Commentary

Geisinger Commonwealth School of Medicine Embraces Accreditor’s DEI Program

  • By Do No Harm Staff
  • March 27, 2024
  • Geisinger Commonweath School of Medicine

Diversity, equity, and inclusion programs are expanding at Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania. The latest iteration is the incorporation of a new DEI training into Geisinger’s residencies and fellowships, as a concerned citizen recently conveyed to Do No Harm.

Equity Matters, an 18-month “framework for continuous learning and process improvement in the areas of DEI and anti-racism”, was created by the Accreditation Council for Graduate Medical Education (ACGME) in 2021. ACGME oversees the accreditation of more than 13,000 residency and fellowship programs and sets professional educational standards for the nearly 160,000 residents and fellows in the United States. This powerful organization is at the forefront of expanding DEI programming and policies in its constituent institutions.

The Equity Matters program offers participants three categories of DEI resources: a library of video trainings, an Equity Practice Toolkit, and a Holistic Recruitment Toolkit. Trainees are equipped with knowledge and resources to implement and scale their home institutions’ efforts to “achieve or enhance cultures of equity.”

Figure 1. Course offered from ACGME “Equity Matters” materials.

The video trainings cover dozens of topics ranging from the unique challenges of undocumented medical students to examining the “health benefits of living ‘white.’” While many of the videos are quite general in their scope, a few target-specific areas of strategic interest, like “Using a Structured Approach to Recruit Diverse Residents, Fellows, and Faculty.” This course asks participants to create a program-specific plan to implement “structural equity practices.”

Figure 2.  Course offered from ACGME “Equity Matters” materials.

Much of the jargon in the trainings is undefined in their syllabi, but based on the goals of the program it is clear that the intention is to equip participants with strategies to tilt the scales of their policies in favor of certain groups deemed diverse and counteract the influence of less favored groups in institutional culture. The other two parts of the program offer further evidence.

The Equity Practice Toolkit and Holistic Recruitment Toolkit apply the lessons from the trainings to specific areas of institutions: culture and recruitment.

The Equity Practice Toolkit focuses on assessing an institution’s culture and identifying areas where its commitments to diversity are lacking. Its content includes strategies to build allies within organizations and leverage those relationships to dismantle policies, systems, and cultural norms that are identified in the assessment as promoting or perpetuating racial bias. Courses include:

  • Environmental Equity Assessment
  • The Power of Culture
  • Allyship
  • Acting to Dismantle Racism
  • Bias Response

The Holistic Recruitment Toolkit applies the same framework more narrowly to admissions and recruitment, with an emphasis on scrutinizing processes. Participants map their institutions’ admissions processes and create strategies to shift practices and achieve specific diversity and equity outcomes. Examples of components in the toolkit are Holistic Principles in Resident Selection and Equity-Based Assessment in Recruitment.

Equity Matters contains a great deal of concerning content, but none of it is particularly exceptional. But what is of particular interest about Equity Matters is the way in which it is scaled through accreditation bodies like ACGME. DEI trainings that are created by accreditation bodies benefit from implicit institutional pressure to participate from accreditors to their constituent programs. Even programs that may not feel intrinsically motivated to adopt DEI trainings risk jeopardizing their relationships with accrediting bodies if they opt out; and inversely, programs that want to improve their relationships with their accreditors will enthusiastically adopt their DEI trainings. By its very creation by ACGME, Equity Matters impacts the incentives for residency and fellowship programs.

Accreditor-created DEI trainings and programs also benefit from added resilience against political attacks. Efforts by policymakers to limit or ban DEI programs in state institutions are complicated by the entangling of accreditors, accreditation standards, and certain DEI policies and programs.

Geisinger Commonwealth School of Medicine’s participation in an accreditor-created DEI program is far from unusual, but examining the way that institutions like Geisinger are responding to pressures from accreditors is crucial to a more comprehensive understanding of the spread of DEI in medical education.