Structural Competency and the Medical Learning Environment—An Overdue Paradigm Shift in Medical Education

Structural competency (SC) is a framework that assists clinicians in naming and analyzing the structural drivers that fundamentally contribute to morbidity and mortality. Undergraduate and graduate medical education is grounded in the experiential learning model where trainees learn through supervis...

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Main Authors: Iman F. Hassan, Rebecca Leeds, Ijeoma Nnodim Opara, Thuy D. Bui, Sharon E. Connor, Sejal Shah, Shwetha Iyer
Format: Article
Language:English
Published: MDPI AG 2025-06-01
Series:Social Sciences
Subjects:
Online Access:https://www.mdpi.com/2076-0760/14/6/356
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author Iman F. Hassan
Rebecca Leeds
Ijeoma Nnodim Opara
Thuy D. Bui
Sharon E. Connor
Sejal Shah
Shwetha Iyer
author_facet Iman F. Hassan
Rebecca Leeds
Ijeoma Nnodim Opara
Thuy D. Bui
Sharon E. Connor
Sejal Shah
Shwetha Iyer
author_sort Iman F. Hassan
collection DOAJ
description Structural competency (SC) is a framework that assists clinicians in naming and analyzing the structural drivers that fundamentally contribute to morbidity and mortality. Undergraduate and graduate medical education is grounded in the experiential learning model where trainees learn through supervised, hands-on, real-world training and caring for patients within hospital and clinic settings. However, our present-day clinical settings fail to create a learning environment in which SC skills can be effectively taught and operationalized. The SC framework is designed to engender praxis, but to make this move upstream, healthcare institutions and medical education leaders need to do more to adapt their learning environment. We posit five elements and associated key actions that are essential to an SC learning environment: (1) the structural analysis of institutional policies and practices; (2) academic freedom and interdisciplinary discourse; (3) redefining medical education standards and metrics; (4) collective action to drive effect change; and (5) community integration and accountability.
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spelling doaj-art-2d6c3a10d6a94f4eaf7bfd45150976792025-08-20T02:21:58ZengMDPI AGSocial Sciences2076-07602025-06-0114635610.3390/socsci14060356Structural Competency and the Medical Learning Environment—An Overdue Paradigm Shift in Medical EducationIman F. Hassan0Rebecca Leeds1Ijeoma Nnodim Opara2Thuy D. Bui3Sharon E. Connor4Sejal Shah5Shwetha Iyer6Department of Medicine, Albert Einstein College of Medicine, New York, NY 10467, USADepartment of Medicine, Center for Family and Community Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USASection of Internal Medicine-Pediatrics, Department of Internal Medicine, School of Medicine, Wayne State University, Detroit, MI 48201, USADepartment of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USADepartment of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USADepartment of Medicine, Albert Einstein College of Medicine, New York, NY 10467, USADepartment of Medicine, Albert Einstein College of Medicine, New York, NY 10467, USAStructural competency (SC) is a framework that assists clinicians in naming and analyzing the structural drivers that fundamentally contribute to morbidity and mortality. Undergraduate and graduate medical education is grounded in the experiential learning model where trainees learn through supervised, hands-on, real-world training and caring for patients within hospital and clinic settings. However, our present-day clinical settings fail to create a learning environment in which SC skills can be effectively taught and operationalized. The SC framework is designed to engender praxis, but to make this move upstream, healthcare institutions and medical education leaders need to do more to adapt their learning environment. We posit five elements and associated key actions that are essential to an SC learning environment: (1) the structural analysis of institutional policies and practices; (2) academic freedom and interdisciplinary discourse; (3) redefining medical education standards and metrics; (4) collective action to drive effect change; and (5) community integration and accountability.https://www.mdpi.com/2076-0760/14/6/356structural competencylearning environmentmedical education
spellingShingle Iman F. Hassan
Rebecca Leeds
Ijeoma Nnodim Opara
Thuy D. Bui
Sharon E. Connor
Sejal Shah
Shwetha Iyer
Structural Competency and the Medical Learning Environment—An Overdue Paradigm Shift in Medical Education
Social Sciences
structural competency
learning environment
medical education
title Structural Competency and the Medical Learning Environment—An Overdue Paradigm Shift in Medical Education
title_full Structural Competency and the Medical Learning Environment—An Overdue Paradigm Shift in Medical Education
title_fullStr Structural Competency and the Medical Learning Environment—An Overdue Paradigm Shift in Medical Education
title_full_unstemmed Structural Competency and the Medical Learning Environment—An Overdue Paradigm Shift in Medical Education
title_short Structural Competency and the Medical Learning Environment—An Overdue Paradigm Shift in Medical Education
title_sort structural competency and the medical learning environment an overdue paradigm shift in medical education
topic structural competency
learning environment
medical education
url https://www.mdpi.com/2076-0760/14/6/356
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