Structural competency curriculum in health sciences education: a scoping review.

OBJECTIVE: The objective of this review was to explore what is known about implementing and evaluating the structural competency framework in undergraduate and graduate health science programs. This review also sought to identify outcomes that were reported as a result of adding this training to various curricula. INTRODUCTION: The structural competency framework was introduced in 2014 to train pre-health and health professionals to understand broader structures that influence health inequities and outcomes of health. Across the globe, programs are incorporating structural competency in the curricula to address structural issues that impact interactions in the clinical setting. The implementation and evaluation of structural competency training across multiple health science programs are poorly understood and deserve further examination. INCLUSION CRITERIA: This scoping review considered papers that described the implementation, evaluation, and outcomes of structural competency training for undergraduate or graduate students and postgraduate trainees in health science programs in any geographic location. METHODS: Papers published in English that addressed the implementation and evaluation of structural competency frameworks in undergraduate and graduate health science programs were included. No date restrictions were imposed. The databases searched included MEDLINE (PubMed), CINAHL (EBSCO), Scopus, Embase, EuropePubMed Central (European Bioinformation Institute), PsycINFO (EBSCO), and Education Resources Information Center (ERIC). Sources of unpublished studies and gray literature searched included ProQuest Dissertations and Theses (ProQuest), PapersFirst (WorldCat), and OpenGrey. Screening of full-text papers and data extraction were performed independently by 2 reviewers. RESULTS: Thirty-four papers were included in this review. Implementation of structural competency training was described in 33 papers, evaluation of training was described in 30 papers, and outcomes were reported in 30 papers. Throughout the included papers, the methods/pedagogical approaches to implementing structural competency in curricula varied. Evaluations focused on knowledge, skills, abilities, attitudes of students, quality, perceptions, and effectiveness of training. CONCLUSIONS: This review revealed that health educators have successfully implemented structural competency training in medical, pharmacy, nursing, residency, social work, and pre-health programs. There are multiple methods of teaching structural competency, and trainers can adapt delivery methods for different educational contexts. Neighborhood exploration; photovoice, including community-based organizations in clinical rotations; incorporating team-building exercises; case-based scenarios; and peer-teaching are among the innovative approaches that can be used to deliver the training. Training can be provided in short intervals or incorporated throughout an entire study plan to enhance students' structural competency skills. Methods of evaluating structural competency training vary and include qualitative, quantitative, and mixed methods.

Effectiveness of implementation strategies to improve nutrition education interventions in adults living in rural and/or low-income communities.

OBJECTIVE: The objective of this project was to promote evidence-based practice and identify how to best implement nutrition education interventions for adults living in rural and/or low-income communities. INTRODUCTION: Adults living in rural and/or low-income communities are at increased risk for poor nutrition and chronic health conditions. Patients are referred to the EversCare Clinic (ECC), an ambulatory clinic at an academic medical center in Mississippi, USA, to receive assistance with social needs. In addition to living in rural and/or low-income communities, over 90% of the patients seen at the ECC are food-insecure, yet nutrition education is inconsistently provided. METHODS: The JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback tools were used. The ECC team conducted a baseline audit of 30 patient electronic health records, designed and implemented best-practice nutrition education strategies, and completed a follow-up audit of 30 patient electronic health records. Four evidence-based criteria for nutrition education in adults living in rural and/or low-income communities were audited, and various interventions were used to address multiple levels. RESULTS: The baseline audit revealed patients were not receiving recommended nutrition education interventions. Following the implementation, there was a 64.2% improvement in compliance with all four best practice criteria. Involving nursing students proved to be an effective method of improving compliance. CONCLUSION: Adherence to best practices regarding implementing nutrition education interventions was satisfactory, with 80% of patients receiving interventions at individual, interpersonal, community, and societal levels. Future audits are planned to ensure sustainability.

Structural competency curriculum in health sciences education: a scoping review protocol.

OBJECTIVE: This scoping review aims to explore existing literature related to structural competency and how this concept is being implemented and evaluated in health sciences programs. The secondary aim is to examine and summarize any documented outcomes related to structural competency training. INTRODUCTION: Structural competency is a concept that was introduced in 2014 to train pre-health and health professionals to understand the broader structures that influence health outcomes. Studies have shown structural competency training is beneficial to health science students. To address health outcomes at the population level, students should collaborate with other disciplines to address the larger structures that influence health. INCLUSION CRITERIA: This scoping review will consider studies that include health science programs that implemented or evaluated structural competency training for undergraduate students, graduate students, and postgraduate trainees. METHODS: The key databases to be searched include MEDLINE, CINAHL, Scopus, Embase, Europe PubMed Central, PsycINFO, and ERIC. The search for unpublished studies will include ProQuest Dissertations and Theses, PapersFirst, and OpenGrey. Studies conducted in English, in any year, setting, or geographical location will be included. Two independent reviewers will perform retrieval of full-text studies and data extraction. The results will be presented in diagrammatic or tabular format with a narrative summary.