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Accreditation & Certification

“A couple of midwives stated that MEAC should require its accredited schools to have policies supporting diversity.”

- Yamasaki McLaughlin, 2012, p. 40

“As stewards of the public's trust and guardians of the social contract, accrediting organizations have an obligation to use their authority to help increase competency and racial and ethnic diversity in the health professions. They can accomplish this by ensuring that all institutions and programs identify these as necessary objectives.” 

(Wagoner, Johnson & Jonas, 2004)

The Important Role
  • "“To address these issues, the Liaison Committee on Medical Education (LCME) has mandated that all medical schools in the United States and Canada include cultural competency among their central educational outcomes. Exactly how this goal is implemented, however, is unclear. Although many have recommended the expansion of multicultural education, even use of the term “cultural competency” is controversial, and often cultural competency initiatives are implemented without an explicit link between the notion of working with culturally diverse populations and the other part of the LCME directive: the need for medical students 'to recognize and appropriately address gender and cultural biases in health care delivery.' There is a distressingly common failure to connect the idea of diversity with the underlying core concept of social justice in health care.” (Kumagai & Lypson, 2009)

  • "We believe that full implementation of such requirements will eventually alter the culture across all areas of medicine. It certainly appears likely that accreditation, particularly with inclusion and emphasis on diversity and cultural competence, also will be able to effect significant change. Modeling aspects of the approaches taken by ACGME and ABMS would provide a major step toward attaining the goal of producing a diverse workforce capable of proffering quality care to a diverse society." (The Role of Accreditation in Increasing Racial and Ethnic Diversity in the Health Professions, 2004)

  • “Academic medicine has responded with a steady increase in efforts to train physicians to provide high-quality, culturally competent care. The American Association of Medical Colleges considers skills in cultural competence to be essential for the provision of quality health care to a diverse patient population, and the Liaison Committee for Medical Education has emphasized the need for training in cultural competence in medical schools. The American Medical Association has stated that to be culturally competent, physicians must be able to provide patient-centered care by adjusting their attitudes and behaviors to the needs and desires of different patients, including accounting for the impact of emotional, cultural, social, and psychological issues on the main biomedical ailment. The ACGME has gone a step further by inserting the requirement that residents must demonstrate cultural competence by showing sensitivity and valuing diversity of patients and colleagues. This in turn requires complex integration of knowledge of the effects of culture on others’ beliefs and behavior, attitudes of the patient and physician, and communication skills.” (Campbell, Sullivan, Sherman & Magee, 2011, pp.126-127)


  • “Physicians keep their certification active by maintaining the following competencies which form the foundation of the ABMS Programs for Maintenance of Certification (ABMS MOC®)...Professionalism: Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient populations.”(ABMS)

  • "All applicants and CPMs are required to complete a workshop, module, or course on Cultural Competency for certification and recertification. Approved Courses/Modules are:

    • A course on cultural competency within a midwifery education program accredited by MEAC or a specific state approved midwifery education program

    • A course on cultural competency within a state approved medical/health education program

    • A cultural competency course offered as a workshop accredited for CEUs by MEAC." (NARM, 2013)

  • For recommendations regarding future needs regarding midwifery certification, recertification and accreditation to promote equity in midwifery education​, see Future Needs


Future Needs
US Midwifery Documents
The Role of Accrediting & Certifying Bodies
Acronym Glossary
Certification Future Needs
Examples & Resources



  • Accreditation Criteria Schools of Public Health: Diversity Criteria, Interpretations and Documentation pp.11-12 (June 2011)

  • Diversity Criterion: Successful Strategies for Responding (Slides - 2015 ASPPH Annual Meeting)

  • Addressing the Diversity Criterion at VCU MPH Program (Slides -2015 ASPPH Annual Meeting)

  • Developing a School-wide Policy on Diversity and Inclusion (Slides -2015 ASPPH Annual Meeting)





  • For a discussion of critical mass and compositional diversity at Rice University and the University of TX at Austin, see pp. 13-14 (Taylor, Milem, Coleman, 2016)

  • The 2015-2016 HEED Award Benchmarking Report Sample. (Williams & Insight into Diversity, 2016)


  • "Different components of cultural competence are often taught through classroom lectures, workshops, electives, standardized patient exercises, clinical clerkships, language training, immersion programs, and other interactive exercises. Most training occurs during the first or second years of medical school, commonly in a case-based or didactic format. Less-structured training is provided in the residency process, with little attention given to cross-cultural issues during a time when young doctors have the opportunity to experience, practice, and internalize multicultural communication skills.” (Campbell, Sullivan, Sherman & Magee, 2011, pp.126-127)

Future Needs
  • Encourage evaluation of the organizations responsible for midwifery certification and accreditation using a racial equity lens

    • Determine if adopting and implementing existing competency, standards and benchmarks are adequate to promote equity in midwifery education

    • Update MEAC and ACME accreditation standards to guide schools in the promotion of equity-focused learning environments

    • Assess racial bias in the midwifery certification and accreditation processes for CPMs, CNMs and CMs

  • Consider implementation of Recommendations to Accrediting Agencies for Increasing Racial and Ethnic Diversity in the Health Professions (Wagoner, Johnson & Jonas, 2004)

  • Encourage a lifelong learning approach to equity/diversity/inclusion:

    • Require regular training and continuing education regarding diversity/inclusion/equity for all midwifery certification and accreditation organization board members and staff

    • Adopt policies and adapt language related to midwifery accreditation, certification and recertification that encourages all midwives to develop a lifelong learning approach to equity/diversity/inclusion.

    • Adopt policies and adapt language related to preceptor registration and oversight that encourages all preceptors to develop a lifelong learning approach to equity/diversity/inclusion.

  • Integrate increased learning opportunities regarding the provision of culturally sensitive and appropriate midwifery care into the midwifery certification and accreditation processes

    • Evaluate how midwifery certification and accreditation processes can be revised to be more consistent with the ICM, MANA & MEAC core competencies regarding culture, cultural sensitivity, cultural appropriateness and/or cultural relevance.

    • Make a specific commitment that more diverse books be referenced and new exam questions be developed relevant to assessing the basic competency of midwifery candidates to provide culturally appropriate care as outlined in the ICM and MANA core competencies. 

  • "Institutions should be deliberate in identifying benchmarks that indicate success on diversity goals." See pp. 13-14 for 2 university examples (Taylor, Milem, Coleman, 2016)

  • Research Needs: “Limited evidence exists demonstrating that the current models of education lend themselves to positive outcomes and implementation in clinical practice. There is currently no consensus on how cultural competence should be taught in residency training and, therefore, considerable variability exists in the design and implementation of cross-cultural education." (Campbell, Sullivan, Sherman & Magee, 2011, pp.126-127

US Midwifery Documents

TIP: To do a quick search for existing competencies or standards that can help promote equity, use the “ctrl+F” function on your keyboard and search for these words in the documents below:

  • Cultur* (which allows you to search for culture and cultural)

  • Equity

  • Social justice

  • Divers* (which allows you to search for diversity and diversification)

  • Inclusi* (which allows you to search for inclusion and inclusivity)

Glossary & Table of Acronyms related to the Profession, Regulation and Education of US Midwives

DOCUMENTS related to Accreditation: 

See Also: Acronym Glossary for full organization titles

Cultural Competencies

SOURCE: Expert Panel on Cultural Competence Education for Students in Medicine and Public Health (2012). Cultural competence education for students in medicine and public health: Report of an expert panel. Washington, D.C.: Association of American Medical Colleges (AAMC) and Association of Schools of Public Health (ASPH). Retrieved from

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