A mixed-method study of medical students’ perceptions of social accountability in medical education. Comparing the roles of equity identities, empathies, and curriculum regulation.

Abstract

The decline in students’ empathy during medical school is attributed in part to an informal curriculum that prioritises biomedical knowledge and lacks a patient perspective of illness. Transformation of medical professionalism to include socially accountable justice actions entails a theoretical shift in curriculum regulative discourse, and curricular justice to diverse medical students. A pre-pandemic, mixed-methods study compares the equity identities and justice discourses of medical students learning in divergent curricula; one regulated by a biopsychosocial model (BPS), the other by social accountability (SA). The study sought to identify teaching and learning needs for values transformation that legitimates integration of social change practices in medical professionalism. Participants expressed emotional empathy for the most disadvantaged groups in Australian society, but in both curricula the cognitive empathy owed to patients vulnerable to social systems inequities, and contextual reasoning of social science solutions, were generally weak. Outsiders with intersectional equity identities have greater insights to social inequities, but less intentions for primary care practice than peers with nil or one equity identity. Following clinical training in high health needs populations participants express solidarity with disadvantaged patients, but cognitive empathy is mostly instrumental; equity practices are mis-recognised as proximal and behaviour-related. Closure of this ‘know-do gap’ centres on transformative pedagogy; to induce a sociological imagination of health care justice, legitimate patients’ perspectives and broaden the social context of health causation. Professional development of emotional and cognitive empathy for patients’ social health improvement, and graduates’ prosocial aspirations, may benefit from learning the health communication science of biosemiotics, a biological approach to systems theory. The tools of Legitimation Code Theory, a discursive knowledge management system, may boost the empathic courage of medical educators to transform physician empathy, gaze, and professional capability toward socially accountable practices.