A major U.S. medical school accrediting organization has removed language from its standards that required accredited schools to teach about health inequities.
The move comes as efforts to diversify the health care workforce and study different health outcomes have come under fire from the Trump administration, and accreditors themselves are under political pressure.
STAT Plus: Jay Bhattacharya once studied health disparities. As NIH director, he has allowed such research to wither.
On Wednesday, the Justice Department contacted three medical schools and asked them to provide data as part of an investigation into their admissions practices. “The current investigation will focus on possible racial discrimination in medical school admissions,” Harmeet K. Dhillon, the Justice Department’s assistant attorney general for civil rights, wrote in each letter, according to the New York Times, which first reported on the investigation.
The Liaison Committee on Medical Education, an accrediting organization, has made significant changes to its standards that encourage schools to teach “structural competency,” the ability to recognize how factors beyond the health care system affect a patient’s health.
Teaching about structural competencies is designed to say to medical students, “Are you aware of the social and political realities that impact patient health?” Stella Saffo, a physician and founder of Just Equity for Health, a company focused on increasing equity in health care. He added that this is a way to encourage doctors to think about factors such as food, housing and access to transportation, and to move away from thinking about purely biomedical factors. “It’s not a natural part of medicine, but it should be,” she said. “So to actively remove that from the curriculum is alarming. I think this speaks to this larger place that we’re in, of the anti-wokeness, anti-DEI movement that unfortunately affects all of us, because teaching structural competencies is beneficial for physicians, whether you’re white, whether you’re black, whether you’re male, whether you’re female.”
The accrediting body’s 2026-2027 standards say schools should teach “the importance of health care disparities and disparities,” as well as “the impact of health disparities on the entire population and approaches to reducing health care inequalities.” The 2027-2028 standards remove that language and replace it with a directive that schools should teach “self-directed learning skills, including the ability to self-identify significant gaps in knowledge or understanding and to discover, analyze, synthesize, and evaluate the reliability of relevant information to fill those gaps.”
The LCME did not directly respond to questions about the thinking behind the changes or make members of its staff available for interviews, but said: “When the 2027-28 DCI is published and posted in April, not just one but all of the elements associated with this standard will be redesigned to more closely align with the way the expectations for graduates entering the next stage of training are organized and articulated.”
The concept of structural competency was introduced by sociologist and psychiatrist Jonathan Metzl in his 2009 book Protest Psychosis, about the overdiagnosis of schizophrenia in Black people. Metzl initially suspected that racism was a major cause of overdiagnosis, “but as I was writing this book, I realized that larger upstream factors, like how we reimburse and define mental illness, and the structures we build around mental illness, are all at play, and that are much more indicative of overdiagnosis than individual attitudes or individual physicians.” “I coined the term structural competency to describe what I thought medicine needed to do.”
As Metzl continued to write about structural competencies, some medical schools began incorporating them into their curricula, and researchers studied their effectiveness. Some schools have specialized lessons on this topic, while others incorporate it into courses they already teach. At Vanderbilt University, where Metzl is dean of the School of Health, Medicine, and Society, he said he has “urged instructors to expand on the reasons they explain health disparities in their courses.” The goal was to move from a focus on racism among individuals to explanations based on “more systemic social science, urban planning, and economics, because people felt those were disparities that were actually traceable.”
STAT Plus: President Trump’s order targeting ‘DEI-based standards’ in medical certification raises concerns
The removal of this requirement does not mean that all schools will stop teaching the subject. But given the already crowded medical curriculum, the missing requirement could deprioritize medical schools, especially in areas with conservative politicians.
It is unclear why the LCME decided to change the wording, but the organization is under political pressure from the Trump administration. In May 2025, the President issued an executive order targeting the use of DEI-based standards by the LCME and two other accrediting agencies. The mandate focused on diversity efforts in admissions and did not explicitly mention structural competency standards. The Accreditation Council for Graduate Medical Education, which regulates residency and fellowship programs, will continue to include “systems-based practice” as one of the core competencies in its 2026 requirements.
A year later, the pressure shows no signs of abating. In February, the CEO of Do No Harm, a group that opposes diversity efforts in health care, wrote an opinion piece in the Wall Street Journal calling DEI a “threat to the health of Americans” and specifically criticizing the language of structural competency standards. “This is a major victory and step forward in the ongoing battle for the future of medical education in the United States,” Curt Miceli, chief medical officer at De No. Harm, said in a statement days after the LCME released its 2027-2028 standards.
But advocates of teaching about structural factors that influence health oppose the change, saying it would worsen care for all patients, regardless of status. They also argue that structural considerations are not entirely inconsistent with positions held by various Trump administration officials.
“What people at MAHA are concerned about is structural,” says Arianna Thompson Rustad, a medical sociologist who works with the Structural Competencies Working Group, which promotes structural competency education. She cited nutrition, the types of food children have access to, incentives to encourage people to eat ultra-processed foods, and clean water as structural issues.
Metzl, who coined the term, agrees. “Structural capacity is about structure, it’s not about Republican or Democratic. I would say there’s certainly some rhetoric about individual choice, but there’s nothing we’ve done to say that individual choice doesn’t matter,” he said. “My hope for the structural competency was that it would actually help bridge the political divide around health, because it focuses on communities and relates to health financing and the cost of medicines, which were important to our previous government and to this government as well.”
STAT’s health inequalities coverage is supported by a grant from the Commonwealth Fund. Our financial supporters have no input into any decisions about our journalism.
