Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians

Neff, Joshua; Knight, Kelly R.; Satterwhite, Shannon; Nelson, Nick; Matthews, Jenifer; Holmes, Seth M.

doi:10.1007/s11606-016-3924-7

Cited by 83 publications

(93 citation statements)

References 31 publications

(35 reference statements)

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“…While there are certainly different ways ethnic groups experience, express, and cope with pain, the existing data does not warrant cultural factors to override consideration of each patient's social and structural conditions (Arcury, Mora, and Quandt ; Campbell et al ; Hollingshead et al ). The new approach calls for medical education to “highlight the important influence of social, political, and economic factors on health outcomes” (Neff et al ). In this study, physicians themselves exalted the importance of communicating clearly with patients, but were unable to guarantee adequate medical interpretation.…”

Section: Discussionmentioning

confidence: 99%

What the Doctors Don't See: Physicians as Gatekeepers, Injured Latino Immigrants, and Workers' Compensation System

Castillo

2018

Anthropology of Work Review

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Workers' compensation systems require injured employees to overcome cumbersome requirements in order to obtain health‐care and salary‐replacement benefits. The structural vulnerabilities of Latino immigrants put them at greater risk for workplace injuries and further complicate their search for redress. As a medico‐legal system, workers' compensation relies on medical professionals to interrogate the bodies of injured low‐wage immigrant workers. This article aims to clarify how workers' trajectories are impacted by interactions with health‐care system. Utilizing activist research methods, I collaborated with Fuerza Laboral, a worker center in Rhode Island, from the fall of 2013 to the end of 2014, to survey and interview injured Latino workers, physicians, and legal professionals. I bring together worker narratives and physician reflections to identify how the compensation system's reliance on biomedicine contributes to poor outcomes for injured immigrant workers. Considering the medical “gaze,” prejudice against injured workers, racial and ethnic bias in medicine, and the pitfalls of cultural competency training, I outline the mechanics of how the medical‐legal system corrodes the patient‐physician relationship. Evaluating the risks of positioning physicians as gatekeepers, I advocate for uncoupling medical evaluations from compensation cases, the importance of healthcare system reform, and medical curricula that emphasize structural analysis. Such reforms may liberalize access to health care for injured workers as well as stymie bias in medical education.

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Section: Discussionmentioning

confidence: 99%

What the Doctors Don't See: Physicians as Gatekeepers, Injured Latino Immigrants, and Workers' Compensation System

Castillo

2018

Anthropology of Work Review

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“…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.…”

Section: Educational Frameworkmentioning

confidence: 99%

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

Sunell¹,

Wright²,

Udahl

et al. 2019

Journal of Dental Education

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With the closure of the Canadian dental therapy program in Saskatchewan in 2011 and the increasing need for oral health providers, there have been growing discussions at the national and provincial levels regarding the re‐establishment of a provider with dental therapy abilities. The aims of this study were to define models for dental therapy education in Canada and explore how dental therapy abilities could best be integrated into Canadian post‐secondary education. In 2017, purposeful sampling was used to invite key informants to participate in a semi‐structured interview. Participants were individuals from government, education, and regulation and those working with underserved populations in Canada and internationally. A 75% response rate (n=53) was achieved. Thematic analysis was employed for coding of data and generation of themes. Respondents highlighted the need to include minimally invasive restorative services in the current scope of dental hygiene practice across all Canadian jurisdictions and to build dental therapy abilities with or upon accredited dental hygiene curricula. The models supported by respondents were a fourth‐year option built on three‐year diploma education, a one‐year postgraduate diploma based on a baccalaureate degree and a current dental hygiene registration, and a three‐year dental therapy diploma incorporating core courses in accredited dental hygiene diploma education. While the respondents' views were divergent, the educational model that received the most support involved a two‐ to three‐term addition to current three‐year dental hygiene diploma education. In contrast to international trends, the respondents valued learner flexibility to exit with a diploma dental hygiene credential, thus making the dental therapy scope optional. These educational models provide a starting point for further analysis and exploration.

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“…The medicalization of social problems has ethical implications for reproductive health care professionals, who must balance their pursuit of patient care and respect for patient autonomy, justice, beneficence, and nonmaleficence with the realities of institutional and structural discrimination experienced by patients. Indeed, research indicates that health care professionals do not feel equipped to understand or intervene upon structural factors, despite acknowledging the impact such factors have on their profession [28,29]. Trained to treat individuals, reproductive health care professionals might contribute to the replication of problematic health care trends by ignoring structural barriers to care [30] because they and their institutions lack the skills and resources to identify, analyze, and imagine structural interventions.…”

Section: Structural Competency As a Response To The Challenges Of Addmentioning

confidence: 99%

Structural Competency and Reproductive Health

2018

AMA Journal of Ethics

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Reproductive health disparities-particularly those experienced by racial and ethnic minority groups-are considered a persistent public health issue in the United States. Frameworks that focus on social determinants of health seek to identify the forces producing these disparities, particularly social conditions that create vulnerability to premature death and disease. Such frameworks pose challenges to health care provision, as structural factors can seem immutable to health care professionals trained to treat individual patients. Here, we discuss the links between reproductive health disparities and social determinants of health. We then apply to reproductive health care the structural competency framework, developed by physician-scholars to encourage health care professionals to address health disparities by analyzing and intervening upon sociopolitical forces.

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Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians

Cited by 83 publications

References 31 publications

What the Doctors Don't See: Physicians as Gatekeepers, Injured Latino Immigrants, and Workers' Compensation System

What the Doctors Don't See: Physicians as Gatekeepers, Injured Latino Immigrants, and Workers' Compensation System

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

Structural Competency and Reproductive Health

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