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

Joshua Neff¹, Seth M Holmes^{2

3}, Kelly R Knight⁴, Shirley Strong⁵, Ariana Thompson-Lastad⁶, Cara McGuinness^{7

8}, Laura Duncan⁹, Nimish Saxena¹⁰, Michael J Harvey¹¹, Alice Langford¹⁰, Katiana L Carey-Simms¹², Sara N Minahan¹³, Shannon Satterwhite¹⁴, Caitlin Ruppel¹⁵, Sonia Lee¹⁶, Lillian Walkover¹⁷, Jorge De Avila¹⁸, Brett Lewis¹⁹, Jenifer Matthews²⁰, Nicholas Nelson²¹

Affiliations

¹ Resident, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
² Associate Professor, Division of Society and Environment, Department of Environmental Science, Policy, and Management, University of California, Berkeley.
³ Associate Professor, Joint Program in Medical Anthropology, University of California, Berkeley.
⁴ Associate Professor, Department of Anthropology, History and Social Medicine, University of California, San Francisco.
⁵ Chief Diversity Officer, Samuel Merritt University.
⁶ Postdoctoral Fellow, Osher Center for Integrative Medicine, University of California, San Francisco.
⁷ Nurse Midwife, Boston Medical Center.
⁸ Clinical Instructor, Department of Obstetrics & Gynecology, Boston University School of Medicine.
⁹ MD/PhD Student in the Medical Scientist Training Program, Department of Anthropology, History and Social Medicine, University of California, San Francisco.
¹⁰ Undergraduate Student, University of California, Berkeley.
¹¹ Assistant Professor, Department of Health Science and Recreation, San José State University.
¹² Reproductive Health Specialist, Planned Parenthood Northern California.
¹³ Nurse Midwife, Highland Hospital, Oakland, California.
¹⁴ Medical Student in the Medical Scientist Training Program, Department of Anthropology, History and Social Medicine, University of California, San Francisco.
¹⁵ Health Policy and Management MPH Student, School of Public Health, University of California, Berkeley.
¹⁶ Senior Manager, Health Outreach Partners.
¹⁷ Postdoctoral Fellow in Global Health, Department of Sociology, Drexel University.
¹⁸ Medical Student, University of Chicago Pritzker School of Medicine.
¹⁹ Medical Student, Oregon Health & Science University School of Medicine.
²⁰ Core Faculty, Department of Adolescent Medicine, UCSF Benioff Children's Hospital Oakland.
²¹ Associate Program Director, Internal Medicine Residency Program, Highland Hospital, Oakland, California.

PMID: 32342010
PMCID: PMC7182045
DOI: 10.15766/mep_2374-8265.10888

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

Joshua Neff et al. MedEdPORTAL. 2020.

. 2020 Mar 13:16:10888.

doi: 10.15766/mep_2374-8265.10888.

Authors

Affiliations

¹ Resident, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
² Associate Professor, Division of Society and Environment, Department of Environmental Science, Policy, and Management, University of California, Berkeley.
³ Associate Professor, Joint Program in Medical Anthropology, University of California, Berkeley.
⁴ Associate Professor, Department of Anthropology, History and Social Medicine, University of California, San Francisco.
⁵ Chief Diversity Officer, Samuel Merritt University.
⁶ Postdoctoral Fellow, Osher Center for Integrative Medicine, University of California, San Francisco.
⁷ Nurse Midwife, Boston Medical Center.
⁸ Clinical Instructor, Department of Obstetrics & Gynecology, Boston University School of Medicine.
⁹ MD/PhD Student in the Medical Scientist Training Program, Department of Anthropology, History and Social Medicine, University of California, San Francisco.
¹⁰ Undergraduate Student, University of California, Berkeley.
¹¹ Assistant Professor, Department of Health Science and Recreation, San José State University.
¹² Reproductive Health Specialist, Planned Parenthood Northern California.
¹³ Nurse Midwife, Highland Hospital, Oakland, California.
¹⁴ Medical Student in the Medical Scientist Training Program, Department of Anthropology, History and Social Medicine, University of California, San Francisco.
¹⁵ Health Policy and Management MPH Student, School of Public Health, University of California, Berkeley.
¹⁶ Senior Manager, Health Outreach Partners.
¹⁷ Postdoctoral Fellow in Global Health, Department of Sociology, Drexel University.
¹⁸ Medical Student, University of Chicago Pritzker School of Medicine.
¹⁹ Medical Student, Oregon Health & Science University School of Medicine.
²⁰ Core Faculty, Department of Adolescent Medicine, UCSF Benioff Children's Hospital Oakland.
²¹ Associate Program Director, Internal Medicine Residency Program, Highland Hospital, Oakland, California.

PMID: 32342010
PMCID: PMC7182045
DOI: 10.15766/mep_2374-8265.10888

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.

Keywords: Cultural Competency; Cultural Humility; Diversity; Health Disparities; Health Equity; Inclusion; Racism; Social Determinants of Health; Structural Competency; Structural Determinants of Health; Structural Violence.

PubMed Disclaimer

Conflict of interest statement

None to report.

References

1. Braveman P, Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep. 2014;129(suppl 2):19-31. https://doi.org/10.1177/00333549141291S206 - PMC - PubMed
1. Adler NE, Boyce WT, Chesney MA, Folkman S, Syme SL. Socioeconomic inequalities in health: no easy solution. JAMA. 1993;269(24):3140-3145. https://doi.org/10.1001/jama.1993.03500240084031 - PubMed
1. 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: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2010.
1. Krieger N. Proximal, distal, and the politics of causation: what's level got to do with it? Am J Public Health. 2008;98(2):221-230. https://doi.org/10.2105/AJPH.2007.111278 - PMC - PubMed
1. Marmot M. The Health Gap: The Challenge of an Unequal World. London, England: Bloomsbury Publishing; 2015. - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous