First, Brook No Dissent
The medical-school accreditation body places an increasing emphasis on “diversity, equity, and inclusion.”
The University of California–Davis School of Medicine has developed a mandatory anti-racism course and introduced a webinar series with talks on “Addressing Structural Racism” and “Moving from Ally to Advocate.” At Louisiana State University Health Shreveport School of Medicine, faculty must undergo annual training on cultural sensitivity, diversity, and bias. The University of Minnesota School of Medicine collaborates on its curriculum with the Medical Education Reform Student Coalition (MERSC), an offshoot of the activist organization White Coats 4 Black Lives.
All these measures exist, at least in part, to help the medical schools meet their accreditation requirements. The Liaison Committee on Medical Education (LCME) accredits medical schools in the United States, and has long required schools to bolster student and faculty diversity and teach cultural competence. Increasingly, however, these requirements appear to carry more weight, as schools have implemented far-reaching diversity, equity, and inclusion (DEI) policies with the express goal of satisfying them.
The Oregon Health and Science University, ranked first in the nation for family medicine, was reaccredited in the summer of 2020, but the LCME found it “unsatisfactory” in the area of “faculty diversity.” In response, the school’s senior associate dean for education promised a “concerted effort and sustained commitment at the highest levels of the institution.”
In November, OHSU adopted a 24-page Diversity, Equity, Inclusion and Anti-Racism Strategic Action Plan, created “in alignment with accreditation requirements.” The new plan makes it virtually impossible for faculty to object to DEI measures without jeopardizing their careers. It institutes ongoing training on “DEI and anti-racism” with “consequences for individuals who are not compliant with the required training.” It also mandates new performance reviews that evaluate “how the employee is contributing to improving DEI, anti-racism and social justice,” along with a social justice section in faculty promotion packages, again reinforced with unelaborated “consequences.” The school even issued its own Inclusive Language Guide, with a long glossary including entries for “Karen,” “Ken,” “whiteness,” “micro-invalidation,” and “white fragility.”
The LCME likewise deemed the University of Minnesota Medical School unsatisfactory in diversity and cultural competence. The school’s accreditation page lists its progress in both areas: hiring a new vice dean for DEI, hiring new DEI directors to “enhance existing DEI curriculum across all 4 years,” and working with the Medical Education Student Reform Coalition. Like its predecessor group, MERSC insists on radical policy changes, calling for a curriculum that focuses on “health inequity,” “systemic racism,” and “white supremacy.”
In June 2020, the University of North Carolina School of Medicine created its “Task Force For Integrating Social Justice Into the Curriculum,” which issued dozens of recommendations that, if implemented, would violate academic freedom. It recommended requiring students to develop political advocacy skills and faculty to adhere to “core concepts of anti-racism,” while calling for faculty evaluations that assess a “growth mindset related to social justice.” After a bout of public attention, the dean said that the school had not adopted many of these recommendations, and he shed light on their origins. “Many or most of the recommendations,” he said in a presentation to the UNC Board of Governors, “really were created as a response to concerns that were highlighted by our accreditation agency, the LCME.”
Such pressure from the accrediting organization might explain the disproportionate emphasis placed on DEI in American medical education. UNC provides a good example: of the university’s 24 DEI officers, eight are employed by the medical school. Yet UNC’s combined undergraduate and graduate enrollment is 31,538, while the school of medicine’s enrollment is just 2,393. The pressure to adopt extensive diversity plans appears too great for both established institutions (such as Michigan Medicine) and upstart schools (such as Kaiser Permanente’s newly created Bernard J. Tyson School of Medicine) to resist.
DEI is infiltrating medical education, often treating political issues such as health disparities as settled questions. If the trend continues, it will further politicize medicine. Unfortunately, the LCME shows no sign of stopping.
Photo by MARK RALSTON/AFP via Getty Images
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