Reddy Anjani T, Lazreg Sonia A, Phillips Robert L, Bazemore Andrew W, Lucan Sean C
J Grad Med Educ. 2013 Sep;5(3):439-45. doi: 10.4300/JGME-D-12-00274.1.
Since 1965, Medicare has publically financed graduate medical education (GME) in the United States. Given public financing, various advisory groups have argued that GME should be more socially accountable. Several efforts are underway to develop accountability measures for GME that could be tied to Medicare payments, but it is not clear how to measure or even define social accountability.
We explored how GME stakeholders perceive, define, and measure social accountability.
Through purposive and snowball sampling, we completed semistructured interviews with 18 GME stakeholders from GME training sites, government agencies, and health care organizations. We analyzed interview field notes and audiorecordings using a flexible, iterative, qualitative group process to identify themes.
THREE THEMES EMERGED IN REGARDS TO DEFINING SOCIAL ACCOUNTABILITY: (1) creating a diverse physician workforce to address regional needs and primary care and specialty shortages; (2) ensuring quality in training and care to best serve patients; and (3) providing service to surrounding communities and the general public. All but 1 stakeholder believed GME institutions have a responsibility to be socially accountable. Reported barriers to achieving social accountability included training time constraints, financial limitations, and institutional resistance. Suggestions for measuring social accountability included reviewing graduates' specialties and practice locations, evaluating curricular content, and reviewing program services to surrounding communities.
Most stakeholders endorsed the concept of social accountability in GME, suggesting definitions and possible measures that could inform policy makers calls for increased accountability despite recognized barriers.
自1965年以来，美国医疗保险（Medicare）一直为毕业后医学教育（GME）提供公共资金。鉴于公共资金的投入，多个咨询团体认为毕业后医学教育应更具社会责任感。目前正在开展多项工作，以制定与医疗保险支付挂钩的毕业后医学教育问责措施，但尚不清楚如何衡量甚至定义社会责任感。
我们探讨了毕业后医学教育利益相关者如何看待、定义和衡量社会责任感。
通过目的抽样和滚雪球抽样，我们对来自毕业后医学教育培训地点、政府机构和医疗保健组织的18名毕业后医学教育利益相关者进行了半结构化访谈。我们使用灵活、迭代的定性分组过程分析访谈现场记录和录音，以确定主题。
在定义社会责任感方面出现了三个主题：（1）创建多元化的医生队伍，以满足地区需求以及解决初级保健和专科短缺问题；（2）确保培训和护理质量，以最好地服务患者；（3）为周边社区和公众提供服务。除1名利益相关者外，其他所有人都认为毕业后医学教育机构有责任承担社会问责。报告的实现社会问责的障碍包括培训时间限制、资金限制和机构阻力。衡量社会问责的建议包括审查毕业生的专业和执业地点、评估课程内容以及审查项目对周边社区的服务。
大多数利益相关者认可毕业后医学教育中的社会问责概念，提出了相关定义和可能的衡量方法，尽管存在公认的障碍，但可为政策制定者要求加强问责提供参考。
