Stand Up and Educate Ourselves on Academic Freedom

Academic freedom (AF) is under increasing global pressure across democratic and autocratic states alike. AF is defined as the right of health professionals, students, and researchers to engage in intellectual inquiry without fear of censorship or retaliation.¹ According to the Academic Freedom Index Update 2025, AF has declined statistically and substantially in 34 countries worldwide over the past decade, including in the United Kingdom and the United States, and only 8 countries showed improvement.² Long-term monitoring identifies threats to research autonomy, freedom of exchange, institutional integrity, and the freedom of academic expression. This concerning trend directly challenges the foundation of graduate medical education (GME), as AF supports the development of evidence-based practice, encourages critical reflection, and fosters innovation. Safeguarding AF in health professions education (HPE) is critical to the advancement of science, the quality of clinical reasoning, and the health of democratic societies.

As a special interest group on AF, established in 2017 within the Netherlands Association of Medical Education, we initially sought to explore the concept of AF more deeply and identify its relevance in our research, our day-to-day teaching, and clinical work. In this article, we encourage engagement from the wider HPE and GME community, provide a practical framework for viewing AF, and call on our colleagues to take action within their own spheres of influence.

Why Academic Freedom Is at Risk

Threats to AF in HPE cannot be viewed in isolation from broader political and societal dynamics. These include politicization of academia, defunding of critical research, and the polarization of scientific discourse. New technologies—like generative AI—and social media amplify these dynamics. Educators and learners may self-censor out of concern for their reputation, job security, or career progression, especially when engaging in controversial or politically sensitive topics.

AF allows educators to present new or unpopular ideas and question existing ideas, and ensures residents encounter diverse perspectives. This is foundational to prepare future health care professionals to deliver critical, up-to-date, and culturally competent care. Without AF, clinical education risks becoming stagnant, overly risk-averse, or vulnerable to nonscientific influence.

We also recognize that concerns about AF arise across the political spectrum. Some worry that academic environments silence conservative or religious perspectives. Others fear that health equity or gender-based content is being politically targeted. A truly inclusive vision of AF must allow space for both progressive and conservative voices, provided that discourse remains evidence-based and professionally respectful. This means that positions can sometimes clash. Therefore, AF requires courageous educators, thoughtful policies, and institutions that support diversity of thought while upholding ethical standards. While making this call, we acknowledge up front that there are physicians, educators, and researchers who truly cannot “stand up” for AF and may realistically fear threats to their jobs or worse for exploring unfavored ideas or information. This should be a strong reason for those who have the support of institutions, professional organizations, or government to stand up for AF.

Examples of Threats in the GME Context

To provide a practical framework for faculty and program leaders in GME, we propose organizing current threats into 4 categories, highlighting their relevance to educators and learners, as well as possible ways to address these challenges. We illustrate these with modified cases.

1. Political and Ideological Pressures

National and local politics increasingly shape what can be taught or studied. In some regions, legislation restricts education or research on reproductive health, health equity, or structural determinants of health.

Recommendations: Find existing institutional pathways for faculty to raise concerns. Expand on these pathways or create new ones with support of relevant stakeholders; support faculty in navigating political constraints while maintaining academic integrity.

Case: A teacher in a trainee course on shared decision-making was requested by the course coordinator to delete explicit references to barriers for access to health care for patient groups with specific backgrounds. To handle this situation the teacher contacted fellow teachers and the curriculum committee on how to deal with this request.

2. Institutional Governance and Reputation Management

Hospital or university leadership may discourage faculty from engaging in work that challenges status quo policies or affects the institution’s public image.

Recommendations: Identify governance structures that include faculty and trainee voices in curricular decisions and elaborate these structures if needed; codify protections for AF in institutional policies.

Case: A PhD supervisor, who was also the medical school dean, asked their PhD student to soften and leave out some of the recommendations in a draft manuscript because they conflicted with current trainee selection policies. In this case, the PhD student discussed this issue within the research team and an independent research integrity officer at the institution.

3. Funding and Research Agenda Control

Research funders may shape what questions are asked or avoided. Trainees in particular may avoid controversial topics for fear of limited publication or grant success.

Recommendations: Encourage transparency through conflict-of-interest disclosures; promote internal grant programs for resident-led or high-risk research; educate and empower next generations by incorporating AF into training programs.

Case: The financiers of a major research project did not want negative study results to be published. To grapple with this problem, the research team sought help from their colleagues in the department and discussed how to deal with the situation. This empowered the team to submit their results for publication, despite attempts by the financiers to dissuade them from publishing the unfavorable results.

4. Digital Media and Self-Censorship

The rise of online harassment and reputational risk has made many educators cautious in public discourse.

Recommendations: Speak up as an organization and show that the organization stands behind the employees; provide training in professional digital communication; clarify institutional backing when expression falls within professional norms.

Case: A researcher felt compelled to stop sharing his expert opinions on migration on social media after receiving explicit threats, including being told that they would “know where to find his family.” The researcher discussed this issue with the institution’s confidentiality officer. After a supportive discussion, the researcher felt better able to deal with the stress resulting from these threats. In collaboration with the communications department, the researcher continued to contribute scientific input to the online discussion.

Call to Action

AF cannot be protected through policy alone. It must be cultivated through dialogue, modeled in practice, and actively embedded in faculty development.³ As change often begins with small steps, we share some low-cost, adaptable formats that are suited to a wide range of HPE environments, including international GME programs with limited institutional support for AF. These formats not only foster awareness but also build the courage and community support needed to uphold AF in everyday educational practice.

We urge our colleagues in the global HPE and GME community to take action:

Facilitate regular discussions on AF and its relevance to clinical education, for example in roundtable meetings designed to facilitate open dialogue with 10 to 20 participants to share and discuss examples of when they have experienced AF infringement, or to reflect on real-world events (eg, newspaper articles or institutional cases) and explore the tensions around AF. This could also be organized during educational meetings, departmental meetings, symposia or conferences for faculty and trainees, or PhDs and their supervisors. Collecting the AF infringement experiences in an anonymized way could result in “cases,” which can then be used as conversation starters to stimulate group reflection, like the Dilemma Game.⁴

Create mechanisms for safely reporting and addressing violations or threats to AF, for example by appointing easy-to-access and independent integrity officers. Actively informing new trainees and faculty about integrity officers and regularly discussing AF and related cases may support the actual move toward an integrity officer when needed.

Share experiences and frameworks across institutions and cultures to build collective resilience, for example by sharing policy documents on AF from peer institutions as benchmarks and starting points for discussion.

By fostering dialogue and reflection on AF, let’s build environments where future clinicians are equipped not only to apply knowledge but also are empowered to question, defend, and advance it.