Bridging Classroom Learning and Clinical Practice: A Model for Teaching Structural Competency in the Clinical Learning Environment

Introduction : Structural competency is essential for teaching health professional students about the social and structural drivers of health (SSDoH) before they enter practice. While some curricula exist, most are classroom-based, and studies suggest that students also seek opportunities to practice these skills in clinical settings with real patients. This curriculum was developed to provide these opportunities. Methods : To address this, we developed the Structural Influence of Health Project, an innovative curriculum within the required third-year Family Medicine Clerkship on the Kansas City campus of the University of Kansas School of Medicine. The program combines didactic seminars, interprofessional home visits, and structured faculty-led debriefs, allowing students to apply structural competency in real-world clinical contexts. Medical students (n=125) completed pre- and post-surveys, and 90 students provided written responses on how to improve the training. This sample size was based on the students enrolled in the Family Medicine clerkship in the 2021-2022 academic year. Results : After being exposed to the curriculum, the students showed a significantly improved ability to identify social and structural contributors affecting patients’ health. Students reported experiential learning opportunities, such as patient home visits, as valuable for applying SSDoH concepts in real-world settings. They appreciated the inclusivity of the curriculum but suggested that it should be more patient- and community-centered. Many have advocated for a shift from problem identification to actionable solutions, with practical approaches integrated into clinical discussions. Expanding the curriculum to include topics such as gender-affirming care, rural health disparities, and insurance challenges was recommended. Future directions may include more deliberate faculty development to allow greater skill with these difficult topics.