Assessment of a Peer-Taught Structural Competency Course for Medical Students Using a Novel Survey Tool

Abstract

Structural competency is an emerging framework for teaching health disparities from a systems-level perspective. A group of medical students piloted a peer-taught course on applying structural competency to patient care. Measuring the impact of educational innovations is critical, yet no literature quantitatively assessing structural competency curricula currently exists for the medical school setting. Students adapted an existing cultural competency assessment instrument to create the Clinical Structural Competency Questionnaire, a 52-item Likert-based survey tool. This tool was used to assess students’ self-reported knowledge, skills, and attitudes before, immediately after, and 6 months after the course. Data were analyzed using the Wilcoxon signed-rank test. Response proportion immediately after the course was 84% (n = 114). Of these, 34% (n = 39) could be matched for all survey time-points. Students reported increases in knowledge of structural competency (p < 0.01). They reported higher levels of comfort addressing structural issues in patient care, including “coming up with a treatment plan which takes into account any structural issues in a patient’s life” (p < 0.01). Student attitudes changed significantly, including a decrease in perceived importance of genetics in determining health and health disparities (p < 0.01), relative to factors like zip code (p < 0.01), voting (p < 0.01), and housing stability (p < 0.01). Medical students perceived an improvement in knowledge, skills, and attitudes regarding application of structural thinking and practices to patient care, after a peer-taught course. Peer-taught structural competency instruction can be effective and should be implemented to train health professional students in understanding and addressing health disparities using systems-level thinking.