Developing and Evaluating an Innovative Structural Competency Curriculum for Pre-Health Students

Abstract

The inclusion of structural competency training in pre-health undergraduate programs may offer significant benefits to future healthcare professionals. This paper presents the results of a comparative study of an interdisciplinary pre-health curriculum based in structural competency with a traditional premedical curriculum. The authors describe a new evaluation tool, the Structural Foundations of Health Survey © (2016), developed to evaluate structural skills and sensibilities. The authors use the survey to evaluate two groups of graduating seniors at Vanderbilt University—majors in an interdisciplinary pre-health curriculum titled Medicine, Health, and Society (MHS), and premed science majors—with particular attention to understanding how political, cultural, economic, and social factors shape health. Results suggest that MHS majors identified and analyzed relationships between structural factors and health outcomes at higher rates and in deeper ways than did premed science majors. MHS students also demonstrated higher understanding of structural and cultural competency in their approaches to race, intersectionality, and racial health disparities. The skills that MHS students exhibited represent proficiencies increasingly emphasized by the MCAT, the AAMC, and other educational bodies that, in an era of epigenetics and social determinants, emphasize how contextual factors shape expressions of health and illness.

A Structural Competency Curriculum for Primary Care Providers to Address the Opioid Use Disorder, HIV, and Hepatitis C Syndemic

“…Montoya's third recommendation is for clinicians to be willing to admit that they do not know everything (i.e., "Be someone you'd like to know" (48, p. 153). This includes knowledge of oneself, not just one's implicit biases (51) but the various types of privileges that shape one's interactions with the world (52,53). Finally, Montoya encourages clinicians to see their patients as more than just the problems they face (48).…”

“…A recent body of work has described structural competency training programs within medical schools, including training for pre-health/pre-med students, medical residents, and students of psychiatry (42,43,52,58,59). As described in Hansen and Metzl's (59) compendium of case studies, these efforts represent a small, but growing, number of interdisciplinary programs designed to bring awareness of structural influences on health into formal medical training programs (59).…”

Educational Models for the Re‐Establishment of Dental Therapy Education in Canada

“…However, the university-based dental hygienists favored Option 2. This option incorporates a greater emphasis on structural competence, [48][49][50] which directs attention to the structural and psychosocial complexities of working with vulnerable populations.…”

Moving towards anti-racist praxis in medicine

“…This level of consciousness-raising must start no later than pre-medical education, continuing throughout ongoing licensure, accountability, and accreditation processes. 17 , 18 …”

“…Undergraduate students who are trained in anti-racist, structural competency have increased capacities for understanding root structural causes of disease. 18 It is not enough for burgeoning clinicians to know the body, inside and out. They must also know the historical body of work about enduring medical practices based on exploitation and/or exclusion and long-standing medical policies that render certain populations sicker than others; such knowledge informs their structural competency skills development.…”