Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians.

BACKGROUND: The influence of societal inequities on health has long been established, but such content has been incorporated unevenly into medical education and clinical training. Structural competency calls for medical education to highlight the important influence of social, political, and economic factors on health outcomes. AIM: This article describes the development, implementation, and evaluation of a structural competency training for medical residents. SETTING: A California family medicine residency program serving a patient population predominantly (88 %) with income below 200 % of the federal poverty level. PARTICIPANTS: A cohort of 12 residents in the family residency program. PROGRAM DESCRIPTION: The training was designed to help residents recognize and develop skills to respond to illness and health as the downstream effects of social, political, and economic structures. PROGRAM EVALUATION: The training was evaluated via qualitative analysis of surveys gathered immediately post-training (response rate 100 %) and a focus group 1 month post-training (attended by all residents not on service). DISCUSSION: Residents reported that the training had a positive impact on their clinical practice and relationships with patients. They also reported feeling overwhelmed by increased recognition of structural influences on patient health, and indicated a need for further training and support to address these influences.

RASSF1A and the rs2073498 Cancer Associated SNP.

RASSF1A is one of the most frequently inactivated tumor suppressors yet identified in human cancer. It is pro-apoptotic and appears to function as a scaffolding protein that interacts with a variety of other tumor suppressors to modulate their function. It can also complex with the Ras oncoprotein and may serve to integrate pro-growth and pro-death signaling pathways. A SNP has been identified that is present in approximately 29% of European populations [rs2073498, A(133)S]. Several studies have now presented evidence that this SNP is associated with an enhanced risk of developing breast cancer. We have used a proteomics based approach to identify multiple differences in the pattern of protein/protein interactions mediated by the wild type compared to the SNP variant protein. We have also identified a significant difference in biological activity between wild type and SNP variant protein. However, we have found only a very modest association of the SNP with breast cancer predisposition.