Competência Estrutural em Eaúde: concepção de competência e desenvolvimento

Abstract

Introduction: Structural Competency in Health (SCH) is an educational framework formulated within American medical education that proposes shifting the focus from individualizing explanations of health inequities to the analysis of the social, political, and economic structures that produce them. SCH is operationalized through five sub-competencies: (1) recognizing structures that shape clinical encounters; (2) developing extra-clinical language; (3) rearticulating cultural presentations into structural ones; (4) imagining structural interventions; and (5) developing structural humility. Objective: To analyze the conception of competence that underlies SCH and how its sub-competencies develop in practical experiences, discussing its pedagogical assumptions in light of Historical-Critical Pedagogy and Latin American critiques of competencebased pedagogies. Methodology: An integrative review (2010-2023) was conducted across five databases (BVS, PubMed, Scopus, Web of Science, Embase). Sixteen articles were selected and analyzed using thematic content analysis. Results: Of the 16 selected articles, 87.5% were produced in the United States. The conception of competence is not explicitly presented in 93.75% of the studies. Sub-competency 1 was identified in 100% of the articles, followed by sub-competency 4 in 75%, sub-competencies 2 and 3 in 60%, and sub-competency 5 in 25%. The training sessions are of short duration (90 minutes to 3 hours), centering on the development of individual knowledge, skills, and attitudes through active methodologies, with little integration into the curricula. Only one study proposes Collective Structural Competency. Discussion: SCH represents an advancement by placing social structures at the center of health training. However, its development tends to reproduce competence-based pedagogy with an individualizing and pragmatist bias. Formal and short-duration settings prioritize knowledge and imagination, whereas community-based and long-duration settings promote intervention skills and structural humility. The low adherence to sub-competency 5 warns of the risk of "structural over-competency." Final Considerations: SCH requires a reorientation from fragmented training toward longitudinal formative processes, articulating clinical practice, territory, and politics, anchored in the critical appropriation of knowledge and collective praxis. Collective Structural Competency highlights the potential for a counter-hegemonic appropriation of SCH in health education.