Understanding Structural Competency in Medical Practice
In the evolving landscape of medical education, a new paradigm is emerging that shifts the focus from individual cultural competency to a broader understanding of structural influences on health outcomes. This approach, termed "structural competency," is rooted in the recognition that stigma and health inequalities are not merely the products of individual interactions but are deeply embedded in the social, economic, and political structures that shape our healthcare systems.
The Five Core Competencies of Structural Competency
The concept of structural competency is built on five core competencies that aim to equip practitioners with the skills necessary to address these broader determinants of health:
- Recognizing the Structures that Shape Clinical Interactions: This involves understanding how various forces, such as economic policies and healthcare systems, influence medical decisions and patient outcomes.
- Developing an Extra-Clinical Language of Structure: Practitioners are encouraged to become fluent in the interdisciplinary languages that describe the social determinants of health, enabling them to better understand and address the complex factors affecting patient care.
- Rearticulating "Cultural" Presentations in Structural Terms: This competency involves reformulating cultural narratives to include structural determinants, thereby providing a more comprehensive understanding of health disparities.
- Observing and Imagining Structural Interventions: Practitioners are trained to recognize that structures are mutable and can be intervened upon, encouraging them to propose and implement changes that address health infrastructures.
- Developing Structural Humility: This final competency emphasizes the importance of recognizing the limitations of one's understanding and the need for ongoing learning and collaboration in addressing structural issues.
Implementing Structural Competency in Practice
For practitioners, integrating structural competency into their practice involves a commitment to ongoing education and collaboration with interdisciplinary teams. It requires a shift in perspective from viewing health issues as isolated incidents to understanding them as manifestations of larger systemic forces.
Practitioners can start by engaging with the extensive literature on structural competency and participating in training programs that emphasize these competencies. By doing so, they can enhance their ability to provide care that not only addresses immediate health concerns but also contributes to long-term solutions for health inequalities.
Encouraging Further Research
The field of structural competency is still developing, and there is a need for continued research to refine and expand its applications in medical practice. Practitioners are encouraged to contribute to this growing body of knowledge by conducting research, sharing their experiences, and collaborating with experts from various disciplines.
To read the original research paper, please follow this link: Structural competency: Theorizing a new medical engagement with stigma and inequality.
