The “Equity Matters Video Library,” a resource from the Accreditation Council for Graduate Medical Education (ACGME), houses dozens of lectures on social justice, intersectionality, and diversity. In one lecture, titled “Whiteness: Power and Privilege in the Context of U.S. Racism,” the speaker asserts that “whiteness has become invisiblized and at the same time normalized.” She adds: “Until we explicitly describe the ways that ‘whiteness’ works, it will remain invisible and characterize the norm.”
It’s not surprising that an equity trainer would employ the idiosyncratic language of contemporary social justice, but the context is noteworthy. As its name suggests, the ACGME accredits medical residency programs. It created Equity Matters as a “framework for continuous learning and process improvement in the areas of diversity, equity, and inclusion (DEI) and anti-racism practices.” And increasingly, this “continuous learning and process improvement” functions as a requirement for medical education, mandated by the ACGME itself.
In 2019, the ACGME embedded the priorities of diversity and inclusion in its Common Program Requirements. According to the ACGME’s chief diversity and inclusion officer, William McDade, this means that programs “must engage in practices that focus on mission-driven, ongoing, systematic recruitment and retention of a diverse workforce.”
What does this mean in practice? McDade suggests a handful of strategies. One is holistic admissions practices—changing admission standards to value personal attributes and experiences, not just metrics such as standardized test scores. Another strategy is expanding the “diversity pipeline” by recruiting underrepresented minorities into the field of medicine earlier in their educational careers. (McDade notes that the ACGME now uses the term “pathways” rather than “pipeline” out of “deference to Native American populations.”)
For programs unsure of how to meet the requirements, the ACGME offers Equity Matters. In an interview, McDade says that “the flexibility of the ACGME common program requirements is such that residency programs can determine how they can best achieve them,” and explains that Equity Matters is “a program to have us learn from the GME community, what it’s doing to reach those goals.” A key feature of the program is a series of lectures espousing an unmistakable ideological agenda.
In a lecture titled “Naming Racism and Moving to Action,” physician and activist Brittani James discusses tools for “antiracist” action. Her key example—in which activists succeeded in pressuring the Journal of the American Medical Association to remove a podcast that questioned mainstream assumptions about racism—serves as a textbook case of silencing dissent and chilling speech. James presents it as a resounding success for the cause, indeed, as a model for those in graduate medical education. JAMA had released the podcast last year, promoting it on Twitter with the provocative question: “No physician is racist, so how can there be structural racism in health care?” In her lecture, James describes how her activist group, the Institute for Antiracism in Medicine, created a petition that called on JAMA to review its leadership and implement antiracist editorial policies. The podcast was removed from the website, and in James’s words, “there was steep accountability of leadership.” What she means is that JAMA’s veteran editor-in-chief, Howard Bauchner, resigned.
Throughout, the lectures preach the watchwords of social justice. In “Whiteness: Power and Privilege in the Context of U.S. Racism,” viewers discover that the “myth of meritocracy” is one of the “white cultural roots of racism denial.” In “Intersectionality: A Primer,” viewers are told that “medicine is brutal to minoritized people,” “medicine has a type of sickness to it,” and that schools must “support, promote, and protect a holistic recruitment of minoritized trainees, staff, clinicians, and faculty.” In “Gender Minorities,” the speaker addresses the question of whether gender distress in children will continue or desist as they grow older. Ignoring consistent evidence to the contrary, the speaker concludes, “What we find is that most children are just not going to waver.”
It’s not surprising that equity trainers, giving lectures for a program with “equity” in the name, would propound the worldview of social justice activists. What is disturbing is that medical education would encourage physicians to treat such highly controversial assertions as established fact. But since residency programs have been told to view Equity Matters as a guide for meeting accreditation requirements, this colorful sample of social justice medicine is a harbinger of things to come.
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