To the Liaison Committee on Medical Education (LCME), 

We write as the Coalition for Structural Competency in Medical Education, a group of medical educators, physicians, public health professionals, social scientists, medical students, community members, and advocates. We are deeply concerned about proposed revisions to LCME Standard 7 that would remove explicit expectations for teaching structural competency in medical school curricula.

The Liaison Committee on Medical Education (LCME) sets the accreditation standards for medical schools in the United States and Canada. These standards shape what future physicians are taught, what skills they are expected to master, and ultimately how they care for patients. Changes to LCME standards do not remain abstract or theoretical, they directly influence clinical training and, in turn, the quality and equity of healthcare that patients receive.

Against this backdrop, the LCME is considering proposed revisions to Standard 7 that would remove explicit expectations for teaching structural competency in medical school curricula, changes that would significantly reshape how future physicians are trained to understand and respond to the forces that affect patient health.

Structural competency is the ability to recognize that many health problems are shaped not only by biology or individual choices, but by broader social, economic, and political systems. Forces such as health care systems, housing, transportation, food access, public policy, and long-standing inequity shape health long before a person ever sees a clinician. Structural competency emphasizes physicians’ responsibility to respond to these forces—through advocacy, community partnership, and efforts to change the structures that determine who becomes sick, who receives timely care, and how patients experience the health care system.

When medical students are trained to understand these structural factors, they are better prepared to listen to patients, avoid harmful assumptions, and provide care that is responsive to real-life circumstances. This training supports better clinical decisions, stronger patient–provider relationships, and more effective care for individuals and communities alike.

The proposed changes to Standard 7 replace clear, evidence-based concepts—such as structural competency, structural humility, and cultural responsiveness—with a minimal statement about caring for patients from a variety of backgrounds. While inclusivity is essential, broad statements without clear expectations do not ensure that students gain the skills needed to recognize bias, address inequities, or respond to the structural barriers their patients face. Without specificity or accountability, important competencies risk becoming optional rather than essential.

We believe that medical education standards should:

• Clearly define the knowledge and skills students must learn to understand how social, economic, and political structures affect health and healthcare.
• Require medical schools to teach and assess these skills, not simply acknowledge them, so that graduates are prepared to apply this understanding in clinical practice.
• Meaningfully include medical students and community members in shaping and evaluating curricula, ensuring that education reflects patients’ lived experiences.
• Treat structural competency as a core element of physician training, not an elective or “add-on,” because understanding how systems affect health is fundamental to safe, ethical, and effective care.

Ultimately, patients are the end users of medical education standards. When accreditation requirements are weakened, patients—especially those already facing barriers to care—bear the consequences. Strong standards help ensure that physicians are equipped not only to diagnose and treat disease, but also to understand the conditions that influence whether care is accessible, appropriate, and effective.

We respectfully urge the LCME and accrediting partners to reaffirm and strengthen the inclusion of structural competency in medical education standards. Doing so affirms a commitment to patient-centered care, health equity, and the preparation of physicians who are equipped to meet the realities of the communities they serve.

With respect and urgency,

The Coalition for Structural Competency in Medical Education

Medical Education Administrators | Clinical Teaching Faculty | Physicians | Public Health Professionals | Social Scientists | Structural Competency Advocates | Community Members | Medical Students | New York City Department of Health & Mental Hygiene