, final year undergraduate medical students were recruited (n=14) to participate in semi-structured interviews. Interviews were transcribed in full and analysed using abductive coding in a grounded theory framework. Relevance: An important strategy of THEnet schools involves integration of the social mission into medical education. However, there is an assumption that learners understand the social mission of their school and the intended social accountability curriculum. Currently, scientific evidence to substantiate this assumption is lacking. It is important for schools addressing the workforce shortage to understand student perceptions of this mission. Results: Participants of JCU perceived the schools social mission to prepare graduates with an understanding of social justice, social inequity, health workforce shortages and health disparities in disadvantaged communities. While initially their career intention may not have been to practice rural medicine, over half the participants reported developing a genuine interest in rural, Indigenous and tropical medicine during their rural and remote clinical placements. Participants reported agreeing with and seeing the value of JCU’s social mission. Most FU participants studied medicine with intent to practice in rural or remote regions, which was reinforced by a curricular focus on cultural awareness, social accountability and diversity. Clinical placements reflected the schools’ social mission by exposing interested students to rural and remote clinical contexts. Participants not interested in rural practice, while agreeing with and valuing the school mission, did not change their career intention. Conclusions: Learners at both medical schools understood and valued the social mission of their schools, however clinical experiences in underserved settings did not necessarily change career intentions.