Journal of General Internal Medicine

, Volume 32, Issue 4, pp 430–433 | Cite as

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

  • Joshua Neff
  • Kelly R. Knight
  • Shannon Satterwhite
  • Nick Nelson
  • Jenifer Matthews
  • Seth M. Holmes
Original Research



The influence of societal inequities on health has long been established, but such content has been incorporated unevenly into medical education and clinical training. Structural competency calls for medical education to highlight the important influence of social, political, and economic factors on health outcomes.


This article describes the development, implementation, and evaluation of a structural competency training for medical residents.


A California family medicine residency program serving a patient population predominantly (88 %) with income below 200 % of the federal poverty level.


A cohort of 12 residents in the family residency program.

Program Description

The training was designed to help residents recognize and develop skills to respond to illness and health as the downstream effects of social, political, and economic structures.

Program Evaluation

The training was evaluated via qualitative analysis of surveys gathered immediately post-training (response rate 100 %) and a focus group 1 month post-training (attended by all residents not on service).


Residents reported that the training had a positive impact on their clinical practice and relationships with patients. They also reported feeling overwhelmed by increased recognition of structural influences on patient health, and indicated a need for further training and support to address these influences.


structural competency social determinants of health structural vulnerability cultural competency medical education 


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Copyright information

© Society of General Internal Medicine 2016

Authors and Affiliations

  • Joshua Neff
    • 1
  • Kelly R. Knight
    • 2
  • Shannon Satterwhite
    • 3
    • 4
  • Nick Nelson
    • 5
    • 6
  • Jenifer Matthews
    • 7
  • Seth M. Holmes
    • 1
    • 2
    • 3
    • 4
    • 5
    • 8
    • 9
  1. 1.Joint Medical ProgramUC Berkeley-UCSFBerkeleyUSA
  2. 2.Department of Anthropology, History, and Social MedicineUCSFSan FranciscoUSA
  3. 3.Medical Scientist Training ProgramUCSFSan FranciscoUSA
  4. 4.Joint Program in Medical AnthropologyUC Berkeley-UCSFSan FranciscoUSA
  5. 5.Department of MedicineHighland HospitalOaklandUSA
  6. 6.Department of MedicineUCSFSan FranciscoUSA
  7. 7.Department of Adolescent MedicineUCSF Benioff Children’s Hospital OaklandOaklandUSA
  8. 8.School of Public HealthUC BerkeleyBerkeleyUSA
  9. 9.University of California BerkeleyBerkeleyUSA

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