Capsule commentary on Neff et al., Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians

Structural competency is the trained ability to discern and acknowledge how health care outcomes are shaped by larger political, social, economic, policy, and legal forces and structures. Although structural competency has become an increasingly known framework for training and teaching, especially in the United States, it has usually not been used in nursing and nursing education. Moreover, very little is known about how to implement structural competency programs in conflict zones. Due to depoliticization that often prevails in both the higher education system and the health care system, the political conflict and the structural violence that significantly impact people’s health are rarely discussed in these systems. This article examines the potential contribution of structural competency training programs for nurses and nursing students in conflict areas by analyzing a program that has emphasized the impact of the Israeli–Palestinian conflict on the health of Jerusalem’s Palestinian residents. The article explains how this program has challenged the denial and silencing of conflict-related sociopolitical issues. At the same time, this program has created heated disagreements and friction. We suggest that structural competency training programs that are adapted to the political context in question may help nurses become organic intellectual leaders and agents of social change for those whose voices are not heard.

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An analysis of social determinants of health and structural competency training in global emergency medicine fellowship programs in the United States

AEM Education and Training ◽

10.1002/aet2.10660 ◽

2021 ◽

Vol 5 (S1) ◽

Author(s):

Lindsay G. Grossman ◽

Oren J. Mechanic ◽

Zvika Orr ◽

Eric C. Cioe‐Peña ◽

Alden Landry ◽

...

Keyword(s):

United States ◽

Emergency Medicine ◽

Social Determinants Of Health ◽

Social Determinants ◽

The United States ◽

Determinants Of Health ◽

Competency Training ◽

Structural Competency ◽

Fellowship Programs

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LO089: Out of province elective restrictions: implications for Royal College Emergency Medicine training

CJEM ◽

10.1017/cem.2016.126 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S61-S61

Author(s):

J.K. Khangura ◽

S. Gupta ◽

K. Pardhan

Keyword(s):

Emergency Medicine ◽

Health Reform ◽

Test Cases ◽

Graduate Degree ◽

Training And Education ◽

Competency Training ◽

Stakeholder Perspectives ◽

Resident Physicians ◽

Specific Career ◽

Training Opportunities

Introduction / Innovation Concept: Several provinces (AB, SK and QC) have recently introduced restrictions to out of province (OOP) electives. Concurrently, enhanced competency training is a prominent part of RCPSC Emergency Medicine (EM) programs (Thoma et al., 2015). We present the implications of OOP elective restrictions on RCPSC-EM training and education. The revised 2008 RCPSC-EM requirements specify a minimum of 6 months devoted to achieving a particular expertise pertinent to the practice of EM. The most restrictive policies permit up to 3 months OOP during the 5-year residency. This limits residents’ ability to pursue enhanced competency training opportunities outside their training site. Enhanced training might be a graduate degree, fellowship or clinical year designed by the resident and program director. Enhanced training can help achieve specific career goals, meet the needs of the institution where the resident will practice, and contribute to the growth and development of EM in Canada. Methods: New OOP policies are evaluated using the Health Reform Analysis (HRA) and SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis methodologies. Stated and implied reasons for reform are evaluated and stakeholder perspectives (health system authorities, partner universities, resident physicians and the general public) provided. Curriculum, Tool, or Material: The material includes previous out of province elective policies and recent reforms. Conclusion: Policies for the 4th year EM elective time are variable across universities. This has resulted in inconsistent approval of residents’ requests for OOP enhanced training. Thus, enhanced training that might be approved at one site, may not be at another. Several test cases already exist and will be presented. This data has not been previously collated or reported to our knowledge. Varied interpretation of newly emerging policies has implications for the consistency, equity, and future of EM residency training in Canada.

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