Incorporating Structural Competency into Clinical Ethics: Piloting New Bioethics Education

AbstractThe Liaison Committee on Medical Education recently adopted structural competency, an approach to understanding and responding to social factors in health and healthcare, as a required part of medical training. We have found that structural competency education shows promise for graduate and continuing bioethics education as well. In postgraduate bioethics education, structural competency focuses on the practical skills of identifying where social forces impact specific patients and how clinicians can respond. This can support clinical ethicists in their attempts to help clinicians identify, understand, and respond to ethical dilemmas caused by social forces, for example, the ways in which resource availability may influence a patient's opportunities and health options, and the impact of the built environment on the health hazards people encounter. We describe how one clinical ethics program integrated structural competency into bioethics education for medical residents and other clinicians. This structural competency education pilot received extremely positive feedback from participating clinicians. Ninety-seven percent of those who responded to evaluation surveys identified structural competency as "valuable" or "very valuable" to their clinical practice. When providing feedback on this education, clinicians described immediately incorporating structural competency strategies in ethically difficult patient care situations. We present a case study shared and developed by clinicians using these strategies to improve patient care. This practical use of structural competency education suggests that there may be benefits to integrating this approach into bioethics education. We suggest next steps for bioethics educators to further examine these educational strategies following our promising pilot.