Integrating structural analysis in the pre-APPE curriculum: Experiences from three institutions

Background Pharmacy graduates must be prepared to address health disparities and the structural and social drivers of health (SSDH) that shape patient outcomes. These skills require intentional introduction, practice, and scaffolding. One approach to operationalizing this within case-based instruction is the Structural Analysis (SA) framework. Educational activity Three Doctor of Pharmacy programs piloted the SA framework as a structured method for integrating SSDH into patient case discussions. Each institution implemented the SA framework within distinct curricular contexts, offering insight into feasibility, learner progression, and instructional challenges. Evaluation findings The SA framework was successfully integrated into required pre-APPE coursework. Although implementation varied by learner level and course structure, students readily identified social determinants of health and contextual influences within patient cases. Steps requiring structural prioritization and multilevel intervention development required more advanced reasoning. At one institution, with repetition and increasing curricular exposure, students demonstrated greater sophistication in addressing upstream structural factors. Analysis of educational activity These pilots demonstrated that SSDH can move from conceptual aspiration to observable clinical reasoning within required coursework. Across varied institutional contexts, students were able to incorporate structural considerations into case-based decision-making, suggesting that these skills are teachable and developmentally attainable. Continued refinement of teaching and assessment strategies and intentional alignment within experiential learning are important next steps in advancing SSDH from awareness to sustained practice.