title: Integrating and Assessing Structural Competency in an Innovative Prehealth Curriculum at Vanderbilt University.
abstract: Structural competency is a framework for conceptualizing and addressing health-related social justice issues that emphasizes diagnostic recognition of economic and political conditions producing and racializing inequalities in health. Strategies are needed to teach prehealth undergraduate students concepts central to structural competency (e.g., structural inequity, structural racism, structural stigma) and to evaluate their impact.
  
  
  
  The curriculum for Vanderbilt University's innovative prehealth major in medicine, health, and society (MHS) was reshaped in 2013 to incorporate structural competency concepts and skills into undergraduate courses. The authors developed the Structural Foundations of Health (SFH) evaluation instrument, with closed- and open-ended questions designed to assess undergraduate students' core structural competency skills. They piloted the SFH instrument in 2015 with MHS seniors.
  
  
  
  Of the 85 students included in the analysis, most selected one or more structural factors as among the three most important in explaining U.S. regional childhood obesity rates (85%) and racial disparities in heart disease (92%). More than half described individual- or family-level structural factors (66%) or broad social and political factors (56%) as influencing geographic disparities in childhood obesity. Nearly two-thirds (66%) described racial disparities in heart disease as consequences of socioeconomic differences, discrimination/stereotypes, or policies with racial implications.
  
  
  
  Preliminary data suggest that the MHS major trained students to identify and analyze relationships between structural factors and health outcomes. Future research will include a comparison of structural competency skills among MHS students and students in the traditional premedical track and assessment of these skills in incoming first-year students.
authors.affiliation: J.M. Metzl is Frederick B. Rentschler II Professor of Sociology and Medicine, Health, and Society, director, Center for Medicine, Health, and Society, and professor of psychiatry, Vanderbilt University, Nashville, Tennessee.J. Petty is senior lecturer and assistant director, Center for Medicine, Health, and Society, and senior lecturer, Vanderbilt University, Nashville, Tennessee.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Metzl
authors.forename: JuLeigh
authors.initials: J
authors.lastname: Petty
mesh_terms: D054521:Cultural Competency / Q000193:education*; D018864:Cultural Diversity; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D006801:Humans; D012935:Social Justice / Q000193:education*; D013337:Students, Medical / Q000523:psychology*; D013714:Tennessee; D014495:Universities