Standard MS-8 states, “Each medical school should have policies and practices ensuring the gender, racial, cultural, and economic diversity of its students” (LCME, 2002, p. 18). In a discussion of LCME intent for this standard, the committee notes, “The standard requires that each school’s student body exhibit diversity in the dimensions noted. 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” (LCME, 2002, p. 18).

Regarding cultural competence, LCME standard ED-21 states, “The faculty and students must demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments” (LCME, 2002, p. 12). LCME further explicates this standard by noting that:

All instruction should stress the need for students to be concerned with the total medical needs of their patients and the effects that social and cultural circumstances have on their health. To demonstrate compliance with this standard, schools should be able to document objectives relating to the development of skills in cultural competence, indicate where in the curriculum students are exposed to such material, and demonstrate the extent to which the objectives are being achieved (LCME, 2002, p. 12).

One outcome of such training might be to address racial and ethnic biases that may affect medical care (Institute of Medicine, 2003). LCME standard ED-22 requires that medical students “learn to recognize and appropriately address gender and cultural biases in themselves and others, and in the process of healthcare delivery” (LCME, 2002, p. 12). LCME intends that the objectives of such training “include student understanding of demographic influences on health care quality and effectiveness, such as racial and ethnic disparities in the diagnosis and treatment of diseases. The objectives should also address the need for self-awareness among students regarding any personal biases in their approach to health care delivery” (LCME, 2002, p. 12).

According to David Stevens, secretary of the LCME, the appropriate role of the LCME in promoting diversity is to “advocate for the improvement of medical education and health care—including establishing expectations that lead to diversity in the physician workforce,” and to “work in every context to achieve this goal” (Stevens, 2003).

Similarly, the Accreditation Council for Graduate Medical Education (ACGME), which accredits residency education programs, has established general competencies in graduate medical education, including standards with regard to patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. Of these general competencies, only the

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