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New Medicine for the U.S. Health Care System: Training Physicians for Structural Interventions

Hansen, Helena MD, PhD; Metzl, Jonathan M. MD, PhD

doi: 10.1097/ACM.0000000000001542
Invited Commentaries

Structural competency provides a language and theoretical framework to promote institutional-level interventions by clinical practitioners working with community organizations, non-health-sector institutions, and policy makers. The special collection of articles on structural competency in this issue of Academic Medicine addresses the need to move from theory to an appraisal of core educational interventions that operationalize the goals of and foster structural competency. In this Commentary, the authors review the role of clinical practitioners in enhancing population-level health outcomes through collaborations with professionals in fields outside medicine, including the social sciences and law. They describe the core elements of structural competency in preclinical and clinical education, as illustrated by the articles of this special collection: perceiving the structural causes of patients’ disease, envisioning structural interventions, and cultivating alliances with non-health-sector agencies that can implement structural interventions. Finally, the authors argue that preparing trainees to form partnerships will empower them to influence the social determinants of their patients’ health and reduce health inequalities.

H. Hansen is assistant professor of anthropology and assistant professor of psychiatry, New York University, New York, New York.

J.M. Metzl is Frederick B. Rentschler II Professor of Sociology and Medicine, Health, and Society, and professor of psychiatry, Vanderbilt University, Nashville, Tennessee.

Funding/Support: Support for this special section was provided in part by NIH grant DA032674 awarded to H. Hansen and by a grant from the REAM Foundation to J. Metzl.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Helena Hansen, Departments of Psychiatry and Anthropology, New York University, 550 First Ave. 20N37, New York, NY 10016; telephone: (212) 998-8189; e-mail:

© 2017 by the Association of American Medical Colleges