Structural competency in emergency medical education: A scoping review and operational framework

Bisan A Salhi; Amy Zeidan; Christine R Stehman; Sarah Kleinschmidt; E Liang Liu; Kristen Bascombe; Kian Preston-Suni; Melissa H White; Jeff Druck; Bernard L Lopez; Margaret E Samuels-Kalow

doi:10.1002/aet2.10754

Structural competency in emergency medical education: A scoping review and operational framework

AEM Educ Train. 2022 Jun 23;6(Suppl 1):S13-S22. doi: 10.1002/aet2.10754. eCollection 2022 Jun.

Authors

Affiliations

¹ Department of Emergency Medicine Emory University Atlanta Georgia USA.
² Department of Anthropology Emory University Atlanta Georgia USA.
³ Department of Emergency Medicine University of Illinois College of Medicine Peoria Illinois USA.
⁴ Department of Emergency Medicine University of Massachusetts Medical School-Baystate Springfield Massachusetts USA.
⁵ Department of Emergency Medicine VA Greater Los Angeles Healthcare System University of California at Los Angeles Los Angeles California USA.
⁶ Department of Emergency Medicine University of Colorado School of Medicine Aurora Colorado USA.
⁷ Department of Emergency Medicine Sidney Kimmel Medical College Philadelphia Pennsylvania USA.
⁸ Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA.

Abstract

Objectives: Existing curricula and recommendations on the incorporation of structural competency and vulnerability into medical education have not provided clear guidance on how best to do so within emergency medicine (EM). The goal of this scoping review and consensus building process was to provide a comprehensive overview of structural competency, link structural competency to educational and patient care outcomes, and identify existing gaps in the literature to inform curricular implementation and future research in EM.

Methods: A scoping review focused on structural competency and vulnerability following Arksey and O'Malley's six-step framework was performed in concurrence with a multistep consensus process culminating in the 2021 SAEM Consensus Conference. Feedback was incorporated in developing a framework for a national structural competency curriculum in EM.

Results: A literature search identified 291 articles that underwent initial screening. Of these, 51 were determined to be relevant to EM education. The papers consistently conceptualized structural competency as an interdisciplinary framework that requires learners and educators to consider historical power and privilege to develop a professional commitment to justice. However, the papers varied in their operationalization, and no consensus existed on how to observe or measure the effects of structural competency on learners or patients. None of the studies examined the structural constraints of the learners studied.

Conclusions: Findings emphasize the need for training structurally competent physicians via national structural competency curricula focusing on standardized core competency proficiencies. Moreover, the findings highlight the need to assess the impact of such curricula on patient outcomes and learners' knowledge, attitudes, and clinical care delivery. The framework aims to standardize EM education while highlighting the need for further research in how structural competency interventions would translate to an ED setting and affect patient outcomes and experiences.