Purpose <p>Structural competency is the trained ability of health professionals to recognize and respond to health and illness as the downstream effects of social, political, and economic structures. Structural competency is critical to developing a workforce that can address existing health disparities. However, structural competency in surgical education is limited. We aimed to address this gap via the development, implementation, and evaluation of a longitudinal Structural Disadvantages Curriculum (SDC) at an academic surgical training program in the US.</p> Methods <p>We developed a curriculum comprising 11 topics, corresponding to populations affected by structural disadvantages. Each topic included a resident lecture, guest lecture, and topic-specific book. A baseline survey was administered to residents before program implementation. The follow-up survey was administered at the end of years 1 and 2. Using Likert scales, surveys measured respondents’ comfort with components of SC and their ability to identify structural factors as determinants of health. Statistical analysis was performed using Fisher’s exact and Chi-squared tests. Content analysis was performed on qualitative questions.</p> Results <p>We analyzed 68 baseline surveys and 37 follow-up surveys (67% and 57% response rate, respectively). Compared to baseline, at follow-up, there was improved comfort in engaging in meaningful conversations with marginalized patients about structural disadvantages (89% vs. 66%, <i>p</i> = 0.01), recognizing evidence-based structural factors that influence health disparities (89% vs. 66%, <i>p</i> = 0.01), and knowledge of resources available to address structural challenges (41% vs. 22%, <i>p</i> &lt; 0.001). Participants overwhelmingly agreed the curriculum increased their empathy for patients facing structural disadvantages (95%), were more aware of the language they use with patients experiencing structural disadvantages (92%), and were more likely to consider structural factors when caring for patients (92%). Content analysis identified multiple strengths and opportunities for improvement within the curriculum.</p> Conclusion <p>Implementation of a novel longitudinal structural competency curriculum at a large general surgery program demonstrated benefits in the perceived ability to identify, discuss, and address structural disadvantages. Residents valued and desired additional resources to enact actionable changes. Future work is needed to translate this into tangible skills and improved patient outcomes.</p>