Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities

• DOI: 10.15766/mep_2374-8265.10888
• Publication Date: 2020-03-05T21:18:53Z
• Authors: Joshua Neff; Seth M. Holmes; Kelly R. Knight; Shirley Strong; Ariana Thompson-L...; Cara McGuinness; Laura Duncan; Nimish Saxena; Michael J. Harvey; Alice Langford; Katiana L. Carey-...; Sara N. Minahan; Shannon Satterwhite; Caitlin Ruppel; Sonia Lee; Lillian Walkover; Jorge De Avila; Brett Lewis; Jenifer Matthews; Nicholas Nelson
• Keywords: Medicine (General); Students, Medical; Structural Determinants of Health; Social Determinants of Health; Health Personnel; Original Publication; 610; 02 engineering and technology; Education; Racism; R5-920; Public Health and Recreation; Clinical Research; Medical; 0202 electrical engineering, electronic engineering, information engineering; Humans; Cultural Competency; Students; Structural Competency; 10. No inequality; Inclusion; Diversity; Health Equity; Prevention; 4. Education; Health Services; 16. Peace & justice; L; 3. Good health; Health Disparities; Good Health and Well Being; Health Occupations; Cultural Humility; San Francisco; Generic health relevance; Curriculum; Structural Violence

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.