Bringing a Structural Competency Framework to the (Simulated) Bedside: The Premature Discharge Objective Structured...

Area of Science:

• Medical Education
• Health Equity
• Structural Competency

Background:

• Structural competency is crucial for addressing health equity in medical education.
• The Liaison Committee on Medical Education (LCME) now mandates structural competency content in medical schools.
• Current curricula often lack practical, clinical application of structural competency principles.

Purpose of the Study:

• To evaluate the integration of an Objective Structured Clinical Exam (OSCE) focused on structural competency within a required fourth-year Health Policy course.
• To assess the impact of this OSCE on medical students' understanding of structural factors influencing patient care and their clinical skills.

Main Methods:

• An OSCE simulating premature discharge was developed and implemented for fourth-year medical students.
• Students participated in simulated clinical encounters, followed by reflection assignments and group debriefings.
• Curricular evaluations and OSCE checklist performance were analyzed to assess student learning and experience.

Main Results:

• Students achieved high performance (89.6%) in patient-centered communication, harm reduction, and discharge planning during the OSCE.
• Participants reported significant value in applying the structural competency framework to understand factors affecting patient care.
• The study represents the first OSCE designed to enhance medical students' understanding of structural competency within a clinical context.

Conclusions:

• Integrating OSCEs into existing courses provides a viable method for teaching and assessing structural competency.
• This approach effectively bridges classroom learning with simulated clinical practice, addressing a gap in current medical education.
• Further research is needed to explore the long-term effects of this curriculum on students' attitudes toward structurally vulnerable populations.