Medicine should be learned in a conducive environment.

Richard Horton argues that an academic health science system must possess societal goals and promote social cohesion and public trust.1Horton R Offline: No dark sarcasm in the classroom.Lancet. 2022; 4001666Summary Full Text Full Text PDF Scopus (3) Google Scholar Indeed, medical education should help to promote better health outcomes for vulnerable populations and disadvantaged communities. However, to this end, it is essential that students learn medicine in a conducive environment of public hospitals, community clinics, and health posts. Unfortunately, the environment often is not conducive, especially in low-income and middle-income countries, where the public health system suffers from low salaries, scarce benefits, and poor incentives and motivation. Additionally, staff shortages prevent front-line doctors from adequately coping with patients’ demands and often erode patient–physician trust. This situation increases violence against doctors and health-care workers, which the World Medical Association describes as “an international emergency that undermines the very foundations of health systems and impacts critically on patient's health”.2World Medical Association73rd World Health Assembly, agenda item 3: covid-19 pandemic response.https://www.wma.net/wp-content/uploads/2020/05/WHA73-WMA-statement-on-Covid-19-pandemic-response-.pdfDate: 2020Date accessed: November 16, 2022Google Scholar In high-income countries, defensive medicine practices have become widespread, considerably increasing health expenditures;3Gelmetti C Cruising between Scylla and Charybdis … just a hope?.Eur J Intern Med. 2016; 27: e10Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar students are even taught to consider malpractice liability when making clinical decisions.4O'Leary KJ Choi J Watson K Williams MV Medical students' and residents' clinical and educational experiences with defensive medicine.Acad Med. 2012; 87: 142-148Crossref PubMed Scopus (29) Google Scholar Finally, a balanced work and family life is particularly important for millennial students5Gillissen A Kochanek T Zupanic M Ehlers JP Millennials medical students generation at the crosswalks: motivations and attitudes towards study and future career—a mixed-method study.Adv Med Educ Pract. 2022; 13: 1305-1319Crossref PubMed Scopus (1) Google Scholar and huge efforts should be made to ensure that this is achievable in public hospitals and clinics by the time they graduate. Public health-care funding has been cut in some high-income countries and is not adequate in low-income and middle-income countries. Without a sufficiently funded public health-care sector, vulnerable and disadvantaged people will continue to suffer from inadequate medical care independently of medical school curriculum improvements. I declare no competing interests. Offline: No dark sarcasm in the classroomTeaching is frequently judged inferior to research by academic leaders. Professors too often boast about how they have escaped their teaching responsibilities to pursue the exalted goal of science. Teaching versus research is a false dichotomy, of course. But the academic reward system weighs heavily in favour of those who prioritise grants and papers over students and tutorials. Teachers sit in the permanent shadow of scientists. And so it was a refreshing contrast last week to observe the International Conference on the Future of Health Professions Education, convened by the University of Miami, FL, USA. Full-Text PDF