Status of Proposed Changes in
Accreditation Standards on Diversity

The Liaison Committee on Medical Education (LCME) held a hearing for public comment on changes in its accreditation standards relating to diversity on Tuesday, November 6, 2007, in Washington, DC, in conjunction with the AAMC Annual Meeting. The hearing was chaired by LCME Co-Chair Steven G. Gabbe, MD, who represented the LCME along with Secretary Dan Hunt, MD, MBA. Testimony was heard from 19 medical school representatives.

The full text and rationale for each proposed change are described below. At its next meeting on February 5-7, 2008, the LCME will determine, after considering the comments received by the public, whether or not to approve the new and revised standards.

Background and rationale for the changes:

Two years ago the LCME initiated a review of its accreditation standards relating to student and faculty diversity, motivated by several changes taking place at the time:

• Recalibration of the methods used by the federal government for documenting racial and ethnic diversity
• Revision of the AAMC definition of the term "under-represented minority" to reflect local physician and population demographics rather than identification of specific racial and ethnic groupings
• Calls from various organizations (including the Institute of Medicine, American Medical Association, Sullivan Alliance to Transform America's Health Professions, etc.) for a more active role by the accreditation community in addressing diversity in the health professions
• A legal climate increasingly cautious about race-conscious admissions policies in higher education

The LCME constituted a working group to examine its approach to diversity, and to recommend any appropriate revisions or new standards that would preserve the medical education community's commitment to diversity while acknowledging the more restrictive legal environment surrounding diversity issues in higher education. The working group concluded that existing standards for diversity among students and faculty were difficult to assess in the absence of a clear statement by schools regarding their institutional goals for diversity. It therefore proposed replacing the two existing standards with a single new standard that applies to the medical school community as a whole, and requires that schools specify their goals for diversity and the means by which progress toward such goals would be assessed.

The working group also noted the "zero-sum" effect that occurs when a cited school attracts qualified diverse students from other medical schools, thus diminishing diversity at other institutions in order to address its own needs. To address that issue, the working group proposed a new standard requiring that all schools make a reasonable effort to expand the pool of qualified applicants. Data provided by the AAMC Division of Diversity Policy and Programs indicates that almost all medical schools already have some type of academic enrichment ("pipeline") program or other initiatives to expand the pool of qualified applicants, and approximately 100 schools have or have recently had pipeline programs extending back to high school or earlier.

Recommended Change #1:

Current standards and annotation to be deleted:

Standard MS-8: Each medical school should have policies and practices ensuring the gender, racial, cultural, and economic diversity of its students.

Annotation: The standard requires that each school's student body exhibit diversity in the dimensions noted. The extent of diversity needed will depend on the school's missions, goals, and educational objectives, expectations of the community in which it operates, and its implied or explicit social contract at the local, state, and national levels.

Standard FA-1: The recruitment and development of a medical school's faculty should take into account its mission, the diversity of the student body, and the population that it serves.

Proposed new standard and annotation:

New Standard IS-x1: Each medical school must have policies and practices to achieve appropriate diversity among its students, faculty, staff, and other members of its academic community, and must engage in ongoing, systematic, and focused efforts to attract and retain students, faculty, staff, and others from demographically diverse backgrounds.

New Annotation: The LCME and CACMS believe that aspiring future physicians will be best prepared for medical practice in a diverse society if they learn in an environment characterized by, and supportive of, diversity and inclusion. Such an environment will facilitate physician training in:

• Basic principles of culturally competent health care
• Recognition of health care disparities and the development of solutions to such burdens
• The importance of meeting the health care needs of medically underserved populations
• The development of core professional attributes, such as altruism and social accountability, needed to provide effective care in a multidimensionally diverse society

Each school should articulate its expectations regarding diversity across its academic community in the context of local and national responsibilities, and regularly assess how well such expectations are being achieved. Schools could include the following elements of diversity in their planning: gender, racial, cultural and economic. Schools should establish focused, significant, and sustained programs to recruit and retain suitably diverse students, faculty members, staff, and others.

Recommended Change #2:

New Standard IS-x2: Each medical school should develop programs or partnerships aimed at broadening diversity among qualified applicants for medical school admission.

New Annotation: Because graduates of U.S. and Canadian medical schools may practice anywhere in their respective countries, it is expected that schools recognize their collective responsibility for contributing to the diversity of the profession as a whole. To that end, schools should work within their own universities and collaborate with other institutions to make admission to medical education programs more accessible to potential applicants of diverse backgrounds. Schools can accomplish that aim through a variety of approaches, including the development of pipeline programs, collaborations with institutions that serve students from disadvantaged backgrounds, community service activities that heighten awareness of and interest in the profession, or academic enrichment programs for applicants who may not have taken traditional pre-medical coursework.

Both Standards IS-x1 and IS-x2 would be located in the Institutional Setting section of Functions and Structure of a Medical School, the LCME's accreditation standards document.