Pushing Social Determinants of Health Further: An Application of Structural Competency to Food Insecurity in Graduate Medical Education

Abstract

This thesis examines the tensions between the social determinants of health framework and structural competency in medical education. It proposes an online assessment tool that can be used to measure one’s ability to identify the social and structural factors that influence health. Discourse about the ways in which social and structural environments influence health has long been recognized in social science academia, but these frameworks have only recently gained traction in clinical medicine and education. My thesis uses food insecurity to examine the misalignment between the structural issues that contribute to health disparities and the actual recommendations and interventions implemented in clinical medicine. The literature review suggests that structural competency can unify the language for understanding and teaching the structural foundations of health in medical education. The design of the online assessment was tested on five Medicine, Health, and Society (MHS) M.A. students and three graduate students in the Biological Sciences M.S. program. The results showed no significant difference in the level of structural competency between both groups, which demonstrates that the lack of a unified language when teaching social and structural influences on health contributed to the difficulty coding written responses. As part of an American Medical Association Reimagining Residency grant program, this study’s health vignette will be included in a future structural competency training module for resident physicians. Overall, this study uses food insecurity as a case study to advance the scholarship about the little recognized differences between the SDOH and structural competency approaches to clinical education and interventions.