House Republicans grill med school accreditor on racial discrimination in new diversity standard

Medical schools were warned last year they could face accreditation probes for failure to train students in antiracism "competencies." Starting next summer, they may feel compelled to treat student and employee applicants differently based on race to reach amorphous diversity targets.

House Education and Workforce Committee Republicans asked the Liaison Committee on Medical Education to explain the practical implications of its accreditation standards on "diversity programs and partnerships," which take effect in July 2024.

Committee Chair Virginia Foxx (R-N.C.) and Higher Education Subcommittee Chair Burgess Owens (R-Utah) want to "confirm your commitment to ensuring that medical schools are preparing future health care professionals to provide health care free from racial discrimination," their May 4 letter says. 

They seek "all communications regarding racial diversity that LCME has published or sent in the past three years" and how it pursues "racial diversity in its own operations," including antiracism efforts and the percentage of its budget spent on diversity, equity, and inclusion initiatives.

The independent body is cosponsored by the American Medical Association and Association of American Medical Colleges. Recognized by the U.S. Department of Education, LCME controls access to some federal funding for med schools and determines who can receive medical licenses in most states.

Medical associations beyond colleges are also incentivizing members to get involved in DEI. The American College of Obstectrics and Gynecology told members they can win free registration for its Maui conference by joining its "systemic equity" initiative and taking an evaluation.

The forthcoming accreditation standards, made public in March, say a medical education program "recognizes the benefits of diversity." This is defined as "the facts [sic]" that having students and faculty from "a variety of socioeconomic backgrounds, racial and ethnic groups, and other life experiences" can improve student interactions and build a workforce that's "more culturally aware" and able to "address current and future health care disparities."

Accredited med schools engage in "ongoing, systematic, and focused recruitment and retention activities" to achieve "mission-appropriate diversity outcomes" for students, faculty, "senior administrative staff" and unspecified "other relevant" academic community members.

"These activities include the use of programs and/or partnerships aimed at achieving diversity among qualified applicants for medical school admission and the evaluation of program and partnership outcomes," the standards say.

They define mission-appropriate diversity as including "persons from different racial, ethnic, economic, and/or social backgrounds and with differing life experiences to enhance the educational environment for all medical students," based on "the program's mission, goals, and policies.

Foxx and Owens asked LCME more than a dozen questions about the new standards, including whether they require or encourage med schools to "treat applicants differently" or award scholarships based on race or would penalize them for race-neutral treatment.

The lawmakers also want to know how the new standards affect instruction, whether, for example, they require or encourage schools to teach that "it is preferable for doctors and patients to be the same race" or that "the American health care system is systemically racist." They asked for LCME's view on these questions and whether "members of a particular race [are] inherently racist or privileged" or oppressed.

LCME "will be responding directly to the members who sent the letter," AAMC spokesperson John Buarotti, who also represents LCME, wrote in an email. He pointed to an AMA Journal of Ethics essay from December 2021 by LCME co-secretaries Barbara Barzansky and Veronica Catanese, to whom the congressional letter was addressed.

The accreditation standard on diversity "neither mandates which categories of diversity medical schools must use nor defines quantitative outcomes they should achieve," they wrote. It simply requires them to "identify diversity categories that motivate its mission and reflect its environment" and "use those categories to implement programs to promote diverse representation of students and faculty." 

LCME evaluations look at "single point-in-time diversity numbers, trends in student and faculty diversity, and outcomes of programs implemented by the school to promote diversity in the categories it identifies as key to its mission," the essay says.

Med schools are increasingly shying away from more objective measures of academic preparedness, potentially threatening the quality of healthcare Americans receive, often with the express or implied purpose of increasing the proportion of "underrepresented" races and ethnicities in the profession.

At least 40 schools don't require the Medical College Admissions Test, administered by AAMC, to enroll in combined bachelor's and medical degree programs, according to admissions consulting firm Inspira Advantage. 

Medical advocacy group Do No Harm, which fights politicized medicine, noted the City University of New York med school touted this omission near the end of a recent International Association of Medical Science Educators webinar. 

The University of Pennsylvania med school selectively exempts MCAT submission for participants in its Penn Access Summer Scholars Program, which partners with five historically black colleges and universities.

The disclosures caught the attention of comedic actor Rob Schneider, a vocal conservative. "They are seriously trying to kill us," he tweeted.

Medical educators also recently denounced objective measures in a Journal of the American Medical Association "viewpoint" essay behind a paywall. According to Fox News, they wrote that looking "solely" at MCAT and GPA scores "is a troubling and regressive way to assess" the excellence and "potential" of would-be doctors "whose identities reflect those of the public."

MCAT scores have "medium to large correlations" with medical student outcomes, according to a study last year in the AAMC journal Academic Medicine. Do No Harm pointed to this study in the context of another in the same journal that found black, Hispanic/Latino and Native American residents did worse on evaluations.

"The authors attributed their findings to biased evaluators, racist tests, or worse training, but if you put ideology aside, the more likely conclusion is that lower standards for students leads to worse performance by residents," Chair Stanley Goldfarb wrote in Newsweek.

Some faculty at elite med schools also promote racial separation. University of California Berkeley and  UC San Francisco medical faculty touted "racial affinity group caucuses" as a "key supplement to antiracism curricula" in the New England Journal of Medicine April 27. 

Do No Harm scolded NEJM for publishing "divisive and highly politicized pieces" that may both worsen a doctor shortage and push "medical education toward segregation."