Cultural complications: Why, how, and lessons learned

Abstract

Highlights Lessons learned in curriculum deployment provide a blueprint for leaders seeking to increase Diversity, Equity & Inclusion. Successful deployment hinges on selecting a forum, identify champions, understanding the audience, and including dissenters. Making scenarios available ahead of time and creating safe spaces for debriefing help ensure robust discussion. Enduring success requires a willingness to adapt and respond to criticism.

Improving Equity, Diversity, and Inclusion in Plastic, Reconstructive, and Aesthetic Surgery in Canada: A Call to Action

“…This initiates conversations in familiar environments and frames EDI principles within the context of surgical care and outcomes. 52 For example our division's experience with cultural cases at the University of Toronto has stimulated intellectual discussion on Indigenous care and facilitated education from an invited Indigenous health navigator who would not have otherwise had a platform for reaching this group.…”

How Should We Discuss Inequity and Iatrogenic Harm in Academic Health Centers?

“…Harris et al's Cultural Complications Curriculum was developed in the context of academic surgical training. 11 This curriculum discusses cultural complications experienced by patients, or harm engendered by racism, sexism, and homophobia. The curriculum has gained traction within a wide range of academic training programs.…”

“…Benefits cited in integrating such discussions on inequity into M&M conferences include their structured, longitudinal format and the requirement for the entire department to attend, which distributes the onus of pursuing health equity among both faculty and trainees. 11,12 Rounds. Another strategy for discussing iatrogenic harm and inequity in health care is Capers et al's "bias and racism rounds," teaching sessions that facilitate documentation and critical review of patient-clinician interactions in a format akin to teaching clinical medicine.…”

Cultural Complications Curriculum: Applicability to Surgical Oncology Programs and Practices

“…Integration of the Cultural Complications Curriculum into a preexisting and standing conference (like M&M) demonstrates a commitment to culture change from departmental leadership and promotes a learning platform where faculty and trainees are engaged simultaneously. 5 As we have gained experience in Cultural Complications at our own institutions through supporting the efforts of others who have gained familiarity with this program and/or launched similar initiatives, we have recognized how this program may be uniquely applicable to the multidisciplinary audiences the exist in cancer programs. In these settings where a variety of perspectives exist, we believe Cultural Complications is well suited to facilitate culture change by establishing a common knowledge base among program participants, improving communication surrounding DEI issues, and supporting strategy development to combat bias, harassment, and discrimination in dynamic environments.…”

“…Recognizing the need to systematically transform culture at our own institutions and noting multiple deficiencies within standard bias training, we developed and implemented a ''Cultural Complications'' program (www.cultura lcomplications.com) aimed at supporting departments wishing to address cultural error. 4,5 The Cultural Complications Curriculum leverages the traditional morbidity & mortality (M&M) conference structure, featuring case presentations, didactic sessions, and group discussions in a regular, dedicated monthly forum intended to raise awareness of core DEI issues in the hospital. Integration of the Cultural Complications Curriculum into a preexisting and standing conference (like M&M) demonstrates a commitment to culture change from departmental leadership and promotes a learning platform where faculty and trainees are engaged simultaneously.…”