Structural Competency in Simulation-Based Health Professions Education: A Call to Action and Pragmatic Guide.

SUMMARY STATEMENT: Simulation-based health professions educators can advance diversity, equity, and inclusion by cultivating structural competency, which is the trained ability to discern inequity not only at an individual level, but also at organizational, community, and societal levels. This commentary introduces Metzl and Hansen's Five-Step Model for structural competency and discusses its unique applicability to the metacognitive underpinnings of simulation-based health professions education. We offer a pragmatic guide for simulation-based health professions educators to collaboratively design learning objectives, simulation cases, character sketches, and debriefs in which structural competency is a simulation performance domain, alongside patient management, resource usage, leadership, situational awareness, teamwork, and/or communication. Our overall goal is to promote a paradigm shift in which educators are empowered to partner with patients, colleagues, and communities to recognize, learn about, and challenge the factors driving health inequities; a skill that may be applied to a broad range of health professions education within and outside of simulation.

Urban primary care physicians' perceptions about initiation of controller medications during a pediatric emergency department visit for asthma.

OBJECTIVE: This study aimed to identify the beliefs and attitudes of primary care providers (PCPs) regarding emergency department (ED) physicians' initiation of controller medications for children with persistent asthma symptoms during an immediate ED visit. METHODS: We performed semistructured interviews and a focus group with a purposive sample of PCPs of asthmatic patients to assess attitudes toward the National Asthma and Education Prevention Program recommendations regarding ED-based initiation of controller medications. Interviews and a focus group were digitally recorded, transcribed, and entered into qualitative software for coding and analysis. A multidisciplinary team used content analysis to identify important themes. RESULTS: A total of 22 pediatricians and 1 nurse practitioner participated, and content saturation was achieved. Of all participants, 57% were from hospital-based practices and 43% were from non-hospital-based practices. All agreed with the new guideline recommendation that emergency medicine physicians should consider initiating controller medications during a short-term visit for asthma. Four major themes were identified: (1) the importance of communication and collaboration between primary care and ED practitioners, (2) patients must meet criteria for inhaled corticosteroids and provide a reliable history, (3) the ED visit offers a lost opportunity for education and may represent a teachable moment, and (4) the ED visit provides a chance to capture patients with frequent exacerbations who are noncompliant with follow-up visits. CONCLUSIONS: Primary care providers who participated in this study believed that the ED visit offers a valuable opportunity for the initiation of controller medications when ED providers use guideline-based criteria and communicate the intervention to the PCP.