Abstract
PURPOSE: Traditional discussions of race-related health inequities in medical education often focus on the racialized individual, neglecting the role of systemic racism and other oppressive structures that drive resource inequities. Structural competency equips healthcare providers and trainees to critically analyze how structural racism creates health disparities. METHOD: This study used focus groups with medical students (n = 56) and key informant interviews with faculty (n = 9) at a single academic medical center to explore experiences and perceptions of discussions about structural competency and the health effects of structural racism in small group learning communities. Activity Theory served as the analytical framework to understand environmental factors shaping these discussions, highlighting primary and secondary contradictions within the model activity system. RESULTS: The analysis revealed several tensions within the activity system that impacted discussions about race, structural racism, and inequities including, (1) questions of whether structural competency should be an explicit medical school outcome, (2) persistent biases in the curriculum, (3) faculty discomfort and limited expertise in leading discussions, (4) questions about who bears responsibility for facilitating these conversations, and (5) implicit and explicit rules shaping which types of knowledge are prioritized. CONCLUSIONS: These findings inform the development of educational tools and faculty support strategies to enhance teaching and learning around structural competency in medical education.