Structural competency: theorizing a new medical engagement with stigma and inequality. Metzl, J. M. & Hansen, H. Soc Sci Med, 103:126–133, February, 2014. Annotation
The authors examine the current state of medical education and recommend changes to emphasize recognition of outside influences on health outcomes. doi abstract bibtex This paper describes a shift in medical education away from pedagogic approaches to stigma and inequalities that emphasize cross-cultural understandings of individual patients, toward attention to forces that influence health outcomes at levels above individual interactions. It reviews existing structural approaches to stigma and health inequalities developed outside of medicine, and proposes changes to U.S. medical education that will infuse clinical training with a structural focus. The approach, termed "structural competency," consists of training in five core competencies: 1) recognizing the structures that shape clinical interactions; 2) developing an extra-clinical language of structure; 3) rearticulating "cultural" formulations in structural terms; 4) observing and imagining structural interventions; and 5) developing structural humility. Examples are provided of structural health scholarship that should be adopted into medical didactic curricula, and of structural interventions that can provide participant-observation opportunities for clinical trainees. The paper ultimately argues that increasing recognition of the ways in which social and economic forces produce symptoms or methylate genes then needs to be better coupled with medical models for structural change.
@article{metzl_structural_2014,
title = {Structural competency: theorizing a new medical engagement with stigma and inequality},
volume = {103},
issn = {1873-5347},
shorttitle = {Structural competency},
doi = {10.1016/j.socscimed.2013.06.032},
abstract = {This paper describes a shift in medical education away from pedagogic approaches to stigma and inequalities that emphasize cross-cultural understandings of individual patients, toward attention to forces that influence health outcomes at levels above individual interactions. It reviews existing structural approaches to stigma and health inequalities developed outside of medicine, and proposes changes to U.S. medical education that will infuse clinical training with a structural focus. The approach, termed "structural competency," consists of training in five core competencies: 1) recognizing the structures that shape clinical interactions; 2) developing an extra-clinical language of structure; 3) rearticulating "cultural" formulations in structural terms; 4) observing and imagining structural interventions; and 5) developing structural humility. Examples are provided of structural health scholarship that should be adopted into medical didactic curricula, and of structural interventions that can provide participant-observation opportunities for clinical trainees. The paper ultimately argues that increasing recognition of the ways in which social and economic forces produce symptoms or methylate genes then needs to be better coupled with medical models for structural change.},
language = {eng},
journal = {Soc Sci Med},
author = {Metzl, Jonathan M. and Hansen, Helena},
month = feb,
year = {2014},
pmid = {24507917},
pmcid = {PMC4269606},
keywords = {Disparities, Inequity, Cultural Humility, Social Determinants of Health, Social Justice, Socioeconomic Factors, Structural Competency, Health Disparities, Physicians, Racial Inequality, Stigma, Medical Treatment/Intervention},
pages = {126--133},
bibbase_note = { <p class="annotation-paragraphs" style="content: 'A'; display: block;"> Annotation </p>The authors examine the current state of medical education and recommend changes to emphasize recognition of outside influences on health outcomes.
},
file = {Full Text:files/231/Metzl and Hansen - 2014 - Structural competency theorizing a new medical en.pdf:application/pdf},
}
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