structural competency structural competency structural competency is a term used in american health professional education to describe the ability of health care providers and trainees to appreciate how symptoms, clinical problems, diseases and attitudes toward patients, populations and health systems are influenced by 'upstream' social determinants of health. the creators of this term jonathan metzl and helena hansen proposed a 5-point model . recognition of "structures that shape clinical interactions" development of "an extraclinical language of structure" rearticulation of "'cultural' presentations in structural terms" observation and imagination of "structural intervention" development of "structural humility" the concept of structural competency is framed in the language of competency based medical education and is proposed as a new iteration of cultural competency which is a defined competency in american medical, nursing and public health education.