Advertisement

Introducing a Structural Competency Framework for Psychiatry Residents: Drawing Your Neighborhood

  • Walter MathisEmail author
  • Kali Cyrus
  • Ayana Jordan
  • Robert Rohrbaugh
Feature: Educational Case Report

Training medical students and residents to address the social determinants shaping the health of their patients is a key component in reducing health disparities [1, 2]. The World Health Organization recognizes differences in community resources as major contributors to health inequality [3] and impacts emotional well-being and mental health [4]. Yet, while physicians understand these factors significantly impact their patient’s health, many feel ill-equipped to intervene, contributing to frustration and burnout [5].

To empower physicians to address social determinants of health, medical educators have begun incorporating structural competency (SC) into training. Developed by two psychiatrists, Metzl and Hansen, SC starts with understanding how structures—the large-scale organization of social, economic, and political power—impact health downstream [6]. It bridges research on social determinants of health to practical clinical interventions, building tools to recognize and act on...

Notes

Compliance with Ethical Standards

Deemed exempt from IRB review by the Yale Human Investigation Committee.

Disclosure

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Hansen H, Braslow J, Rohrbaugh RM. From cultural to structural competency-training psychiatry residents to act on social determinants of health and institutional racism. JAMA Psychiatry. 2018;75(2):117–8.CrossRefGoogle Scholar
  2. 2.
    Sharma M, Pinto AD, Kumagai AK. Teaching the social determinants of health: a path to equity or a road to nowhere? Acad Med. 2018;93(1):25–30.CrossRefGoogle Scholar
  3. 3.
    About social determinants of health. World Health Organization. 2018. http://www.who.int/social_determinants/sdh_definition/en/. Accessed 13 Apr 2018.
  4. 4.
    Compton MT, Shim RS. The social determinants of mental health. Arlington: American Psychiatric Association; 2015.Google Scholar
  5. 5.
    Goldstein D, Holmes J. 2011 Physicians’ daily life report. Robert Wood Johnson Foundation. 2011. https://www.rwjf.org/content/dam/web-assets/2011/11/2011-physicians%2D%2Ddaily-life-report. Accessed 14 Apr 2018.
  6. 6.
    Metzl JM, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014;103:126–33.CrossRefGoogle Scholar
  7. 7.
    Metzl JM, Hansen H. Structural competency and psychiatry. JAMA Psychiatry. 2018;75(2):115–6.CrossRefGoogle Scholar
  8. 8.
    Sawatsky AP, Nordhues HC, Merry SP, Bashir MU, Hafferty FW. Transformative learning and professional identity formation during international health electives: a qualitative study using grounded theory. Acad Med. 2018;93(9):1381–90.CrossRefGoogle Scholar
  9. 9.
    Kumagai AK, Lypson ML. Beyond cultural competence: critical consciousness, social justice, and multicultural education. Acad Med. 2009;84(6):782–7.CrossRefGoogle Scholar
  10. 10.
    Boler M. Feeling power: emotions and education. New York: Routledge; 1999.Google Scholar
  11. 11.
    Knowles MS. Andragogy in action. San Francisco: Jossey-Bass; 1984.Google Scholar
  12. 12.
    Mapping Resources. National geographic Society. 2018. https://www.nationalgeographic.org/education/mapping . Accessed 13 Apr 2018.
  13. 13.
  14. 14.
    Wright DE. Active learning: social justice education and participatory action research. New York: Routledge; 2015.CrossRefGoogle Scholar
  15. 15.
    Bourgois P, Holmes SM, Sue K, Quesada J. Structural vulnerability: operationalizing the concept to address health disparities in clinical care. Acad Med. 2017;92(3):299–307.CrossRefGoogle Scholar
  16. 16.
    The eight dimensions of wellness. Substance Abuse and Mental Health Services Administration. 2017. https://www.samhsa.gov/wellness-initiative/eight-dimensions-wellness. Accessed 1 Nov 2018.
  17. 17.
    Bromage B, Encandela JA, Cranford M, et al. Understanding health disparities through the eyes of community members: a structural competency education intervention. Acad Psychiatry. 2018; in press.Google Scholar
  18. 18.
    Toom A. Students-enthusiasts in online classes: their contribution to the educational process. IAFOR J Edu. 2015;3(2):126–40.Google Scholar
  19. 19.
    Tervalon M, Murray-garcía J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117–25.CrossRefGoogle Scholar

Copyright information

© Academic Psychiatry 2019

Authors and Affiliations

  1. 1.Yale School of MedicineNew HavenUSA
  2. 2.Johns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations