A Qualitative Analysis of Surgical Faculty and Surgical Resident Perceptions of Potential Barriers to Implementing a Novel Surgical Education Curriculum

Lee, Gillian J.; Ortega, Gezzer; Reidy, Emma; Atkinson, Rachel B; Pichardo, Margaret S.; Reich, Amanda J.; Ladin, Keren; Chun, Maria B J; Demko, Caroline; Barreiro-Rosado, Jeenn A.; Udyavar, N. Rhea; Kent, Tara S.; Green, Alexander R.; Haider, Adil H.; Smink, Douglas S.

doi:10.1016/j.jsurg.2020.09.023

Cited by 6 publications

(4 citation statements)

References 17 publications

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“…To develop the PACTS curriculum, our team conducted semistructured, in-depth interviews with attending surgeons, surgical residents, and patients, and analyzed them using a grounded theory framework to establish a targeted needs assessment and to inform the curriculum. 21,23 Gaps identified included poor cross-cultural communication, lack of skills for working with interpreters and treating patients with limited English proficiency, challenges with providing informed consent, and differences in expectations regarding pain. These data helped us shape the specific learning objectives and 4 modules of the curriculum: (1) an introduction to cultural dexteritybuilding trust and effective cross-cultural communication ("trust"); (2) optimizing communication with patients with limited English proficiency ("LEP"); (3) informed consent in cross-cultural surgeon-patient relationships ("Informed Consent"); (4) management of Pain in cross-cultural surgical care ("pain management").…”

Section: Curriculum Designmentioning

confidence: 99%

A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents’ Knowledge, Cross-Cultural Care, Skills, and Beliefs

Smink,

Ortega,

Dacier

et al. 2024

Annals of Surgery

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Objectives: This trial examines the impact of the Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS) curriculum on surgical residents’ knowledge, cross-cultural care, skills, and beliefs. Summary Background Data: Cross-cultural training of providers may reduce healthcare outcome disparities, but its effectiveness in surgical trainees is unknown. Methods: PACTS focuses on developing skills needed for building trust, working with patients with limited English proficiency, optimizing informed consent, and managing pain. The PACTS trial was a randomized crossover trial of 8 academic general surgery programs in the United States: The Early group (“Early”) received PACTS between Periods 1 and 2, while the Delayed group (“Delayed”) received PACTS between Periods 2 and 3. Residents were assessed pre- and post-intervention on Knowledge, Cross-Cultural Care, Self-Assessed Skills, and Beliefs. Chi-square and Fisher’s exact tests were conducted to evaluate within- and between-intervention group differences. Results: Of 406 residents enrolled, 315 were exposed to the complete PACTS curriculum. Early residents’ Cross-Cultural Care (79.6% to 88.2%, P<0.0001), Self-Assessed Skills (74.5% to 85.0%, P<0.0001), and Beliefs (89.6% to 92.4%, P=0.0028) improved after PACTS; Knowledge scores (71.3% to 74.3%, P=0.0661) were unchanged. Delayed resident scores pre- to post-PACTS showed minimal improvements in all domains. When comparing the two groups at Period 2, Early residents had modest improvement in all 4 assessment areas, with statistically significant increase in Beliefs (92.4% vs 89.9%, P=0.0199). Conclusion: The PACTS curriculum is a comprehensive tool that improved surgical residents’ knowledge, preparedness, skills, and beliefs, which will help with caring for diverse patient populations.

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Section: Curriculum Designmentioning

confidence: 99%

A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents’ Knowledge, Cross-Cultural Care, Skills, and Beliefs

Smink,

Ortega,

Dacier

et al. 2024

Annals of Surgery

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“…This resident engagement is critical to buy-in, and interventions that increase self-awareness of one's own implicit bias may make participation in a cultural competency curriculum more enticing. 91 The use of visual art to improve general observational skills and cultural sensitivity is more common in medical student education as compared to GME. 92,93 This may be due to perceptions that residents and fellows do not have time for non-clinically focused education, or perhaps that these humanities-oriented programs are not appealing to more senior trainees.…”

Section: Unique Interventionsmentioning

confidence: 99%

Cultural Competency Curricula in US Graduate Medical Education: A Scoping Review

Atkinson

Khubchandani

Chun

et al. 2022

Journal of Graduate Medical Education

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Background Cultural competency training provides participants with knowledge and skills to improve cross-cultural communication and is required for all graduate medical education (GME) training programs. Objective The authors sought to determine what cultural competency curricula exist specifically in GME. Methods In April 2020, the authors performed a scoping review of the literature using a multidatabase (PubMed, Ovid, MedEdPORTAL) search strategy that included keywords relevant to GME and cultural competency. The authors extracted descriptive data about the structure, implementation, and analysis of cultural competency curricula and analyzed these data for trends. Results Sixty-seven articles met criteria for inclusion, of which 61 (91%) were focused exclusively on residents. The most commonly included specialties were psychiatry (n=19, 28.4%), internal medicine (n=16, 23.9%), and pediatrics (n=15, 22.4%). The shortest intervention was a 30-minute online module, while the longest contained didactics, electives, and mentoring programs that spanned the entirety of residency training (4 years). The sample sizes of included studies ranged from 6 to 833 participants. Eight (11.9%) studies utilized OSCEs as assessment tools, while 17 (25.4%) conducted semi-structured interviews or focus groups. Four common themes were unique interventions, retention of learning, trainee evaluation of curricula, and resources required for implementation. Conclusions Wide variation exists in the design, implementation, and evaluation of cultural competency curricula for residents and fellows.

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“…Lee et al noted that institutional support, participant engagement, and clear applicability to surgical practice are essential for this curricula to be successful. [ 43 ] Policy changes. Potential changes include updating the code of conduct to include cultural humility, promoting an open-door policy to facilitate reporting, applying the rules swiftly and equally to all staff members, and increasing representation in the hiring process.…”

Section: Phased Approach To Cultural Competence Trainingmentioning

confidence: 99%

“…Lee et al noted that institutional support, participant engagement, and clear applicability to surgical practice are essential for this curricula to be successful. [ 43 ]…”

Section: Phased Approach To Cultural Competence Trainingmentioning

confidence: 99%

Cultural Competence, Safety, Humility, and Dexterity in Surgery

2022

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Purpose of Review As the United States’ population diversifies, urgent action is required to identify, dismantle, and eradicate persistent health disparities. The surgical community must recognize how patients’ values, beliefs, and behaviors are influenced by race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability, sexual orientation, and occupation. Recent Findings Lately, health disparities have been highlighted during the COVID-19 pandemic. Surgery is no exception, with notable disparities occurring in pediatric, vascular, trauma, and cardiac surgery. In response, numerous curricula and training programs are being designed to increase cultural competence and safety among surgeons. Summary Cultural competence, safety, humility, and dexterity are required to improve healthcare experiences and outcomes for minorities. Various opportunities exist to enhance cultural competency and can be implemented at the medical student, resident, attending, management, and leadership levels.

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A Qualitative Analysis of Surgical Faculty and Surgical Resident Perceptions of Potential Barriers to Implementing a Novel Surgical Education Curriculum

Cited by 6 publications

References 17 publications

A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents’ Knowledge, Cross-Cultural Care, Skills, and Beliefs

A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents’ Knowledge, Cross-Cultural Care, Skills, and Beliefs

Cultural Competency Curricula in US Graduate Medical Education: A Scoping Review

Cultural Competence, Safety, Humility, and Dexterity in Surgery

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