Cited by 262Innovations in Medical EducationCultural Competency in Health CareHealth and Medical Education

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

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Neff, Joshua, Holmes, Seth M., Knight, Kelly R., Strong, Shirley, Thompson-Lastad, Ariana, McGuinness, Cara, Duncan, Laura, Saxena, Nimish, Harvey, Michael J., Langford, Alice, Carey-Simms, Katiana L., Minahan, Sara N., Satterwhite, Shannon, Ruppel, Caitlin, Lee, Sonia, Walkover, Lillian, De Avila, Jorge, Lewis, Brett, Matthews, Jenifer, Nelson, Nicholas·2020·MedEdPORTAL

DOI 10.15766/mep_2374-8265.10888PMC PMC7182045

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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.

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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: Neff, Joshua
Holmes, Seth M.
Knight, Kelly R.
McGuinness, Cara
Harvey, Michael J.
Satterwhite, Shannon
Lee, Sonia
Walkover, Lillian
Matthews, Jenifer
Venue: MedEdPORTAL
Publisher: Association of American Medical Colleges
Published: 2020-03-13
Volume: 16
Pages: 10888-10888
ISSN: 2374-8265 (ISSN-L)
DOI: 10.15766/mep_2374-8265.10888
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
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: Social Sciences › Education › Innovations in Medical Education
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities

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