Reducing Disparities

The California Medical Association (CMA) believes cultural and linguistic competencies are essential to providing quality and accessible care, and also acknowledges that society has embedded and endemic structural racism and biases that affect the care that an individual receives.

Students completing a classroom activity

To help bridge the gap, the UCLA Continuing Medical Education (CME) office has created a library of resources on cultural and linguistic competency (CLC) and implicit bias (IB) that reduce health disparities, as well as comply with state law. 

California Medical Association’s (CMA) Definitions


Cultural and Linguistic Competency (CLC)

The ability and readiness of health care providers and organizations to humbly and respectfully demonstrate, effectively communicate, and tailor delivery of care to patients with diverse values, beliefs, identities and behaviors, in order to meet social, cultural and linguistic needs as they relate to patient health.

Implicit Bias (IB)

The attitudes, stereotypes and feelings, either positive or negative, that affect our understanding, actions and decisions without conscious knowledge or control. Implicit bias is a universal phenomenon. When negative, implicit bias often contributes to unequal treatment and disparities in diagnosis, treatment decisions, levels of care and health care outcomes of people based on race, ethnicity, gender identity, sexual orientation, age, disability and other characteristics.


Having many different forms, types or ideas; showing variety. Demographic diversity can mean a group composed of people of different genders, races/ethnicities, cultures, religions, physical abilities, sexual orientations or preferences, ages, etc.


As defined by the bills, the exemption provisions are for CME activities that are research-based or contain no direct patient care component. Exemptions must be validated with documentation demonstrating the absence of relevance of CLC/IB material.


CMA’s Continuing Medical Education CLC & IB Standards FAQ

California Business and Professions Code (B&P) 2190.1 mandates that continuing medical education (CME) courses include curriculum that includes understanding of cultural and linguistic competency (CLC) and implicit bias (IB) in the delivery of health care, and further mandates that evaluative standards be developed by January 1, 2022. 

The standards were developed to help reduce health care disparities by ensuring that CME activities in California reflect this important aspect of caring for patients. 

The requirement to address CLC in California-based CME activities has been in place since 2006. The new IB requirement now provides an opportunity to provide a framework for supporting the adoption of these requirements universally.

The CLC and IB standards are codified into B&P 2190.1 from Assembly Bill (AB) 1195 (Coto, 2005) and AB 241 (Kamlager-Dove, 2019).

CMA has been delegated the authority to create these standards for California CME providers by the Medical Board of California. As the accrediting body for CME by and for California’s physician educators, CMA is in the best position to develop standards that reflect the needs of the community it serves.

CMA worked with an advisory council with expertise in CME and health equity beginning in October 2020 to develop standards that would be meaningful and relevant to all types and sizes of CME providers; the Accreditation Council for Continuing Medical Education (ACCME) also provided input and support. Draft standards were presented for public call for comment in April-May of 2021. Comments were reviewed by CMA, and the advisory council made relevant adjustments prior to the final release. 

The CLC and IB standards are effective January 1, 2022.

All CME providers located in California.

Yes. The statute is written to apply to organizations accredited by both CMA and ACCME in California.

No. CME providers located outside of California are not required to adhere. However, organizations are encouraged to utilize the resources to help address these important topics.

CME activities that are planned and implemented by a CME provider located in California must adhere to the standards, regardless of where the activity is held.

The standards apply to CME activities planned and implemented by CME providers located in California rather than the learner's location. All accredited activities by CME providers located in California must include the CLC and IB standards, regardless of where an activity is held.

Yes, a CME course dedicated solely to research or other issues that does not include a direct patient care component is exempted.

CMA and ACCME expect that you will comply with state regulations as part of your adherence to the ACCME CME Program and Business Management Procedures Policy. 

At initial accreditation and reaccreditation, as well as during the annual reporting process, you will be asked to attest that you have complied with all ACCME requirements, including this policy. Adherence with the law is separate from your accreditation decision.

The standards have been developed to be broad and fit the needs of all types of providers and topics, and most topics should be able to include relevant education on CLC and IB. Providers are encouraged to explore the resources, as well as make use of the many CLC and IB tools created by credible medical, academic and research organizations. 

If providers are unable to identify relevant materials, they should evaluate whether their content falls into the exempted categories (research focused and/or contains no direct patient care component) and make appropriate documentation in their files.

CMA will provide ongoing support and resources at

Per B&P 2190.1, all accredited CME activities with a direct patient care component are expected to include CLC and IB unless the activity is research focused.

An RSS is considered a single activity, and CLC and IB should be included as appropriate (in at least one session for example), unless the RSS is focused on research.

View the “implementation resources” on CMA’s website for ideas to incorporate CLC and IB into CME.

The standards and best practices were designed to align with some of the components of the commendation criteria. Just as in the commendation criteria, the CLC and IB standards are designed to be flexible to fit the needs of all types and sizes of CME providers in ways that are meaningful and achievable. CME providers are encouraged to consider ways to incorporate commendable practices that meet CLC and IB standards and criteria.

The standards incorporate CLC and IB into CME activities throughout the planning process, as well as give planners and speakers the tools needed to include them in a manner that works best with the content. 

The best practices can be utilized with the CME activity and at the program and organizational level.

While not required for compliance with the law, the best practices exemplify how CME programs can excel in this work.
Source: California Medical Association