Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities
Joshua Neff,
Seth M. Holmes,
Kelly R. Knight,
Shirley Strong,
Ariana Thompson-Lastad,
Cara McGuinness,
Laura Duncan,
Nimish Saxena,
Michael J. Harvey,
Alice Langford,
Katiana L. Carey-Simms,
Sara N. Minahan,
Shannon Satterwhite,
Caitlin Ruppel,
Sonia Lee,
Lillian Walkover,
Jorge De Avila,
Brett Lewis,
Jenifer Matthews,
Nicholas Nelson
Affiliations
Joshua Neff
Resident, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
Seth M. Holmes
Associate Professor, Division of Society and Environment, Department of Environmental Science, Policy, and Management, University of California, Berkeley; Associate Professor, Joint Program in Medical Anthropology, University of California, Berkeley
Kelly R. Knight
Associate Professor, Department of Anthropology, History and Social Medicine, University of California, San Francisco
Shirley Strong
Chief Diversity Officer, Samuel Merritt University
Ariana Thompson-Lastad
Postdoctoral Fellow, Osher Center for Integrative Medicine, University of California, San Francisco
Cara McGuinness
Nurse Midwife, Boston Medical Center; Clinical Instructor, Department of Obstetrics & Gynecology, Boston University School of Medicine
Laura Duncan
MD/PhD Student in the Medical Scientist Training Program, Department of Anthropology, History and Social Medicine, University of California, San Francisco
Nimish Saxena
Undergraduate Student, University of California, Berkeley
Michael J. Harvey
Assistant Professor, Department of Health Science and Recreation, San Josá State University
Alice Langford
Undergraduate Student, University of California, Berkeley
Katiana L. Carey-Simms
Reproductive Health Specialist, Planned Parenthood Northern California
Sara N. Minahan
Nurse Midwife, Highland Hospital, Oakland, California
Shannon Satterwhite
Medical Student in the Medical Scientist Training Program, Department of Anthropology, History and Social Medicine, University of California, San Francisco
Caitlin Ruppel
Health Policy and Management MPH Student, School of Public Health, University of California, Berkeley
Sonia Lee
Senior Manager, Health Outreach Partners
Lillian Walkover
Postdoctoral Fellow in Global Health, Department of Sociology, Drexel University
Jorge De Avila
Medical Student, University of Chicago Pritzker School of Medicine
Brett Lewis
Medical Student, Oregon Health & Science University School of Medicine
Jenifer Matthews
Core Faculty, Department of Adolescent Medicine, UCSF Benioff Children's Hospital Oakland
Nicholas Nelson
Associate Program Director, Internal Medicine Residency Program, Highland Hospital, Oakland, California
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.
