Not just what is taught, but how it is lived: socially accountable education in health professions education.

Social accountability (SA) is a defining institutional mandate in health professions education (HPE), yet how educational approaches associated with SA are experienced in practice remains insufficiently understood. Rather than examining what these approaches aim to achieve, this study explores how they are encountered, interpreted, and made meaningful by those directly involved. We conducted an interpretive descriptive study using rich picture interviews combined with semi-structured interviews with 46 participants, including learners, clinical teachers, community organization members, patient partners, and leaders in SA. Participants depicted and discussed their experiences with educational approaches related to SA. Data were analyzed using reflexive thematic analysis. Five interrelated themes were identified. Participants described (a) an evolving reorientation in how they understood and positioned themselves in relation to responsibility, (b) the limits of abstraction, where experiential encounters revealed dissonance between lived realities and curricular representations, (c) reflexivity as uneven and pedagogically mediated, requiring dialogue, continuity, and psychological safety, (d) institutional conditions as shaping what can be questioned or enacted, including hierarchy, role modeling, and competing priorities, and (e) social accountability as a collective and relational practice, in which participation, reciprocity, and whose perspectives shape educational processes mattered. Across these themes, the presence of an educational approach did not itself determine how socially accountable education was experienced or made meaningful. Meaning was shaped through the interplay between what encounters made visible, opportunities to interpret and question those experiences, the institutional conditions in which they occurred, and whose perspectives were able to shape the educational process. Advancing SA in HPE therefore requires attention not only to which educational approaches are included, but to how they are experienced, facilitated, and negotiated within educational and community relationships.