Structural Competency: A Lifeline in a Time of Crisis

Emergency departments occupy a unique position in the healthcare system: they are often where the consequences of upstream policy manifest most acutely. Structural competency-a framework for understanding how economic, political, and historical forces shape health-offers emergency medicine educators a practical means of preparing trainees to recognize and respond to those forces. This framework is grounded in five core domains: recognizing structures that shape clinical interactions, developing an extra-clinical language of structure, rearticulating "cultural" presentations in structural terms, observing and imagining structural interventions, and developing structural humility. In this current political climate, structural competency can serve as a catalyst for training reform, particularly in areas where recent legislative changes have directly impacted patient care: reproductive health, immigration enforcement, and gender-affirming care. Drawing on published curricula, institutional experience, and a growing body of evidence documenting the structural barriers facing emergency department patients, we outline how the five domains of structural competency translate into specific educational interventions such as didactic teaching, simulation, community engagement, and systems-level initiatives. By focusing on practical strategies that extend beyond the bedside, this commentary highlights the importance of equipping trainees to navigate policy-driven challenges and deliver equitable care. Structural competency is therefore not an abstract framework but a practical tool for equipping residents to provide equitable care in a rapidly changing sociopolitical environment.