#KeyLIMEPodcast 272: Excellence is in the eye of the beholder

It’s Linda’s choice this week, as she introduces a study from Latin America examining social accountability and how to accurately measure it .  The researchers used three phases to develop, validate and estimate social accountability, using their tool: The Social Accountability Instrument for Latin American Medical Schools (SAIL).

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KeyLIME Session 272

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Puschel et. al., Academic excellence in Latin America: Social accountability of medical schools Medical Teacher June 2020.


Linda Snell (@LindaSMedEd)


I chose this as this is not a topic we have discussed on KeyLIME, and also because most of the articles we review are from North America, with some from Europe or Australasia. Time for a change!

Social accountability is a key dimension of and a standard of excellence in medical education.

But what is social accountability and why is it important?

The social role of medical schools goes beyond the responsibility to train competent physicians to the responsibility to contribute to society and have a role in reducing health disparities.

It flows that we should try to measure it accurately… as it might be an accreditation standard. But there is little research or valid / reliable instruments to estimate social accountability which limits measuring the impact that medical schools have on society. Studies done are from high-income countries, descriptive, with wide variation in the criteria used to estimate social accountability, and with wide variation across cultures, especially from Latin America where there is a broad range of economic and social disparity and >500 med schools.


‘to develop an instrument and validate its use for measuring social accountability in Latin American med schools.’

SAIL The Social Accountability Instrument for Latin American Medical Schools

COMPROMISO Consenso en Medicina para Promover Instituciones Socialmente Responsables.

Key Points on the Methods

Mixed methods, three phases to develop, validate and estimate social accountability

  1. Qualitative analysed 3 focus group discussions with 29 ‘academic experts’ (convenience sample at LACRE) à defined the principal dimensions and attributes (items) associated with social accountability
  2. Two-round Delphi consensus method with 24 Latin American experts (experienced faculty members who were well recognized in medical education, using snowball) from 8 countries,  à design an instrument with high content validity.
  3. Assessed the psychometric properties of the instrument (survey) – purposive sample of 110 academic leaders and faculty from 49 (of ~500) med schools from 16 (of 20) Latin American countries.  Inclusion criteria:  representing countries with the highest number of medical schools in the region,  from  countries within the highest & socioeconomic status , and a mixed profile of academic representatives. Factor analysis, internal consistency

Key Outcomes

Good variety of individuals and schools meeting inclusion criteria.
90% response rate on survey!!

Phase 1 -> 41 item survey
Phase 2 -> 21 items in 4 domains:
mission and QI e.g. educational vision and mission based on the current and future needs of health in the country, public health policies e.g. school contributes to the development of public policies that improve population health,
community engagement e.g. Postgrad curriculum includes early & consistent learning experiences & community service,
professional integrity e.g. values professional integrity & social commitment in academic selection and promotion
(4 point scale – 1, absent; 2, in progress; 3, sufficient; 4, outstanding)
Phase 3 -> mean global score 2.92 – discrepancy of score compared to another rating scale where all rated >80 %ile (this scale uses reputation, publication, faculty student ration, int’l student ratio);
Various factor analyses showed internal consistency

Key Conclusions

The authors conclude ‘There are validity arguments (content and reliability) to support the measurement of social accountability using the SAIL instrument. Its application showed that it provides a complementary dimension to that traditionally obtained when estimating quality in medical schools.’ It is the 1st Latin American instrument and measures areas that are not included in the traditional accreditation standards.

Supports use in LA where ‘SAIL instrument has a stronger emphasis on the contribution of medical schools in the development of public policies in areas of particular relevance for low- and middle-income countries.‘ thus might be generalizable  to these countries outside LA.

Propose it be incorporated in institutional evaluations e.g. international rankings and national accreditation systems.

Spare Keys – other take home points for clinician educators

Let’s talk about sampling:

Convenience sample phase 1

Purposive Ph 2 and 3

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