At leading U.S. medical schools, education of future doctors about racism, promotion of diversity, and service of patients of color are in need of improvement, survey results suggest.

White Coats 4 Black Lives, a national group of medical students and doctors-in-training, released its second annual Racial Justice Report Card (RJRC), which indicates that medical schools have improved, but there’s still work to do.

“Addressing racial justice through medical schools translates to improved outcomes in very broad arenas, such as a better environment for POC (people of color) medical students, faculty and staff, health equity among patients, and economic benefit of local communities,” said Mariquit Lu, co-founding member of White Coats 4 Black Lives.

“Medical schools and their affiliated academic health institutions are gatekeepers to health and wealth in their communities,” she told Reuters Health by email. “They provide healthcare to a large population, employ large workforces, and set the standards and priorities of medical training.”

Historically, she said, medical schools have made strides in recognizing the importance of having diverse health professionals from a variety of backgrounds. Metrics have focused on “diversity” by increasing the number of minority students and “inclusion” by creating a comfortable environment for diverse viewpoints and experiences. The report card focuses on the next steps in “racial justice,” including anti-racist training, discrimination reporting, protection of marginalized patients and immigrants, and staff compensation and insurance.

For the 2019 report card, medical students at 17 institutions graded their schools with an “A,” “B” or “C” based on 14 metrics. The medical schools earned an overall “B-,” “C+” or “C,” indicating that metrics aren’t met or are partially met; none of the schools received an overall grade of “A.”

The report card has helped students initiate conversations at their institutions, Lu said.

“Some students felt that their institution [responded to the] RJRC with genuine interest. Others reported that they’ve subsequently been targeted, chastised, dismissed, or even silenced,” she said. “Some say that the report card has definitely struck a nerve among administrators, and that they’re using that attention to start organizing and have used the RJRC findings to ask for tangible change, from symbolic to policy to practice.”

An unrelated study published in JAMA Network Open looked at race and ethnicity at U.S. medical schools from 2002-2017 and found that numbers of Black, Hispanic, American Indian and Alaska Native students had increased, yet these groups still remain underrepresented.

“We still have a way to go, but we need to measure our efforts in better and smarter ways,” said senior co-author Dr. Jaya Aysola, assistant dean of inclusion and diversity at the University of Pennsylvania in Philadelphia. (Penn earned an overall “C” on the RJRC.)