G. Tortorello1,3, C. Wirtalla2,3, E. Bailey2,3, R. Hoffman2,3, C. Sharoky2,3, R. Kelz1,2,3 1University Of Pennsylvania,Perelman School Of Medicine,Philadelphia, PA, USA 2University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA 3University Of Pennsylvania,Center For Surgery And Health Economics,Philadelphia, PA, USA
Introduction:
Disparities in surgical outcomes have been well documented. Programs designed to improve provider knowledge on cultural competency (CC) have focused on minority health. We sought to examine provider-population distance using the CAGE Framework in the setting of programs designed to teach CC in an effort to identify an efficient strategy for future programmatic development.
Methods:
The CAGE Framework, originally designed to assess similarity across nations using 4 individual indices, was adapted for use in the healthcare setting (See Table). A systematic review to identify CC curricula in undergraduate and graduate medical education programs identified 13 such programs. Trainee characteristics of participants were abstracted. To approximate the patient characteristics, population statistics for each local city were taken from the US Census Bureau Report 2010. Trainee characteristics were compared with patient characteristics using the Wilcoxen rank-sum. The correlation between CAGE score and program success was assessed with the sample Pearson correlation coefficient.
Results:
The participants at each study site and the respective city populations varied on all CAGE characteristics. Across all sites, when compared to patients, a greater proportion of trainees were white/Caucasian (67.3% vs 46.7%, p=0.0587), insured (13.8% vs. 0%, p<0.0001), more highly educated (100% vs. 41.9% with Bachelor's degree, p<0.0001), and had greater median incomes ($198,545 vs. $60,594, p<0.0001). The median scores by CAGE index can be seen in the Table with larger numbers representing greater dissimilarity between patients and trainees. The mean Hospital Referral Region for the study cities was 6,185 sq. miles (median 3,441; min 212; max 20,939). Following the CC program, the mean increase in post-test score was 32% (median 18%; min 8%; max 88%). The post-test scores and CAGE distance were not significantly correlated, r=-0.12 (p=0.714).
Conclusion:
The CAGE distance between trainees enrolled in CC curricula and their patient populations illustrates the dissimilarity between the two cohorts across multiple heterogeneous sites within the United States. As the CAGE distance between providers and their patients varies significantly between training sites, both the content and intensity of CC training may need to be locally determined. CC programs need to enable cultural dexterity among providers to encourage the respectful care of patients that may be unfamiliar based on dissimilar backgrounds.
