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Teaching medical trainees to see societal infrastructure as a clinical issue

In an article published in the journal Frontiers in Medicine, we argue that medical education must broaden its focus: rather than treating infrastructure such as housing, transportation, energy, water supply as only a public-health or social background issue, trainees should regard infrastructural deficiencies as direct clinical determinants of patient health. 

We highlight concrete examples (e.g., missed appointments due to transport failures, disrupted dialysis from electricity outages, contaminated water causing toxicity) showing how infrastructure can precipitate or worsen clinical problems. We propose educational innovations: embedding infrastructure-related history-taking, case-based learning driven by infrastructural triggers, community placements in underserved areas, and interdisciplinary learning (with urban planners, engineers, public health) to equip future clinicians with “systems-citizen” skills and advocacy capability. 

The goal is to reframe clinical practice to include infrastructure as a proximal driver of disease, thereby reducing health inequities and enabling clinicians to engage meaningfully in structural interventions beyond traditional biomedical care.

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