A simulation at the University of Massachusetts medical school in Worcester, Mass., May 11, 2016.
Photo: Elise Amendola/Associated Press
Regarding your editorial “Medical Education Goes Woke” (July 27): Medical curricula adapt as new evidence arises, and the Association of American Medical Colleges’ responsibility is to disseminate new curricular approaches, as we have done with others, like telehealth. We know from the data that social determinants—the conditions where people live—and precursors, like poverty and racism, account for about half of what affects our health. Disparities in Covid-19 outcomes, particularly among people of color, illustrate why these social determinants cannot be ignored.
We also know that race is a social construct. There’s a growing body of evidence about what race is and isn’t, and its effect on health. These new insights are improving medical practice. They can also improve medical education, where they are taught in addition to, not at the expense of, the most solid grounding in STEM disciplines.
We join the editorial board in wanting to separate politics from science, but we disagree on the approach. Let’s pay heed to the latest evidence. Integrating diversity, equity and inclusion competencies into medical education will help create better doctors and better outcomes for patients. We all want that.
David J. Skorton and Henri R. Ford
Washington and Miami
Dr. Skorton is president and CEO of the Association of American Medical Colleges. Dr. Ford is dean of the University of Miami medical school and chairman of the AAMC’s council of deans.
Your editorial brings back chilling memories from my medical education in Central Europe. For two years, we had mandatory weekly seminars on Marxism-Leninism, from dialectic materialism and scientific socialism to political economy and socialist ethics. Doesn’t this word salad have some parallels with our new political education?
Zoltan Trizna, M.D.
Austin, Texas
The addition of diversity, equity, and inclusion competencies to medical education is not political. It is founded in strong science that has demonstrated the negative effects of racism, discrimination and bias on public health, healthcare quality and diversity of the health workforce. The disparities in maternal mortality between black and white women, which persist even after controlling for income and education, are a case in point.
Medical students must learn about this in order to change it. AAMC’s recommendations will make tomorrow’s doctors more informed and effective caregivers, colleagues and leaders.
Victor J. Dzau,
M.D.
President, National Academy of Medicine
Washington
Deeming race and gender “social constructs” might seem innocuous, but consider cemento-osseous dysplasia. It’s an oral condition, most prevalent among African-American females, that looks much like cancer and other lesions, despite its benign nature.
Ignoring race and gender removes two of the most useful metrics for diagnosing the disease. Misdiagnosis can lead to biopsies and root-canal therapies, which are expensive and carry risks. The new changes might spare some feelings—but at the expense of the patients they are meant to protect.
Sam Cox
Columbia College of Dental Medicine
New York
Ultimately, the power to regulate medical-school standards lies not with the Liaison Committee on Medical Education (LCME), nor its adviser, the AAMC, but with the states, which grant medical licenses. To date, all U.S. states have recognized the standards promulgated by the LCME and insist that all doctors obtain their training at LCME-certified schools. It isn’t hard to imagine, though, that this trust could be revoked by some states—Florida comes to mind—if LCME standards were to stray too far from core medical competencies.
Joseph Bernstein, M.D.
Leonard Davis Inst. of Health Economics
Haverford, Pa.
