사회적 책무성: 의과대학이 복무할 인구집단의 건강을 향상시키기 위한 프레임워크(Acad Med, 2018)

사회적 책무성: 의과대학이 복무할 인구집단의 건강을 향상시키기 위한 프레임워크(Acad Med, 2018)

Social Accountability: A Framework for Medical Schools to Improve the Health of the Populations They Serve
James Rourke, MD, MClinSc, FCFP(EM), LLD

 

배경
Background

사회적 계약뿐만 아니라 법률, 규정, 인가를 허가함으로써 의과대학은 미래의 의사를 교육하고 사회의 요구에 부응하는 의학 연구를 하도록 위임된다. 따라서, 사회적 책무는 의과대학과 의과대학의 기초가 된다. 1,2 따라서 사회적 책임은 모든 의대의 계획, 행동 및 영향을 통해 기대되어야 한다be expected. 하지만, 모든 의과대학의 맥락은 다르므로, 각 학교가 지역사회, 지역, 국가의 요구에 가장 잘 참여하고, 협력하고, 대응하는 방법은 다를 것이다.
By permit of legislation, regulation, and accreditation as well as the social contract, medical schools are entrusted to educate tomorrow’s doctors and conduct medical research to serve the needs of society; thus, social accountability is the foundation of both medical practice and medical schools.1,2 Social accountability should, therefore, be expected throughout every medical school’s plans, actions, and impact. However, every medical school’s context is different, so how each school can best engage with, partner with, and respond to the needs of its community, region, and nation will vary.

1995년 Boelen과 Heck3에 의해 세계보건기구에 의해 개발되고 정의된 [사회적 책무]의 개념은 다음과 같다.
The concept of social accountability as developed and defined for the World Health Organization by Boelen and Heck3 in 1995 states:

[의과대학은] 교육, 연구 및 서비스 활동을 의무적으로 봉사해야 하는 지역사회, 지역, 국가의 우선적인 건강 문제를 해결하기 위해 지시direct할 의무가 있다. 우선적인 건강 문제는 정부, 의료 기관, 보건 전문가 및 대중이 공동으로 확인해야 한다.
[Medical schools have] the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve. The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public.

2001년 보고서 "사회적 책임: 캐나다 의과대학의 비전:"을 통해 캐나다의 의과대학은 사회적 책임의 조기 채택자가 되었다. "캐나다 의대 교육의 미래 (FMEC: A Collective Vision for MD Education)"와 "캐나다 대학원 의학 교육을 위한 집단 비전"을 포함한 많은 후속 보고서를 통해 캐나다 의대는 사회적 책임이 캐나다 의학교육의 토대를 형성한다는 것을 재확인했다. 이제 사회적 책무의 입증은 캐나다 인증 요건에 포함된다.9
Canadian medical schools became early adopters of social accountability with the 2001 report “Social Accountability: A Vision for Canadian Medical Schools.”4 Through a number of later reports, including “The Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education” and “A Collective Vision for Postgraduate Medical Education in Canada,” Canadian medical schools have reconfirmed that social accountability forms the foundation for medical education in Canada.5–8 And now demonstration of social accountability is included in the Canadian accreditation requirements.9

사회적 책무는 이제 의과대학이 [지역사회, 지역 및 국가, 특히 소외계층과 취약계층의 요구에 참여하고, 협력하고, 이에 대응하는 것]으로 이해되고 있다.

Social accountability is now understood to involve medical schools engaging, partnering with, and responding to the needs of their community, region, and nation, especially their underserved and vulnerable populations.1,13

의료 교육에서 뛰어난 성과와 우수성을 장려하고 촉진하기 위해, AMEE(세계 최대 의료 교육 기관)는 ASPIRE 이니셔티브를 수립하였으며, 이 이니셔티브는 2012년 AMEE에서 시작되었다. 
To encourage and promote outstanding performance and excellence in medical education, AMEE (the world’s largest medical education organization) established the ASPIRE initiative, which was launched at AMEE 2012. 

ASPIRE 이니셔티브가 인정하기로 선택한 우수성의 첫 세 가지 영역은 학생 평가, 학생 참여 및 사회적 책임이었다. ASPIRE는 이러한 분야에서 수상 신청서를 제출한 의과대학 평가에 사용할 기준을 개발하기 위해 전문가 패널을 설립했다. 첫 번째 두 가지(학생과 학생 참여의 평가)는 훨씬 더 광범위하고 의과대학 전체를 포함하기 때문에 사회적 책임보다 더 쉽게 정의되었다.
The first three areas of excellence the ASPIRE initiative chose to recognize were assessment of students, student engagement, and social accountability. ASPIRE established expert panels to develop the criteria to be used for assessing medical schools that submitted applications for awards in these areas. The first two (assessment of students and student engagement) were more readily defined than social accountability because this is much broader and involves the whole medical school.

궁극적으로 ASPIRE는 의과대학의 사회적 책임에 대한 글로벌 컨센서스의 기초적인 연구, 10개의 출판된 문헌 및 진화하는 세계 경험을 바탕으로 ASPIRE-to-Excellence Award for Social Accountability의 기준을 개발하였다. 이 기준에 따르면,

• 의과대학은 조직과 기능에서 사회적 책임 계획을 문서화하고,
• 의과대학은 교육 및 연구 프로그램 활동에서 사회적 책임 활동을 문서화하고,
• 의과대학 교육, 연구, 서비스, 졸업생, 그리고 파트너십이 공동체, 지역, 국가의 헬스케어와 건강에 긍정적인 영향을 보여줄 것으로 기대된다.

Ultimately, ASPIRE developed the criteria for the ASPIRE-to-Excellence Award for Social Accountability based on the foundational work of the Global Consensus for Social Accountability of Medical Schools,10 published literature, and evolving world experience. To be successful, schools are expected to

• document social accountability plans in their organization and functions;
• document social accountability actions in their education and research program activities; and
• demonstrate positive impacts of their education, research, service, graduates, and partnerships on the health care and health of their community, region, and nation.1,16,17 

따라서 이러한 기준(및 그 기준)은 설문 등급, 연구 자금 및 학생당 교직원 수, 입학 등급 평균 및 MCAT 점수를 포함한 기타 조치 등을 사용하는 US News & World Report 등급과 상당히 대조적이다.

Thus, these criteria (and their measures) provide quite a contrast to the U.S. News & World Report ratings of medical schools, which consider survey ratings, research funding, and other measures, including number of faculty per student, admission grade point average and MCAT scores, and, for primary care medical schools, the percentage of graduates entering primary care residency training programs.

 

공통 테마
Common Themes

2017년 12월 현재 ASPIRE 사회책임상 신청은 29건이다. 29개 학교 또는 네트워크는 각각 자신의 사회문화적-지리적 맥락에 맞추기 위해 사회적 책임 의무를 설정했다. 모든 것이 사회적 책임에 대한 의지를 보여주었지만, 많은 사람들은 아직 입증할 수 있는 영향을 미치지 못했거나 아직 가지지 못했다(예: 졸업생이 아직 시행되지 않은 새로운 학교). 그 결과, 지금까지 다음 10개 학교 또는 네트워크만이 ASPIRE-to-Excellence Award for Social Accountability를 받았다.

As of December 2017, there have been 29 applications for ASPIRE social accountability awards. Each of the 29 schools or networks established their social accountability mandate to fit their own socio-cultural-geographic context. While all demonstrated commitment to social accountability, many did not have or did not yet have a demonstrable impact (e.g., new schools whose graduates were not yet in practice). As a result, so far only the following 10 schools or networks have received the ASPIRE-to-Excellence Award for Social Accountability:

• Southern Illinois University School of Medicine (SIUSOM),
• Northern Ontario School of Medicine,
• Hull York Medical School,
• University of New Mexico School of Medicine (UNMSOM),
• Memorial University of Newfoundland Faculty of Medicine,
• Brody School of Medicine at East Carolina University,
• University of Leeds School of Medicine,
• Florida International University Herbert Wertheim College of Medicine,
• Leaders in Indigenous Medical Education (LIME) Network, and
• Université Laval Faculté de Médecine.

수상 경력에 빛나는 10개 의과대학의 주요 공통 주제는 다음과 같다.
The major common themes among the 10 award-winning medical schools include:

• 사회적 책무가 학교의 목적과 의무에서 명백하고 계획 및 일상적인 관리에 통합
• 학교 입학은 학교 공동체, 지역 및 국가의 인구학적 혼합을 반영하는 데 초점을 맞추고 있다.
• 학교 교육과정은 지역사회·지역·국가의 고유한 지리적·사회적·문화적 맥락과 우선적인 건강 요구에 관련
• 학교 지역사회, 지역 및 국가의 지리적, 사회적, 문화적 혼합의 다양성을 반영하는 임상 학습 및 서비스 학습 경험의 포함
• 취약하고 서비스가 부족한 환자, 지역사회 및 인구에 대한 건강의 사회적 결정요인을 이해하고 행동하기 위한 지역사회 기반 학습 경험에 대한 광범위한 노출 포함
• 학교 지역사회, 지역 및 국가의 우선적인 건강 요구에 영감을 받아 대응하고 연구과제 개발, 협력 및 연구 참여, 지식 번역/이동 참여 등 연구에 지역사회를 적극적으로 참여시키는 연구
• 이 학교의 졸업생들과 보건 서비스 제휴는 취약하고 소외된 인구에 중점을 두고 지역사회, 지역, 국가의 건강과 보건에 긍정적인 영향을 미친다.
  
  

1. Social accountability being evident in the school’s purpose and mandate and integrated into its planning and day-to-day management;
2. School admissions being focused on reflecting the demographic mix of the school’s community, region, and nation;
3. The curriculum being relevant to the unique geographic, social, and cultural context and the priority health needs of the school’s community, region, and nation;
4. The inclusion of clinical learning and service-learning experiences reflecting the diversity of the geographic, social, and cultural mix of the school’s community, region, and nation;
5. The inclusion of extensive exposure to community-based learning experiences to understand and act on social determinants of health for vulnerable and underserved patients, communities, and populations;
6. Research being inspired by and responding to the priority health needs of the school’s community, region, and nation and actively engaging the community in research, including developing the research agenda, partnering and participating in research, and taking part in knowledge translation/mobilization; and
7. The school’s graduates and its health service partnerships having a positive impact on the health and the health care of its community, region, and nation with an emphasis on vulnerable and underserved populations.

예시
Exemplars

서던일리노이 대학교 의과대학
Southern Illinois University School of Medicine

SIUSOM의 미션은 교육, 환자 관리, 연구, 지역사회 서비스를 통해 일리노이 중부와 남부 주민들에게 제공하는 것이다. SIUSOM은 지역사회, 전문 조직, 보건 관리자 및 정책 입안자들과 매우 다양한 파트너십을 맺고 이 임무를 충족시킬 수 있도록 지원합니다. 예를 들어, 시골지역 보건 이니셔티브는 의료 서비스에 대한 접근성을 높이고, 지역 의료 인프라를 개선하고, 의대생들에게 시골지역 중심의 교육 기회를 제공함으로써 일리노이 중부와 남부 지역의 시골지역과 소외지역을 지원하기 위한 SIUSOM의 지원 활동의 주요 구성요소이다.
The mission of SIUSOM is to provide for the people of central and southern Illinois through education, patient care, research, and community service. SIUSOM has a wide variety of partnerships with communities, professional organizations, health managers, and policy makers to help meet this mission. For example, the Rural Health Initiative is a major component of SIUSOM’s outreach efforts to assist rural and underserved areas in central and southern Illinois by increasing access to health care services, improving local health care infrastructure, and providing rural-focused educational opportunities for medical students.

SIUSOM의 입학 위원회는 미래 학생들을 선발하기 위해 전인적holistic 과정을 사용한다. 사용된 선택 기준 중 하나는 광범위한 자원봉사 및 지역사회 봉사의 증거이다. 또한 SIUSOM에는 의사가 되는 것에 관심이 있는 지역 고등학생들을 격려하고, 의학의 진로를 위해 저표현 소수민족과 교육/경제적으로 불리한 학생들을 준비함으로써 지역사회에 봉사하는 파이프라인 프로그램이 마련되어 있다. SIUSOM의 의대생 선발과정은 지역의 인구통계학적 혼합을 대표한다.
SIUSOM’s admissions committee uses a holistic process to select its future students. One of the selection criterion used is evidence of extensive volunteer work and/or community service. In addition, there are pipeline programs in place at SIUSOM that serve the community by encouraging local high school students interested in becoming physicians and by preparing underrepresented minority and educationally/economically disadvantaged students for careers in medicine. SIUSOM’s medical student admissions represent the demographic mix of the region.

2008년 졸업생을 대상으로 실시한 사회선교학점수에서 SIUSOM은 졸업생의 45%가 일차의료 분야에서, 46.5%가 보건 전문직 부족 지역에서 practice하는 등 전국 15위에 올랐다.18 또한 전체 SIUSOM 의과대학 졸업생의 절반이 레지던트 후 일리노이 주에서 계속 practice하고 있다.
In a study of graduates in practice in 2008, SIUSOM was ranked 15th in the country on the social mission score, with 45% of the school’s graduates practicing in primary care fields and 46.5% practicing in health professional shortage areas.18 Furthermore, half of all SIUSOM medical school graduates continue to practice in Illinois after residency.

SIUSOM Continuing Medical Education 사무소는 일리노이 주 하부에서 의사 개업을 개선하기 위한 교육 활동을 제공한다. 예를 들어, 학교는 일리노이 주 다운타운에 있는 50개의 주요 접근 병원의 의사들이 캠퍼스 기반의 공식적인 교육 경험에 참여할 수 있도록 화상 회의 사이트 네트워크를 개발했다.
The SIUSOM Office of Continuing Medical Education provides educational activities to improve physician practice throughout downstate Illinois. For example, the school has developed a network of video conferencing sites that allow physicians at 50 critical access hospitals throughout downstate Illinois to participate in campus-based formal educational experiences.

SIUSOM에서 수행된 대부분의 연구는 지역사회의 요구에 기초한다. 학교도 지역사회단체와 협력교부금을 적극 추진하고 있으며 지역사회단체가 보건관련교부금을 마련함에 따라 자문역할을 하며 기술지원을 하고 있다.

The vast majority of research conducted at SIUSOM is grounded in the needs of the community. The school is also actively engaged in collaborative grants with community groups, and serves as advisors and provides technical assistance to community groups as they prepare health-related grants.

2017년 SIUSOM은 ASPIRE 시상 과정을 거치는 것의 가치에 대해 발간하였다.19
In 2017, SIUSOM published about the value of going through the ASPIRE awards process.19

 

뉴멕시코 대학교 의과대학
University of New Mexico School of Medicine

UNMSOM은 의료교육의 사회적 책임에 있어 선구적인 기관이다. UNMSOM은 설립 이후 뉴멕시코 주에 대한 서비스를 명확한 우선순위로 포함시켰으며, 기관의 성공을 위한 척도로서 인구의 건강과 건강 형평성을 개선하는 데 초점을 맞추었다.20
UNMSOM is a pioneering institution in social accountability in medical education. Since its inception, UNMSOM has included service to the state of New Mexico as a clear priority and has focused on improving the population’s health and health equity as a measure of the institution’s success.20

UNMSOM의 프로그램의 사실상 다른 모든 측면과 마찬가지로, 입학 정책은 특정 의료 요구를 충족시키고 주로 시골 지역, 다양하며 상대적으로 저소득 국가의 인구 건강 상태를 개선하려는 학교의 명시적인 commitment에 크게 영향을 받는다. UNMSOM은 또한 중학교 때부터 시작하는 잘 설계되고 잘 관리되는 파이프라인 노력을 가지고 있다. UNMSOM의 학생 중 30% 이상이 의학에서 underrepresented background에서 왔으며, 히스패닉계/라티노계 및 미국계 인도계 학생의 수는 다른 MD 부여 의과대학과 비교하여 UNMSOM을 다양성의 95번째 백분위수에 둔다.
Like virtually all other aspects of UNMSOM’s programs, the admissions policies are heavily influenced by the school’s explicit commitment to meet the specific health care needs and improve the population health status of their predominantly rural, substantially diverse, and relatively lower-income state. UNMSOM also has well-designed and well-managed pipeline efforts that start as early as middle school. Over 30% of UNMSOM’s student body comes from backgrounds that are underrepresented in medicine, and the number of Hispanic/Latino and American Indian students puts UNMSOM in the 95th percentile for diversity in comparison with the nation’s other MD-granting medical schools.

UNMSOM은 보건 직업 교육의 핵심 요소로서 서비스 학습을 강력하게 촉진한다. 따라서, 더 전통적인 도시, 3차 교육 보건소에서의 경험의 균형을 맞추기 위해, 모든 의대생들은 또한 커리큘럼의 매 년 동안 소외된 지역 사회 기반 환경(도시 및 보호 지역, 농촌 농업 및 목장 공동체)에서 실질적인 경험을 가지고 있다.
UNMSOM strongly promotes service-learning as a core component of health professions education. Accordingly, to balance their experiences in more traditional urban, tertiary academic health center venues, all medical students also have practical experiences in underserved, community-based settings (urban and reservation Native American sites and rural farming and ranching communities) during each year of the curriculum.

2017년에는 미국의 다른 141개 MD 부여 의과대학보다 UNMSOM 졸업생은 가정의학에 매칭되는 비율이(30.2%) 높았다.21

In 2017, a higher percentage of UNMSOM senior medical students matched in family medicine residencies (30.2%) than any of the other 141 MD-granting medical schools in the United States.21

뉴멕시코 대학교(UNM) 보건 과학 센터 연구 프로그램은 "뉴멕시코 거주자들에게 영향을 미치는 중요한 건강 문제에 초점을 맞추고 있으며, 임상 및 기초 과학을 연결하여 분자 의학 분야의 발견을 임상 환경에 보다 신속하게 전달할 수 있다." 또한 UNM Clinical & Translation Science Center의 학술-커뮤니티 파트너십은 지역 보건 결정을 알리기 위한 증거 기반 관행의 보급을 지원하는 협업적이고 지속 가능한 연구를 통해 뉴멕시코의 다양한 인구의 건강과 웰빙을 개선하기 위해 노력하고 있습니다.

The University of New Mexico (UNM) Health Sciences Center research programs “are focused around critical health problems affecting New Mexico residents and bridge the clinical and basic sciences to more rapidly deliver discoveries in molecular medicine to the clinical setting.”22 In addition, the UNM Clinical & Translational Science Center’s academic–community partnerships work to improve the health and well-being of New Mexico’s diverse population through collaborative and sustainable research that supports the dissemination of evidence-based practices to inform local health decisions.

SIUSOM과 UNMSOM은 2011년 Beyond Flexner Alliance에 의해 입학 과정, 학부 및 대학원 과정, 학생 지원 이니셔티브를 통해 사회에 대한 의무를 가장 많이 이행한 6개 모델 학교 중 2개로 선정되었다.23

Both SIUSOM and UNMSOM were selected by the Beyond Flexner Alliance in 2011 as two of six model schools that most fulfilled their obligation to society through their admissions processes, undergraduate and graduate programs, and student support initiatives.23

라임 네트워크
LIME Network

LIME 네트워크 애플리케이션은 ASPIRE가 의과대학이 아니라 오히려 오스트레일리아와 Aotaroa/뉴질랜드의 모든 의과대학의 대표자 집합이기 때문에 ASPIRE에게 challenge였다. ASPIRE는 네트워크 고려를 위한 파일럿으로서 신청을 받아들였고, 제출이 너무 강해서 상을 받았다.
The LIME Network application presented a challenge to ASPIRE as it is not a medical school but, rather, a collective of representatives from all the medical schools in Australia and Aotearoa/New Zealand. ASPIRE accepted the application as a pilot for considering networks, and the submission was so strong it earned an award.

LIME은 2005년에 설립되었으며 의료 교육에서 원주민 보건의 교육 및 학습의 질과 효과를 보장하고, 호주 원주민 및 토레스 해협 아일랜드인(호주 출신)과 마오리족(아오테아로아/뉴질랜드 출신)의 (—그러므로 총칭하여 원주민—) 의과대학생 채용 및 졸업에 있어 모범 사례를 제공하기 위해 노력하고 있다. 24 LIME 네트워크는 의료 교육, 연구 및 서비스 제공에서 원주민 보건의 우수성을 홍보하면서 지식과 혁신을 증진하고 협력적인 노력을 지속하는 실천 공동체로서 운영됩니다.25
LIME was established in 2005 and is committed to ensuring the quality and effectiveness of teaching and learning of Indigenous health in medical education, as well as best practices in the recruitment and graduation of Aboriginal and Torres Strait Islander (from Australia) and Māori (from Aotearoa/New Zealand)—henceforth, collectively referred to as Indigenous—medical students.24 The LIME Network operates as a community of practice, which furthers knowledge and innovation and sustains collaborative efforts while promoting excellence in Indigenous health in medical education, research, and service delivery.25

LIME은 원주민의 리더십과 지식의 우수성을 인식하고 홍보하며 이러한 목표를 달성하기 위해 여러 협력 요소를 사용한다. 그 일환으로, LIME 품질 검토 프로세스는 개별 의과대학이 원주민 건강 커리큘럼의 품질과 원주민의 의료 교육 프로그램 참여를 지원하기 위한 시책의 효과를 평가할 수 있는 자체적인 내부 검토 프로세스를 고안하고 시행하도록 장려한다. 
LIME recognizes and promotes the primacy of Indigenous leadership and knowledge and uses multiple collaborative components to achieve these goals. As part of this, the LIME quality review processes encourage individual medical schools to devise and implement their own internal review processes by which they can evaluate the quality of the Indigenous health curriculum and the effectiveness of initiatives to support the participation of Indigenous people in medical education programs.

공식적인 커리큘럼 이니셔티브를 지원하고 지속적이고 체계적인 변화를 지원하기 위해 원주민 보건 교육과 관련하여 잠재 커리큘럼을 다루는 것도 필수적이다.26 따라서 LIME 네트워크는 원주민 보건 및 개발의 이니셔티브를 지원하는 데 필요한 프로세스를 강조하기 위한 다양한 검토 도구를 개발하였고, 그 기관의 지배적인 가치가 원주민 건강의 가치와 학습에 어떤 영향을 미치는지 관심을 가졌다

It is also essential to address the hidden curriculum in relation to Indigenous health education to support formal curricular initiatives and for lasting and systemic change.26 The LIME Network, therefore, has developed a range of review tools to highlight the processes required to support initiatives in Indigenous health and development and to draw attention to how the dominant values of the institution have an impact on the value and learning of Indigenous health.

LIME 담당자와 그 동료들은 원주민 의료 및 보건 교육에 참여하고 있으며, 원주민 의학교육을 지원하는 모범 교육 사례, 자원 개발, 평가 및 프로그램 평가에 대한 학술적 작업을 개발하고 원주민 학생들의 모집과 유지를 지원합니다. 또한, LIME의 리더십은 오스트레일리아 및 Aotaroa/New Zealand의 인증 기관과 성공적으로 협력하여 모든 관련 영역에서 원주민 보건 또는 보건 인력 개발을 특별히 강조하는 인증 표준을 도입하였다.

LIME representatives and their colleagues engage with and deliver initiatives in Indigenous medical and health education and develop scholarly work on best teaching practices, resource development, and assessment and program evaluation to support Indigenous medical education, as well as the recruitment and retention of Indigenous students.25 Further, the leadership of LIME successfully engaged with the accrediting body for Australia and Aotearoa/New Zealand to introduce accreditation standards that specifically highlight Indigenous health or health workforce development across all relevant domains.

2011년 오스트레일리아에서 의학을 공부하는 원주민 학생 수는 처음으로 인구 대등도population parity에 도달했다. 그 해에 원주민 의대 1학년 학생들의 intake가 2.5%로 가장 높았으며, Aotaroa/New Zealand는 인구 통계학적 형평성 면에서 원주민 학생 졸업에 근접했다. 그리고 2013년, "호주 정부의 보건 인력 프로그램의 검토"(The Mason Review)는 "영연방은 LIME(Leaders in Native Medical Education) 네트워크의 성공에 기초해야 한다"고 권고했다. 27

In 2011, the number of Indigenous students studying medicine in Australia reached population parity for the first time, with the intake of first-year Indigenous medical students at a high of 2.5%, and Aotearoa/New Zealand is close to graduating Indigenous students at demographic equity. And in 2013, the “Review of Australian Government Health Workforce Programs” (the Mason Review) recommended that “the Commonwealth should build on the success of the Leaders in Indigenous Medical Education (LIME) Network.”27

과제들
Challenges

사회적 책임에 대한 ASPIRE-to-Excellence Award for Social Accountability Framework는 GME를 포함하지 않는데, 이는 GME가 대부분의 국가에서 대부분의 의대의 의무에 포함되지 않기 때문이다. 그러나 캐나다와 미국에서는 GME가 의대의 핵심 요소이며, 학부 의대(UME)보다 내일에 필요한 의사를 개발하는 데 더 중요할 수 있다. GME가 역량 기반 교육으로 크게 변모함에 따라 많은 사람들이 다음과 같은 질문을 던지고 있습니다. 왜, 어떻게, 누가, 그리고 어떤 차이를 만들까요? 이러한 질문은 사회적 책임과 사회의 요구에 부응하는 직업 훈련과 밀접한 관련이 있다. GME 프로그램이 다양하기 때문에 UME에 적용하는 것보다 이 단계의 의학 교육 연속체에 사회적 책임 원칙을 적용하는 것이 훨씬 더 어려워 앞으로 해야 할 일이 많이 남아 있다. 이것은 GME 프로그램과 이들을 후원하고 인가하는 기관에게 우선순위가 되어야 한다.
The ASPIRE-to-Excellence Award for Social Accountability framework does not include GME—often referred to as resident training or vocational training—because GME is not included in the mandate of most medical schools in most countries. In Canada and the United States, however, GME is a core component of medical school, and it may be even more important than undergraduate medical education (UME) in developing the doctors needed for tomorrow. As GME undergoes the major transformation to competency-based training, many are asking: Why, how, who, and what difference will it make? These questions are closely related to social accountability and providing vocational training directed toward meeting society’s needs. Because of the wide variety of GME programs, it is even more difficult to apply social accountability principles to this phase of the medical education continuum than it is to apply them to UME, so much work remains to be done. This should be a priority for GME programs and the organizations that fund and accredit them.

이러한 사회적 책임 대화의 또 다른 관심사는 생태계/환경에 관한 의대의 역할이다. 의과대학이 봉사하는 인구의 [건강의 사회적 결정요인에 주요 기여자로서의 생태계/환경]과 [의과대학과 그 파트너들이 생태계/환경에 미치는 영향]이 모두 사회적 책임의 중요한 요소로 떠오르고 있다. 의과대학은 생태계의 건강 및 환경 모범 사례를 개발하고, 역할 모델링하며, 교육함으로써 강력한 긍정적 생태계/환경적 영향을 미칠 수 있습니다.28 ASPIRE는 현재 이것을 2019년 버전의 사회적 책임 상 기준에 통합하기 위해 노력하고 있다.

Another issue of concern for this social accountability conversation is the role of medical schools with regard to the ecosystem/environment. Both the ecosystem/environment as a major contributor to the social determinants of health of the populations served by the medical school and the impact of the medical school and its partners on the ecosystem/environment are emerging as important components of social accountability. Medical schools can have a powerful positive ecosystem/environmental impact by developing, role modeling, and teaching ecosystem health and environmental best practices.28 ASPIRE is now working on integrating this into the 2019 version of the social accountability award criteria.

결론 Conclusion

사회적으로 책임 있는 의과대학은 지역사회, 지역 및 국가의 요구에 참여하고, 협력하고, 이에 대응한다. 이들이 봉사하는 인구(특히 소외되고 취약하며 소외된 인구)의 건강 향상은 의대 교육, 연구 및 환자 관리의 중요한 결과 척도로 간주해야 한다. 모든 의과대학은 사회적 책임의 우수성을 위해 노력해야 하지 않을까?

Socially accountable medical schools engage with, partner with, and respond to the needs of their communities, regions, and nations. Improvement in the health of the populations they serve (especially those who are marginalized, vulnerable, and underserved) should be considered vital outcome measures of medical school education, research, and patient care. Shouldn’t all medical schools strive for excellence in social accountability?

 

 

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Acad Med. 2018 Aug;93(8):1120-1124.

 doi: 10.1097/ACM.0000000000002239.

Social Accountability: A Framework for Medical Schools to Improve the Health of the Populations They Serve

James Rourke 1

Affiliations collapse

Affiliation

• 1J. Rourke is professor of family medicine and former dean of medicine (2004-2016), Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada, and chair, ASPIRE-to-Excellence Panel on Social Accountability, Association for Medical Education in Europe; ORCID: http://orcid.org/0000-0001-8019-0294.

• PMID: 29642103
• DOI: 10.1097/ACM.0000000000002239Abstract
• Social accountability has gained importance and greater acceptance in the ever-increasing complexity and interconnectivity of patient care, education, and research that is the threefold mission of academic health science centers and networks. In this Invited Commentary, the author provides a brief overview of the development of the concept of social accountability and the criteria for the Association for Medical Education in Europe ASPIRE-to-Excellence Award for Social Accountability, which provide a useful framework for medical schools to consider when examining their own social accountability. Per these criteria, schools are expected to document social accountability plans in their organization and functions; document social accountability actions in their education and research program activities; and demonstrate positive impacts of their education, research, service, graduates, and partnerships on the health care and health of their community, region, and nation. Award-winning schools integrate social accountability into the school's mission, planning, and day-to-day management. The health needs and diversity of the school's community, region, and nation are reflected in the school's admissions, curriculum, learning experiences, research activities, health care partnerships, and graduates. The author also describes three award winners as exemplars of social accountability and concludes by challenging every medical school and graduate medical education program to focus on meeting the needs of the populations it serves, especially those who are marginalized, vulnerable, and underserved.