Turning students into competent physicians in just four years is a tall order. They have so much to learn: anatomy and physiology and genetics, disease processes, how to diagnose disease and communicate with patients, and more. It’s made even harder by the fact that medical knowledge continues to evolve at an accelerating pace, necessitating ongoing learning throughout a physician’s career.
A key part of this evolution is the growing understanding that most of individuals’ health is influenced by conditions in the neighborhoods, workplaces, and communities where they live and work. An intricate web of social, behavioral, economic, and environmental factors, including access to quality education and housing, have greater influence on patients’ health than physicians do, even when we can offer the most groundbreaking scientific offerings.
These powerful factors, variously referred to as social determinants or social drivers of health, are also linked to underlying causes, including poverty and structural racism — manifested by inequalities in income, education, and housing. The impact of structural racism and its negative effects on the medical profession and on patient care and community health are being increasingly well-documented.
Earlier this year, for example, a study published in the journal Health Affairs revealed the undeniable impacts of structural racism on patients’ access to trauma care and other hospital services. Populations that remain marginalized by policies even today, such as rural communities with large numbers of people who are Black and/or American Indian/Alaska Natives, suffer disproportionately.
There’s another aspect of medicine and medical education we are not proud to admit. Consider the chilling results of a 2016 study, in which half of medical students and residents surveyed held one or more erroneous beliefs, such as “Black people’s nerve endings are less sensitive than white people’s.” Such inaccurate assumptions, as well as biases built into some algorithms that guide how care is provided, are detrimental to patients.
In an effort to make medical education pay more formal attention to social drivers of health and issues of diversity, equity, and inclusion, the Association of American Medical Colleges (AAMC), with which we are affiliated, has developed and is releasing today a new set of competencies for medical education across the continuum that we believe are paramount to effectively and compassionately care for patients everywhere. Simply stated, diversity and inclusion are foundational for promoting and achieving health equity, which, ultimately, is the outcome physicians should strive to deliver to all of their patients. These competencies are the observable abilities of a health professional related to a specific activity that integrates relevant knowledge, skills, values and attitudes, and they are designed to help them do that.
The competencies can help educators design or adapt curricula, and both educators and learners can use them to make progress in their individual professional development and diversity, equity, and inclusion journeys. They include the need to recognize and mitigate stigma and bias in interactions with patients, families and other health professionals; the essential role of physicians for screening and referring patients for appropriate resources to address social drivers of health such as food insecurity and access to housing, utilities, transportation; and the need for physicians to understand and work to correct systemic biases and cultural misrepresentations that enable and perpetuate racial bias and race-based health care inequities, including, for example, knowing that race is a social construct that is a cause of health care inequities and not a risk factor for disease.
These diversity, equity, and inclusion competencies are intended as a guide for those who develop curricula across the continuum of medicine, from medical students and residents to attending physicians and faculty members. We believe this topic deserves just as much attention from learners and educators at every stage of their careers as the latest scientific breakthroughs.
While these competencies represent a significant addition to medical education across the continuum of training, it’s typical and necessary for curricula to evolve with new insights, just as science itself does. The AAMC has previously introduced competencies that address other emerging issues in health care, such as telehealth and patient safety.
The diversity, equity, and inclusion competencies represent a multiyear effort that began in 2019 through a collaborative, transparent, and iterative process. The competencies were developed by leaders from across the medical education and clinical practice communities, and involved hundreds of reviewers who provided input through surveys and focus groups.
Publicly releasing the guidelines is just the beginning of what we see as an ongoing conversation as medical schools review these competencies and put them into practice. As in other areas of society, collaboration is essential, especially in the realm of education, where the needs of different types of learners may vary. Ongoing dialogue is a necessary stepping stone toward achieving the diverse, equitable, inclusive — and healthy — world we envision for our nation’s future.
A physician’s learning is never finished. We hope that formally integrating diversity, equity, and inclusion competencies in medical education across the continuum of learning will help create environments in which physicians, patients, and their communities can thrive.
David J. Skorton is a cardiologist and president and CEO of the Association of American Medical Colleges. Henri R. Ford is a pediatric surgeon, chair of the AAMC Council of Deans, and dean and chief academic officer of the University of Miami Miller School of Medicine.
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