In October 2021, the Association of American Medical Colleges (AAMC) and the American Medical Association jointly released its 54-page Advancing Health Equity: A Guide to Language, Narratives and Concepts, which received widespread criticism for its ideologically-charged language and recommendations. The guide suggested physicians update their language using “equity-focused alternatives,” trading terms such as “vulnerable” for “oppressed” and “disadvantaged” for “historically and intentionally excluded.”
The AAMC now plans to release “diversity, equity, and inclusion competencies.” The National Association of Scholars has acquired the pre-publication version of these competencies (see below). Drawing from Advancing Health Equity, these competencies encode the watchwords of identity politics as official standards, for both students and medical professors. If medical schools adopt these competencies, they will establish social justice activism, along with a controversial set of political beliefs, as de facto professional requirements for students and faculty.
Under development for more than a year, the competencies take the form of educational standards, different skill benchmarks for distinct stages of a physician's education, designed to facilitate “curricular and professional development” and “formative performance assessment.” They come at an opportune moment, as medical schools around the country have promised extensive training and curricula in diversity, equity, inclusion, and “anti-racism.”
Here is a selection of the competencies, which I have organized into categories.
Diversity and Intersectionality
Demonstrates knowledge of the intersectionality of a patient’s multiple identities and how each identity may present varied and multiple forms of oppression or privilege related to clinical decisions and practice (student)
Role models how knowledge of intersectionality informs clinical decision making and practice (faculty)
Identifies the systems level policies, procedures, and practices that may or may not promote diversity and inclusion in the health care system (student)
Leads, advocates, and/or participates in the development, implementation, and review of policies, procedures, and practices that promote diversity and inclusion in the health care system (faculty)
Oppression and Disruption
Role models and teaches how to engage in reflective practices related to individual identities, power, and privileges to improve interactions with patients, families, communities, and members of the health care team (faculty)
Identifies systems of power, privilege, and oppression and their impacts on health outcomes (e.g., white privilege, racism, sexism, heterosexism, ableism, religious oppression) (student)
Teaches how systems of power, privilege, and oppression inform policies and practices and how to engage with systems to disrupt oppressive practices (faculty)
Describes the impact of various systems of oppression on health and health care (e.g., colonization, white supremacy, acculturation, and assimilation) (student)
Demonstrates moral courage, self-advocacy and allyship when facing and/or witnessing injustice (e.g., microaggression, discrimination, racism) (student)
Role models moral courage, self-advocacy, allyship, and being an active bystander/upstander to address and prevent injustices (faculty)
Activism and Institutional Change
Role models anti-racism in medicine and teaching including strategies that are grounded in critical understanding of unjust systems of oppression (faculty)
Teaches and examines system level strategies to remedy the impact of systems of oppression on health and health care (faculty)
Promotes social justice and engages in efforts to eliminate health care disparities (early career)
Leads or participates in organizational and public policy approaches to promote social justice, eliminate health care disparities, and address social determinants of health (faculty)
Leads, participates in, or supports interprofessional partnerships with local health departments or community-based organizations to develop culturally responsive interventions (faculty)
These are only draft competencies, subject to change, but they would require enormous revisions to bypass obvious concerns about ideological conformity and academic freedom. Already, such terms as “social justice” and “equity” connote ideological commitments with which many students and faculty members disagree. But the competencies go further than merely implying extreme ideologies: they require students and faculty to actively view the world through the lens of oppression and embrace the concept of intersectionality. They call on faculty to disrupt “oppressive practices,” and they include “assimilation” in their list of “systems of oppression.” Moreover, all the competencies are subject to interpretation—professors and administrators who consider themselves social justice activists can easily apply them stringently.
Soon, such scenarios won’t be hypothetical, as some medical schools have already signaled their readiness to adopt the newly-developed competencies. In its “Action Plan for Anti-Racism in Medical Education,” created in 2020, Columbia University’s Vagelos College of Physicians & Surgeons promised to “add Diversity, Equity, and Inclusion (DEI) competencies to the school’s medical education program objectives.” It notes the competencies in development: “Dean Gordon and Drs. Cunningham and Canfield are currently reviewing a draft of DEI Competencies developed by the Association of American Medical Colleges. When final, these competencies will be proposed to [the Committee on Education Policy and Curriculum].” In a 2021 update, the school promises that it “will continue to work with this group.”
Meanwhile, in its “Diversity, Equity, and Inclusion Task Forces Quarterly Update,” Indiana University School of Medicine promises: “Rapid refinement of the IU School of Medicine health equity, diversity, and inclusion competency objectives for addition to undergraduate competencies using the recently released Association of American Medical Colleges (AAMC) DEI competency draft as a starting point.”
Other universities have committed to using DEI competencies, and the AAMC now provides guidance. Oregon Health and Science University—ranked first in family medicine—recently promised to “develop and incorporate DEI, anti-racism and social justice core competencies in performance appraisals of faculty and staff.” In 2020, Michigan Medicine promised to “implement multiple levels of education based on DEI competencies, including baseline general education for faculty, staff and learners.”
The AAMC cosponsors the Liaison Committee for Medical Education (LCME), which accredits medical schools. Already, the LCME has elicited increasingly arduous DEI policies. With these new competencies, schools will have a ready-made tool for displaying their commitment to DEI, which can help satisfy accreditors.
While they might satisfy accreditors, these competencies will deal a blow to medical education. They will force students and physicians to embrace social justice activism, prompt schools to evaluate students and faculty based on their adherence to a controversial set of beliefs, and ensure the violation of academic freedom.
Source Documents from the AAMC
Photo by Paul Becker (Becker1999) on Flicker // CC BY 2.0
