Alonso Luaces Maria, Bridges Kristina M, Mabachi Natabhona M, Smith Margaret L, Francis Carrie L
Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA.
Research and Evaluation Division, DARTNet Institute, Aurora, CO, USA.
J Med Educ Curric Dev. 2025 Sep 25;12:23821205251380021. doi: 10.1177/23821205251380021. eCollection 2025 Jan-Dec.
Traditional discussions of race-related health inequities in medical education often focus on the racialized individual, neglecting the role of systemic racism and other oppressive structures that drive resource inequities. Structural competency equips healthcare providers and trainees to critically analyze how structural racism creates health disparities.
This study used focus groups with medical students (n = 56) and key informant interviews with faculty (n = 9) at a single academic medical center to explore experiences and perceptions of discussions about structural competency and the health effects of structural racism in small group learning communities. Activity Theory served as the analytical framework to understand environmental factors shaping these discussions, highlighting primary and secondary contradictions within the model activity system.
The analysis revealed several tensions within the activity system that impacted discussions about race, structural racism, and inequities including, (1) questions of whether structural competency should be an explicit medical school outcome, (2) persistent biases in the curriculum, (3) faculty discomfort and limited expertise in leading discussions, (4) questions about who bears responsibility for facilitating these conversations, and (5) implicit and explicit rules shaping which types of knowledge are prioritized.
These findings inform the development of educational tools and faculty support strategies to enhance teaching and learning around structural competency in medical education.
医学教育中关于种族相关健康不平等的传统讨论通常聚焦于被种族化的个体，而忽视了系统性种族主义及其他导致资源不平等的压迫性结构所起的作用。结构胜任力使医疗服务提供者和受训人员能够批判性地分析结构种族主义是如何造成健康差异的。
本研究在一家学术医疗中心，通过对医学生（n = 56）进行焦点小组访谈以及对教师（n = 9）进行关键信息人访谈，来探索在小组学习社区中关于结构胜任力讨论的经历和看法，以及结构种族主义对健康的影响。活动理论作为分析框架，用于理解塑造这些讨论的环境因素，突出模型活动系统中的主要和次要矛盾。
分析揭示了活动系统中影响关于种族、结构种族主义和不平等讨论的几种矛盾，包括：（1）结构胜任力是否应作为医学院明确的成果这一问题；（2）课程中持续存在的偏见；（3）教师在主持讨论时的不适和有限的专业知识；（4）关于谁负责推动这些对话的问题；（5）塑造哪些类型的知识被优先考虑的隐含和明确规则。
这些发现为开发教育工具和教师支持策略提供了参考，以加强医学教育中围绕结构胜任力的教学与学习。
