Medical School Accreditor Drops Health Equity Teaching Requirement Amid Political Pressure

The Liaison Committee on Medical Education, the leading U.S. medical school accreditor, removed language from its 2027-2028 standards requiring schools to teach about health inequities and structural competency, replacing it with generic direction about self-directed learning skills. The change follows a May 2025 Trump administration executive order targeting DEI-based standards in medical accreditation and a Department of Justice investigation led by assistant attorney general Harmeet K. Dhillon into possible race discrimination in medical school admissions at three institutions. Structural competency, a concept introduced by Vanderbilt sociologist and psychiatrist Jonathan Metzl in 2009, teaches physicians to recognize how factors like housing, food access, and transportation impact patient health beyond the healthcare system itself. Health equity advocates like physician Stella Safo worry that without accreditation requirements, medical schools in conservative areas will deprioritize teaching about health disparities, while groups like Do No Harm argue DEI initiatives threaten healthcare quality.

Removal of health equity teaching requirements by medical accreditor

• ▪The Accreditation Council for Graduate Medical Education will still include Systems-Based Practice as one of its core competencies in its 2026 requirements
• ▪The Liaison Committee on Medical Education's 2027-2028 standards replaced health equity language with direction that schools should teach skills of self-directed learning
• ▪The Liaison Committee on Medical Education significantly changed its standard that encouraged schools to teach structural competency
• ▪The Liaison Committee on Medical Education's 2026-2027 standards required schools to teach the importance of health care disparities and health inequities
• ▪The Liaison Committee on Medical Education removed language from its standards that had required schools to teach about health inequities

Political pressure from Trump administration on DEI initiatives

• ▪The Trump administration issued an executive order in May 2025 targeting the use of DEI-based standards by the Liaison Committee on Medical Education and two other accrediting bodies
• ▪The Department of Justice investigation into medical schools will focus on possible race discrimination in medical school admissions
• ▪The Trump administration's May 2025 executive order focused on diversity initiatives in admissions and did not explicitly mention the structural competency standard
• ▪The CEO of Do No Harm wrote an opinion piece in The Wall Street Journal in February calling DEI a threat to Americans' health
• ▪The Department of Justice contacted three medical schools on Wednesday asking for data as part of a probe into their admissions practices
• ▪Harmeet K. Dhillon is the Justice Department's assistant attorney general for civil rights

Concept and importance of structural competency in medical education

• ▪Jonathan Metzl's 2009 book The Protest Psychosis was about the overdiagnosis of schizophrenia in Black people
• ▪Stella Safo is a physician and founder of Just Equity for Health
• ▪Jonathan Metzl introduced the concept of structural competency in his 2009 book The Protest Psychosis
• ▪Jonathan Metzl is the chair of the department of health, medicine, and society at Vanderbilt University

Debate over impact of removing structural competency standards

• ▪Kurt Miceli is chief medical officer at Do No Harm
• ▪Ariana Thompson-Lastad is a medical sociologist who works with the Structural Competency Working Group

Perspective of Health equity advocates and medical sociologists

• ▪Stella Safo founded Just Equity for Health as a company focused on making health care more equitable

Perspective of Medical schools and accreditation bodies

• ▪Some medical schools incorporated structural competency into curriculum after Jonathan Metzl wrote about the concept in 2009
• ▪The Accreditation Council for Graduate Medical Education will maintain Systems-Based Practice as a core competency despite political pressure