Setu Mehta, a third-year student at Johns Hopkins University School of Medicine in Maryland, regularly posts her opinions about academic and societal issues on social media. She believes it’s important for students “to express themselves” — but worries about inadvertently crossing some unclear line between her free speech rights and her responsibility to follow the professional standards of the medical field.
“Students feel vulnerable,” Mehta told the audience during a panel discussion, “Supporting Learners’ Free Speech,” held at Learn Serve Lead 2024: The AAMC Annual Meeting on Nov. 9 in Atlanta. “There are repercussions for what you say.”
For 90 minutes, medical school students and administrators discussed how to develop and carry out guidelines for students to safely and responsibly express their opinions — from classrooms and social posts to op-eds and protest marches — and allow others to do the same. The discussion was guided by moderator Lauren Cobbs, MD, associate dean for student affairs at Texas Tech University Health Sciences Center School of Medicine.
“Freedom of speech is an essential condition for optimal discovery, patient care, and education,” said panelist James Woodruff, MD, professor of medicine and dean of students at the University of Chicago Pritzker School of Medicine and UChicago Medicine. “Protecting free speech should be a continuous commitment” for both learners and leaders.
But that free speech comes with responsibility, speakers stressed.
“Free speech means you’re not going to be arrested,” said panelist Lisa Worley, BS, associate vice president for medical communications and media relations at the University of Miami Leonard M. Miller School of Medicine. “It doesn’t mean there won’t be repercussions.”
Those repercussions can include being accused of offending certain groups or having your words reflect poorly on your institution or the medical profession, through choice of language, tone, or by coming off as ignorant about an aspect of an issue. Students face questions about what crosses the line into unacceptable speech, and the answers often depend on the issue discussed, the venue (online or in class), the audience, and recent events that can turn up the heat.
“This conversation about professionalism and its interaction with free speech is nuanced,” Mehta said. “If we can’t express ourselves, how can we be heard?”
Addressing the administrators in the room, Mehta said that students “are relying on you as leaders to create an environment where they feel heard, but they also feel it’s OK to make mistakes and learn.”
Guidelines for students
Medical schools are trying to create that environment.
“It’s our obligation to train people to have constructive dialogue through free expression,” Woodruff said. “Trainees have to know not only how to pursue free expression but how to facilitate it” among their peers and as they grow into leadership positions.
Panelists described a plethora of initiatives that can provide that training, including:
- Written policies and guidelines, developed in partnership with students. For instance, Guiding Principles for Civic Advocacy by Medical Students and Prospective Applicants was developed by an AAMC Group on Student Affairs workgroup, said panelist Katherine Chretien, MD, dean for medical student affairs and director of medical student wellness at Johns Hopkins, who chaired the workgroup.
- Scheduled, in-person discussions about issues and how to advocate, including single-session town halls, multiple-session seminars, and small group meetings held in response to specific, recent events.
- Trainings that focus on the how-to of various forms of expression. At George Washington School of Medicine & Health Sciences, all first- year students are required to take a session (up to two hours) on social media and professionalism, Chretien said. At Johns Hopkins, students can also take a workshop on writing and pitching op-eds to media sites.
- Easy access to deans and other leaders, through formats such as scheduled group breakfasts and “pop ups,” as described by Loretta Jackson-Williams, MD, PhD, vice dean for medical education and professor of emergency medicine at the University of Mississippi Medical Center School of Medicine.
“Any time the students feel that they have not been heard, they have the opportunity to come directly to us in a very relaxed atmosphere,” Jackson-Williams said. “The students don’t feel that they have to go through formal channels to talk with the deans.”
One important message from leaders was that students’ responsibilities regarding free speech and activism evolve as they become practicing physicians.
“You’re about to become a physician. That changes everything,” said Worley from the Miller School of Medicine. “You’re going to go from advocating for yourself to advocating for your patients.”
She urged them to embrace the role: “An MD carries weight. Your voice means something. Advocate for change.”
