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J Surg Educ. 2018 Sep - Oct;75(5):1159-1170. doi: 10.1016/j.jsurg.2018.01.016. Epub 2018 Feb 16.

Qualitative Analysis of a Cultural Dexterity Program for Surgeons: Feasible, Impactful, and Necessary.

Author information

1
Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, Massachusetts. Electronic address: nudyavar@bwh.harvard.edu.
2
Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
3
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
4
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
5
Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, Massachusetts.

Abstract

OBJECTIVES:

Ineffective cross-cultural communication contributes to adverse outcomes for minority patients. To address this, the authors developed a novel curriculum for surgical residents built on the principle of cultural dexterity, emphasizing adaptability to clinical and sociocultural circumstances to tailor care to the needs of the individual patient. This study's objective was to evaluate the feasibility, acceptability, and perception of this program upon conclusion of its first year.

DESIGN, SETTING, AND PARTICIPANTS:

The curriculum was implemented at 3 general surgery programs. The flipped classroom model combined independent study via e-learning modules with interactive role-playing sessions. Sessions took place over 1 academic year. Four focus groups were held, each with 6 to 9 participants, to gain feedback on the curriculum. Focus groups were recorded and transcribed, and the data were analyzed using a grounded theory approach.

RESULTS:

Five major themes emerged: (1) Role modeling from senior colleagues is integral in developing communication/interpersonal skills and attitudes toward cultural dexterity. (2) Cultural dexterity is relevant to the provision of high-quality surgical care. (3) Barriers to providing culturally dexterous care exist at the system level. (4) "Buy-in" at all levels of the institution is necessary to implement the principles of cultural dexterity. (5) The shared experience of discussing the challenges and triumphs of caring for a diverse population was engaging and impactful.

CONCLUSION:

Early implementation of the curriculum revealed that the tension between surgical residents' desire to improve their cultural dexterity and systemic/practical obstacles can be resolved. Combining surgically relevant didactic materials with experiential learning activities can change the paradigm of cross-cultural training.

KEYWORDS:

Interpersonal and Communication Skills; Professionalism; cultural dexterity; flipped classroom; focus groups; health care disparities

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