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Table 1 Barriers and enablers to implementing social accountability

From: A qualitative study of enablers and barriers influencing the incorporation of social accountability values into organisational culture: a perspective from two medical schools

  Barriers Enablers
External factors Economic instability Government/funders expectation of accountability
Potential instability in partner organisations Effective partnerships especially with voluntary organisations
Economic contribution to regional development and local health improvement
Institutional systems & staff Emphasis on maintaining academic prestige Good communication between the institution and partners
Success defined in terms of degree results rankings and graduates becoming tertiary specialists Emphasis on advocacy and enabling communities to advocate for themselves
Staff personal time pressures, political views, level of interest, conceptual understanding and commitment
Research priorities, design, delivery Emphasis on laboratory research Patient and public participation with grassroots developed projects
Need to ensure financial viability of research departments
Explicit requirement to identify patient benefit in research proposals
Social accountability viewed as a distraction
Source of funding Emphasis on translational research
Support from regional health authorities
Student selection & values Widening participation seen as detrimental to prestige Targeted support to students from underrepresented backgrounds
Difficulty of selecting students on their values
Change in student values over time in education Recruiting internationally
Graduate retention
Curriculum design & delivery Narrow focus of curriculum on clinical skills and procedures Teaching on wider heath determinants and communities
Involvement of students in community projects or, voluntary work
Uncertainty of geographical location for which students should be trained
Empowering students to challenge other health professionals
Relative newness of the concept Auditing of outcomes of such placements and providing
Adequate support to students in external placements
Implementation & evaluation Difficulty of developing metrics to gauge progress Presence of fully supported champions
Assessment fatigue Demonstrating the impact of the institution via assessment
Availability of guidance
Assessment as a driver of change