Social Accountability of Medical Schools and Social Representations of Medical Students in the Context of the More Doctors Program

ABSTRACT Several debates, in the national and international context, have suggested the need for changes in medical education, so that it is in line with the organization of health systems. From this perspective, it is proposed that schools be guided by social accountability, which consists of ordering teaching, research and activities in service to meet health needs with a focus on areas that are difficult to reach. A more recent reference in medical education at the national level was the More Doctors Program, which provided for a new regulatory framework for medical education. It is evaluated that the modifications introduced by the Program can influence the elaboration of new social representations of medical students. Through the theory of social representations, a qualitative study was carried out to analyze the perception about the social accountability of the medical schools of 149 medical students, of the seventh semester of four courses of Federal Higher Education Institutions in the Northeast Region. Two of the courses are in the interior and were created by virtue of the More Doctors Program and another two correspond to courses in the state capital existing for more than 60 years. From the curriculum analysis of each course, they were termed “traditional” or “new”. In the results, it was observed that the students of the different courses resemble each other in terms of admission by quotas, but students of “new” courses have a greater entrance under affirmative action policies, including regional access criteria. Both groups of students have emphasized the term “duty” as a priority, which may refer to a more individual scope of the notion of accountability. The terms “citizenship” and “ethics” were also highlighted in both groups. Only for students in “new” schools were terms such as “commitment”, “justice” and “SUS” cited. This insight suggests a broader notion of social accountability in school students created under the More Doctors Program, despite insufficient national literature on this topic. The conclusion emphasizes the importance of the Program in the implantation of medical schools in regions that did not previously have this training. It also reinforces the relevance of the dedication of the teachers who implemented the courses in the interior of the Northeast, demonstrating the need to deepen in the themes that involve teacher development. It is suggested that there is a need to broaden the analysis of experiences such as these, so that they can be explored with the radicalism necessary to strengthen the Unified Health System.

摘要
国家及国际层面的多场讨论均提出，医学教育需进行改革，以契合卫生系统的组织架构。基于此视角，有观点提出医学院校应以社会问责（social accountability）为导向，即统筹教学、科研与服务活动，聚焦偏远地区以满足当地卫生健康需求。在国家层面，医学教育领域较新的政策参考为《更多医生计划（More Doctors Program）》，该计划为医学教育制定了全新的监管框架。有评估指出，该计划所引入的改革可能会影响医学生新型社会表征（social representations）的构建。
本研究依托社会表征理论（theory of social representations），针对东北部地区4所联邦高等教育机构医学专业的149名第七学期医学生展开质性研究，分析其对所在医学院校社会问责的认知情况。其中2个专业位于内陆地区，且是依托《更多医生计划（More Doctors Program）》设立的；另外2个专业位于州首府，办学历史已逾60年。研究人员通过对各专业的课程分析，将其划分为“传统型”与“新型”两类。
结果显示，不同专业的学生在配额招生方面并无显著差异，但“新型”专业的学生通过平权行动政策（affirmative action policies，包括区域准入标准）入学的比例更高。两组学生均将“责任”列为首要关注词汇，这或许指向问责概念更偏向个体的维度。两组学生还均提及了“公民身份”与“伦理”这两个词汇。仅“新型”院校的学生提及了“承诺”“正义”以及“统一卫生系统（SUS）”等词汇。尽管国内相关研究文献较为匮乏，但该研究结果表明，依托《更多医生计划（More Doctors Program）》设立的院校，其学生对社会问责的认知更为宽泛。
研究结论强调了该计划在此前无医学教育资源的地区新设医学院校的重要意义。同时，研究也凸显了东北部内陆地区课程开设团队的奉献精神的价值，表明有必要深化涉及教师发展的相关主题研究。研究建议，应拓宽此类办学经验的分析维度，以必要的彻底性开展探索，以强化统一卫生系统（SUS）的建设。