Impacting the Culture of Neurologic Care: Piloting a Structural Competency Training into Neurology Core Competencies
Kendra Anderson1, Sonia Kaur Singh2, Thy Nguyen2
1Neurology, University of Texas Health Science Center, 2University of Texas Health Science Center
Objective:
To determine the effectiveness of piloting a three-part structural competency training into the curriculum for neurology residents, fellows, and faculty utilizing materials from a structural competency training program developed by Neff and colleagues.
Background:
In today’s medical education landscape, providing training on the structural factors that propagate health inequities is essential to prepare physician learners to provide socially just and equitable patient care. Resident physicians have expressed a need for this training in their education, as they feel overwhelmed by the lack of knowledge regarding interventions to address structural inequality in patient care.
Design/Methods:
Three structural competency workshops were offered during neurology trainee didactics. Pre- and post-workshop surveys were administered for each workshop. Attendees were asked to rate their experience on a Likert-scale from 1 (strongly disagree) to 5 (strongly agree).
Results:
Wilcoxon signed rank tests indicated participants’ knowledge of structural violence significantly increased following the first workshop (M = 4.36, SD = 0.75) relative to their pre-workshop understanding (M = 3.05, SD = 1.28), z = -2.89, p = .005, with a large effect size (r = 0.55). Most notably, attendees were significantly better at (1) identifying the six levels of intervention for structural vulnerability (pre-test M = 1.67; post-test M = 4.50), p = .005, and (2) confidently designing interventions to address the structural vulnerabilities of their patients (pre-test M = 1.83; post-test M = 4.60), p = .01. Overall, participants “agreed” the workshops were valuable (M = 4.40, SD = .70), should be routinely offered (M = 4.50, SD = .850), and that they would change aspects of their practice based on their newly acquired knowledge (M = 4.20, SD = .92).
Conclusions:
Incorporating structural competency training into the curriculum for neurology trainees is not only feasible, but is also valued and has important implications for how learners deliver patient care.