JTurning students into competent physicians in just four years is a tall order. They have so much to learn: anatomy, physiology and genetics, disease processes, how to diagnose disease and communicate with patients, and more. This is made even more difficult by the fact that medical knowledge continues to evolve at an accelerated rate, which requires continuous learning throughout a doctor’s career.
A key part of this evolution is the growing understanding that the health of most individuals is influenced by the conditions in the neighborhoods, workplaces and communities where they live and work. A complex web of social, behavioral, economic and environmental factors, including access to quality education and housing, has a greater influence on the health of patients than physicians, even when we can offer the scientific offerings the most revolutionary.
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, which manifest themselves in inequalities in income, education and housing. The impact of structural racism and its negative effects on the medical profession, patient care and community health are 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 Black and/or Native American/Alaskan people, suffer disproportionately.
There is another aspect of medicine and medical education that we are not proud to admit. Consider the chilling results of a 2016 study, in which half of medical students and residents surveyed had one or more mistaken beliefs, such as “black nerve endings are less sensitive than white people’s.” These inaccurate assumptions, as well as the biases built into some algorithms that guide how care is delivered, are detrimental to patients.
In an effort to bring more formal attention in medical education to the 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 today releasing a new set of skills for medical education across the continuum that we believe are paramount to effectively and compassionately caring for patients everywhere. Simply put, diversity and inclusion are fundamental to 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 healthcare professional related to a specific activity that incorporates relevant knowledge, skills, values and attitudes, and they are designed to help them do so.
Competencies can help educators design or adapt curricula, and educators and learners can use them to advance in their individual professional development and their diversity, equity and inclusion journeys. They understand the need to recognize and mitigate stigma and bias in interactions with patients, families, and other healthcare professionals; the essential role of physicians in screening and directing patients to appropriate resources to combat social factors of health such as food insecurity and access to housing, public services, 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, not a risk factor for disease.
These Diversity, Equity and Inclusion Competencies are intended as a guide for those developing curricula across the continuum of medicine, from medical students and residents to treating physicians and corps members. professorial. We believe this topic deserves as much attention from learners and educators at every stage of their career as the latest scientific breakthroughs.
While these skills represent an important addition to medical education throughout the training continuum, it is typical and necessary for curricula to evolve with new knowledge, much like science itself. The AAMC has already introduced skills that address other emerging issues in healthcare, such as telehealth and patient safety.
The Diversity, Equity and Inclusion Competencies represent a multi-year 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 feedback through surveys and focus groups.
The public release of the guidelines is just the beginning of what we see as an ongoing conversation as medical schools examine these skills and put them into practice. As in other areas of society, collaboration is essential, especially in education, where the needs of different types of learners may vary. Ongoing dialogue is a necessary stepping stone toward realizing the diverse, equitable, inclusive, and healthy world we envision for our nation’s future.
A doctor’s apprenticeship is never finished. We hope that the formal integration of diversity, equity, and inclusion skills into medical education across the learning continuum will help create environments in which physicians, patients, and their communities can blossom.
David J. Skorton is a cardiologist and president and CEO of the Association of American Medical Colleges. Henri R. Ford is a pediatric surgeon, chairman of the AAMC Board of Deans, and dean and director of studies at the University of Miami Miller School of Medicine.