How AAIM’s Equity-Based Grading Reforms Threaten Merit and Competency in Medical Education

The Alliance for Academic Internal Medicine (AAIM) states that it “promotes the advancement and professional development of its members,” who are involved in educating future internal medicine (IM) physicians. 

Considering that IM specialists are experts in diagnosis and non-surgical treatment of patients with complex medical conditions, it’s vital for the most qualified candidates to enter this field.

Yet, AAIM appears to be more interested in achieving “equity” over merit in undergraduate medical education (UME). The August 2025 edition of AAIM’s “Diversity Now” newsletter references an October 14 webinar on “Enhancing Equity in Assessment within the UME Grading Process – A Data Driven Approach.” 

It turns out that AAIM has addressed this topic before; indeed, it maintains a resource on its website titled “Recommendations to Reduce Bias in Grading.” 

This document outlines desired changes for the assessment of IM clerkship participants so that “no one is disadvantaged from achieving [their full learning] potential because of structural or social barriers.” 

Faculty must complete training in “implicit bias” and “microaggressions” on an ongoing basis to “mitigate against potential effects of the individual bias of those responsible for assigning grades.”

But that isn’t enough to achieve equity, according to the AAIM:

If standardized exams are used in clerkship grading, limit the weight that standardized exam scores, including National Board of Medical Examiner’s subject or shelf exams, have in determining a student’s grade. Differences between population group outcomes in standardized examinations likely reflect unequal opportunities afforded to underrepresented in medicine (UIM) students. In addition, deemphasizing exam scores might allow students to shift their attention to other important patient skills that they need to develop.

This is a remarkable statement. Essentially, AAIM is arguing that merit and achievement should be devalued, because focusing on these objective metrics of competency might disadvantage certain racial groups.

This naturally compromises the quality of medicine to advance perverse ideological goals, and drives everyone – of all races – to mediocrity.

And, although the original work for these recommendations was published in 2021, AAIM continues to host the material on its website.

AAIM’s proposed grading reforms represent more than procedural adjustments. They signal a willingness to subordinate merit-based assessment to identity-based considerations in the name of equity. 

The question is straightforward: Should medical students be evaluated primarily on their clinical competency and medical knowledge, or should assessment systems incorporate identity-based considerations to achieve predetermined demographic outcomes? The answer has profound implications for the future of IM education and, ultimately, the quality of patient care.