Using a Structural Competency Framework to Teach Structural Racism in Pre-Health Education

• In Event: Racism and Health II

Abstract

Racial disparities in health and healthcare are increasingly shown to reflect biases embedded in the U.S. healthcare system. This paper contributes to a growing body of literature that posits structural competency as a conceptual framework for bridging the gap between individual and institutional bias, or between what racism in medicine is and what it does. Structural competency calls on healthcare providers and students to recognize how institutions, markets, or healthcare delivery systems shape symptom presentations and to mobilize for correction of health and wealth inequalities in society.

To date, most structural competency interventions have targeted healthcare providers and medical students. Yet the inclusion of structural competency training in pre-health undergraduate programs may offer significant benefits to future healthcare professionals. This paper presents the results of a comparative study of an interdisciplinary pre-health curriculum based in structural competency with a traditional premedical curriculum. The author describes a new evaluation tool, the Structural Foundations of Health Survey (2016), developed to evaluate structural skills and sensibilities. The author uses the survey to evaluate two groups of graduating seniors at Vanderbilt University—majors in an interdisciplinary pre-health curriculum titled Medicine, Health, and Society (MHS), and premed science majors—as well as first-semester freshmen, with particular attention to understanding how structural factors shape health. Results suggest that MHS majors identified and analyzed relationships between structural factors and health outcomes and structural racism at higher rates and in deeper ways than did premed science majors and freshmen, and also demonstrated higher understanding of structural and implicit racism and health disparities. The skills that MHS students exhibited represent proficiencies increasingly stressed by the MCAT, the AAMC, and other educational bodies that emphasize how contextual factors shape expressions of health and illness.

Author

• Jonathan Metzl, Vanderbilt MHS