Abstract
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 authors describe a new evaluation tool, the Structural Foundations of Health Survey © (2016), developed to evaluate structural skills and sensibilities. The authors use 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—with particular attention to understanding how political, cultural, economic, and social factors shape health. Results suggest that MHS majors identified and analyzed relationships between structural factors and health outcomes at higher rates and in deeper ways than did premed science majors. MHS students also demonstrated higher understanding of structural and cultural competency in their approaches to race, intersectionality, and racial health disparities. The skills that MHS students exhibited represent proficiencies increasingly emphasized by the MCAT, the AAMC, and other educational bodies that, in an era of epigenetics and social determinants, emphasize how contextual factors shape expressions of health and illness.
Highlights
The inclusion of structural competency training in pre-health undergraduate programs may offer significant benefits to future healthcare professionals
Pre-health students learn a great deal about the biological aspects of illness but traditionally receive less training regarding the social and economic structures that produce inequities in the distribution of these illnesses. Instruction in these latter issues becomes increasingly important as developments in economics, sociology, the medical humanities, urban planning, epigenetics, and neuroscience uncover the vital roles that social contexts play in even the most seemingly biological of illnesses (Johnstone and Baylin 2010; Slopen et al 2014), and as educational bodies such as the AAMC (Englander et al 2013; Association of American Medical Colleges 2014) and the MCAT (Association of American Medical Colleges 2015; Schwartzstein 2013) increasingly emphasize recognition of the Bsocial foundations^ of health
While most students reported Bgood^ professional preparation (Table 2), MHS majors reported better preparation than premed majors regarding understanding the relationships between socioeconomic status and health, ability to discuss controversial issues, knowledge of the U.S healthcare system, and knowledge of the Patient Protection and Affordable Care Act (ACA)
Summary
The inclusion of structural competency training in pre-health undergraduate programs may offer significant benefits to future healthcare professionals. Pre-health students learn a great deal about the biological aspects of illness but traditionally receive less training regarding the social and economic structures that produce inequities in the distribution of these illnesses Instruction in these latter issues becomes increasingly important as developments in economics, sociology, the medical humanities, urban planning, epigenetics, and neuroscience uncover the vital roles that social contexts play in even the most seemingly biological of illnesses (Johnstone and Baylin 2010; Slopen et al 2014), and as educational bodies such as the AAMC (Englander et al 2013; Association of American Medical Colleges 2014) and the MCAT (Association of American Medical Colleges 2015; Schwartzstein 2013) increasingly emphasize recognition of the Bsocial foundations^ of health
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