“I Will Meet the Patient Wherever They Are At:” Using Structural Competency and Simulation to Improve Attitudes and Practices Towards Structurally Vulnerable Patients

Introduction Structurally vulnerable patients experience worse health outcomes, exacerbated by healthcare workers’ negative attitudes and limited understanding of structural barriers to care. Structural competency may improve attitudes towards structurally vulnerable patients, but the impact on attitudes and practices has not been rigorously evaluated, particularly in clinical settings. Methods Medical students at Weill Cornell Medical College in New York City participated in a structural competency-informed curriculum aligned with transformative learning theory which incorporates clinical skills training with simulation and reflection during academic years 2022–2023 and 2023–2024. Authors conducted a convergent mixed-methods study using pre-post surveys and thematic analysis of reflections to explore if and how the curriculum impacted students’ attitudes and practices towards structurally vulnerable patients. Surveys included the Medical Condition Regard Scale (MCRS) and items accessing self-efficacy in applying the curriculum’s learning objectives. Results Of 190 students, 77 (40.5%) completed the pre-survey and 50 (26.3%) completed pre- and post-surveys. The mean pre-course MCRS score ( n = 50) was 4.18/6 (SD 0.79) and the mean post-course MCRS score was 4.57/6 (SD 0.75), showing a mean increase of 0.39 (SD 0.49, t-test P < 0.001, Cohen’s d = 0.81). Thematic analysis of 21 reflections identified four themes highlighting how students employed patient-centered communication strategies, utilized best practices in discharge planning, engaged in critical self-reflection and reframing, and appreciated how structural barriers shape health. Conclusion Findings suggest that integrating education on structural factors with clinical skills training, reinforced through simulation and reflection, can improve self-reported attitudes and perceived self-efficacy in caring for structurally vulnerable patients.