In the Nation's Compelling Interest Ensuring Diversity in the Health-Care Workforce (2004) / Chapter Skim
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Contribution C: The Role of Accreditation in Increasing Racial and Ethnic Diversity in the Health Professions
Contribution C: The Role of Accreditation in Increasing Racial and Ethnic Diversity in the Health Professions
Pages 317-344
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From page 317... ...
Background information also includes looking at ways in which accrediting bodies can assist through standards to achieve diversity in student bodies and faculties. Within this context, we examine the recent Supreme Court decision to determine the latitude now allowed to develop new standards for admissions.
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In addition, accrediting organizations direct each educational institution/program to show evidence that it accomplishes the following: · Provides adequate resources necessary to achieve its purposes; that is, financial resources, sufficiently prepared faculty and instructional staff, clearly defined admissions policies, and a coordinated and coherent curriculum; · Defines educational objectives; and · Demonstrates evidence that those objectives are being achieved. A private form of self-regulation, accreditation offers a strong incentive to institutions/programs to improve academic quality as they go through the required periodic reviews.
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Who Governs Accrediting Bodies The ED oversees all accrediting bodies, including specifying and approving the role and scope of their activities (Commissioned Paper C)
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Medical institutions usually acknowledge that, without being proscriptive, the accreditation process has served as a powerful influence in shaping the medical education experience. Accrediting organizations initiate the accreditation process every 5 to 10 years or sooner, depending on the success of the institution/program in demonstrating continuing compliance and improvements in the quality of its educational program.
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CACMS is structured similarly to the LCME, with equal representation from the Association of Canadian Medical Colleges and the Council on Medical Education of the Canadian Medical Association, making it a joint venture between the organization representing academic medicine and the organization representing organized medicine. Although the committees function independently and meet separately, cross-representation occurs at both the membership and the secretariat levels.
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Accreditation standards are written in narrative fashion and divided into two categories, "musts" and "shoulds." The "musts" standards require compliance regardless of circumstances. Although accrediting bodies expect institutions/programs to comply with "should" standards, they allow them to be modified by extenuating circumstances.
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HEALTH PROFESSIONS'/MEDICAL EDUCATION'S RESPONSIBILITY WITHIN THE SOCIAL CONTRACT The concept of the social contract dates back to the seventeenthcentury writing of Hobbes and Locke and the later works of Rousseau. In more recent times, various authors writing about medicine's contract with society have advanced two general themes: First, the responsibility of medical schools to society arises from the nature of the profession itself.
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Jordan Cohen, have clearly articulated the importance of medical schools' responsibility to society and their requirement to fulfill a social contract, particularly in regard to meeting society's need for a diverse health care workforce (Cohen et al., 2002)
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. Several medical schools in the United States have achieved diversity in their student bodies through a focused mission or by means of special programs.
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. Diversity in Admissions The Impact of the Supreme Court Decision The major impact of the Supreme Court decision rendered on June 23, 2003, as it pertains to accreditation, centers squarely on the admissions process and an institution's ability to produce a diverse health care workforce.
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Cohen commented that the recent Supreme Court decision gave medical schools (and presumably all health professions' schools) the power to fulfill one of our most solemn obligations: the development of a health professions workforce that truly mirrors our society (Cohen, 2003)
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Core Competencies as Part of the Social Contract In fulfilling the social contract, institutions/programs have an obligation to ensure that health profession and medical school graduates demonstrate achievement through outcome measures as specified in the accreditation standards. In addition, they must meet graduation requirements, pass appropriate licensure exams, pass appropriate certification exams, and satisfy other criteria that measure competency as deemed appropriate by the institution/program.
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Leaders in health education, accrediting bodies, and federal agencies have debated the subject of competencies for many years, focusing on defining those they consider essential, attempting to determine indicators of achievement, and devising measurable outcomes. In recent years the Accreditation Council for Graduate Medical Education (ACGME)
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Accrediting organizations should require univer sities and their health-care programs to revise their mission statements to include more specific references to racial and ethnic diversity, cul tural competency, and culturally appropriate care for diverse popula tions. Such standards could further suggest including faculty develop mental processes to enhance the teaching of cultural competency.
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Accrediting bodies should develop standards man dating that institutions/programs incorporate cultural competency into the curriculum. Because some of the other health professions' stan dards already emphasize the importance of teaching cultural compe tency (reviewed later in this paper)
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THREE HEALTH PROFESSIONS' ACCREDITING BODIES' STANDARDS RELATING TO DIVERSITY The standards of health professions' accrediting organizations differ in regard to core competencies. However, most have developed a limited number of standards requiring that students achieve a degree of competence in matters of diversity and that programs establish diversity in admissions.
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. In keeping with this commitment, DEP has established standards for dental education programs that directly pertain to achieving diversity in admissions: "Admissions policies and procedures must be designed to include recruitment and admission of a diverse student population." Another standard states, "Graduates must be competent in managing a diverse patient population and have the interpersonal and communication skills to function successfully in a multicultural environment." It should be noted that all of the dental accreditation standards contain the word "must," thus disallowing circumstantial means of noncompliance.
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The older of the two, the National League for Nursing Accrediting Commission (NLNAC) , has responsibility for the specialized accreditation of all types of nursing education programs, both postsecondary and higher degree, that offer a certificate, diploma, or a recognized professional degree.
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. In the report 21 Competencies for the Twenty-First Century, only one of the core competencies relates to diversity: Competency 12 advocates the need to provide culturally sensitive care to a diverse society by: "creating a diverse learning environment by recruiting a culturally and racially diverse faculty and student body" (O'Neil and the Pew Health Commission, 1998, pp.
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. Within the scope of this commitment, the LCME has established standards geared toward increasing racial and ethnic diversity in the student body and on medical school faculty.
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Standard ED22 hinges on the development of measurable core competencies. Once accrediting bodies have developed the core competencies, they should place a high priority on determining how the competencies are being achieved.
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Ensure that the standard's word ing is changed from "should" to "must" in all current and newly created standards. The subtext of this standard states: "The extent of diversity needed will depend on the school's missions, goals, and educational objectives, expectations of the community in which it operates, and its implied or explicit social contract at the local, state and national levels." This subtext gives institutions tremendous latitude to gear their policies and practices toward their current missions, goals, educational objectives, and social contract, which may be woefully inadequate to create a diverse student body or to train medical students to be racially, culturally, and gender sensitive.
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. THE ROLE OF OTHER ORGANIZATIONS IN AIDING ACCREDITATION We believe that select governmental organizations, private foundations, accrediting organizations, and national health professions share a common interest in supporting diversity and developing a set of core competencies
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Other modules could include those that address challenges of health care access, health-care delivery, cultural competency, patient education, and any other modules that better the quality of health care and increase patient safety. It will be imperative to continuously monitor any efforts undertaken by any or all of these organizations to identify, support, and pursue diversity within the health professions student body, workforce, faculty, and staff.
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Together these groups can collaborate on all relevant issues regarding the attainment of diversity; the design, measurement, and assessment of core competencies; and the methods by which to encourage the development of educational materials. Accrediting bodies are exceptionally positioned to spearhead this cooperative effort.
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1998. Commission on Dental Accreditation, Accreditation Standards for Dental Education Program.
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2003. Medical schools' social contract: More than just education and research.
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· Improve the management of federal education activities. · Increase the accountability of federal education programs to the president, Congress, and the public.
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