Joshua Neff1, Kelly R Knight2, Shannon Satterwhite3,4, Nick Nelson5,6, Jenifer Matthews7, Seth M Holmes8,9,10,11,12,13,14. 1. Joint Medical Program, UC Berkeley-UCSF, Berkeley, CA, USA. 2. Department of Anthropology, History, and Social Medicine, UCSF, San Francisco, CA, USA. 3. Medical Scientist Training Program, UCSF, San Francisco, CA, USA. 4. Joint Program in Medical Anthropology, UC Berkeley-UCSF, San Francisco, CA, USA. 5. Department of Medicine, Highland Hospital, Oakland, CA, USA. 6. Department of Medicine, UCSF, San Francisco, CA, USA. 7. Department of Adolescent Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA. 8. Joint Medical Program, UC Berkeley-UCSF, Berkeley, CA, USA. sethmholmes@berkeley.edu. 9. Department of Anthropology, History, and Social Medicine, UCSF, San Francisco, CA, USA. sethmholmes@berkeley.edu. 10. Medical Scientist Training Program, UCSF, San Francisco, CA, USA. sethmholmes@berkeley.edu. 11. Joint Program in Medical Anthropology, UC Berkeley-UCSF, San Francisco, CA, USA. sethmholmes@berkeley.edu. 12. Department of Medicine, Highland Hospital, Oakland, CA, USA. sethmholmes@berkeley.edu. 13. School of Public Health, UC Berkeley, Berkeley, CA, USA. sethmholmes@berkeley.edu. 14. University of California Berkeley, 50 University Hall, MC 7360, Berkeley, CA, 94720, USA. sethmholmes@berkeley.edu.
Abstract
BACKGROUND: The influence of societal inequities on health has long been established, but such content has been incorporated unevenly into medical education and clinical training. Structural competency calls for medical education to highlight the important influence of social, political, and economic factors on health outcomes. AIM: This article describes the development, implementation, and evaluation of a structural competency training for medical residents. SETTING: A California family medicine residency program serving a patient population predominantly (88 %) with income below 200 % of the federal poverty level. PARTICIPANTS: A cohort of 12 residents in the family residency program. PROGRAM DESCRIPTION: The training was designed to help residents recognize and develop skills to respond to illness and health as the downstream effects of social, political, and economic structures. PROGRAM EVALUATION: The training was evaluated via qualitative analysis of surveys gathered immediately post-training (response rate 100 %) and a focus group 1 month post-training (attended by all residents not on service). DISCUSSION: Residents reported that the training had a positive impact on their clinical practice and relationships with patients. They also reported feeling overwhelmed by increased recognition of structural influences on patient health, and indicated a need for further training and support to address these influences.
BACKGROUND: The influence of societal inequities on health has long been established, but such content has been incorporated unevenly into medical education and clinical training. Structural competency calls for medical education to highlight the important influence of social, political, and economic factors on health outcomes. AIM: This article describes the development, implementation, and evaluation of a structural competency training for medical residents. SETTING: A California family medicine residency program serving a patient population predominantly (88 %) with income below 200 % of the federal poverty level. PARTICIPANTS: A cohort of 12 residents in the family residency program. PROGRAM DESCRIPTION: The training was designed to help residents recognize and develop skills to respond to illness and health as the downstream effects of social, political, and economic structures. PROGRAM EVALUATION: The training was evaluated via qualitative analysis of surveys gathered immediately post-training (response rate 100 %) and a focus group 1 month post-training (attended by all residents not on service). DISCUSSION: Residents reported that the training had a positive impact on their clinical practice and relationships with patients. They also reported feeling overwhelmed by increased recognition of structural influences on patient health, and indicated a need for further training and support to address these influences.
Entities:
Keywords:
cultural competency; medical education; social determinants of health; structural competency; structural vulnerability
Authors: Michael S Krasner; Ronald M Epstein; Howard Beckman; Anthony L Suchman; Benjamin Chapman; Christopher J Mooney; Timothy E Quill Journal: JAMA Date: 2009-09-23 Impact factor: 56.272
Authors: Marshall H Chin; Amanda R Clarke; Robert S Nocon; Alicia A Casey; Anna P Goddu; Nicole M Keesecker; Scott C Cook Journal: J Gen Intern Med Date: 2012-08 Impact factor: 5.128
Authors: Enrico G Castillo; Jessica Isom; Katrina L DeBonis; Ayana Jordan; Joel T Braslow; Robert Rohrbaugh Journal: Acad Med Date: 2020-12 Impact factor: 6.893
Authors: S Spitzer-Shohat; D Sagi; M Schuster; M Ben-Ami; M Rivo; R Tur-Kaspa; M C J Rudolf Journal: J Gen Intern Med Date: 2019-07 Impact factor: 5.128
Authors: Bisan A Salhi; Jennifer W Tsai; Jeffrey Druck; Jacqueline Ward-Gaines; Melissa H White; Bernard L Lopez Journal: AEM Educ Train Date: 2019-12-19
Authors: Rachel B Atkinson; Jasmine A Khubchandani; Maria B J Chun; Emma Reidy; Gezzer Ortega; Paul A Bain; Caroline Demko; Jeenn Barreiro-Rosado; Tara S Kent; Douglas S Smink Journal: J Grad Med Educ Date: 2022-02
Authors: Bisan A Salhi; Amy Zeidan; Christine R Stehman; Sarah Kleinschmidt; E Liang Liu; Kristen Bascombe; Kian Preston-Suni; Melissa H White; Jeff Druck; Bernard L Lopez; Margaret E Samuels-Kalow Journal: AEM Educ Train Date: 2022-06-23