Medical School Accreditation Drops Health Inequity Teaching Requirement Amid Political Pressure

Political currents are reshaping medical education in the United States, with increasing scrutiny and, in some cases, reversals of initiatives designed to diversify the medical workforce and address health inequities. Recent actions by the Liaison Committee on Medical Education (LCME), the body that accredits medical schools, and investigations launched by the Department of Justice signal a growing wave of political pressure on these institutions.

On Wednesday, the Department of Justice announced It’s requesting data from three medical schools as part of a probe into their admissions practices. Assistant Attorney General Harmeet K. Dhillon, in letters to the schools, indicated the investigation will focus on potential race discrimination in admissions, according to reporting from The Modern York Times. This action follows a May 2025 executive order from President Trump targeting diversity, equity, and inclusion (DEI) standards used by accrediting bodies, including the LCME.

Shifting Standards for Accreditation

The LCME has recently revised its accreditation standards, removing specific language that encouraged medical schools to teach “structural competency.” This concept, introduced by sociologist and psychiatrist Jonathan Metzl in his 2009 book “The Protest Psychosis,” aims to equip physicians with the ability to recognize how social, political, and economic factors beyond the healthcare system impact patient health. Metzl initially explored the overdiagnosis of schizophrenia in Black people, discovering that systemic factors played a larger role than individual biases. He published further research on the topic, and some medical schools began incorporating structural competency into their curricula.

Previously, the LCME standards required schools to address health care disparities and inequities, and the impact of these disparities on various populations. The updated 2027-2028 standards, however, now emphasize “skills of self-directed learning,” requiring students to identify gaps in their knowledge and discover credible information. While the LCME maintains that the changes are part of a broader redesign to align with expectations for residency training, advocates express concern that the removal of specific language will lead to a de-prioritization of this crucial area of medical education. The LCME stated that “when the 2027-28 DCI is published and posted in April, not just one, but all of the elements associated with this standard have been re-designed to align more closely with the way in which the expectations for graduating students entering residency, the next stage of training, are bundled and articulated.”

What is Structural Competency?

Stella Safo, founder of Just Equity for Health, explains that structural competency encourages physicians to consider factors like access to food, housing, and transportation – elements often overlooked in traditional biomedical approaches. “It’s not like a natural part of medicine, although it should be,” Safo said. “So the active removal of it from the curriculum is something that is concerning.” The goal is to move beyond individual-level explanations for health outcomes and recognize the systemic forces at play.

Vanderbilt University, where Metzl chairs the department of health, medicine, and society, has actively broadened the explanations for health disparities taught in its courses, focusing on social science, urban planning, and economics. This approach aims to move beyond interpersonal racism and address the underlying structural issues contributing to health inequities.

Broader Context: NIH and DEI Initiatives

These developments occur alongside changes within the National Institutes of Health (NIH). Jay Bhattacharya, the current director of the NIH, nominated by President Trump and confirmed by the Senate in March 2025, has overseen a shift in priorities regarding DEI initiatives. STAT News reported that research on disparate health outcomes has diminished under his leadership. Bhattacharya previously championed a Trump administration report restricting federal advocacy for gender-affirming care for individuals under 19, as noted by Wikipedia.

The changes at the LCME and NIH reflect a broader political climate increasingly critical of DEI initiatives. Kurt Miceli, chief medical officer at Do No Harm, a group advocating against DEI in medicine, celebrated the LCME’s revised standards as “a major victory.”

Implications for Patient Care and Medical Training

While proponents of structural competency argue it improves care for all patients, regardless of background, concerns remain about the potential impact of these changes on medical education. A lack of explicit requirements may lead schools, particularly those in politically conservative areas, to reduce emphasis on these topics.

However, advocates emphasize that understanding structural factors isn’t necessarily at odds with conservative viewpoints. Ariana Thompson-Lastad, a medical sociologist with the Structural Competency Working Group, points to issues like nutrition, food access, and medication costs as structural concerns that should appeal across the political spectrum. Metzl echoes this sentiment, stating that structural competency is about structures, not political ideologies, and could potentially bridge divides around health policy.

The Accreditation Council for Graduate Medical Education (ACGME) will continue to include “Systems-Based Practice” as a core competency in its 2026 requirements for residency programs, suggesting some continued emphasis on understanding the broader context of healthcare.

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.

Looking Ahead: Monitoring the Impact

The coming months will be crucial in assessing the long-term impact of these changes. Medical schools will need to determine how to integrate, or not integrate, structural competency into their curricula. The Department of Justice investigations will likely shape admissions policies at the targeted institutions. Ongoing monitoring of NIH research priorities will reveal the extent to which studies on health disparities continue to be supported. The evolving landscape of medical education and research will undoubtedly be shaped by these ongoing political and regulatory pressures.