The Association of American Medical Colleges (AAMC) just released its official Diversity, Equity, and Inclusion (DEI) Competencies. Designed for curriculum development, the competencies function as DEI educational standards, providing a set of ideal “diversity” and “inclusion” skills for three stages of a physician’s education. For graduating medical students, the competencies include “describ[ing] the impact of various systems of oppression on health and health care (e.g., colonization, White supremacy, acculturation, assimilation).” For graduating residents, they include “promoting social justice and engag[ing] in efforts to eliminate health care disparities,” and for faculty physicians, “teach[ing] how systems of power, privilege, and oppression inform policies and practices and how to engage with systems to disrupt oppressive practices.”
Ultimately, these new competencies provide a blueprint for infusing the themes of identity politics—“intersectionality,” “white privilege,” “microaggression,” “allyship”—into medical education. In March, the National Association of Scholars acquired and published a draft version of the competencies. A number of critics spoke up, noting how the competencies would function as an obvious threat to academic freedom and, more broadly, sound medical education.
With the publication of these official competencies, the AAMC appears to be doubling-down. The official version includes only cosmetic changes to the draft. In their op-ed introducing the competencies, the president of the AAMC and the chair of the AAMC’s Council of Deans emphatically stated their support: “We believe this topic deserves just as much attention from learners and educators at every stage of their careers as the latest scientific breakthroughs”—a truly remarkable statement of priorities from the leaders of America’s foremost medical education association.
This statement of priorities—that DEI should be on par with science—is all the more noteworthy given the ideologically-charged nature of the competencies. Consider just a few:
Demonstrates knowledge of the intersectionality of a patient’s multiple identities and how each identity may result in varied and multiple forms of oppression or privilege related to clinical decisions and practice [students]
Identifies systems of power, privilege, and oppression and their impacts on health outcomes (e.g., White privilege, racism, sexism, heterosexism, ableism, religious oppression) [students]
Articulates race as a social construct that is a cause of health and health care inequities, not a risk factor for disease [students]
Practices moral courage, self-advocacy, allyship, and being an active bystander or upstander to address injustices [residents]
Role models anti-racism in medicine and teaching, including strategies grounded in critical understanding of unjust systems of oppression [faculty]
Role models how knowledge of intersectionality informs clinical decision-making and practice [faculty]
Concepts such as “intersectionality” and “allyship” connote substantive political positions; to declare that faculty and students must embrace them clearly violates academic freedom. But perhaps more significantly, these concepts are often interpreted idiosyncratically to enforce a narrow and damaging orthodoxy. At medical schools that adopt the competencies, it will undoubtedly become harder for students and faculty to voice support for a meritocracy or skepticism toward “gender-affirming care” for minors. Such views, after all, are commonly labeled “oppressive.”
In practice, the competencies are likely to elicit a wave of highly dubious medical curricula—to say nothing of medical research. The report also lists a series of examples of how to integrate the competencies into medical education, drawing from existing medical school curricula. One notable example comes from the Center for Antiracism in Practice at Mount Sinai’s Icahn School of Medicine. The report provides minimal details on the exact content of the Center’s workshops, but the school itself offers a few hints. Last year, the Icahn School of Medicine created a professional development program to train administrators at other medical schools on how to implement Icahn’s own anti-racism initiative. The program frequently invokes the so-called “Characteristics of White Supremacy Culture”—the bizarre notion that attributes such as “objectivity,” “individualism,” and “a sense of urgency” constitute white supremacy culture.
Unfortunately, medical schools and residency programs are primed to incorporate these competencies into their curricula. After all, medical accreditation bodies such as the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education now solicit increasingly robust DEI programming, a phenomenon that the AAMC notes in its report on the competencies. Some medical schools—including Columbia University’s Vagelos College of Physicians and Surgeons and Indiana University’s School of Medicine—have already expressed their interest in adopting the de facto standards. UT Austin’s Dell School of Medicine recently adopted a set of health equity competencies for its undergraduates that bear a striking resemblance to the AAMC’s.
The AAMC’s DEI competencies will hamper free expression, politicize medical education, encourage physicians to engage in misbegotten activism, and in the longer run, lead to substantively harmful policies. We should hope that students and faculty alike speak up and reject them.
John Sailer is a Research Associate at the National Association of Scholars and serves as Keeping the Republic Project Lead.
Photo by Paul Becker (Becker1999) on Flicker // CC BY 2.0