# Embedding social accountability through transformative pedagogies: a case study from a South African physiotherapy curriculum

## TL;DR

This study explores how physiotherapy lecturers in South Africa integrate social accountability into their curriculum and the challenges they face in implementing transformative teaching strategies.

## Contribution

The paper provides insights into the implementation of social accountability in physiotherapy education in a low- to middle-income context.

## Key findings

- Lecturers understand social accountability as a multidimensional construct involving professional identity and advocacy.
- Transformative pedagogies like contextual learning and reflection are used but face implementation challenges.
- Gaps exist between curricular goals and actual student experiences in fostering social accountability.

## Abstract

Health profession curricula must produce healthcare professionals who are not only clinically competent but also socially accountable. This requires graduates to understand and respond to the health systems and social contexts within which they practice, and lecturers play an important role in facilitating the attainment of these competencies. Despite growing calls for socially accountable health professional education globally, limited research exists on how these principles are understood and implemented within physiotherapy curricula, particularly in low- and middle-income contexts where health inequities are pronounced.

To explore how physiotherapy lecturers understand and integrate the principles of social justice and social accountability into a South African undergraduate curriculum and to examine the pedagogical strategies employed to foster transformative learning.

A qualitative descriptive case study with an interpretivist paradigm was conducted at the Division of Physiotherapy, Stellenbosch University. The study was part of a broader multi-institutional study, and a collaborator external to the Division of Physiotherapy conducted two focus groups (n = 10 participants) and eight individual semi-structured interviews with permanent lecturers involved in curriculum coordination and development. Mezirow’s transformative learning theory and established theories of social justice and social accountability guided a hybrid inductive and deductive thematic analysis via AtlasTi® software.

Two key themes emerged: (1) understanding social accountability and its underpinning elements, including professional accountability, professional identity formation, interprofessional engagement, advocacy and systems awareness, and citizenship, and (2) pedagogical strategies for transformative learning, encompassing contextual and experiential learning, structured reflection, progressive scaffolding, interprofessional collaboration, and discursive pedagogy with role modelling. While participants demonstrated a sophisticated understanding of social accountability as a multidimensional construct, significant implementation challenges were identified, including inconsistent student exposure, logistical barriers to authentic learning experiences, limited scaffolding for transformative action, and insufficient faculty development support.

Social accountability is a recognised but complex goal within the physiotherapy curriculum. While transformative pedagogies are employed, critical gaps remain between curricular intent and implementation, particularly in scaffolding students’ progression from critical reflection to transformative action. Strengthening pedagogical coherence, enhancing faculty development, and expanding authentic experiential learning opportunities may support the development of socially responsive physiotherapy graduates equipped to address health system challenges and promote health equity.

Not applicable.