R. Udyavar1, D. Smink1,2, J. Mullen3, T. Kent4, A. Green3, A. Harlow1, M. Castillo-Angeles1, A. Columbus1,2, A. Haider1,2 1Brigham And Women’s Hospital, Center For Surgery And Public Health,Department Of Surgery,Boston, MA, USA 2Brigham And Women’s Hospital,Department Of Surgery,Boston, MA, USA 3Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA 4Beth Israel Deaconess Medical Center,Department Of Surgery,Boston, MA, USA
Introduction: Ineffective cross-cultural communication has been shown to contribute to adverse outcomes for minority patients. To address this, we developed a novel curriculum for surgical residents built on the principle of cultural dexterity, emphasizing adaptability to clinical and sociocultural circumstances to tailor the approach to the needs of the individual patient within a cultural context. Our objective was to evaluate the feasibility, acceptability, and residents’ perception of this program upon conclusion of its first year.
Methods: The curriculum was implemented at 3 general surgery programs. It employed a flipped classroom model consisting of independent study via e-learning modules and interactive role-playing sessions for skills application. Skills focused on the physician/patient relationship, limited English proficiency, informed consent, and pain management. Sessions took place during compulsory didactic sessions over the course of 1 academic year. We conducted 4 focus groups, each with 6-9 participants, to get rich feedback on the curriculum and delivery model. Two of the focus groups consisted of PGY-1 categorical and preliminary general surgery interns, while the remaining 2 consisted of general surgery residents distributed across all levels of training. Focus groups were held during residents’ protected academic time and recorded, transcribed, and coded for content analysis.
Results: Five major themes emerged from the data: (1) Role modeling from senior residents, fellows, and faculty members is integral in developing communication/interpersonal skills and attitudes towards cultural dexterity. (2) Residents understand that cultural dexterity is relevant and crucial to the provision of high-quality surgical care. (3) Nevertheless, residents express a sense of personal helplessness regarding their ability to implement macro-level improvements. (4) They emphasize the need to encourage “buy-in” at all levels of the institution as a whole to ensure that cultural dexterity becomes engrained in the system’s ethos. (5) Cultural dexterity training encourages residents to discuss the challenges and triumphs of providing surgical care to a diverse population, and it is the shared experience that residents find most engaging and impactful.
Conclusion: Early implementation of the novel cultural dexterity curriculum revealed that the tension between surgical residents’ desire to improve their cross-cultural communication skills and the systemic/practical obstacles to providing culturally dexterous care are not insurmountable. Combining surgically relevant didactic materials with experiential learning activities has the potential to change the paradigm of surgical education.
