Exploring how medical graduates perceive and enact social accountability during their first five years of practice
DOI:
https://doi.org/10.36834/sf39zn08Abstract
Background: Social accountability (SA) is a guiding principle of many medical schools, yet little is known about how institutional aspirations for socially accountable practice are translated into the realities of early clinical practice. This study explored how graduates from a medical school with a SA mandate perceived and enacted SA during their first five years of independent practice.
Methods: We employed an explanatory sequential mixed-methods design. In the quantitative phase, a questionnaire informed by DeVellis’ framework for scale development was distributed to recent medical graduates within their first five years of practice. Six semi-structured individual interviews were conducted with graduates from three training sites of a Québec medical school. Two researchers coded interview transcripts and data were analyzed thematically.
Results: Findings from the questionnaire indicated that most respondents strongly endorsed the importance of SA but reported uneven preparedness to apply it in practice. Qualitative findings were organized around five themes: 1) defining and appropriating SA through core values; (2) translating SA values into everyday practice; (3) navigating systemic and moral tensions; (4) the influence of training and role models; and (5) a broader orientation toward advocacy, prevention, and collective leadership.
Conclusions: While participants expressed strong commitments to equity and justice, they faced constraints in translating these values into practice. Findings suggest that SA is experienced less as a fixed competency than as a dynamic orientation that graduates continually negotiate within the realities of early clinical practice. These findings highlight the importance of aligning training, mentorship, and health system structures with the aspirations of socially accountable medical education.
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