Table 2.

Structural competency

Suggestion II – Structural competency

Clinical ethics consultants need structural competencies to facilitate a structural understanding within CEC via counter-storytelling. Metzl and Hansen [62] have developed a training for medical education called Structural Competency Training, which aims at promoting awareness about how individual level health outcomes, decisions and interactions result from structural level processes. It involves five core competencies, including 1) recognizing the structures that shape clinical interactions; 2) developing extra-medical conceptual tools to understand social structures; 3) replacing cultural framings of difference with structural frameworks; 4) observing and imagining structural interventions; and 5) developing structural humility, i.e., awareness about the limits of one’s own understanding and knowledge. The training has been adapted for mental healthcare [63] and clinical case descriptions [64]. In line with this, we strongly encourage an adaptation for clinical ethics training and advise clinical ethics consultants to engage with existing approaches in the meantime. Furthermore, completion of such training may be promoted by certifying structurally trained consultants.