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Surgeons’ Perceptions Toward Providing Care for Diverse Patients

The Need for Cultural Dexterity Training

Changoor, Navin R., MD*,†; Udyavar, Nidhi R., MD*; Morris, Megan A., PhD, MPH*; Torain, Maya, BS*; Mullen, John T., MD; Kent, Tara S., MD, MS§; Smink, Douglas S., MD, MPH*,¶; Green, Alexander, MD, MPH||; Haider, Adil H., MD, MPH, FACS*,¶

doi: 10.1097/SLA.0000000000002560

Objective: We sought to understand the experiences of surgical residents and faculty with treating culturally diverse patients, and identify recommendations for establishing and implementing structured cultural competency training.

Summary Background Data: Cultural competency training for medical professionals could reduce healthcare disparities, yet is currently not a standard part of surgical residency training. Few studies have explored the perspectives of surgical residents and faculty on the skills needed to provide cross-cultural care.

Study Design: A purposeful sample of surgical residents and faculty from 4 academic institutions was recruited for semistructured qualitative interviews. We developed an in-depth interview guide and performed interviews to thematic saturation. Interviews were audio-recorded, transcribed, and analyzed using grounded theory methodology.

Results: We interviewed 16 attending surgeons and 15 surgical residents. Participant demographics were: male (51.6%), White (58.1%), Black (9.7%), Asian (22.5%), and Hispanic (9.7%). Four main themes emerged from the data: 1) aspects of culture that can inform patient care; 2) specific cultural challenges related to surgical care, including informed consent, pain management, difficult diagnoses and refusal of treatment, emergency situations, and end-of-life issues; 3) need for culturally competent care in surgery to navigate cultural differences; 4) perceived challenges and facilitators to incorporating cultural competency into the current training paradigm.

Conclusions: Surgeons identified the need to provide better cross-cultural care and proposed tenets for training. Based on these findings, we suggest the development and dissemination of a cultural dexterity training program that will provide surgeons with specific knowledge and skills to care for patients from diverse sociocultural backgrounds.

*Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA

Department of Surgery, Howard University College of Medicine, Washington, DC

Department of Surgery, Massachusetts General Hospital, Boston, MA

§Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA

Department of Surgery, Brigham and Women's Hospital, Boston, MA

||Department of Internal Medicine, Massachusetts General Hospital, Boston, MA.

Reprints: Adil H. Haider, MD, MPH, FACS, The Center for Surgery and Public Health, 1620 Tremont St, BC 4-020, Boston, MA 02120. E-mail:

This work was partially funded by the Harvard Affinity Research Collaborative (Grant number: #112227). The funding supported the design and conduct of the study, data collection and analysis, and preparation and submission of the manuscript.

The authors report no conflicts of interest.

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