Medscape recently released a report entitled, “A Constant Evolution: The Unique Culture of Medical School: Medscape 2025 Report.” The report’s underlying premise is that a warm, welcoming, and supportive culture in medical school allows students to not only “survive” their training, but to truly “thrive” in their educational journey.

What defines medical education today

Yet, reading between the lines, this emphasis on “culture” and environment also poses a very different question: Has medical education subtly morphed into a consumer-driven enterprise, where feelings of belonging trump the rigorous mastery of knowledge and skills needed to produce competent physicians? With only one question focused on study time, the survey is otherwise absent any mention of academics or the learning that takes place. To that end, the report’s noted cultural “evolution” leaves unanswered what remains of the academic culture that should be at the heart of any medical school.

At its core, medical schools exist to forge professional, highly competent doctors equipped not only to diagnose and treat, but also to deliver safe and effective care that meets the highest standards of medical excellence. Whether or not medical schools achieve this goal in the context of “culture,” however, isn’t the focus of the report.

Instead, beneath the “culture” umbrella are measures like how supportive school administrators are, whether the school reaches out to help students, the state of “friend time” during medical school, how difficult it is maintaining a relationship, diversity, and how much classmates “discuss school on social media.” Supportive administrators and peers are undoubtedly valuable, but they are not the ultimate measure of medical education. Notably missing from Medscape’s report is an evaluation of elements one may expect to find in an academic culture like pursuit of knowledge, intellectual rigor, ethical standards, critical inquiry, open debate, teaching quality, mentorship, collegiality, and merit.

The rise of the student-as-consumer model

Unfortunately, this focus on student as consumer echoes broader trends in higher education, where institutions compete for applicants by promising emotional fulfillment rather than academic excellence. By following the latest trends, one might assume that medical schools are scrambling to attract applicants. Reality tells a different tale: For the 2025-2026 academic year there were over 1 million total applications representing nearly 55,000 applicants competing for just over 23,000 first-year allopathic medical school seats. In a landscape where demand vastly outpaces supply, medical schools have the leverage (and the responsibility) to prioritize academic excellence and professional formation over appeasing consumer expectations.

Nevertheless, this shift toward emotional comfort and belonging places personal well-being above the core goal of producing capable, well-trained physicians. While a toxic environment can hinder learning and is unacceptable, the true measure of a school’s worth is its ability to train clinically competent doctors, not merely make for comfortable students. Medical training is demanding by its very nature: mastering vast amounts of information and honing critical skills requires sustained effort and dedication, which naturally entails sacrifice given the constraints of time and our human abilities. Compassion need not be sacrificed, and neither should rigor be compromised. It is this academic rigor that forges excellence, excellence necessary to handle the operating room’s unpredictability or a patient’s deteriorating vitals without hesitation.

Why academic excellence still matters

What receives surprisingly little attention amid these cultural metrics is the quality of learning itself. While the report briefly mentions competition for grades and residency placements, it stops short of examining whether the reported “cultural gains” translate into stronger mastery of core subjects and clinical reasoning. Instead, it highlights trends such as a decreased emphasis on studying. A second-year medical student is quoted as follows: “Especially after the conversion of the Step 1 exam to pass/fail, it seems like medical students are less preoccupied with studying and … more interested in setting themselves apart by participating in research, clinical volunteering, etc.”

Unforetold is the risk entailed in fueling a new kind of competition, one centered on superficial resume-building rather than substantive competence. While such experiences may seem impressive on paper, they cannot replace the disciplined repetition and deep study required to internalize the fundamentals of medicine. If the drive to excel is dulled by a lowered performance bar, we must ask: Are we cultivating physicians equipped to master complexity, or merely those content to meet the minimum standard?

The goal of medical education must remain just that: medical education, not “consumer” satisfaction. Beyond merely seeking a feeling of belonging, prospective students should be most concerned with how their chosen medical school will shape them into becoming a great doctor. Administrators, likewise, must strike a balance between fostering support and upholding uncompromising standards. Ultimately, the culture must reinforce, not replace, the rigorous academic foundation required to train competent physicians.

In the end, patients aren’t concerned with how “welcome” a surgeon felt in medical school; they care whether the scalpel is steady. When cultural priorities absent academics overshadow rigor, we risk inviting mediocrity into a profession that demands nothing less than excellence. Medical schools must remain steadfast in their core mission and duty to patients: shaping students into physicians through meticulous, deliberate, and hard-earned development. From there, a culture rooted in academic rigor will follow.

Kurt Miceli is an internal medicine and psychiatry physician.