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Queer Frontiers in Medicine: A Structural Competency Approach

Donald, Cameron A. MS; DasGupta, Sayantani MD, MPH; Metzl, Jonathan M. MD, PhD; Eckstrand, Kristen L. MD, PhD

doi: 10.1097/ACM.0000000000001533

In 2014, the Association of American Medical Colleges (AAMC) published a report proposing qualifiers of competence to guide medical educators towards training physicians to appropriately care for individuals who are or may be lesbian, gay, bisexual, transgender (LGBT); gender nonconforming (GNC); and/or born with differences in sex development (DSD). These qualifiers provide content and context to an existing framework heavily used in competency-based medical education, emphasizing individual and interpersonal abilities to enhance care delivered to individuals identifying as LGBT, GNC, and/or born with DSD. However, systemic and societal forces including health insurance, implicit bias, and legal protections significantly impact the health of these communities. The concept of structural competency proposes that it is necessary to consider these larger forces contributing to and sustaining disease and health in order to fully address identity-based health needs. Competing competency frameworks for addressing diversity may be counterproductive to the ultimate goal of improving health outcomes among diverse communities. In this article, frameworks are reconciled by proposing structural competency as one approach for teaching identity-based health-related competencies that can be feasibly implemented for medical educators seeking to comply with the AAMC’s recommendations. This article aims to “queer”—or to open up—possibilities in medical education in an effort to ultimately support the provision of equitable and responsible health care to people who are LGBT, GNC, and/or born with DSD through the use of innovative frameworks and teaching materials.

C. Donald is a first-year medical student, University of California, San Francisco, School of Medicine, San Francisco, California.

S. DasGupta is a faculty member, Graduate Program in Narrative Medicine, Center for the Study of Ethnicity and Race, and Institute for Comparative Literature and Society, Columbia University, New York, New York.

J.M. Metzl is Frederick B. Rentschler II Professor of Sociology and Psychiatry and director, Center for Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee.

K.L. Eckstrand is founding chair, Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development, Association of American Medical Colleges, Washington, DC, and a second-year psychiatry resident, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Cameron A. Donald, University of California San Francisco, School of Medicine; telephone: (707) 349-0041; e-mail:

© 2017 by the Association of American Medical Colleges