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. 2022 Oct;37(13):3465-3470.
doi: 10.1007/s11606-022-07751-7. Epub 2022 Aug 3.

The Structural Analysis: Incorporating Structurally Competent Clinical Reasoning into Case-Based Presentations

Iman F Hassan  1 , Thuy Bui  2
Affiliations

The Structural Analysis: Incorporating Structurally Competent Clinical Reasoning into Case-Based Presentations

Iman F Hassan et al. J Gen Intern Med. 2022 Oct.

Abstract

Structural and social determinants of health account for the health disparities we see along social hierarchies, and their impact has been made more evident by the recent COVID-19 pandemic. There have been increasing calls to incorporate structural competency into medical education. The structural and social context, however, has yet to be fully integrated into everyday clinical practice and little has been published on how to concretely imbed structural competency into clinical reasoning. The authors provide a framework for structural analysis, which incorporates four key steps: (1) developing a prioritized clinical problem list, (2) identifying social and structural root causes for clinical problems, (3) constructing and documenting a prioritized structural problem list, and (4) brainstorming solutions to address structural barriers and social needs. They show how structural analysis can be used to operationalize structural reasoning into everyday inpatient and outpatient clinical assessments.

Keywords: medical education; social determinants of health; structural competency.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Structural analysis diagram to identify root causes of health outcomes. From left to right, upstream structural determinants of health, mediators, and more downstream social determinants of health.
Figure 2
Figure 2
Example completed structural analysis diagram showing structural determinants, mediators and downstream social determinants which impact a health outcome.
Figure 3
Figure 3
Re-envisioned structural problem list and sample assessment and plan.
See this image and copyright information in PMC

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