measure outcomes for this standard remains marginal; even the best informed LCME site visitors have no way to assess whether both faculty and students have met the cultural competency (understanding) as set forth. In all likelihood, the visiting team’s focus would center on assessing the types of cultural competency curricular programs available for students and the content of faculty development programs being offered to address this issue.

11. Recommendation. Considering the intent and scope of this standard, we recommend crafting standards directed toward achieving the two separate outcomes currently stated in ED–21 and developing measurable outcomes to assess cultural competency (understanding) in the separate standards.

Having been a site team visitor to several institutions, this author (Wagoner) suggests that once the LCME has strengthened existing standards and instituted new ones, the organization provide a more comprehensive training program for site visitors on how to properly interpret standards.

2. ED–22: “Medical students must learn to recognize and appropriately address gender and cultural biases in themselves and others, and in the process of health care delivery.”

This critically important standard essentially speaks to the matter of trust, a subject much discussed in health professions’ literature. Trust in the doctor-patient relationship can only be established when physicians overcome preconceived biases and acquire insight and understanding into another person’s values, beliefs, and needs. In the article, “Trust, Patient Well-Being and Affirmative Action in Medical School,” DeVille highlights the importance of trust, calling it “central to the individual physician’s ability to practice good medicine.” He notes that minorities’ historical and current experience with the medical profession and health delivery system frequently breeds suspicion rather than faith. He concludes: “Society and the medical profession have a compelling interest and duty to produce physicians who inspire trust” (DeVille, 1999, p. 247). Although schools can be cited for noncompliance of this standard, this author (Wagoner) knows of no institution that has been cited for failure to achieve the outcome specified by ED–22 or for lacking a mechanism by which to assist individual students in overcoming biases.

12. Recommendation. Standard ED–22 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. An array of assessment instruments could furnish this information.

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