SAAHE conference, 2011 – day 2

Social accountability: the mark of excellence in health professional education by Charles Boelen

Moved from interrogation → an assertion

What is a health professional?

Flexner’s report changed the scope of medical education by introducing a scientific background, especially in education

Medical education should be patriotic (Flexner)

Educating → health professionals → for a strategy → to meet people’s needs (must begin with identifying people’s needs); the 4 layers are not necessarily closely correlated

There are many influences on the process, besides the input we provide in our HEIs

What are people’s needs and values today? What will they be in 20 years time? We’re training professionals for today and tomorrow

Not teaching for health professionals, but change agents

Social accountability: 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 the mandate to serve. The priority health concerns are to be identified jointly by governments, health care organisations, health professionals and the public”

Priority health concerns:

  • quality (ideally, we provide the best to everyone)
  • equity (who are the most vulnerable?)
  • cost-benefit (resources are fixed and we have to work within them)
  • relevance (what are the most relevant problems to address?)

As educators, we can’t achieve the values above on our own, we need to work with others

Functions of a school:

  • Education
  • Research
  • Service

Stakeholders (Boelen, 2000, Towards unity for health, WHO):

  • Policy makers
  • Health professions
  • Academic institutions
  • Health managers
  • Communities

Social accountability (evaluate impact of commitments)

Social responsiveness (more explicitly aware, use data to drive action)

Social responsibility (awareness)

We should accompany our graduates when they leave our schools

Be critical of the health system

Conceptualisation of professional (role of the school) → production of professional (educational interventions) → usability of professional (society’s satisfaction). Using a commercial model to explore ideas

Pay more attention before beginning training, as well as afterwards

Boelen & Woollard, 2009. The CPU model: conceptualisation-production-usability. Medical Education, 43: 887-894

The concept of social accountability helps us to answer the question: “Why are we doing all of this?”

Global consensus for social accountability of medical schools (

A socaily accountable medical shool should:

  • respond to current and future health needs
  • reorient education, research and service accordingly
  • strengthen governance and partnership with other stakeholders
  • use evaluation and accreditation to determine impact

Preparing for the future:

  • ethics → impact
  • democracy → transparency
  • globalisation → competition
  • public support → synergy

What is our common purpose?”


Developing enterprising health care professionals. How should we meet the challenge? By Prof. Deborah Murdoch-Eaton


  • making the most of opportunities
  • identifying areas for improvement
  • developing innovative solutions
  • implementing and refining strategies

Health professionals will always work in a business, whether private or public. A business is only as good as it’s employees

Need confidence to implement changes

Reference to “Health professionals for a new century. Frenk et al, The Lancet”

Provoke” global reforms in all health professions

Core role of universities as social institutions

Need to be effective in an ever-changing environment and knowledge-base

Change in accordance with local needs

Graduate attributes = set of core skills that are not discipline-specific, “meta-skils”

  • Communication
  • Higher order reasoning
  • Critical thinking
  • Ability to use technology

Students should not all fit into the “same box”, need to develop those who can lead and innovate

Structured (and repeated) opportunities to practice skills

Incorporate self-reflection and appraisal of own abilities, provide evidence of own learning / experiences

Soft skills:

  • teamwork
  • creativity
  • project planning
  • presentation skills
  • IT skills
  • time management
  • networking
  • negotiating
  • leadership

Be enterprising in teaching style and assessment

Embedding of enterprise:

  • strands
  • blocks / modules
  • extra-curricular

How do we colleagues to collaborate?

What are the persuasive arguments?

Fit for (whose) purpose?

Empower students to help retain them in the country

Need to give guidance and time to think and reflect deeply, not related to “competence-driven outcomes”

Values, cultures and ethics are hard to measure

new knowledge is regulated by measuring it against exising scholarship through the process of peer review, rather than the extent to which it meets the needs of those external to the field”

Teach students to ask relevant questions, empower them to become change agents


Blackboard training initiative by A Botha

Staff training using Blackboard within institution

(People think that) Blackboard can:

  • support good teaching practice
  • support learning styles
  • encourage collaboration
  • keep abreast of learning technologies

Staff were overwhelmed and reported needing extra time for training

Trying to improve quality of people trained, rather than getting numbers through the system

The problem with LMSs is that they don’t take the student into account, the focus is on the lecturer, the content and the course

What is the relationship between activity on the LMS and the throughput?


E-learning: student’s perspective by G Sinombe

Used to increase access to course materials and information, increase contact and participation in courses and enhance variety of learning styles ← blended approach

Courses (reading material, notes, assignments, etc.) uploaded ← not e-learning (by whatever definition you choose to use for “e-learning”)

Student responses differed, some attempted to use, some didn’t try at all

Why do some students not try? Study aimed to determine student perceptions and challenges that impacted on their use

Student responses:

  • good tool
  • good for slow learners
  • enhances communication between lecturer and student
  • flexibility in time and place
  • easy access to courses
  • hard to find unoccupied computer
  • network slow, when available
  • hard to access off-campus
  • helps me to share ideas outside of the classroom
  • enhances sharing of ideas

Is “e-learning” necessary? How does it improve performance? This has to be taken in context…what is the context in which you want to use it?


Students’ approaches to learning disciplines in an integrated curriculum by D Manning

How many students achieve pass marks while scoring below the minimum in individual subjects?

In how many disciplines are passing students scoring below the pass mark

Students going into clinical years with substantial gaps in their knowledge

What is going to be done about this?

Is there a need for discipline based subminimums and consideration of logistical solutions


Ready for the catwalk? By what criteria should a new model be judged? By F Cilliers

How does assessment influence learning? Cilliers et al, AHSE, 2010, December

One or more sources of impact, through one or more mechanisms, leading to one or more learning effects

Test the model in a different context to what it was designed for i.e. model developed in theory, then evaluated in clinical practice

Quality of learning” ← how was this defined?

Interaction with preceptors:

  • regular accountability
  • personal consequences
  • emotional valence

Preparing out of a fear of humiliation, rather than a desire for understanding. Just wanted to “survive” the ward round

“You will learn because you don’t want to continue to live in fear”

Tyrants” and “teddy bears” ← categories of supervisors

You don’t want to disappoint the “teddy bears”, go out of your way to participate, gather more information

But they are still motivated by others, rather than for themselves. Did any students report a desire for understanding based on what it would mean for their own clinical practice?

Teddy bears” = scope and safety to ask questions and explore areas of personal interest


Reviewing assessment to promote medical student engagement in basic sciences to cure and care better by C Brand

Curricula are living, self-organising organic systems

De-load” some of the course content

Threshold concepts = conceptual gateway that opens up previously inaccessible domains

All change begins with conversation


Introduction of a new clinical assessment: did it achieve it’s aim? by L Green-Thompson

Students arrive in the clinical environment unprepared

Introduced an observed examination (mini-CEX) and then evaluated student perceptions of the exam

Landscape of assessment”

Students reported that the clinical exam was a valuable experience: “a good opportunity to see how far I had come”

Assessments are theoretical events, rather than clinical events”


Workshop: Making use of adult learning theories by Dr. David Taylor

Theories not mutually exclusive, each have something to recommend them

Instrumental learning theories:

  • Behaviourist → stimulus – response (e.g. Skinner)
  • Cognitive → mental process not behaviour (e.g. Piaget, constructivism)
  • Experiential → behaviour in practice (e.g. Kolb)

Humanistic theories:

  • Andragogy → need, readiness, motivation (e.g. Knowles)
  • Self-directed learning → what about the social context?
  • Transformative learning → disorienting dilemma that drives learning, context, critical reflection (e.g. Mezirow)

Situated cognition (e.g. communities of practice):

  • Learning and thinking are social
  • Structured by tools available
  • Dependant on situation
  • Knowing is supported by doing (e.g. Wenger)

How difficult it is to “get into” a new discipline. Need to acquire an understanding of the profession before you can “be in it”

The challenge for a learner is to find out enough about the subject to enable learning

Expectancy valence theory: low expectation of success results in poor motivation for learn, unless rewards are overwhelming → can’t give students tasks that they can’t achieve

  • You need to recognise what you already know
  • You need to know how the new knowledge fits in
  • Dialogue makes it easier

Feedback will drive future learning

What are the responsibilities of the learner and teacher respectively in each phase of a learning cycle?

Dissonance (putting the cat among the pigeons):

  • Teacher’s responsibility to challenge student to move outside of their comfort zone
  • Learner needs to be open to being challenged, need to identify their own gaps, pre-conceived perspectives impact on worldview

Critical friendship”

Teachers don’t need to be responsible for the answers, but they need to enable the discovery

Hypotheses that can’t be tested are useless (Poppper)

It’s possible to be critically reflective on your own but feedback is important for error correction → create your own dissonance

Laurillard: feedback is a continuous process that occurs as part of a 2-way dialogue (“conversation”)

Feedback sandwich” 🙂