• Iman F Hassan and Thuy Bui.
• Albert Einstein College of Medicine, Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.
• J Gen Intern Med. 2022 Oct 1; 37 (13): 3465-3470.

AbstractStructural and social determinants of health account for the health disparities we see along social hierarchies, and their impact has been made more evident by the recent COVID-19 pandemic. There have been increasing calls to incorporate structural competency into medical education. The structural and social context, however, has yet to be fully integrated into everyday clinical practice and little has been published on how to concretely imbed structural competency into clinical reasoning. The authors provide a framework for structural analysis, which incorporates four key steps: (1) developing a prioritized clinical problem list, (2) identifying social and structural root causes for clinical problems, (3) constructing and documenting a prioritized structural problem list, and (4) brainstorming solutions to address structural barriers and social needs. They show how structural analysis can be used to operationalize structural reasoning into everyday inpatient and outpatient clinical assessments.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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