title: Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians.
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.
  
  
  OBJECTIVE
  This article describes the development, implementation, and evaluation of a structural competency training for medical residents.
  
  
  METHODS
  A California family medicine residency program serving a patient population predominantly (88 %) with income below 200 % of the federal poverty level.
  
  
  METHODS
  A cohort of 12 residents in the family residency program.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Joint Medical Program, UC Berkeley-UCSF, Berkeley, CA, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Neff
authors.affiliation: Department of Anthropology, History, and Social Medicine, UCSF, San Francisco, CA, USA.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Knight
authors.affiliation: Medical Scientist Training Program, UCSF, San Francisco, CA, USA.|Joint Program in Medical Anthropology, UC Berkeley-UCSF, San Francisco, CA, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Satterwhite
authors.affiliation: Department of Medicine, Highland Hospital, Oakland, CA, USA.|Department of Medicine, UCSF, San Francisco, CA, USA.
authors.forename: Nick
authors.initials: N
authors.lastname: Nelson
authors.affiliation: Department of Adolescent Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA.
authors.forename: Jenifer
authors.initials: J
authors.lastname: Matthews
authors.affiliation: Joint Medical Program, UC Berkeley-UCSF, Berkeley, CA, USA. sethmholmes@berkeley.edu.|Department of Anthropology, History, and Social Medicine, UCSF, San Francisco, CA, USA. sethmholmes@berkeley.edu.|Medical Scientist Training Program, UCSF, San Francisco, CA, USA. sethmholmes@berkeley.edu.|Joint Program in Medical Anthropology, UC Berkeley-UCSF, San Francisco, CA, USA. sethmholmes@berkeley.edu.|Department of Medicine, Highland Hospital, Oakland, CA, USA. sethmholmes@berkeley.edu.|School of Public Health, UC Berkeley, Berkeley, CA, USA. sethmholmes@berkeley.edu.|University of California Berkeley, 50 University Hall, MC 7360, Berkeley, CA, 94720, USA. sethmholmes@berkeley.edu.
authors.forename: Seth M
authors.initials: SM
authors.lastname: Holmes
mesh_terms: D002140:California; D002983:Clinical Competence; D003154:Community Medicine / Q000193:education; D054521:Cultural Competency / Q000193:education*; D003479:Curriculum; D005069:Evaluation Studies as Topic; D017144:Focus Groups; D054624:Health Status Disparities; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D010817:Physician-Patient Relations; D015397:Program Evaluation
keywords: cultural competency; medical education; social determinants of health; structural competency; structural vulnerability