Resident, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
Associate Professor, Division of Society and Environment, Department of Environmental Science, Policy, and Management, University of California, Berkeley.
MedEdPORTAL. 2020 Mar 13;16:10888. doi: 10.15766/mep_2374-8265.10888.
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.
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.
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.
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.
健康和医疗保健差距的研究表明，社会、经济和政治因素是健康不良结果的关键驱动因素。然而，这种结构性力量对健康和医疗保健的影响在医学培训中并没有得到统一的纳入。结构能力框架为培训医疗专业人员提供了一种模式，使他们能够认识到并应对上游结构性因素对患者健康和医疗保健的影响。
我们报告了一个简短的、跨专业的结构能力课程，该课程于 2015 年至 2017 年在旧金山湾区的 32 个不同地点实施。我们与医学和跨专业教育专家协商，开发了开放式书面反应调查，以定性评估该课程对参与者的影响。对 15 次迭代的定性数据进行了定向主题分析、编码语言和概念分析，以确定关键主题。
从参与者评论的分析中得出了三个核心主题。首先，参与者重视课程将结构能力框架应用于现实世界中的临床、社区和政策环境的重点。其次，具有临床经验的参与者（住院医师、研究员和教师）报告说，该课程帮助他们重新思考他们对患者的看法。第三，参与者报告说，他们重新感受到了进入医疗保健行业的最初动力。
该结构能力课程通过使学习者能够理解和应对社会、经济和政治结构因素在患者和社区健康中所扮演的角色，填补了健康专业教育的空白。
