Petty JuLeigh, Metzl Jonathan M, Keeys Mia R
Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN, USA.
Department of Sociology, Vanderbilt University, Nashville, TN, USA.
J Med Humanit. 2017 Dec;38(4):459-471. doi: 10.1007/s10912-017-9449-1.
The inclusion of structural competency training in pre-health undergraduate programs may offer significant benefits to future healthcare professionals. This paper presents the results of a comparative study of an interdisciplinary pre-health curriculum based in structural competency with a traditional premedical curriculum. The authors describe a new evaluation tool, the Structural Foundations of Health Survey © (2016), developed to evaluate structural skills and sensibilities. The authors use the survey to evaluate two groups of graduating seniors at Vanderbilt University-majors in an interdisciplinary pre-health curriculum titled Medicine, Health, and Society (MHS), and premed science majors-with particular attention to understanding how political, cultural, economic, and social factors shape health. Results suggest that MHS majors identified and analyzed relationships between structural factors and health outcomes at higher rates and in deeper ways than did premed science majors. MHS students also demonstrated higher understanding of structural and cultural competency in their approaches to race, intersectionality, and racial health disparities. The skills that MHS students exhibited represent proficiencies increasingly emphasized by the MCAT, the AAMC, and other educational bodies that, in an era of epigenetics and social determinants, emphasize how contextual factors shape expressions of health and illness.
在健康相关专业本科课程中纳入结构能力培训，可能会给未来的医疗保健专业人员带来显著益处。本文介绍了一项比较研究的结果，该研究对比了基于结构能力的跨学科健康相关专业课程与传统医学预科课程。作者描述了一种新的评估工具——《健康结构基础调查问卷》（2016年版），该工具旨在评估结构技能和认知。作者使用该调查问卷对范德堡大学的两组即将毕业的大四学生进行评估，一组是跨学科健康相关专业课程“医学、健康与社会”（MHS）的专业学生，另一组是医学预科理科专业学生，特别关注理解政治、文化、经济和社会因素如何塑造健康。结果表明，与医学预科理科专业学生相比，MHS专业学生能以更高的比例、更深入的方式识别和分析结构因素与健康结果之间的关系。MHS专业学生在处理种族、交叉性和种族健康差异问题时，对结构和文化能力也有更高的理解。MHS专业学生所展现的技能代表了美国医学院入学考试（MCAT）、美国医学协会（AAMC）和其他教育机构日益强调的能力，在表观遗传学和社会决定因素的时代，这些机构强调背景因素如何塑造健康和疾病的表现。
