Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities
Top Cited Papers
- 13 March 2020
- journal article
- Published by Association of American Medical Colleges in Mededportal
- Vol. 16, 10888
- https://doi.org/10.15766/mep_2374-8265.10888
Abstract
Research on disparities in health and health care has demonstrated that social, economic, and political factors are key drivers of poor health outcomes. Yet the role of such structural forces on health and health care has been incorporated unevenly into medical training. The framework of structural competency offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care. We report on a brief, interprofessional structural competency curriculum implemented in 32 distinct instances between 2015 and 2017 throughout the San Francisco Bay Area. In consultation with medical and interprofessional education experts, we developed open-ended, written-response surveys to qualitatively evaluate this curriculum's impact on participants. Qualitative data from 15 iterations were analyzed via directed thematic analysis, coding language, and concepts to identify key themes. Three core themes emerged from analysis of participants' comments. First, participants valued the curriculum's focus on the application of the structural competency framework in real-world clinical, community, and policy contexts. Second, participants with clinical experience (residents, fellows, and faculty) reported that the curriculum helped them reframe how they thought about patients. Third, participants reported feeling reconnected to their original motivations for entering the health professions. This structural competency curriculum fills a gap in health professional education by equipping learners to understand and respond to the role that social, economic, and political structural factors play in patient and community health.Keywords
This publication has 36 references indexed in Scilit:
- To Fight Burnout, OrganizeThe New England Journal of Medicine, 2018
- From Cultural to Structural Competency—Training Psychiatry Residents to Act on Social Determinants of Health and Institutional RacismJAMA Psychiatry, 2018
- New Medicine for the U.S. Health Care System: Training Physicians for Structural InterventionsAcademic Medicine, 2017
- The Social Determinants of Health: It's Time to Consider the Causes of the CausesPublic Health Reports, 2014
- Enhancing Meaning in WorkJAMA, 2009
- Closing the gap in a generation: health equity through action on the social determinants of healthThe Lancet, 2008
- The Healer's Art: Education in Meaning and ServiceJournal of Cancer Education, 2008
- Losing Culture on the Way to Competence: The Use and Misuse of Culture in Medical EducationAcademic Medicine, 2006
- Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural EducationJournal of Health Care for the Poor and Underserved, 1998
- Socioeconomic inequalities in health. No easy solution.1993