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

Abstract

Introduction: 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. Methods: 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. Results: 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. Discussion: 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.

Structural Competency in Conflict Zones: Challenging Depoliticization in Israel

“…Neff et al. (2020) define structural competency as “the capacity for health professionals to recognize and respond to health and illness as the downstream effects of broad social, political, and economic structures” (p. 2).…”

“…This violence is structural because it results from durable systemic inequality produced by large-scale social forces [ … ] rather than from isolated individual actions or serendipity. (Karandinos & Bourgois, 2019, p. 207)For this theorization, we translated and adapted materials from the trainings developed by the Structural Competency Working Group in the San Francisco Bay Area (Neff et al., 2017, 2019, 2020) that they have generously provided us. 6…”

A Scoping Review of Active-Learning Strategies for Teaching Social Determinants of Health in Pharmacy

“…Literature regarding SDOH pedagogy has been explored in medical and nursing professions. [8][9][10][11][12][13] However, educational strategies for teaching SDOH within pharmacy programs are currently undefined. The Center for Advancement of Pharmacy Education (CAPE 2013) emphasizes the importance of social determinants of health, and SDOH is also referenced in Standard 3.5 of the 2016 Accreditation Council for Pharmacy Education (ACPE) Standards.…”

How Do We Explain the Social, Political, and Economic Determinants of Health? A Call for the Inclusion of Social Theories of Health Inequality Within U.S.-Based Public Health Pedagogy

“…Work is currently under way by the author and colleagues to assess students’ perceived relevance of social theories of health inequality to their future careers and to their ability to address those inequalities. Additionally, the emerging structural competency literature, which describes a new, theory-driven, pedagogical framework for training health care professionals to recognize and respond to disease and its unequal distribution as the outcome of social structures, such as inequitable systems, policies, and institutions (Metzl & Hansen, 2014; Neff et al, 2017; Neff et al, 2019; Neff et al, 2020), might also inform these pedagogical changes. Finally, assessment of the impact of this instruction on subsequent public health research and practice undertaken by graduates—and ultimately on levels of health inequality—is also needed.…”