Structural competency in emergency medical education: A scoping review and operational framework

Area of Science:

• Medical Education
• Public Health
• Social Determinants of Health

Background:

• Existing medical education curricula lack clear guidance on integrating structural competency and vulnerability, particularly within emergency medicine (EM).
• Structural competency is crucial for addressing health disparities and promoting justice in healthcare settings.

Purpose of the Study:

• To provide a comprehensive overview of structural competency in EM education.
• To link structural competency to educational and patient care outcomes.
• To identify literature gaps for curricular implementation and future research in EM.

Main Methods:

• A scoping review following Arksey and O'Malley's framework was conducted.
• A multistep consensus process, including the 2021 SAEM Consensus Conference, was employed.
• Feedback was integrated to develop a national structural competency curriculum framework for EM.

Main Results:

• 291 articles were screened, with 51 relevant to EM education.
• Structural competency was conceptualized as an interdisciplinary framework emphasizing historical power, privilege, and a commitment to justice.
• Inconsistent operationalization and lack of consensus on measuring effects were noted; learner-specific structural constraints were not examined.

Conclusions:

• Emphasizes the need for national structural competency curricula in EM with standardized proficiencies.
• Highlights the necessity of assessing curriculum impact on patient outcomes and learner development.
• Aims to standardize EM education and guide future research on structural competency interventions in emergency departments (EDs).