Acad Med. 2024 Aug 1;99(8):857-862. doi: 10.1097/ACM.0000000000005756. Epub 2024 May 10.
Structural competency is increasingly valued as a framework to address health equity within undergraduate medical education. As of academic year 2023-2024, the Liaison Committee on Medical Education (LCME) requires that medical schools have content regarding basic principles of structurally competent health care. Despite encouraging data about the effectiveness of structural competency curricula, most occur within the walls of a classroom and do not enter the authentic or simulated clinical space.
From 2022 to 2023, an objective structured clinical exam (OSCE) focused on premature discharge, previously known as discharge against medical advice, was integrated into the required fourth-year Health Policy course at Weill Cornell Medical College, which uses the framework of structural competency. After a simulated clinical encounter, students completed a reflection assignment and participated in group debriefing to reflect on how policy coursework affected their simulated clinical experience. Students completed an evaluation about their OSCE experience, and OSCE checklist performance was analyzed.
Of 82 students who participated in the curriculum, 68 completed a curricular evaluation, and 62 consented to have their OSCE performance evaluated for research. Mean overall OSCE checklist performance evaluating students' patient-centered communication skills, harm reduction skills, and discharge planning and counseling was 14.3/16 (89.6%; standard deviation, 9.8%). Students reported it was valuable to focus on structural factors affecting care within the simulated clinical encounter by using the structural competency framework.
To the authors' knowledge, this is the first OSCE for medical students designed to deepen their understanding of structural competency by embedding the experience into an existing course using the framework. Future work should explore how this curriculum affects students' attitudes toward structurally vulnerable patients. With structural competency as an LCME requirement, the use of OSCEs may give educators a means to teach and assess fundamental concepts.
结构能力越来越被视为解决本科医学教育中健康公平问题的框架。截至 2023-2024 学年，医学教育联络委员会（LCME）要求医学院校必须包含有关基本结构能力医疗保健原则的内容。尽管有关结构能力课程有效性的令人鼓舞的数据，但大多数课程都在课堂范围内进行，并未进入真实或模拟的临床环境。
2022 年至 2023 年，一项针对提前出院（以前称为出院违反医嘱）的客观结构化临床考试（OSCE）被整合到威尔康奈尔医学院必修的第四年健康政策课程中，该课程使用结构能力框架。在模拟临床接触后，学生完成反思作业并参加小组讨论，以反思政策课程如何影响他们的模拟临床经验。学生完成了对 OSCE 体验的评估，并且对 OSCE 检查表的表现进行了分析。
在参与课程的 82 名学生中，有 68 名完成了课程评估，有 62 名同意对其 OSCE 表现进行研究评估。评估学生以患者为中心的沟通技巧、减少伤害技巧、出院计划和咨询的整体 OSCE 检查表平均得分为 14.3/16（89.6%；标准差，9.8%）。学生报告说，在模拟临床接触中使用结构能力框架专注于影响护理的结构因素非常有价值。
据作者所知，这是第一次为医学生设计的 OSCE，旨在通过在现有课程中使用框架嵌入该体验来加深他们对结构能力的理解。未来的工作应该探讨该课程如何影响学生对结构脆弱患者的态度。随着结构能力成为 LCME 的要求，OSCE 可能为教育工作者提供一种教授和评估基本概念的方法。
