Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities
De Avila, J
Social Determinants of Health
Structural Determinants of Health
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/4258
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AbstractCopyright © 2020 Neff et al. Introduction: Research on disparities in health and health care has demonstrated that social, economic, and political factors are key drivers of poor health outcomes. Yet the role of such structural forces on health and health care has been incorporated unevenly into medical training. The framework of structural competency offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care. Methods: We report on a brief, interprofessional structural competency curriculum implemented in 32 distinct instances between 2015 and 2017 throughout the San Francisco Bay Area. In consultation with medical and interprofessional education experts, we developed open-ended, written-response surveys to qualitatively evaluate this curriculum's impact on participants. Qualitative data from 15 iterations were analyzed via directed thematic analysis, coding language, and concepts to identify key themes. Results: Three core themes emerged from analysis of participants' comments. First, participants valued the curriculum's focus on the application of the structural competency framework in real-world clinical, community, and policy contexts. Second, participants with clinical experience (residents, fellows, and faculty) reported that the curriculum helped them reframe how they thought about patients. Third, participants reported feeling reconnected to their original motivations for entering the health professions. Discussion: This structural competency curriculum fills a gap in health professional education by equipping learners to understand and respond to the role that social, economic, and political structural factors play in patient and community health.
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Examining the Effects of Structured and Non-Structured Therapeutic Activity Programming in a Forensic Mental Health Treatment FacilityIwasaki, Yoshitaka; Davey, Adam; Stahler, Gerald; Eyrich-Garg, Karin (Temple University. Libraries, 2011)Examining the Effects of Structured and Non-Structured Therapeutic Activity Programming in a Forensic Mental Health Treatment Facility: North Florida Evaluation and Treatment Center (NFETC) is an evaluation and treatment center for individuals with mental illnesses who are involved in the criminal justice system. NFETC offers services to adult males who are either incompetent to proceed to trial or have been judged to be not guilty by reason of insanity. In 2005, DCF implemented a system of structured programming in their state forensic psychiatric hospitals. Resident programming went from a referral based activity program (approximately 6 hours per week for each resident) to a structured activity program (approximately 24 hours per week for each resident). In the previous system, a resident's involvement in the referral based activity program was initiated by the residents' counselor and based on the resident's interests. In the current structured TAP program, all residents now average 24 hours per week of activity involvement. Resident attendance is mandatory for those well enough to attend programming. Despite the importance decreasing length of stay (LOS) has on state legal and criminal systems, little research exists on the role recently implemented structured programming plays in resident LOS. This study contains Retrospective Quantitative analyses on the relationships between facility programming and resident demographics, criminal charges, mental health diagnoses, LOS, and attendance and participation rates; as well as Qualitative analyses on program offerings and staff impressions of the current structured programming at NFETC. The results suggest that, despite many differences between the samples of residents receiving the two programs, there is a therapeutic value to the activity programs offered regardless of the program setting. With consideration of staff perspectives and quantitative findings, the current program can be restructured to provide additional benefit. The benefits of activity programming in general were evident in the results of the analyses run separately for each program. Within the Referral based programming, residents with lower participation levels had an increased LOS. Within the structured TAP programming, residents with lower participation levels had an increased LOS and residents with high participation levels had a decreased LOS. These results indicate that involvement in therapeutic activities, regardless of programming format, may be beneficial in decreasing LOS. The Qualitative staff interview component of the current research provided additional insight into issues related to the prior and current program offerings at NFETC, much of which were supported by the Quantitative data. Qualitative findings included staff impressions of both programs as well as issues regarding LOS, value of therapeutic activities, accessibility, attendance, resident choice, internal motivation, safety, program content, and resident participation. The issues, if addressed, have the potential to streamline the program at NFETC into a more effective and useful therapeutic element. These Quantitative and Qualitative findings should serve as suggestions for a program revamping at NFETC.
The functions of nonsuicidal self-injury: Converging evidence for a two-factor structureKlonsky, ED; Glenn, CR; Styer, DM; Olino, TM; Washburn, JJ (2015-09-28)© 2015 Klonsky et al. Research has identified more than a dozen functions of non-suicidal self-injury (NSI), but the conceptual and empirical overlap among these functions remains unclear. The present study examined the structure of NSI functions in two large samples of patients receiving acute-care treatment for NSI. Two different measures of NSI functions were utilized to maximize generalizability of findings: one sample (n = 946) was administered the Inventory of Statements About Self-injury (ISAS; Klonsky and Glenn in J Psychopathol Behav Assess 31:215-219, 2009), and a second sample (n = 211) was administered the Functional Assessment of Self-Mutilation (FASM; Lloyd et al. in Self-mutilation in a community sample of adolescents: descriptive characteristics and provisional prevalence rates. Poster session at the annual meeting of the Society for Behavioral Medicine, New Orleans, LA, 1997). Exploratory factor analyses revealed that both measures exhibited a robust two-factor structure: one factor represented Intrapersonal functions, such as affect regulation and anti-dissociation, and a second factor represented Social functions, such as interpersonal influence and peer bonding. In support of the two-factor structure's construct validity, the factors exhibited a pattern of correlations with indicators of NSI severity that was consistent with past research and theory. Findings have important implications for theory, research, and treatment. In particular, the two-factor framework should guide clinical assessment, as well as future research on the implications of NSI functions for course, prognosis, treatment, and suicide risk.
A Scoping Review of the Literature on the Relationship Between Social and Structural Determinants of Health and Neurosurgical OutcomesCabey, Vielka Whitney; Jones, Nora L.; Jones, Nora L. (Temple University. Libraries, 2021)This thesis discloses findings from a scoping review of Social and Structural Determinant of Health (SSDOH)-related academic and grey literature from neurosurgery and fields with neurosurgical overlap. The purpose of this thesis is to identify which social determinants have been assessed, for which surgical procedures they were evaluated, and what disparities were found. To identify studies to include or consider for this systematic review, the review team worked with a medical librarian to develop detailed search strategies for each database. Studies were screened by title and abstract independently by two reviewers. Disagreements between reviewers were resolved by a third reviewer, blinded to the decisions of the primary reviewers. The scoping review of the SSDOH in neurosurgical outcomes identified 99 studies from the year 1990 to 2020. Identified studies were targeted predominantly toward spine surgery patients, evenly distributed in analyses of gender, race and economic stability. The relatively low volume of neurosurgical papers focused on the SSDOH and emphasis on one subspecialty demonstrates the need for an expanded interest in the SSDOH in neurosurgery.