Institutional accreditation is a voluntary, peer-review process that assures the public that an institution provides a quality education. Programmatic accreditation, on the other hand, evaluates specific programs within an institution.
Because the healthcare sector serves such a diverse population and risks are intrinsically high, it is imperative to incorporate diversity and inclusion into healthcare accreditation standards. Yet only a handful of programmatic health profession accrediting agencies have implemented standards demonstrating their commitment to this important work. Others lag behind, simply complying with local, state, and federal laws regarding areas of diversity and inclusion without enacting their own comprehensive requirements.
The following are examples of several agencies that have implemented diversity standards.
Liaison Committee on Medical Education
The Liaison Committee on Medical Education (LCME) accredits medical educational programs leading to an MD degree.
The LCME includes diversity in its standards in a section titled “Diversity/Pipeline Programs and Partnerships,” which states: “A medical school has effective policies and practices in place and engages in ongoing, systematic, and focused recruitment and retention activities to achieve mission-appropriate diversity outcomes among its students, faculty, senior administrative staff, and other relevant members of its academic community. These activities include the use of programs or partnerships aimed at achieving diversity among qualified applicants for medical school admission and the evaluation of program and partnership outcomes.”
In order to achieve “mission-appropriate” diversity outcomes, programs must evaluate their student demographics to determine which groups are underrepresented, says Assistant Secretary for the LCME Dan Hunt, MD.
“No one tells them what diversity means,” Hunt says. “They have to determine, based on their mission, who is missing in the learning environment or what people they want to [recruit and] graduate to address society’s deficits.”
Hunt gives as an example a program in Michigan, which is located in an area with a large Arab American population. “Arab Americans are a relatively underserved group in healthcare,” he says. “There aren’t many students graduating from U.S. medical schools that speak Arabic, so [the program in Michigan is trying] to get more Arabic-speaking people in school.”
Additionally, many medical programs in the Dakotas, where there is a large population of Native Americans, focus on recruiting members of this underrepresented group to diversify their student bodies and better reflect the surrounding communities.
Beyond ethnic diversity, many LCME-accredited programs consider other areas of inequity, such as socioeconomic status and cultural differences, in their student populations. Hunt says some programs have also begun to focus on what he calls “rurality” in their recruitment efforts.
“If you came from a small town, literature shows that you are much more likely to practice in a small town,” he says. “So we see a fair number of schools targeting students from rural backgrounds as part of their definition of diversity.”
While individual programs have leeway in determining which groups to concentrate their efforts on, the LCME holds them accountable for recruiting and graduating these students. To meet diversity accreditation requirements set forth by the organization, programs must go beyond simply welcoming and encouraging students from underrepresented groups.
“They actually have to have outreach programs and partnerships to increase the national pool of a particular [desired] group,” Hunt says. “They need to reach out to high schools and encourage these students to think about a career in healthcare.”
In addition, LCME makes a point to call out member programs that aren’t meeting diversity standards.
“It’s unusual for any accrediting body to withdraw accreditation,” Hunt says, adding that this is a dramatic and difficult process. “… There’s a lot of discussion about how to better develop the diversity of the [student body]; however, nobody has ever lost accreditation because of [diversity], but if you get cited repeatedly, it’s a very embarrassing situation for the school.”
For more information, visit lcme.org.
Accreditation Committee for Education in Nursing
The Accreditation Committee for Education in Nursing (ACEN) provides specialized accreditation for all types of nursing programs in secondary, postsecondary, and hospital-based governing organizations that offer certificates or degrees.
ACEN’s accreditation standards require that a program’s curriculum include cultural, ethnic, and socially diverse concepts, which may also involve regional, national, or global perspectives and experiences, according to ACEN Associate Director Sharon Beasley, PhD.
“Some programs have specific courses that [concentrate] on diverse or vulnerable populations, but [diversity education] is typically woven throughout the curriculum,” Beasley says. “It is a concept introduced in the basic fundamental courses, [but] it’s easier to embed diversity throughout the curriculum than focus on it in a specific class.”
She says that ACEN rarely encounters issues with programs not providing adequate diversity education. “In nursing, it’s hard not to include diversity in the curriculum because our patient populations are so diverse,” Beasley says. “We care for patients of various ethnicities, nationalities, cultures, and ages, as well as various vulnerable populations like HIV-infected individuals. The list goes on and on.”
In addition, Beasley says ACEN nursing programs are always looking for new ways to encourage students to consider diversity and inclusion.
“We’ve visited programs where they look not only for diverse individuals, but for those from very vulnerable populations as well, which tend to be diverse,” she says. “For example, some of the latest data indicate that the highest rate of HIV infection is among African American women.”
ACEN emphasizes to its members that being comfortable treating patients of all backgrounds is an essential aspect of becoming a nurse. “If a student is having issues working with diverse patients, then it’s likely that [he or she] isn’t going to make it through the program,” Beasley says.
If a program does not include diversity education in its curriculum, ACEN will direct it to find a way to meet its standards; however, because diversity is an innate aspect of nursing, Beasley says ACEN has not had any issues with noncompliance.
For more information, visit acenursing.org.
Commission on Dental Accreditation
The American Dental Association’s (ADA) Commission on Dental Accreditation (CODA) is the only accrediting body recognized by the U.S. Department of Education that accredits postsecondary dental education programs.
CODA’s accreditation standards underwent a comprehensive revision in 2010, with implementation in 2013, which resulted in an increased focus on diversity. Through the commission’s process for standards development, both the educational and practicing communities were able to provide input on the modification of these standards.
CODA operates on the belief that cultural competence among students, faculty, and the dental patient population is necessary in dental education, as is achieving diversity among students and faculty. While the commission understands that a significant amount of diversity-related education occurs through informal interactions among diverse individuals, it specifically evaluates three dimensions of diversity in dental programs: structural, curriculum, and institutional climate.
Structural diversity centers around the “numerical distribution of students, faculty, and staff from diverse backgrounds in a program or institution,” CODA accreditation standards state. As such, dental programs accredited by CODA are expected to establish and sustain initiatives that recruit and retain diverse students, faculty, and staff.
Curriculum diversity includes both the diversity-related educational content that promotes shared learning and “the integration of skills, insights, and experiences of diverse groups in all academic settings.” Additionally, graduates must be able to manage and treat a diverse patient population and have the social skills to succeed in a multicultural work environment.
Institutional climate involves the “general environment in programs and institutions that support diversity as a core value and [that] provide opportunities for informal learning among diverse peers,” according to the commission’s standards. Furthermore, CODA believes that the recognition of dental healthcare disparities in underserved populations and the development of core professional attributes, like empathy, are essential elements in creating an exemplary institutional climate for dental programs.
For more information, visit ada.org/en/coda.
There are dozens of programmatic healthcare accreditation agencies in the U.S., and while some have made diversity and inclusion critical components of their accreditation standards, others have yet to implement policies or practices in these important areas.●
Lauren Healey is a senior staff writer for INSIGHT Into Diversity.