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Year : 2019  |  Volume : 32  |  Issue : 3  |  Page : 133-134

Balancing health disparities through socially accountable medical education

Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

Date of Web Publication18-Apr-2020

Correspondence Address:
Aleksandar Radonjic
Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8l1
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/efh.EfH_160_19

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How to cite this article:
Radonjic A, Yarkhani E. Balancing health disparities through socially accountable medical education. Educ Health 2019;32:133-4

How to cite this URL:
Radonjic A, Yarkhani E. Balancing health disparities through socially accountable medical education. Educ Health [serial online] 2019 [cited 2022 Dec 5];32:133-4. Available from:

Dear Editor,

We read with great interest a recent commentary by Handoyo et al., highlighting the various potential personality types that account for rural physician retention rates.[1] Globally, many patients lack access to health care due to a pervasive dearth of primary care physicians in rural areas. Strong evidence points to discrepancies in the career choices of medical graduates and uneven geographical distributions of working physicians as the primary driving factors behind this imbalance. Handoyo et al. suggest that intrinsic factors such as having family nearby or believing in spiritual awareness may play a role in keeping physicians in rural areas. They also mention that those who are financially motivated are likely to live in urban areas. The authors conclude that the medical school curriculum should incorporate community-oriented rotations to foster early inspiration to work in rural areas.

We would like to emphasize this last point; as second-year medical students in a school that has adopted socially accountable medical education (SAME), we are uniquely placed to comment on and endorse this practice. There has been a growing perception that medical schools themselves hold a large onus to guide their trainees into areas of societal need. Dussault and Franceschini previously noted that medical education systems are often disengaged from gaps in the health workforce, and thus specialty choices of graduating physicians do not represent public demands.[2] Generalists are particularly underrepresented in postgraduate training programs despite the growing need for these physicians in many aspects of global health. In response, some institutions have rightfully acknowledged this burden and have integrated SAME into their curricula.[3]

The premise of SAME is to integrate student learning through community placements where teachers are based in underserviced rural areas. Thus, SAME distinguishes itself from other programs by actively engaging and involving community members in the longitudinal nature of a medical student's career. Reeve et al. cite that graduates from these schools are more likely to work in public systems with longer commitments to community service and underserved areas.[4] Furthermore, medical students from SAME schools were better trained and more likely to meet the needs of rural areas.

However, given the small number of institutions that have accepted SAME to date, other educational facilities are unlikely to adopt such involved changes to their curricula unless strong evidence supports positive patient-related outcomes. Accrediting long-term health outcomes to medical school curricula remains the largest hurdle SAME must overcome as we move forward. Unsurprisingly, it will be difficult for descriptive studies to ascribe causality in the complex adaptive system perspective that underlies most health networks. However, some, including The Training for Health Equity Network,[5] have begun to tackle this problem via collaboration across institutions. In any case, SAME remains a compelling and promising educational philosophy that may, in the future, contribute balance to our current health disparities.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Handoyo NE, Prabandari YS, Rahayu GR. Identifying motivations and personality of rural doctors: A study in Nusa Tenggara timur, Indonesia. Educ Health (Abingdon) 2018;31:174-7.  Back to cited text no. 1
Dussault G, Franceschini MC. Not enough there, too many here: Understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health 2006;4:12.  Back to cited text no. 2
Iputo JE. Faculty of health sciences, Walter Sisulu University: Training doctors from and for rural South African communities. MEDICC Rev 2008;10:25-9.  Back to cited text no. 3
Reeve C, Woolley T, Ross SJ, Mohammadi L, Halili SB Jr., Cristobal F, et al. The impact of socially-accountable health professional education: A systematic review of the literature. Med Teach 2017;39:67-73.  Back to cited text no. 4
Ross SJ, Preston R, Lindemann IC, Matte MC, Samson R, Tandinco FD, et al. The training for health equity network evaluation framework: A pilot study at five health professional schools. Educ Health (Abingdon) 2014;27:116-26.  Back to cited text no. 5


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