Kathryn Rampon, University of Kansas School of Medicine
Laurel Witt, University of Kansas School of Medicine
Kristina Bridges, University of Kansas School of Medicine
Hannah Maxfield, University of Kansas School of Medicine
Kalee Kirmer-Voss, University of Kansas School of Medicine
Ashley Crowl, University of Kansas School of Pharmacy
Purpose
The Structural Influences on Health Project is an innovative, experiential, longitudinal curriculum to teach and assess structural competency embedded in a Family Medicine (FM) Clerkship. The project utilizes the structural competency framework. Both the teaching and assessment of structural competencies in the clinical learning environment are challenging and under-studied.
Methods
The curriculum project was delivered in three phases. First, inter-professional groups of medical and pharmacy students engaged in didactic seminars on structural drivers of health. Second, with physician and pharmacy faculty, students performed clinical home visits for patients experiencing structural vulnerability. Third, students completed a reflective written assignment and presented their projects during a structured, faculty-facilitated debrief. During that session, faculty formatively assessed students’ knowledge and skills of structural competency. Empathy scales were collected before and after the project using an adapted Toronto Empathy Scale. The written responses were analyzed qualitatively by a coding team.
Results
Data were collected during two academic years. All medical students enrolled locally in the required third-year FM clerkship and all fourth-year pharmacy students enrolled in an elective with FM performed home visits in the Kansas City area. Student satisfaction with the project was positive, and results showed an increase in their perceived understanding of structural vulnerability. Empathy scales were unchanged after the project. Written reflective data indicated the clinical home visit was valuable for bridging classroom content with the clinical learning environment.
Conclusions
This innovative structural competency curriculum connected classroom learning with experiential learning in the clinical setting. Overall, students described the course as inclusive and well-supported by educators, contributing to a positive and enriching learning experience. Students did not experience decreased empathy as a result of this curriculum. Educators may look to home-based care as a means to deepen students’ understanding and assess the structural competencies of health professions students.