The primary accreditation body for medical schools in the U.S. has eliminated a requirement from its standards that mandated teaching about health inequities in schools it accredits.
This decision occurs amidst criticism from the Trump administration regarding efforts to diversify the medical workforce and examine unequal health outcomes, while the accreditation body itself faces political pressure.
On Wednesday, the Department of Justice reached out to three medical schools to request data as part of an investigation into their admissions procedures. “At this time, our investigation will focus on possible race discrimination in medical school admissions,” Harmeet K. Dhillon, the Justice Department’s assistant attorney general for civil rights, stated in the letters, as reported by The New York Times, which first covered the investigations.
The Liaison Committee on Medical Education, the accreditation organization, made significant alterations to its standards, which previously encouraged schools to teach “structural competency,” a skill aimed at understanding how factors outside the healthcare system affect patients’ health.
Stella Safo, a physician and founder of Just Equity for Health, explained that teaching structural competency aims to make medical students aware of social and political realities affecting patient health. It encourages consideration of factors like access to food, housing, and transportation, moving beyond purely biomedical perspectives. “It’s not like a natural part of medicine, although it should be,” she remarked, raising concerns about the curriculum change. “This reflects the broader anti-woke, anti-DEI movement affecting us all, as structural competency benefits doctors and patients of all backgrounds.”
The accreditation group’s 2026-2027 standards mandated teaching “The importance of health care disparities and health inequities,” and “The impact of disparities in health care on all populations and approaches to reduce health care inequities.” In contrast, the 2027-2028 standards removed this language, replacing it with a focus on teaching “skills of self-directed learning,” such as identifying knowledge gaps and evaluating information credibility.
The LCME did not directly address questions regarding these changes or provide an interview with a staff member. However, they noted that the 2027-28 DCI, upon its publication in April, will feature redesigned elements aligning more closely with expectations for students entering residency.
Jonathan Metzl, a sociologist and psychiatrist, introduced the concept of structural competency in his 2009 book “The Protest Psychosis,” which examined the overdiagnosis of schizophrenia in Black individuals. Initially attributing this to racism, Metzl later recognized broader systemic factors, such as mental illness definitions and reimbursement structures, as significant contributors. “I coined the term structural competency to describe what I thought medicine needed to be doing,” he explained.
As Metzl continued his research on structural competency, some medical schools adopted the concept into their curricula, and researchers examined its effectiveness. Some institutions offered dedicated lessons, while others integrated the topic into existing courses. At Vanderbilt University, where Metzl chairs the department of health, medicine, and society, educators were encouraged to expand explanations of health disparities beyond interpersonal racism to include systemic social science, urban planning, and economic factors.
The removal of this requirement does not mean all schools will cease teaching the subject. However, due to the already packed medical curriculum, the absence of a mandate might lead institutions, particularly those influenced by conservative politicians, to give it less priority.
While the reasons behind the LCME’s decision remain unclear, the organization faces political pressure from the Trump administration. In May 2025, the president issued an executive order targeting DEI-based standards used by LCME and other accrediting bodies. This order focused on diversity initiatives in admissions, without specifically mentioning the structural competency standard. Meanwhile, the Accreditation Council for Graduate Medical Education, which oversees residency and fellowship programs, continues to include “Systems-Based Practice” as a core competency in its 2026 requirements.
Over the past year, political pressure has persisted. In February, the CEO of Do No Harm, a group opposing diversity initiatives in medicine, wrote an opinion piece in The Wall Street Journal labeling DEI a “threat to Americans’ health,” specifically criticizing the structural competency standard. Following the publication of the 2027-2028 standards, Kurt Miceli, chief medical officer at Do No Harm, described the changes as a major victory in the ongoing debate over the future of medical education in the U.S.
Supporters of teaching about structural health factors argue that removing the requirement worsens care for all patients, regardless of identity. They maintain that structural considerations align with some priorities of Trump administration officials.
“There are structural issues that people in MAHA care about,” stated Ariana Thompson-Lastad, a medical sociologist with the Structural Competency Working Group, which advocates for structural competency education. She cited nutrition, access to healthy foods, incentives for consuming ultra-processed foods, and clean water as examples of structural concerns.
Metzl concurs, emphasizing that “Structural competency is about structures, not political affiliations.” He acknowledged the rhetoric of individual choice but stressed, “nothing we’ve done dismisses its importance.” Metzl hopes structural competency can bridge political divides in health, as it focuses on community aspects, health finances, and medication costs, which are important to both past and current governments.
STAT’s coverage of health inequities is supported by a grant from the Commonwealth Fund. Our financial supporters are not involved in any decisions about our journalism.
