IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v300y2022ics0277953621007851.html
   My bibliography  Save this article

Imagining the ‘structural’ in medical education and practice in the United States: A curricular investigation

Author

Listed:
  • Burson, Randall C.
  • Familusi, Olivia O.
  • Clapp, Justin T.

Abstract

A number of conceptual frameworks have emerged with the goal of helping clinicians understand and navigate the intersections of the health system and broader political, economic, and cultural processes when they care for patients. In this study, we analyze the impact that one emerging framework, “structural competency,” had on medical students' and physicians' understanding of societal problems affecting patient health and the practices of health systems. In this sub-analysis of a longitudinal qualitative study conducted between August and December 2020, we analyzed 19 semi-structured interviews with 7 first-year medical students, 7 upper-level medical students, and 5 physician course facilitators who participated in a course called Introduction to Medicine and Society at an medical school in the United States affiliated with a large urban academic medical center. This paper focuses on three main findings: how medical students and faculty describe “structures” and their effects on patients and patient care; how they use or imagine using structural competency to improve patient-physician communication and work interprofessionally to address social needs; and the emotional and personal reactions that confronting societal challenges provokes. We conclude that structural competency enhances existing efforts to improve patient-physician communication and to address patients' social needs. However, we highlight how structural competency efforts might fall short of their goal to shift physicians’ perspectives “upstream” to the determinants of health due to both critical ambiguities in the concept and inattention to the emotional and personal impacts of addressing societal problems in the clinic. These findings have practical implications for how clinicians are trained to act on societal issues from within the health system and conceptual implications for refining how existing frameworks and curricula conceive of the intersection between healthcare and broader processes.

Suggested Citation

  • Burson, Randall C. & Familusi, Olivia O. & Clapp, Justin T., 2022. "Imagining the ‘structural’ in medical education and practice in the United States: A curricular investigation," Social Science & Medicine, Elsevier, vol. 300(C).
    • Handle: RePEc:eee:socmed:v:300:y:2022:i:c:s0277953621007851
    DOI: 10.1016/j.socscimed.2021.114453
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953621007851
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2021.114453?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Metzl, Jonathan M. & Hansen, Helena, 2014. "Structural competency: Theorizing a new medical engagement with stigma and inequality," Social Science & Medicine, Elsevier, vol. 103(C), pages 126-133.
    2. Paul E Farmer & Bruce Nizeye & Sara Stulac & Salmaan Keshavjee, 2006. "Structural Violence and Clinical Medicine," PLOS Medicine, Public Library of Science, vol. 3(10), pages 1-6, October.
    3. Lomas, Jonathan, 1998. "Social capital and health: Implications for public health and epidemiology," Social Science & Medicine, Elsevier, vol. 47(9), pages 1181-1188, November.
    4. Pilnick, Alison & Dingwall, Robert, 2011. "On the remarkable persistence of asymmetry in doctor/patient interaction: A critical review," Social Science & Medicine, Elsevier, vol. 72(8), pages 1374-1382, April.
    5. Sharon R. Kaufman & Janet K. Shim & Ann J. Russ, 2006. "Old Age, Life Extension, and the Character of Medical Choice," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 61(4), pages 175-184.
    6. Feagin, Joe & Bennefield, Zinobia, 2014. "Systemic racism and U.S. health care," Social Science & Medicine, Elsevier, vol. 103(C), pages 7-14.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Metzl, Jonathan M. & Hansen, Helena, 2014. "Structural competency: Theorizing a new medical engagement with stigma and inequality," Social Science & Medicine, Elsevier, vol. 103(C), pages 126-133.
    2. Shilo St. Cyr & Elise Trott Jaramillo & Laura Garrison & Lorraine Halinka Malcoe & Stephen R. Shamblen & Cathleen E. Willging, 2021. "Intimate Partner Violence and Structural Violence in the Lives of Incarcerated Women: A Mixed-Method Study in Rural New Mexico," IJERPH, MDPI, vol. 18(12), pages 1-16, June.
    3. Sandra Ziegler & Camilla Michaëlis & Janne Sørensen, 2022. "Diversity Competence in Healthcare: Experts’ Views on the Most Important Skills in Caring for Migrant and Minority Patients," Societies, MDPI, vol. 12(2), pages 1-23, March.
    4. Asad, Asad L. & Kay, Tamara, 2015. "Toward a multidimensional understanding of culture for health interventions," Social Science & Medicine, Elsevier, vol. 144(C), pages 79-87.
    5. Yanrong Qiu & Kaihuai Liao & Yanting Zou & Gengzhi Huang, 2022. "A Bibliometric Analysis on Research Regarding Residential Segregation and Health Based on CiteSpace," IJERPH, MDPI, vol. 19(16), pages 1-21, August.
    6. Winskell, Kate & Sabben, Gaëlle, 2016. "Sexual stigma and symbolic violence experienced, enacted, and counteracted in young Africans’ writing about same-sex attraction," Social Science & Medicine, Elsevier, vol. 161(C), pages 143-150.
    7. Warren Kealy-Bateman & Georgina M. Gorman & Adam P. Carroll, 2021. "Patient/Consumer Codesign and Coproduction of Medical Curricula: A Possible Path Toward Improved Cultural Competence and Reduced Health Disparity," SAGE Open, , vol. 11(2), pages 21582440211, June.
    8. Slaughter-Acey, Jaime C. & Brown, Tony N. & Keith, Verna M. & Dailey, Rhonda & Misra, Dawn P., 2020. "A tale of two generations: Maternal skin color and adverse birth outcomes in Black/African American women," Social Science & Medicine, Elsevier, vol. 265(C).
    9. Michael A. Flynn & Pietra Check & Andrea L. Steege & Jacqueline M. Sivén & Laura N. Syron, 2021. "Health Equity and a Paradigm Shift in Occupational Safety and Health," IJERPH, MDPI, vol. 19(1), pages 1-13, December.
    10. Yonghua Li & Qinchuan Ran & Song Yao & Likun Ding, 2023. "Evaluation and Optimization of the Layout of Community Public Service Facilities for the Elderly: A Case Study of Hangzhou," Land, MDPI, vol. 12(3), pages 1-29, March.
    11. Nauenberg, Eric & Laporte, Audrey & Shen, Leilei, 2011. "Social capital, community size and utilization of health services: A lagged analysis," Health Policy, Elsevier, vol. 103(1), pages 38-46.
    12. Llanwarne, Nadia & Newbould, Jennifer & Burt, Jenni & Campbell, John L. & Roland, Martin, 2017. "Wasting the doctor's time? A video-elicitation interview study with patients in primary care," Social Science & Medicine, Elsevier, vol. 176(C), pages 113-122.
    13. Colin Forsyth & Sheba Meymandi & Ilan Moss & Jason Cone & Rachel Cohen & Carolina Batista, 2019. "Proposed multidimensional framework for understanding Chagas disease healthcare barriers in the United States," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 13(9), pages 1-23, September.
    14. Yang, Lawrence H. & Chen, Fang-pei & Sia, Kathleen Janel & Lam, Jonathan & Lam, Katherine & Ngo, Hong & Lee, Sing & Kleinman, Arthur & Good, Byron, 2014. "“What matters most:” A cultural mechanism moderating structural vulnerability and moral experience of mental illness stigma," Social Science & Medicine, Elsevier, vol. 103(C), pages 84-93.
    15. Marlow, Marguerite & Christie, Hope & Skeen, Sarah & Rabie, Stephan & Louw, Jacobus G. & Swartz, Leslie & Mofokeng, Shoeshoe & Makhetha, Moroesi & Tomlinson, Mark, 2021. "Alcohol use during pregnancy in rural Lesotho: “There is nothing else except alcohol”," Social Science & Medicine, Elsevier, vol. 291(C).
    16. Costas S. Constantinou & Panayiota Andreou & Monica Nikitara & Alexia Papageorgiou, 2022. "Cultural Competence in Healthcare and Healthcare Education," Societies, MDPI, vol. 12(6), pages 1-4, November.
    17. Hunt, Joanne Elizabeth, 2022. "Making space for disability studies within a structurally competent medical curriculum: Reflections on Long Covid," SocArXiv p9qyk, Center for Open Science.
    18. Schultz, Jennifer & O'Brien, A. Maureen & Tadesse, Bedassa, 2008. "Social capital and self-rated health: Results from the US 2006 social capital survey of one community," Social Science & Medicine, Elsevier, vol. 67(4), pages 606-617, August.
    19. Roy, Michael J. & Donaldson, Cam & Baker, Rachel & Kerr, Susan, 2014. "The potential of social enterprise to enhance health and well-being: A model and systematic review," Social Science & Medicine, Elsevier, vol. 123(C), pages 182-193.
    20. Semaan, Salaam & Sternberg, Maya & Zaidi, Akbar & Aral, Sevgi O., 2007. "Social capital and rates of gonorrhea and syphilis in the United States: Spatial regression analyses of state-level associations," Social Science & Medicine, Elsevier, vol. 64(11), pages 2324-2341, June.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:300:y:2022:i:c:s0277953621007851. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.