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Toward Structural Competency in Emergency Medical Education.
Bisan A Salhi1,2, Jennifer W Tsai3, Jeffrey Druck4
1Department of Emergency Medicine Emory University Atlanta GA.
AEM Education and Training
|February 20, 2020
Summary
Structural competency in emergency medicine (EM) education addresses how societal factors, not just individual bias, impact patient health. This framework equips emergency physicians to better serve vulnerable populations in the emergency department (ED).
Area of Science:
- Public Health
- Medical Education
- Health Equity
Background:
- Emergency departments (EDs) are critical access points to healthcare, making health inequities particularly relevant in emergency medicine (EM).
- Traditional cultural competency models in EM education aim to address bias but have limitations in fully capturing patient needs.
- Existing models may oversimplify group differences and inadvertently reinforce patient-centered blame for health issues.
Purpose of the Study:
- To introduce and extend the framework of structural competency to the emergency department (ED) setting.
- To highlight the relevance of structural competency in emergency medicine (EM) education.
- To provide practical examples for incorporating structural competency into EM training.
Main Methods:
- Conceptual framework development.
- Application of structural competency principles to the unique context of the emergency department (ED).
- Illustrative examples for integration into emergency medicine (EM) residency education.
Main Results:
- Structural competency offers a more comprehensive approach than cultural competency for addressing health disparities in the ED.
- Recognizes the impact of broad societal forces (e.g., poverty, racism) on patient health outcomes.
- Provides a pathway for emergency physicians to understand and address root causes of illness beyond the individual encounter.
Conclusions:
- Structural competency is a vital framework for emergency medicine (EM) education to address systemic drivers of health inequity.
- This approach better equips emergency physicians to care for stigmatized and disenfranchised populations.
- Integrating structural competency into EM training can lead to more effective and equitable patient care within the ED.
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