The leading medical school accreditation body in the U.S. has removed language from its standards that had required schools it validates to teach about health inequities.
The action comes as initiatives to diversify the medical workforce and study disparate health outcomes have come under fire from the Trump administration, and as the accreditation body itself has been subjected to political pressure.
On Wednesday, the Department of Justice contacted three medical schools, asking for data as part of a probe into their admissions practices. “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, wrote in each of the letters, according to The New York Times, which first reported on the investigations.
The accreditation organization, the Liaison Committee on Medical Education, significantly changed its standard that encouraged schools to teach “structural competency,” the ability to recognize how factors beyond the health care system impact patients’ health.
Teaching about structural competency was designed to say to medical students, “Do you know the social, political realities affecting your patient’s health?” said Stella Safo, a physician and founder of Just Equity for Health, a company focused on making health care more equitable. She added it is a way to encourage physicians to think about factors like access to food, housing, and transportation — and to move away from thinking about purely biomedical factors. “It’s not like a natural part of medicine, although it should be,” she said. “So the active removal of it from the curriculum is something that is concerning. I think it speaks to this larger place that we’re in of the anti-woke, anti-DEI movement that’s unfortunately affecting all of us, because teaching structural competency is helpful for your doctors if you’re white, you’re Black, you’re a man, you’re a woman.”
The accreditation group’s 2026-2027 standards said schools should teach “The importance of health care disparities and health inequities,” along with “The impact of disparities in health care on all populations and approaches to reduce health care inequities.” The 2027-2028 standards remove that language, replacing it with the direction that schools should teach “skills of self-directed learning, including the ability to self-identify critical gaps in knowledge or understanding and to find, analyze, synthesize, and appraise the credibility of relevant information to fill those gaps.”
LCME did not directly respond to questions about the thinking behind the changes or make a member of its staff available for an interview 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 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.”
The concept of structural competency was introduced by sociologist and psychiatrist Jonathan Metzl in his 2009 book “The Protest Psychosis,” about the overdiagnosis of schizophrenia in Black people. Initially, Metzl suspected that overdiagnosis was largely attributable to racism, “but what I came to realize writing that book was that there were all of these bigger upstream factors that had to do with the ways we were reimbursing and defining mental illness, and the structures we were building around mental illness that were much more indicative of that overdiagnosis than were the individual attitudes and individual physicians,” he said. “I coined the term structural competency to describe what I thought medicine needed to be doing.”
As Metzl continued writing about structural competency, some medical schools began incorporating it into their curriculum, and researchers studied its effectiveness. Some schools would teach dedicated lessons on the topic, while others incorporated it into courses that they were already teaching. At Vanderbilt University, where Metzl is the chair of the department of health, medicine, and society, “we really pushed instructors to broaden the reasons that they were explaining health disparities in their courses,” he said. The goal was to move from focusing on interpersonal racism to “a much more systemic social science and urban planning and economics based explanation, because people felt like those were actually disparities that they could track.”
Removal of the requirement does not mean all schools will stop teaching the topic. But, given how crowded medical curricula already are, a lack of a requirement may lead medical schools — particularly in areas with conservative politicians — to deprioritize it.
It’s unclear why LCME decided to change the language, but the body has come under political pressure from the Trump administration. In May 2025, the president issued an executive order targeting the use of DEI-based standards by LCME and two other accrediting bodies. The order focused on diversity initiatives in admissions, and did not explicitly mention the structural competency standard. The Accreditation Council for Graduate Medical Education, which regulates residency and fellowship programs, will still include “Systems-Based Practice” as one of its core competencies in its 2026 requirements.
In the year since, there has been no sign that the pressure is letting up. In February, the CEO of Do No Harm, a group that advocates against diversity initiatives in medicine, wrote an opinion piece in The Wall Street Journal calling DEI “a threat to Americans’ health,” specifically calling out the language in the structural competency standard. In the days after LCME published the 2027-2028 standards, Kurt Miceli, chief medical officer at Do No Harm, wrote in a statement that “this marks a major victory and step forward in the ongoing battle over the future of medical education in America.”
But advocates of teaching about structural factors impacting health have pushed back on the change, saying that it makes care for all patients — regardless of their identity — worse. They also argue that considerations of structure are not entirely at odds with positions held by various Trump administration officials.
“There are things that the MAHA people care about that are structural,” said Ariana Thompson-Lastad, a medical sociologist who works with the Structural Competency Working Group, which promotes teaching of structural competency. She pointed to nutrition, the kinds of foods children have access to, incentives pushing people toward eating ultra-processed foods, and clean water as structural issues.
Metzl, who coined the term, agrees. “Structural competency is about structures, it’s not about Republicans or Democrats. I would say that certainly there’s individual choice rhetoric, but there’s nothing in what we’ve been doing that says that individual choice is not important,” he said. “My hope with structural competency was that it was something that could actually help bridge political divides around health. Because it’s community-focused and having to do with health finances and costs for medications: things that were important to our last government, and to this government.”
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