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

MedEdPORTAL

Kelly R. Knight¹  Nimish Saxena²  Michael J. Harvey³  Sara N. Minahan⁴  Shirley Strong⁵  Seth M. Holmes⁶  Ariana Thompson-Lastad⁷  Jorge De Avila⁸  Alice Langford⁹  Lillian Walkover^1,10  Nicholas Nelson^1,11  Laura Duncan^1,12  Sonia Lee^1,13  Jenifer Matthews^1,14  Cara McGuinness^1,15  Caitlin Ruppel^1,16  Joshua Neff^1,17  Brett Lewis^1,18  Shannon Satterwhite^1,19  Katiana L. Carey-Simms^1,19 

[1] Associate Professor, Joint Program in Medical Anthropology, University of California, Berkeley;;Clinical Instructor, Department of Obstetrics &Gynecology, Boston University School of Medicine;Assistant Professor, Department of Health Science and Recreation, San Josá State University;Associate Professor, Department of Anthropology, History and Social Medicine, University of California, San Francisco;Associate Professor, Division of Society and Environment, Department of Environmental Science, Policy, and Management, University of California, Berkeley;Chief Diversity Officer, Samuel Merritt University;Health Policy and Management MPH Student, School of Public Health, University of California, Berkeley;MD/PhD Student in the Medical Scientist Training Program, Department of Anthropology, History and Social Medicine, University of California, San Francisco;Medical Student in the Medical Scientist Training Program, Department of Anthropology, History and Social Medicine, University of California, San Francisco;Medical Student, University of Chicago Pritzker School of Medicine;Nurse Midwife, Boston Medical Center;Nurse Midwife, Highland Hospital, Oakland, California;Postdoctoral Fellow in Global Health, Department of Sociology, Drexel University;Postdoctoral Fellow, Osher Center for Integrative Medicine, University of California, San Francisco;Reproductive Health Specialist, Planned Parenthood Northern California;Resident, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles;Senior Manager, Health Outreach Partners;Undergraduate Student, University of California, Berkeley;

关键词: Structural Competency;    Structural Determinants of Health;    Social Determinants of Health;    Health Disparities;    Racism;    Structural Violence;   

DOI  :  10.15766/mep_2374-8265.10888

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown