Developing Structural Competence in Residents through Migrant Farmworker Health

10-08-2017 16:16

Powerpoint presentation and related hand-out presented at the AAFP Global Health Conference in October 2017

Learning objectives:

1) Learners will be able to describe the size and demographics of the farmworker population in the US, as well as their unique barriers to care, medical needs and similarities to underserved populations in developing nations.

2) Learners will be able to explain different ways that care for farmworkers can be incorporated into physician training.

3) Learners will be able to articulate the definition of structural competency and how caring for farmworkers can foster the development of critical attitudes and practices leading to expertise in structural competence.



Migrant farmworkers are a largely invisible global population (Summers 2015). Training clinicians to work with vulnerable migrants has been identified as a priority (Pottie 2014). However, while family physicians are trained to elicit individuals' stories, they are rarely trained in identifying the structural inequities affecting their patients’ health (Metzl 2014).  By providing care for migrant farmworkers in labor camps, family medicine residents experience first-hand structural determinants of health likely to be missed within the walls of the usual healthcare facility.

   We describe two models for utilizing migrant farmworker experiences in family medicine residencies to teach the importance of structural determinants of health. Qualitative data from resident interviews show the ability for these rotations to develop learners' structural competence and humility in a way that traditional curricula do not. Challenges have included competing residency priorities and providing year-round experiences for learners given the seasonal nature of farm work​.


Metzl JM, Hansen H. Structural competency: Theorizing a new medical engagement with stigma and inequality.Social Science & Medicine. 2014 103;126e133.

Summers P, Quandt SA, Talton JW, Galvan L, Arcury TA. Hidden farmworker labor camps in North Carolina: an indicator of structural vulnerability. Am J Pub Health. 2015 105;12. 2570-2575.

Pottie K, Batista R, Mayhew M, Mota L, Grant K. Improving Delivery of Primary Care for Vulnerable Migrants.Can Fam Physician.  2014 ;60(1):e32-40.

Author(s):Gayle Thomas, MD; Jonathan Fricke, MD, MPH; Cheryl K. Seymour, MD; Carrie Griffin, DO
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