Diversity-Based Training in Medicine

Diversity-based training is a requirement for accreditation.

In the U.S. the Liaison Committee on Medical Education (LCME) accredits medical education programs that lead to an M.D. degree. Accreditation by LCME is based on standards for the functions and structure of a medical school (LCME 2024).

LCME standards include goals of achieving diversity among qualified applicants, having an anti-discrimination policy, and medical curriculum for students to address biases (LCME 2024). This curriculum must include:

• The different way people perceive health and illness and how they respond to different symptoms, diseases, and treatments.
• Principles of culturally and structurally competent healthcare.
• The impact of healthcare disparities on all populations and how to reduce health inequities.
• Knowledge, skills, and professional attributes needed for effective care in a diverse society.

Accreditation is needed for funding and physician licensing.

Only students from a medical school with LCME accreditation are eligible to take the United States Medical Licensing Examination (USMLE), also known as the Board Examination (USMLE 2024). Graduates of a medical school must come from an LCME accredited medical school to enter a residency program (LCME).

In MO, applicants for a permanent physician or surgeon license must be a graduate of a medical school that is accredited by the American Medical Association (AMA) or LCME, or an osteopathic college accredited by the American Osteopathic Association (20 Mo. CSR § 2150). The LCME is jointly sponsored by the Association of American Medical Colleges and the AMA (LCME).

To be eligible to participate in programs of the Higher Education Act of 1965 (e.g., Pell Grants), institutions of higher education must be accredited (Higher Education Act § 600.4, § 668.13). Medical schools must also be accredited to receive grants through the Public Health Service Act (Public Health Service Act). This includes:

• Grants for planning, operating, or participating in a residency program.
• Financial assistance through traineeships or fellowships for medical school students, residents, and physicians.

Multiple states have prohibited mandatory teaching of a set of social concepts.

AL, FL, ND, SD, TN, and UT prohibit requiring the teaching or training of specific social concepts at higher education institutions (Figure 1). FL specifically prohibits Florida College System institutions from using state or federal funds to advocate for specific social concepts.

In these statutes, social concepts have varying definitions, which include:

• Promotion of differential treatment based on personal identity characteristics.
• Discussion about an individual’s race, sex, ethnicity, sexual orientation, or their sociopolitical views.
• Discussion about inherent privilege, sexism, or racism, and implicit bias.
• Fault or bias being assigned based on race, religion, sex, ethnicity, or national origin.
• Critical race theory and other types of critical or radical theory.

Among these bills, only AL and FL use the term Diversity, Equity, and Inclusion (DEI) in their bills.

• FL does not define the term and includes it with the other social concepts listed above.
• AL defines DEI programs as programs or trainings where attendance is based on one’s race, sex, gender identity, ethnicity, national origin, or sexual orientation.

AL, FL, ND, TN, and UT specify that the bill language is not to be interpreted to prohibit training or programs necessary to comply with federal, state, or local law. It is unknown how the lack of this statement in ND’s law affects medical school accreditation.

Figure 1. States with bills that prohibit requiring the training of specific social concepts in higher education. These states have defined which social concepts are in their bills and can be found in-text of this Science Note.

References

20 Mo. CSR § 2150 (2023). https://www.sos.mo.gov/cmsimages/adrules/csr/current/20csr/20c2150-2.pdf.

HB 261, 65 Legislature, 2024 Gen. Sess. (Utah 2024). https://le.utah.gov/~2024/bills/static/HB0261.html.

HB 999, 2023 Legislature, 2023 Reg. Sess. (Fla. 2023). https://www.flsenate.gov/Session/Bill/2023/999/BillText/c1/PDF

HB 1012. 2022 Legislature, 97th Legislative Session. (S.D. 2022). https://sdlegislature.gov/Session/Bill/23006/236257.

Higher Education Act. Title 34 § 600.4 (1994). https://www.govinfo.gov/content/pkg/CFR-2023-title34-vol3/pdf/CFR-2023-title34-vol3-part600.pdf.

Higher Education Act. Title 34 § 668.13 Certification procedures (1994). https://www.govinfo.gov/content/pkg/CFR-2023-title34-vol3/pdf/CFR-2023-title34-vol3-part668.pdf.

Liaison Committee on Medical Education. (n.a.). Scope and Purpose of Accreditation. Accessed March 11, 2024. https://lcme.org/about/.

Liaison Committee on Medical Education. (2024). Functions and Structure of a Medical School. https://lcme.org/publications/.

Public Health Service Act . Title VII Sec. 705 (2022). https://www.govinfo.gov/content/pkg/COMPS-8778/pdf/COMPS-8778.pdf.

SB 129, 2024 Reg. Sess. (Ala. 2024). https://alison.legislature.state.al.us/files/pdfdocs/SearchableInstruments/2024RS/SB129-enr.pdf.

SB 2247. 68th Legislative Assembly, Reg. Sess. (N.D. 2023). https://ndlegis.gov/assembly/68-2023/regular/documents/23-0417-06000.pdf

SB 2290, 2022 General Assembly, 2022 Gen. Sess. (Tenn. 2022). https://wapp.capitol.tn.gov/apps/BillInfo/default.aspx?BillNumber=SB2290&GA=112.

United States Medical Licensing Examination. (n.a.). About the USMLE. Accessed March 12, 2024. https://www.usmle.org/about-usmle.