Building structural competency through community engagement

Abstract

Context The importance of addressing the social determinants of health (SDOH) in medical education has been ubiquitously recognised. However, current pedagogical approaches are often limited by inadequate or ahistorical exploration of the fundamental causes of health inequity. Community‐engaged pedagogy and structural competency frameworks advocate for progressing from passive SDOH education to directly discussing systemic aetiologies of health inequity through reciprocal partnership with marginalised communities. Herein, we describe the development and exploratory evaluation of a community‐engaged structural competency curriculum implemented in 2019 at the University of Nebraska Medical Center. Our curriculum explored the downstream impacts of sociopolitical structures on local health inequities. We engaged university, health system and community stakeholders throughout curriculum development, implementation and evaluation. Curricular components included didactic lectures, reflective writing assignments and a community‐based, stakeholder‐led experience in North Omaha. Methods We used inductive thematic analysis to explore free‐text responses to a post‐curriculum survey. Results Eighteen community stakeholders, eleven multidisciplinary UNMC facilitators, and all 132 first‐year medical students were involved in the curriculum pilot, with 93% and 55.1% of students and faculty/community facilitators, respectively, responding to the post‐session evaluation. Analysis revealed themes including widespread desire for community‐engaged teaching, appreciation for the hyperlocal focus of curricular content and recognition of the importance of creating space for lived experiences of community members. Discussion Co‐created by a university‐community coalition, our pilot findings highlight the crucial role of community‐engaged pedagogy in promoting critical understanding of historic structural inequities and present‐day health disparities. Our communities can and should be reciprocal partners in training the physicians of tomorrow.

Using adult learning characteristics and the humanities to teach undergraduate healthcare students about social determinants of health

“…Another approach to focus on structural SDOH is to add more community engagement activities. Khazanchi et al ( 2021 ) included a community engagement component in their evaluation to highlight structural SDOH and their impact in communities. Authors discuss “community-engaged pedagogy” where authors focused on inequities in terms of social, political, and historical contexts to discuss inequities with students, public health practitioners, and community leaders (Khazanchi et al, 2021 ).…”

“…Khazanchi et al ( 2021 ) included a community engagement component in their evaluation to highlight structural SDOH and their impact in communities. Authors discuss “community-engaged pedagogy” where authors focused on inequities in terms of social, political, and historical contexts to discuss inequities with students, public health practitioners, and community leaders (Khazanchi et al, 2021 ). During the course evaluation, authors found that community engagement was listed as a strength of the curriculum, and students requested more student engagement and small group discussions (Khazanchi et al, 2021 ).…”

A Fundamental Shift in Nursing is a Requisite for Achieving Health Equity: The Nurses' Role in Addressing Social Determinants of Health

“…However, after four decades of implementation, there is little evidence to suggest that this approach has improved health equity metrics (Filmer & Herbig, 2018; Horvat et al), despite being mandated by the Joint Commission on Accreditation of Health care Organizations (The Joint Commission, 2014). More recently, a shift toward structural competencies (Metzl & Hansen, 2014) has been proposed as an interprofessional approach to addressing the SDH-driving health inequities (Neff et al, 2020) while emphasizing principles of community engagement (Khazanchi, et al, 2021). Metzl and Hansen (2014) assert that health care providers can be trained in “recognizing the structures that shape clinical interactions, developing an extra-clinical language of structure, rearticulating ‘cultural’ formulations in structural terms, observing and imagining structural interventions and developing structural humility over time” (p. 126).…”

Bringing structural competency to the forefront of dental education

“…Educating providers and agencies in structural competency aids in shifting an old paradigm and antiquated pedagogical model. Khazanchi et al 24 . suggest that current pedagogical methodologies are often limited by a lack of historical or traditional development of the root causes of health inequality.…”

“…8 Educating providers and agencies in structural competency aids in shifting an old paradigm and antiquated pedagogical model. Khazanchi et al 24 suggest that current pedagogical methodologies are often limited by a lack of historical or traditional development of the root causes of health inequality. A communityfocused pedagogy and structural competency framework encourage the transition from passive learning to actively addressing the social determinants of health and the systemic causes of health inequity through partnerships with marginalized and vulnerable communities.…”