Purpose
Literature indicates at least 80% of a person’s health is determined by Social and Structural Determinants of Health (SSDH)  and a 2019 report from the National Academy of Science, Engineering and Medicine called on health educators to incorporate curriculum to advance health equity. However, experts including Neff, et al, point out that…” role of such structural forces on health and health care has been incorporated unevenly into medical training.”

Methods
At Touro University California, Structural Competency was adopted as a formal Program Learning Outcome, ensuring integration into the undergraduate medical curriculum.  Dedicated time built into the curriculum includes an introductory Foundations of Structural Competency course in the first month of medical school. A “PDSA” type model is utilized to assess content and student feedback and has led to a longitudinal Standardized Patient series built upon both structural competency foundations as well integration of early ‘doctoring’ skillsets to provide a scaffolding, simulation-based learning experience that overlaps and augments (rather than displace or increase) existing curriculum. The curriculum provides case-based scenarios with direct faculty supervision to assess student’s ability to address SSDH as they move into clinical rotations and residency.  

Results
Four cohorts of students have completed the Structural Competency curriculum since its inception.  Course surveys identified that prior to beginning medical school students generally felt structural competency is important with an even greater number expressing importance upon completion of the curriculum.  Continual review and revision have provided a template to effectively integrate and assess SSDH in medical education.

Conclusion
Recognition of structural determinants of health and the importance of diversity, equity and inclusion in healthcare has led to calls for increased education regarding SSDH in medical education.  Our work provides an overview of barriers and opportunities to integrate structural competency into medical curriculum.  This lighting talk will provide examples along with a flexible template that educators can utilize to develop, increase and improve structural competency and diversity, inclusion and equity in medical curriculum.