Social Accountability Across Caribbean Offshore Medical Schools: A Qualitative Study.

Abstract

Background: Social accountability requires medical schools to align their education, research, and service activities with the community health needs. Although global models, such as the WHO framework and THEnet, provide clear guidance, the extent to which Caribbean offshore medical schools (OMS) incorporated these principles remains unclear. Given their significant contributions to the U.S. primary care workforce and their local economic impact, this study examines the social accountability across Caribbean OMS.

Methods: The authors conducted a qualitative analysis of accreditation standards for social accountability among six World Federation of Medical Education (WFME)-recognized accreditation agencies operating in the Caribbean region. Using purposive sampling, the authors conducted a qualitative framework analysis of 22 accredited Caribbean OMS. Different accreditation agencies recognized by the WFME have accredited these schools. Data from schools' websites, including mission statements, curricula, research activities, community services, clinical services, and local economic impact, were analyzed using Framework Analysis.

Results: The accreditation standards for social accountability varied across accreditation agencies. The analysis of Caribbean OMS revealed substantial variation in how explicitly they incorporated the social accountability frameworks. Only three schools demonstrated a strong commitment to social accountability, as evidenced by mission statements and structured community service activities. Fourteen schools demonstrated partial social accountability by incorporating community service or social determinants of health components into their activities, but lacked comprehensive, measurable strategies aligned with established social accountability frameworks. The other five schools exhibited limited explicit social accountability, with mission statements focused primarily on affordability and accessibility rather than community impact or responsiveness to local health needs.

Conclusions: The findings highlight that Caribbean OMS display a heterogeneous approach to social accountability. These findings highlight opportunities for regional alignment with global standards, such as those promoted by the WHO, and underscore the need for more intentional and measurable approaches to social accountability across the region.

Supplementary information: The online version contains supplementary material available at https://doi.org/10.1007/s40670-026-02788-3.