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Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians.



The influence of societal inequities on health has long been established, but such content has been incorporated unevenly into medical education and clinical training. Structural competency calls for medical education to highlight the important influence of social, political, and economic factors on health outcomes.


This article describes the development, implementation, and evaluation of a structural competency training for medical residents.


A California family medicine residency program serving a patient population predominantly (88 %) with income below 200 % of the federal poverty level.


A cohort of 12 residents in the family residency program.

Program description

The training was designed to help residents recognize and develop skills to respond to illness and health as the downstream effects of social, political, and economic structures.

Program evaluation

The training was evaluated via qualitative analysis of surveys gathered immediately post-training (response rate 100 %) and a focus group 1 month post-training (attended by all residents not on service).


Residents reported that the training had a positive impact on their clinical practice and relationships with patients. They also reported feeling overwhelmed by increased recognition of structural influences on patient health, and indicated a need for further training and support to address these influences.

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