Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians
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.
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.
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.
KEY WORDSstructural competency social determinants of health structural vulnerability cultural competency medical education
- 2.Centers for Disease Control and Prevention. Establishing a Holistic Framework to Reduce Inequalities in HIV, VIral Hepatitis, STDs, and Tuberculosis in the United States. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2010. http://ses.sp.bvs.br/local/File/Establishing%20a%20Holistic%20Framework%20to%20Reduce%20Inequities%20in%20HIV,%20Viral%20Hepatitis,%20STDs,%20and%20Tuberculosis%20i. Accessed 20 November 2016.
- 4.CSDH. Closing the gap in a generation: health equity through action on the socialdeterminants of health. Final Report of the Commission on Social Determinants of Health.Geneva, World Health Organization; 2008.Google Scholar
- 6.Marmot M. The Health Gap: The Challenge of an Unequal World. London: Bloomsbury Publishing; 2015.Google Scholar
- 11.Bourgois P, Holmes SM, Sue K, Quesada J. Structural vulnerability: operationalizing the concept to address health disparities in clinical care. Acad Med. 2016.Google Scholar
- 19.Hansen H. Faculty Roundtable Discussion on Curricular Reform. 6th Biennial National Conference for Clinician-Scholars in the Social Sciences and Humanities: Policies and Politics of Care, Philadelphia, April 18, 2015.Google Scholar
- 27.Bourgois P, Schonberg J. Righteous Dopefiend. Berkeley: University of California Press; 2009.Google Scholar
- 28.Holmes SM. Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States. Berkeley: University of California Press; 2013.Google Scholar
- 29.Waitzkin H. The Micropolitics of the Doctor-Patient Relationship. The Second Sickness: Contradictions of Capitalist Health Care. New York: Rowman & Littlefield; 2000:119–164.Google Scholar
- 33.Wear D, Zarconi J, Aultman JM, Chyatte MR, Kumagai AK. Remembering Freddie Gray: Medical Education for Social Justice. Acad Med. 2016.Google Scholar
- 34.Knight KR. addicted.pregnant poor. Durham, NC: Duke University Press; 2015.Google Scholar
- 37.Metzl J. The Protest Psychosis: How Schizophrenia Became a Black Disease. Boston: Beacon Press; 2009.Google Scholar