Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities

Introduction: Research on disparities in health and health care has demonstrated that social, economic, and political factors are key drivers of poor health outcomes. Yet the role of such structural forces on health and health care has been incorporated unevenly into medical training. The framework of structural competency offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care. Methods: We report on a brief, interprofessional structural competency curriculum implemented in 32 distinct instances between 2015 and 2017 throughout the San Francisco Bay Area. In consultation with medical and interprofessional education experts, we developed open-ended, written-response surveys to qualitatively evaluate this curriculum\u27s impact on participants. Qualitative data from 15 iterations were analyzed via directed thematic analysis, coding language, and concepts to identify key themes. Results: Three core themes emerged from analysis of participants\u27 comments. First, participants valued the curriculum\u27s focus on the application of the structural competency framework in real-world clinical, community, and policy contexts. Second, participants with clinical experience (residents, fellows, and faculty) reported that the curriculum helped them reframe how they thought about patients. Third, participants reported feeling reconnected to their original motivations for entering the health professions. Discussion: This structural competency curriculum fills a gap in health professional education by equipping learners to understand and respond to the role that social, economic, and political structural factors play in patient and community health

Translators Producing Knowledge: Where There Is No Doctor in Tamil

Where There Is No Doctor is one of the most widely used community health books in the world and has been translated into over 80 languages. This paper traces four aspects of translation in Tamil-language editions of the text, including Doctor Illaadha Idaththil and related books. First, translators choose and create language to produce a colloquial text related to, but different from, the original. Second, the translated text, as part of a genre of health writing, is edited to motivate readers to take new and different actions related to their bodies and wellbeing. Third, the success of this work is assessed by asking future readers to respond to the draft. Finally, the finished translation circulates to new arenas, influencing popular writing on health and ways of understanding the body. Analyzing the translation of a health text through the lens of postcolonial translation studies, this paper argues that the translation and adaptation of Where There Is No Doctor and the books it inspired engage translators, clinicians, and future readers in a transnational knowledge production process

Translating Where There Is No Doctor: How the production of local knowledges propels global travels

This dissertation focuses on how health knowledges are produced and travel through an analysis of the translation and adaptation of Where There Is No Doctor, one of the most widely used health manuals in the world. First published in the 1970s, it spread around the globe with health social movements, and has been translated into over 80 languages. Using qualitative methods and grounded theory analysis, this research explores translations and adaptations in Hindi, Tamil, Kannada, and English for use in India. The analysis sits at the intersection of sociology of health and illness, critical global health, and postcolonial science and technology studies. I make three key arguments: (1) the book serves both an instrumental role as a tool for people training community health workers, and a symbolic, political role, for health professionals focused on advocacy; (2) the book’s invitation to adapt content and illustrations to meet local needs, and to integrate lay and expert knowledges across a variety of medical systems, allows it to travel as a successfully global object; and (3) health knowledges produced in these editions are fundamentally new knowledges

Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities.

IntroductionResearch on disparities in health and health care has demonstrated that social, economic, and political factors are key drivers of poor health outcomes. Yet the role of such structural forces on health and health care has been incorporated unevenly into medical training. The framework of structural competency offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care.MethodsWe report on a brief, interprofessional structural competency curriculum implemented in 32 distinct instances between 2015 and 2017 throughout the San Francisco Bay Area. In consultation with medical and interprofessional education experts, we developed open-ended, written-response surveys to qualitatively evaluate this curriculum's impact on participants. Qualitative data from 15 iterations were analyzed via directed thematic analysis, coding language, and concepts to identify key themes.ResultsThree core themes emerged from analysis of participants' comments. First, participants valued the curriculum's focus on the application of the structural competency framework in real-world clinical, community, and policy contexts. Second, participants with clinical experience (residents, fellows, and faculty) reported that the curriculum helped them reframe how they thought about patients. Third, participants reported feeling reconnected to their original motivations for entering the health professions.DiscussionThis structural competency curriculum fills a gap in health professional education by equipping learners to understand and respond to the role that social, economic, and political structural factors play in patient and community health

Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities.

IntroductionResearch on disparities in health and health care has demonstrated that social, economic, and political factors are key drivers of poor health outcomes. Yet the role of such structural forces on health and health care has been incorporated unevenly into medical training. The framework of structural competency offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care.MethodsWe report on a brief, interprofessional structural competency curriculum implemented in 32 distinct instances between 2015 and 2017 throughout the San Francisco Bay Area. In consultation with medical and interprofessional education experts, we developed open-ended, written-response surveys to qualitatively evaluate this curriculum's impact on participants. Qualitative data from 15 iterations were analyzed via directed thematic analysis, coding language, and concepts to identify key themes.ResultsThree core themes emerged from analysis of participants' comments. First, participants valued the curriculum's focus on the application of the structural competency framework in real-world clinical, community, and policy contexts. Second, participants with clinical experience (residents, fellows, and faculty) reported that the curriculum helped them reframe how they thought about patients. Third, participants reported feeling reconnected to their original motivations for entering the health professions.DiscussionThis structural competency curriculum fills a gap in health professional education by equipping learners to understand and respond to the role that social, economic, and political structural factors play in patient and community health