In this episode, our guest host Dr. Vishal Kumar interviews medical anthropologist and social scientist Dr. Kelly Knight of UCSF. They discuss the meaning of structural competency, methods for incorporating this concept into medical education, and how it can be applied to alleviate physician burnout.

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SHOW NOTES

Dr. Knight starts by defining structural competency as the recognition of the underlying policies, systems, and hierarchies that produce social determinants of health. While these structures may sometimes be invisible, they have a large impact on health outcomes. Examination of these factors allows us to think about interventions that can make healthcare more equitable.

Next, we highlight effective ways to integrate structural competency into medical education. Dr. Knight shares information about national shared curricula that are designed with the flexibility for each institution to modify the content according to their community’s needs.

Finally, we examine redlining as an example of structural violence, signifying intentional disinvestment in marginalized communities. Dr. Knight believes that change starts with an initial acknowledgement and recognition of policies that make populations vulnerable to illness. She also encourages individual healthcare providers to take action by developing interpersonal communication skills, strategizing ways to make the clinical space more focused on healing, and working with elected individuals to create equity at a policy level. All of these efforts may allow for healthcare providers to reconnect with their original motivation to help patients and have a protective effect against burnout.

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RESOURCES

Structural Competency Working Group:

https://www.structcomp.org/

Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians:

https://pubmed.ncbi.nlm.nih.gov/27896692/

Mountains Beyond Mountains: The Quest of Dr. Paul Farmer:

https://www.amazon.com/Mountains-Beyond-Tracy-Kidder/dp/0812973011

The REPAIR Project:

https://repair.ucsf.edu/home

Do No Harm Coalition:

https://www.donoharmcoalition.org/

UCSF Health Equity Collaborative:

https://thecollaborative.ucsf.edu/training-health-equity-collaborative