The Next Flexner Moment: Reclaiming Medicine's Social Contract
“Every system is perfectly designed to get the results it gets.” Don Berwick
Working in Graduate Medical Education for more than a decade, across multiple institutions and leadership roles, I’ve seen the power and the limitations of the systems we’ve inherited. I’ve sat in rooms where decisions are made based on tradition rather than purpose. I’ve watched residents struggle under processes that were designed for oversight but not humanity. And I’ve witnessed how often medical education speaks about equity and service, yet operates within structures never built for today’s realities.
Its has become increasingly clear to me:
We are in our next “Flexner moment.”
Just as the 1910 Flexner Report reshaped medical training for an industrial era, we are now being asked to reshape it for a human era one defined by social accountability, community partnership, and a renewed sense of purposes.
The Cracks in Our Current System
From my vantage point in GME leadership, the gaps in our current system are not theoretical. They are lived experiences for trainees, faculty, and communities:
Students and residents who feel disconnected from the populations they serve.
Curricula built around institutional convenience rather than community priorities.
A persistent mismatch between workforce needs and where learners are placed.
Processes-accreditation, evaluation, reporting that often feel like compliance tasks instead of opportunities for insight.
And underlying all of this, a widening gap between what medicine promises and what society experiences.
The truth is simple:
Our medical education system was never designed to produce equitable outcomes.
And yet, we have an opportunity and a responsibility to redesign it.
What Social Accountability Really Means (from a GME Leader’s Perspective)
I’ve always believed that social accountability is not a program, office, or task force. It is a mindset that touches every administrative process, every curriculum decision, every clinical partnership.
In practice, it asks:
Are we admitting the learners our communities most need?
Are our training sites positioned where care gaps are largest?
Are we elevating community voice with the same respect as academic voice?
Are our data systems capturing what matters most to people, not just what matters to regulators?
Are we producing physicians who see themselves as partners in community health, not just experts in disease?
Social accountability is not sentimental.
It is strategic.
It aligns mission with workforce.
It turns systems into tools for healing.
And it requires leaders willing to ask uncomfortable questions.
If We Wrote A New “Flexner Report” Today
If I were asked to help shape a modern Flexner Report- something I think our field deeps needs. It would be built on six foundational truths:
Begin with Community Voice
Curriculum design should start not with an internal retreat, but with community partners, patients, and public health leaders. In my work, I’ve seen how transformative it is when communities are not an afterthought but a co-architecht.
Redefine Excellence
We must move beyond prestige metrics and instead measure:
community impact,
workforce distribution,
equity outcomes,
and improvements in population health.
Medical education should not be judged only by match lists. It should be judged by what happens to the communities our graduates eventually serve.
Train for the Workforce We Actually Need
Primary care, rural medicine, maternal health, addiction, behavioral health-these are not “electives.” They are national needs. And GME leaders are uniquely positioned to align training capacity with those needs.
Center for the Humanity of Learners
Across every institution I’ve worked in, when residents feel seen, supported, and grounded in meaning, they flourish.
Social accountability includes accountability to them.
Their wellbeing is not peripheral. It is foundational.Use Technology to Bridge Gaps, Not Widen Them
Data systems, dashboards, AI tools-these can accelerate transparency, equity, and engagement. But leadership must ensure that technological innovation reflects human-centered design, not just operational efficiency.
Lead with Cultural Humility and Courage
The next era of medical education requires leaders who are:
collaborative rather than hierarchical,
transparent rather than performative,
purpose-driven rather than prestige-driven,
and accountable to the communities that entrust us with their future physicians.
This is the leadership standard our moment demands.
What Medical Education Must Ask Itself Now
The questions facing us are not administrative they are moral:
What is the purposes of medical education in 2025?
Who is accountable to?
How do we center the needs of communities without losing the integrity of academic medicine?
And what structure must we retire in order to make space for what’s needed next?
As someone who has spent years in the administrative heart of medical education, I believe this deeply:
We are at an inflection point.
Not a crisis, not a collapse-an inflection point.
A moment of possibility.
We can choose to preserve historical structures simply because they are familiar.
Or we can choose to build a system that honors the communities medicine was always meant to serve.
This is our chance to rewrite the social contract.
To reclaim purpose.
To usher in the next Flexner moment and do it with intention, equity, and humanity at the center.
And perhaps, finally to design a system that reflects not only who we are today, but who we aspire to become.