‘Structural Competency: Theorizing a New Approach to Stigma and Inequality’ at Boosting Statewide Momentum to Achieve System Goals

This workshop will detail an important and increasingly influential new framework for addressing stigma in clinical practice. Structural competency shifts the focus away from approaches to stigma and inequalities that emphasize cross-cultural understandings of individual patients, toward attention to forces that influence health outcomes at levels above individual interactions. The workshop will review existing structural approaches to stigma and health inequalities developed outside of medicine, and proposes changes to U.S. medical education and clinical practice that will infuse clinical training with a structural focus.

We will then analyze how “structural competency,” consists of training in five core competencies:

1. recognizing the structures that shape clinical interactions;
2. developing an extra-clinical language of structure;
3. rearticulating “cultural” formulations in structural terms
4. observing and imagining structural interventions; and
5. developing structural humility.

Examples are provided of structural health scholarship that should be adopted into medical didactic curricula, and of structural interventions that can provide participant-observation opportunities for clinical trainees.

Learning Objectives:

1. Define structural competency and understand how structural competency differs from cultural competency
2. Understand how structural factors have historically shaped stigmatizations of mental illnesses such as schizophrenia
3. Recognize ways that structural competency can be evaluated

Presented by: Jonathan Metzl, MD, PhD, , Vanderbilt University