Reframing U.S. Allopathic Undergraduate Medical Education as a Multilevel System: A Social Ecological Model of Public Benefit

Undergraduate medical education (UME) in the United States is often discussed in terms of individual learner outcomes, institutional prestige, and private returns, with less attention to its broader societal contributions and value within higher education. This paper reframes U.S. allopathic UME as a multilevel system that generates public benefit and applies the social ecological model (SEM) to examine how institutional design shapes socially distributed outcomes. Rather than treating UME as a pure public good, the paper argues that it is more accurately understood as a system that produces public benefits through its influence on physician workforce capacity, distribution, preparedness, social mission outcomes, and responsiveness to population needs. Using UME as the focal organizational actor, the analysis maps microsystem, mesosystem, exosystem, macrosystem, and chronosystem influences onto learner experiences, training networks, regional workforce conditions, policy environments, and evolving societal expectations. The paper concludes by proposing a research and institutional design agenda that treats affordability, workforce alignment, accreditation standards, learning environment data, and graduate outcomes as inputs for aligning UME more intentionally with public benefit.