Structural competency: Theorizing a new medical engagement with stigma and inequality
Structural competency: Theorizing a new medical engagement with stigma and inequality
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DOI：
10.1016/j.socscimed.2013.06.032
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发表时间：
2014-02-01
影响因子：
5.4
通讯作者：
Hansen, Helena
中科院分区：
文献类型：
--
作者：
Metzl, Jonathan M.;Hansen, Helena
本文描述了医学教育从强调对个体患者的跨文化理解的教学方法到污名和不平等的转变，转向关注影响个体互动水平上的健康结果的力量。它审查了现有的结构性方法，以应对医学以外的耻辱和健康不平等，并建议对美国医学教育进行改革，将临床培训注入结构性重点。这种方法被称为“结构能力”，包括五个核心能力的训练：1)识别塑造临床互动的结构；2)开发一种非临床的结构语言；3)用结构术语重新表述“文化”公式；4)观察和想象结构干预；以及5)培养结构谦逊。提供了应纳入医学教学课程的结构性健康奖学金的例子，以及可为临床实习生提供参与者观察机会的结构性干预措施的例子。论文最终认为，越来越多地认识到社会和经济力量产生症状或甲基化基因的方式，然后需要更好地与结构变化的医学模型相结合。(C)2013年提交人。爱思唯尔有限公司出版。保留所有权利。
This paper describes a shift in medical education away from pedagogic 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. It reviews existing structural approaches to stigma and health inequalities developed outside of medicine, and proposes changes to U.S. medical education that will infuse clinical training with a structural focus. The approach, termed "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. The paper ultimately argues that increasing recognition of the ways in which social and economic forces produce symptoms or methylate genes then needs to be better coupled with medical models for structural change. (C) 2013 The Authors. Published by Elsevier Ltd. All rights reserved.