One academic health center’s response to a freedom of expression controversy

Academic health centers (AHCs) face unique challenges regarding freedom of expression, a topic that recently has caused considerable public controversy at universities across the United States. Little has been published on institutional responses to these controversies. To inspire conversation, reflection, and policy development at other AHCs, in this article, the authors outline steps taken by the Medical College of Wisconsin (MCW) in 2023 and 2024 to respond to an immediate challenge to freedom of expression and to develop a long-term response that will support the institution's commitment to freedom of expression as an essential element of education, patient care, and scientific inquiry. The authors describe the work of the MCW Committee on Freedom of Expression, including its formation, the steps it took to develop guiding principles, and the reaction of faculty, staff, and particularly medical students to initial educational programming around applying the newly developed principles. As a private institution, MCW has greater legal latitude than public AHCs, which allowed the committee to engage leaders and stakeholders in a reflective process, asking questions about the institution's position as a "public square," how to best address the needs of institutional and clinical partners, and the impact of power and inequity on broad protections of freedom of expression. To date, among stakeholders, students have been the most hesitant to embrace the new principles and consistently have shared concerns. Feedback from students has demonstrated that self-censorship is widespread, social justice concerns are a high priority, and structured programming can support and scaffold constructive conversations. The authors conclude that providing opportunities for engagement with institutional freedom of expression principles, especially when uncomfortable, is an essential step in integrating them into educational and clinical practices.