Structural Competency of Pre-health Students: Can a Single Course Lead to Meaningful Change?

Scholars within the medical sciences recently have called on undergraduate educators to incorporate the social sciences in order to teach pre-health students structural competencies - or the ability to articulate how social structures produce racial, ethnic, gender, class, and other disparities - in order to better serve these populations medically. Authors used a semester-long course to assess how experiential learning focused on the topic of structural inequities improves structural competency. In Fall 2018, 27 students completed a hands-on, experiential, course focused on structural factors and health disparities. The authors conducted a mixed-methods, pre-/post-test design to solicit data on students' views on the reasons for high rates of obesity, gender pay disparities, and racial/ethnic housing segregation. Using systematic qualitative data analysis and statistical analysis of coded answers, the authors were able to detect pre-/post-test differences in the number of times students identified structural reasons for the disparities. Statistical analysis showed that students were able to identify an average of 4.63 structural reasons at pre-test, and that increased to 5.93 reasons at post-test (statically significant (p = 0.007)), indicating an increase in structural awareness after participation in the course. Qualitative analysis, using systematic methods of coding and a modified constant comparison method, demonstrated that students' ability to articulate structural reasons for inequality greatly improved. This experiential learning course, while relatively short, was found to increase students' ability to identify structural factors and articulate them with deeper understandings. Future curriculum development should consider incorporating experiential learning to promote structural competency, rather than a more traditional passive, content-delivery method of training.

Stigmatized neighborhoods, social bonding, and health.

The relationship between living in impoverished neighborhoods and poor health is well established, but impacts of neighborhood stigma on health are not well understood. Drawing on long-term research with Latino immigrants, we examine how neighborhood stigma and social bonding affect health in Phoenix, Arizona. During preliminary ethnographic analysis, we developed a novel neighborhood stigma scale. In survey research, we examined effects of neighborhood stigma and social bonding on self-reported physical and mental health. Regression models show that perceived neighborhood stigma and low social bonding are associated with poorer physical and mental health, controlling for other factors.