Concordance of Resident and Patient Perceptions of Culturally Dexterous Patient Care Skills

Rachel Atkinson, MD
Department of Surgery
Poster Overview

Purpose: PACTS (Provider Awareness and Cultural dexterity Toolkit for Surgeons) is a curriculum to improve the quality of care that surgical residents provide to culturally diverse patients. We examined whether residents and their patients agree on how culturally dexterous (competent) residents are at baseline, prior to receiving this curriculum.

Methods: Prior to curriculum implementation, surgical residents and inpatients completed assessments about their cultural dexterity skills and care, respectively. A score of 75% was considered culturally dexterous.

Results: 179 residents completed self-assessments, including 88 (49.2%) women and 97 (54.2%) junior residents. 54.7% were White, 19% Asian, and 8.9% Black/African American. Of the 494 patients surveyed, 238 (48.2%) were female and 320 (64.8%) were White. 50% of residents viewed themselves as culturally dexterous, while 57% of patients reported receiving culturally dexterous care (p=0.09). Residents who perceived themselves to be culturally dexterous were more likely to self-identify as non-White (p<0.05). Black patients were more likely to report poorly dexterous care (p<0.05).

Conclusions: Only half of patients reported receiving culturally dexterous care from surgical residents, which supports the need for the PACTS curriculum. White patients felt they received better care, and non-White residents were more likely to feel confident in their cultural dexterity skills.

Scientific Abstract

Purpose: PACTS (Provider Awareness and Cultural dexterity Toolkit for Surgeons) is a curriculum to improve surgical residents’ cultural dexterity. We examined concordance between residents’ self-perceived cultural dexterity skills and patients’ perceptions of their skills.

Methods: Prior to curriculum implementation, surgical residents and inpatients completed assessments about their cultural dexterity skills and care, respectively. Responses were classified as high or low competency. Assessments were considered dexterous if 75% of responses were in the high category.

Results: 179 residents completed self-assessments, including 88 (49.2%) women and 97 (54.2%) junior residents. 54.7% were White, 19% Asian, and 8.9% Black/African American. Of the 494 patients surveyed, 238 (48.2%) were female and 320 (64.8%) were White. 50% of residents viewed themselves as culturally dexterous, while 57% of patients reported receiving culturally dexterous care (p=0.09). Residents who perceived themselves to be culturally dexterous were more likely to self-identify as non-White (p<0.05). Black patients were more likely to report poorly dexterous care (p<0.05).

Conclusions: Half of patients reported receiving culturally dexterous care from surgical residents, consistent with residents’ self-assessment of their own skills. White patients were more likely to report receiving culturally dexterous care. Non-White residents were more likely to feel confident in their cultural dexterity skills.

Clinical Implications
Patients of various minority groups have worse clinical outcomes (i.e. complications and death) as compared to non-minority patients. This is partially due to inefficient communication by providers. The PACTS curriculum teaches residents to communicate more effectively with minority patients.
Research Areas
Authors
Rachel B. Atkinson, MD, Gezzer Ortega, MD, MPH, Alexander R. Green, MD, MPH, Maria B.J. Chun, PhD, David T. Harrington, MD, Pamela A. Lipsett, MD, MHPE, John T. Mullen, MD, Emil Petrusa, PhD, Emma Reidy, MPH, Adil H. Haider, MD, MPH and Douglas S. Smink, MD, MPH, on behalf of the PACTS Trial Group
Principal Investigator
Douglas S. Smink, MD, MPH

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