The Association of American Medical Colleges (AAMC) has led the way on DEIA in medical education through the leadership of David Acosta, MD, AAMC’s Chief Diversity and Inclusion Officer, who not only gave a keynote lecture at our AAP Annual Meeting in Denver (Sept. 2022), but also a keynote lecture at the APA Mental Health Services Conference in Washington, DC (Oct. 2022). Their DEI work is described at https://www.aamc.org/what-we-do/equity-diversity-inclusion
with this outstanding 2022 detailed summary of portfolios, initiatives, and programs: https://www.aamc.org/media/62421/download?attachment
I want to highlight five important reports as described at the AAMC website with links to the reports.
Diversity, Inclusion, Culture, and Equity (DICE) Inventory (4/2021).
“The Diversity, Inclusion, Culture, and Equity (DICE) Inventory is a specialty product designed for academic medicine professionals striving to understand and improve the diversity and inclusion within their institution. This product is delivered as a Microsoft Excel spreadsheet that asks for your input on a proprietary set of questions about your organization and generates a report that assesses your institution's culture for diversity, inclusion and equity.”
AMA-AAMC Advancing Health Equity: A Guide to Language, Narrative and Concepts (10/2021). “Reference this guide for definitions and background information on DEI topics covered in the DICE Inventory.”
The Power of Collective Action: Assessing and Advancing Diversity, Equity, and Inclusion Efforts at AAMC Medical Schools (11/2022). “This report presents the aggregated findings from the 101 medical schools that completed the Diversity, Inclusion, Culture, and Equity (DICE) Inventory. The report provides a baseline illustration on the current state of activities, policies, or procedures pertaining to DEI in medical schools and expands on reported practices to aid all medical schools in bolstering their DEI efforts moving forward.”
Diversity, Equity, and Inclusion Competencies Across the Learning Continuum
(7/2022). “These cross-continuum competencies help educators design or adapt curricula and help educators and learners in their individual professional development and DEI journeys. The competencies are for use in:
- Engaging health care professionals in collaborative DEI discussions, including cross-continuum and cross-discipline colleagues.
- Conducting gap analyses of local curricula and training programs.
- Self-assessing and planning individual professional development.
- Developing curricular learning objectives.
- Developing assessment tools.
- Furthering research and scholarship in medical education and DEI.
Guiding the strategic integration of DEI into the formal curricula and the clinical learning environment.”
5. AAMC Framework for Addressing and Eliminating Racism at the AAMC, in Academic Medicine, and Beyond. “In October 2020, the AAMC released this Framework that outlines four
pillars of work that will guide the AAMC’s efforts to create a shared vision of the AAMC and academic medicine institutions as diverse, equitable, inclusive, and anti-racist
The Accreditation Council for Graduate Medical Education (ACGME) DEIA efforts are led by William McDade, MD, PhD, Chief Diversity, Equity, and Inclusion Officer as described at the ACGME website: “The Department of DEI focuses on four key focus areas: education; outreach; research; and accreditation.” I wanted to highlight these three initiatives:
1. ACGME Equity Matters (7/2022 launch) is “an initiative that supplies a framework for continuous learning and process improvement in the areas of diversity, equity, and inclusion (DEI) and antiracism practices. The initiative aims to drive change within graduate medical education (GME) by increasing physician workforce diversity, and building safe and inclusive learning environments, while promoting health equity by addressing racial disparities in health care and overall population health.”
2. Barbara Ross-Lee, DO Diversity, Equity, and Inclusion Award “recognizes efforts to achieve diversity, equity, and inclusion in the graduate medical education (GME) community…The award recognizes ACGME-accredited Sponsoring Institutions and programs, as well as specialty organizations working to diversify the underrepresented physician workforce and create inclusive workplaces that foster humane, civil, and equitable environments.”
3. ACGME Common Program Requirement (CPR) accreditation standard on diversity and inclusion. This accreditation standard for all GME residency and fellowship training programs of all medical specialties became effective July 1, 2019, and retained as originally stated in a CPR revision effective July 1, 2022:
“IC. The program, in partnership with its Sponsoring Institution, must engage in practices that focus on mission-driven, ongoing, systematic recruitment and retention of a diverse and inclusive workforce of residents (if present), fellows, faculty members, senior administrative staff members, and other relevant members of its academic community. (Core)
Background and Intent: It is expected that the Sponsoring Institution has, and programs implement, policies and procedures related to recruitment and retention of minorities underrepresented in medicine and medical leadership in accordance with the Sponsoring Institution’s mission and aims. The program’s annual evaluation must include an assessment of the program’s efforts to recruit and retain a diverse workforce, as noted in V.C.1.c).(5).(c).”
https://www.acgme.org/globalassets/pfassets/programrequirements/cprresidency_2022v3.pdf (see bottom of page 5)
In contrast to the work of these two organizations, a 501(c)(3) tax-exempt organization Do No Harm Medicine is “a diverse group of physicians, healthcare professionals, medical students, patients, and policymakers united by a moral mission: Protect healthcare from a radical, divisive, and discriminatory ideology. We believe in making healthcare better for all – not undermining it in pursuit of a political agenda.” https://donoharmmedicine.org The anti-Critical Race Theory (CRT) movement at local school boards about K through 12 education has morphed into including anti-DEIA efforts at the UME and GME levels. Be forewarned!
Recent Newsroom items reported on the website include the following:
1. California Med School Scored Near-Perfect Marks On Its Wokeness Report Card, Docs Show (1/6/2023). This article acknowledged that UC Davis Medical School scored 98.9% on the AAMC DICE as the highest score, but reframed the DICE instrument as a “Wokeness Report Card.”
2. Missouri Takes On Medical Schools – And Medical Elites Hate It (1/11/2023). “Missouri is moving to get divisive and discriminatory race-based ideology out of medical schools – and the medical establishment is throwing a fit. Look no further than a recent email Do No Harm obtained, which is from a listserv maintained by the Association of Family Medicine Residency Directors (AFMRD). The email is in response to Rep. Ben Baker’s new bill that seeks to stop medical schools from forcing ‘Critical Race Theory’ and ‘Diversity, Equity, and Inclusion’ on students and faculty.”
3. Missouri Bill Targets Woke Medical Schools (1/17/2023). “Will Missouri be the first state to stop the woke takeover of medical schools? Yes, if State Rep. Ben Baker’s new bill passes. It’s called the ‘Do No Harm’ Act – and it’s a model piece of legislation for any state lawmaker who wants to ensure their medical schools teach medicine, not divisive and discriminatory ideology.”
The Manhattan Institute has provided a template of how state legislatures and governors can enact laws to restrict DEIA activities in their article “Abolish DEI Bureaucracies and Restore Colorblind Equality in Public Universities”:
Governor DeSantis of Florida has recently proposed this kind of legislation: https://www.flgov.com/2023/01/31/governor-desantis-elevates-civil-discourse-and-intellectual-freedom-in-higher-education/
“ Specifically, the 2023 proposal raises the standards of learning and civil discourse of public higher education in Florida by:
- Prohibiting higher education institutions from using any funding, regardless of source, to support DEI, CRT, and other discriminatory initiatives;
- Requiring institutions’ presidents and boards of trustees to take ownership of hiring and retention decisions, without interference from unions and faculty committees;
- Allowing institutions’ presidents and boards of trustees to conduct a post-tenure review of a faculty member at any time with cause;
- Prohibiting postsecondary institutions from using discriminatory political filters, including political loyalty oaths and DEI statements, in the hiring process.“
Francis Lu, MD
Kim Professor in Cultural Psychiatry, Emeritus, UC Davis