2011; 33: 654–658 Social accountability in medical education – An Australian rural and remote perspective PAUL WORLEY 1 & RICHARD MURRAY 2 1 Flinders University, Australia, 2 James Cook University, Australia Abstract Australia’s medical education system is undergoing a socially motivated transformation focused on improving access to medical care for rural and remote communities. A rural and remote backbone of Rural Clinical Schools (RCS), University Departments of Rural Health, regional medical schools, and the postgraduate college, ACRRM, have enabled community responsive innovation and partnerships with rural health services that once would have been difficult to imagine. This article argues that this transformation is succeeding because of the passionate leadership of rural medical and community leaders, government seed funding to encourage rural medicine as an academic discipline, rigorous research and consultation that underpinned each step of the innovation pathway, and a political campaign to invest in rural medical education as a form of rural social capital. Introduction I love a sunburnt country A land of sweeping plains Of ragged mountain ranges Of droughts and flooding rains I love her far horizons I love her jeweled sea Her beauty and her terror The wide brown land for me My Country, Dorothea Mackellar, 1904 Australia’s history is steeped in the lyric of the ‘bush’, the rural and remote inland that has been immortalized in song and verse. However, the nation’s modern emblems are urban icons such as the Sydney Opera House and the Harbour Bridge. Australia is now one of the most urbanized countries in the world as 70% of its population now hugs the southeast coastline. With health professional training and student selection located in the urban coastal fringe, the appeal of the bush for professionals has waned. The far horizons have been depleted of health workforce, a key resource that underpins the safety and sustainability of rural communities. It is in this context that Australia has seen a quiet revolution, a rurally led transformation of medical education that is seeing teaching, scholarship, and research become more responsive to rural and remote community needs. It is the evolution of this socially transformed Australian medical education that this article will describe. The current network of rural academic centers, regional medical schools, and high-profile rural medical curricula and research has not come about by chance. Demographic context As Australia’s population approaches 22 million, around 7.9 million people currently live in regional, rural and remote areas (Australian Bureau of Statistics [ABS] 2010). As the population density decreases, the burden of disease increases (Australian Institute of Health and Welfare [AIHW] 2010). Contributing to this increased burden of disease, but not accounting for it in its entirety, is the increased percentage of the population in remote areas that identifies as Aboriginal. Practice points . Australia has developed socially accountable approaches to medical education at both undergraduate and postgraduate levels simultaneously to overcome rural medical workforce shortages. . Government funding of rural medical education has been seen as an investment in rural social capital. . Innovative approaches, supported by the national accreditation authority, have been required to adapt medical education to the contexts of rural and remote Australia. . Educational approaches developed in rural Australia are now becoming mainstreamed into urban medical education. Correspondence: P. Worley, Box 2100, GPO Adelaide, Adelaide, South Australia 5062, Australia. Tel: þ61 8 8204 4160; fax: þ61 8 8204 5845; email: paul.worley@flinders.edu.au 654 ISSN 0142–159X print/ISSN 1466–187X online/11/080654–5 ß 2011 Informa UK Ltd. DOI: 10.3109/0142159X.2011.590254