Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities
Open accessAbstract
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.
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Meaningful engagement in advocacy can mitigate burnout.
“Data suggests that meaningful engagement in advocacy can reinforce physician identity and the choice to practice medicine8–11,26, provide an outlet for stress management27, mitigate burnout7–9,26,28, and support professional development29.”
From Advocacy Curricula in Graduate Medical Education: an Updated Systematic Review from 2017 to 2022 (2023) · cites this paper as [9]
The Discussion (page unavailable) says collective action to address structural problems can help address burnout, which supports the possibility that advocacy may mitigate it. But the paper presents this as an argument, not a measured effect of meaningful advocacy engagement, and says further research is needed. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMeaningful engagement in advocacy can reinforce physician identity and the choice to practice medicine.
“Data suggests that meaningful engagement in advocacy can reinforce physician identity and the choice to practice medicine8–11,26, provide an outlet for stress management27, mitigate burnout7–9,26,28, and support professional development29.”
From Advocacy Curricula in Graduate Medical Education: an Updated Systematic Review from 2017 to 2022 (2023) · cites this paper as [9]
The Results report that some medical students and physicians felt reconnected to their reasons for entering medicine after structural-competency training; one fellow also said the training inspired policy advocacy. The paper does not show that meaningful engagement in advocacy itself reinforced physician identity or the choice to practice medicine. (LLM, conf=0.83)
Experimental — accuracy not yet measuredSeveral curricula recommended that educators explicitly discuss how developed skills can be applied in a medical career and emphasize that advocacy is achievable and important to physician identity irrespective of career path.
“Several curricula recommended that educators explicitly discuss how developed skills can be applied in a medical career9,12,14 and emphasize that advocacy is achievable and important to physician identity irrespective of career path13.”
From Advocacy Curricula in Graduate Medical Education: an Updated Systematic Review from 2017 to 2022 (2023) · cites this paper as [9]
The Methods > Implementation section describes teaching why structural competency matters for providers, using an example of provider advocacy and discussing ways to intervene in and beyond the clinic. This supports presenting advocacy as important and actionable, but our copy does not say educators should link it to physician identity irrespective of career path. (LLM, conf=0.84)
Experimental — accuracy not yet measuredLack of formal, explicit, and consistent training leads to inadequate preparation of trainees.
“Lack of formal7, 8,11,19,21, explicit9,31, and consistent11,16,32 training leads to inadequate preparation13,28,33 of trainees and negatively impacts patient care13.”
From Advocacy Curricula in Graduate Medical Education: an Updated Systematic Review from 2017 to 2022 (2023) · cites this paper as [9]
Trainees value real-world application of advocacy frameworks as well as active learning opportunities.
“trainees value real-world application of advocacy frameworks9,10,12,14 as well as active learning opportunities40.”
From Advocacy Curricula in Graduate Medical Education: an Updated Systematic Review from 2017 to 2022 (2023) · cites this paper as [9]
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- Authors
- Neff, J., Holmes, S. M., Knight, K. R., Strong, S., Thompson-Lastad, A., McGuinness, C., Duncan, L., Saxena, N., Harvey, M. J., Langford, A., Carey-Simms, K. L., Minahan, S. N., Satterwhite, S., Ruppel, C., Lee, S., Walkover, L., De Avila, J., Lewis, B., Matthews, J., & Nelson, N.
- Affiliations
- University of California, Los Angeles (US)
- University of California, Berkeley (US)
- University of California, San Francisco (US)
- Samuel Merritt University (US)
- Postdoctoral Fellow, Osher Center for Integrative Medicine, University of California, San Francisco
- Boston University (US)
- San Jose State University (US)
- Planned Parenthood (US)
- Highland Hospital (US)
- Senior Manager, Health Outreach Partners
- Drexel University (US)
- Medical Student, University of Chicago Pritzker School of Medicine
- Oregon Health & Science University (US)
- UCSF Benioff Children's Hospital (US)
- Corresponding author
- Neff, Joshua
- ORCID
- Venue
- MedEdPORTAL
- Published
- 2020-03-13
- Volume
- 16
- Pages
- 10888-10888
- ISSN
- 2374-8265 (ISSN-L)
- PMC
- PMC7182045
- OpenAlex
- W3009702730
- Cited by
- 262
- References
- 40
- Citations by year
- 2026: 18 · 2025: 38 · 2024: 49 · 2023: 57 · 2022: 46 · 2021: 41 · 2020: 12 · 2012: 1
- FWCI
- 29.25
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- other-oa
- Locations
- MedEdPORTAL (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion, other-oa)
- San José State University ScholarWorks (San Jose State University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- TUScholarShare (Temple University) (submittedVersion, cc-by)
- Funders
- University of California Berkeley
- University of California, San Francisco
- National Institute of General Medical Sciences (T32GM007618)
- National Center for Complementary and Integrative Health (T32AT003997)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Health Sciences › Health Professions › General Health Professions › Health and Medical Education
- Keywords
- structural competency, health disparities, structural determinants of health, interprofessional education, medical curriculum, residents and fellows, social determinants of health, health policy, curriculum evaluation, learner perceptions
- MeSH terms
- Curriculum, Health Occupations, Health Personnel, Humans, San Francisco, Students, Medical
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