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Objectives: This trial examines the impact of the Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS) curriculum on surgical residents' knowledge, cross-cultural care, skills, and beliefs. Background: Cross-cultural training of providers may reduce health care outcome disparities, but its effectiveness in surgical trainees is unknown. Methods: PACTS focuses on developing skills needed for building trust, working with patients with limited English proficiency, optimizing informed consent, and managing pain. The PACTS trial was a randomized crossover trial of 8 academic general surgery programs in the United States: The Early group ("Early") received PACTS between periods 1 and 2, while the Delayed group ("Delayed") received PACTS between periods 2 and 3. Residents were assessed preintervention and postintervention on Knowledge, Cross-Cultural Care, Self-Assessed Skills, and Beliefs. χ² and Fisher exact tests were conducted to evaluate within-intervention and between-intervention group differences. Results: Of 406 residents enrolled, 315 were exposed to the complete PACTS curriculum. Early residents' Cross-Cultural Care (79.6%-88.2%, P< 0.0001), Self-Assessed Skills (74.5%--85.0%, P<0.0001), and Beliefs (89.6%-92.4%, P=0.0028) improved after PACTS; knowledge scores (71.3%-74.3%, P=0.0661) were unchanged. Delayed resident scores pre-PACTS to post-PACTS showed minimal improvements in all domains. When comparing the 2 groups in period 2, Early residents had modest improvement in all 4 assessment areas, with a statistically significant increase in Beliefs (92.4% vs 89.9%, P=0.0199). Conclusions: The PACTS curriculum is a comprehensive tool that improved surgical residents' knowledge, preparedness, skills, and beliefs, which will help with caring for diverse patient populations. [ABSTRACT FROM AUTHOR]

Due to the current economic crisis, research administrators at public universities are grappling with declining state funding and are faced with identifying other potential sources of revenue to support operations. Research administrators at all levels are forced to do more with less. Department level research administrators must be innovative since they have the least control over distribution of resources, including fiscal, staffing, and space. They must be adequately trained to deal with periodic shifts in the centralization and decentralization of duties that result from fiscal uncertainty and leadership changes. Therefore, strategically planning to accommodate department level assistance for its faculty who are engaged in or are pursuing extramural funding has become imperative. This article discusses a public university department's initiative to support both its faculty and the central administrative office by attempting to reduce administrative burdens. This was accomplished through increasing self-sufficiency of department-level research administration staff via professional development efforts and engaging in collaborative efforts with other departments and the central administrative office.

The article focuses on the need for cultural faculty development initiatives at the University of Hawai‘i John A. Burns School of Medicine (JABSOM) in response to recent legal decisions impacting affirmative action and diversity initiatives. Topics discussed include JABSOM's commitment to diversity, the lack of mandatory cultural training for faculty, and recommendations for implementing a comprehensive schoolwide training program to address cultural competence and diversity.

Past research has examined the complex reasons for the apparent reluctance of East Asian Americans (ie, Chinese, Japanese, Koreans) to seek mental health services when needed. The current study analyzed East Asian American (EAA) mental health, utilizing inpatient hospitalization data from the Hawai‘i Health Information Corporation (HHIC) database. Frequency of inpatient hospitalizations for specific mental health diagnoses (depression, bipolar disorder, schizophrenia, and suicide attempts/ideation) in EAA patients was examined. White, Native Hawaiian, and Filipino patients were included for comparative purposes. Retrospective data on adult (18 years and over) inpatient visits in Hawai‘i from 2007 to 2017 were analyzed. Variables available for analysis were detailed race/ethnicity, age, sex, island, and insurance type as well as readmission rates, severity of illness (SOI), and initial length of stay (LOS). Overall, there were no significant differences between race/ethnicity groups in regards to readmission, SOI, or LOS for a majority of the diagnoses. However, for depression, even when adjusting for other demographics, Japanese and Chinese patients had significantly higher initial LOS and SOI than White patients, though the strength of this association was weak (R Squared model fits being less than .1 for both outcomes). The reason for these findings requires further examination, including whether EAAs may be reticent to seek help and/or whether healthcare providers are not recognizing the need for assistance. [ABSTRACT FROM AUTHOR]

Orthopaedic surgery is no stranger to health care disparities and the American Academy of Orthopaedic Surgeons (AAOS) has expressed a commitment to a culturally competent and diverse workforce. Addressing workforce diversification is critical to recruiting a more diverse orthopaedic workforce and engaging the community to improve patient care and ensure equitable care for all. Unfortunately, these concerns were acknowledged by the AAOS almost 2 decades ago, without much significant progress. This article discusses mentoring as a means to address workforce diversification in orthopaedics and provides recommendations on how orthopaedics can enhance its efforts. [ABSTRACT FROM AUTHOR]

Identifying practical and effective tools to evaluate the efficacy of cultural competency (cc) training in medicine continues to be a challenge. Multiple measures of various lengths and stages of psychometric testing exist, but none have emerged as a "gold standard." This review attempts to identify cc measures with potential to economically, efficiently, and effectively provide insight regarding the value of cc training efforts to make it easier for wider audience utilization. A scoping review of 11 online reference databases/search engines initially yielded 9,626 items mentioning cc measures. After the initial review, focus was placed on measures that assessed cultural competence of medical students, residents, and/or attending physicians. Six measures were identified and reviewed: (1) Cross-Cultural Care Survey, (2) Cultural Competence Health Practitioner Assessment, (3) Cultural Humility Scale, (4) Health Beliefs Attitudes Survey, (5) Tool for Assessing Cultural Competency Training, and (6) the Tucker-Culturally Sensitive Health-Care Provider Inventory. Relevant literature documenting use and current psychometric assessments for each measure were noted. Each measure was found to be of value for its particular purpose but needs more strenuous reliability and validity testing. A commitment to include psychometric assessments should be an expected part of studies utilizing these measures. [ABSTRACT FROM AUTHOR]

In 2008 the University of Hawai'i at Mānoa's (UHM) Department of Surgery introduced the concept of cross-cultural health care (aka cultural competency) to its faculty and trainees. Much work remains before the cultural efforts wellknown outside the department are embraced within, but it has been prioritized for curriculum development and research. An example of the department's efforts include the Cross-Cultural Health Care Research Collaborative, which was created as a forum for faculty who have an interest in cultural issues related to healthcare and healthcare delivery. Participants from 14 UHM departments and other organizations developed projects and mentored students, resulting in over ten peer-reviewed publications. A related effort is the JABSOM Cultural Competency Resource Guide, which is in its 7th edition and reflects JABSOM activities and those of its collaborators. Another highlight is the Biennial Cross-Cultural Health Care Conference: Collaborative and Multidisciplinary Interventions, with six conferences held since 2010, hosting attendees from 28 US Mainland states and 11 countries. Additionally, the department has been recognized as one of the first to develop a cultural standardized patient exam for surgical residents. These nationally-recognized efforts resulted in invitations to serve on the very first cultural competency panel at the American College of Surgeons Clinical Congress and as a consultant on the development of Brigham and Women's Hospital's Center for Surgery and Public Health's Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS), a standardized curriculum for surgical residents. The department plans to continue its work on these projects and document outcomes. [ABSTRACT FROM AUTHOR]

Use of mobile tablet computers (MTCs) in residency education has grown. The objective of this study was to investigate the impact of MTCs on multiple specialties' residency training and identify MTC adoption impediments. To our knowledge, this current project is one of the first multispecialty studies of MTC implementation. A prospective cohort study was formulated. In June 2012 iPad2s were issued to all residents after completion of privacy/confidentiality agreements and a mandatory hard-copy pre-survey regarding four domains of usage (general, self-directed learning, clinical duties, and patient education). Residents who received iPads previously were excluded. A voluntary post-survey was conducted online in June 2013. One-hundred eighty-five subjects completed pre-survey and 107 completed post-survey (58% overall response rate). Eighty-six pre- and post-surveys were linked (response rate of 46%). There was a significant increase in residents accessing patient information/records and charting electronically (26.9% to 79.1%; P<.001), but a significant decrease in looking up drug and treatment reference material (97.0% to 82.1%; P=.0039). There was a significant increase in MTC use as a primary means of charting when conducting rounds (4.9% to 39.5%; P<.001) and a significant decrease in using paper charts (30.1% to 15.7%; P=.0073). There was also a significant increase in MTC use as a primary means for explaining a diagnosis (7.7% to 57.7%; P<.001). The use of MTC has an impact on how residents approach medical education, clinical practice, and patient education. The survey tool may be useful in collecting data on MTC use by other graduate medical education programs. [ABSTRACT FROM AUTHOR]

Background: As the health care field moves toward patient-centered care (PCC), increasing emphasis has been placed on the benefits of patient decision aids for promoting shared decision making (SDM). This study provides a baseline measure of knowledge, attitudes, and practices (KAP) among Hawai'i's physicians with respect to patient decision aids (DAs). Physicians throughout the State of Hawai'i were invited to complete a survey assessing their knowledge, attitudes, and practices with respect to the clinical use of DAs. One hundred and seventy four valid surveys were analyzed. Reported awareness and use of DAs were low, but recognition of the benefits of SDM and openness to the use of DAs were very high. The leading perceived barriers to the implementation of DAs were lack of awareness, lack of resources, and limited physician time to learn about DA technology. However, a significant majority of the respondents reported that DAs could empower patients by improving knowledge (88%), increasing satisfaction with the consultation process (81%), and increasing compliance (74%). Among physicians currently employing DAs, use of brochures or options matrix sheets was the most common aid tool. However, leading recommended DA formats were paper-based brochures for clinic use (75%) and interactive online website programs for outside clinic use (73.5%). Given growing emphasis on the PCC model and the recognized desire of many patients to participate in the medical decision making process, positive responses toward SDM and the use of DAs by Hawai'i physicians are promising. [ABSTRACT FROM AUTHOR]

Background: Cultural competency is an important skill that prepares physicians to care for patients from diverse backgrounds. Objective: We reviewed Accreditation Council for Graduate Medical Education (ACGME) program requirements and relevant documents from the ACGME website to evaluate competency requirements across specialties. Methods: The program requirements for each specialty and its subspecialties were reviewed from December 2011 through February 2012. The review focused on the 3 competency domains relevant to culturally competent care: professionalism, interpersonal and communication skills, and patient care. Specialty and subspecialty requirements were assigned a score between 0 and 3 (from least specific to most specific). Given the lack of a standardized cultural competence rating system, the scoring was based on explicit mention of specific keywords. Results: A majority of program requirements fell into the low- or no-specificity score (1 or 0). This included 21 core specialties (leading to primary board certification) program requirements (78%) and 101 subspecialty program requirements (79%). For all specialties, cultural competency elements did not gravitate toward any particular competency domain. Four of 5 primary care program requirements (pediatrics, obstetrics-gynecology, family medicine, and psychiatry) acquired the highspecificity score of 3, in comparison to only 1 of 22 specialty care program requirements (physical medicine and rehabilitation). Conclusions: The degree of specificity, as judged by use of keywords in 3 competency domains, in ACGME requirements regarding cultural competency is highly variable across specialties and subspecialties. Greater specificity in requirements is expected to benefit the acquisition of cultural competency in residents, but this has not been empirically tested. [ABSTRACT FROM AUTHOR]

The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and/or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility -- more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. [ABSTRACT FROM AUTHOR]

Due to the current economic crisis, research administrators at public universities are grappling with declining state funding and are faced with identifying other potential sources of revenue to support operations. Research administrators at all levels are forced to do more with less. Department level research administrators must be innovative since they have the least control over distribution of resources, including fiscal, staffing, and space. They must be adequately trained to deal with periodic shifts in the centralization and decentralization of duties that result from fiscal uncertainty and leadership changes. Therefore, strategically planning to accommodate department level assistance for its faculty who are engaged in or are pursuing extramural funding has become imperative. This article discusses a public university department's initiative to support both its faculty and the central administrative office by attempting to reduce administrative burdens. This was accomplished through increasing self-sufficiency of department-level research administration staff via professional development efforts and engaging in collaborative efforts with other departments and the central administrative office. [ABSTRACT FROM AUTHOR]

The article presents abstracts of papers presented at the conference "Cross-Cultural Health Care: Collaborative and Multidisciplinary Interventions" held in Hawai'i on February 11-12, 2010, including the development of evidence-based practice in substance use prevention, cultural competency and the use of the Tool for Assessing Cultural Competency Training (TACCT) workshop to assess cultural competency.

The purpose of this study was to explore the prevalence of breast cancer anxiety and risk counseling in women undergoing mammography, and the association with known risk factors for cancer. Women awaiting mammography were surveyed regarding anxiety, prior breast cancer risk counseling, demographic and risk factors. Anxiety was assessed via 7-point Likert-type scale (LS). Risk was defined by Gail model or prior breast cancer. Data were analyzed by nonparametric methods; significance determined at alpha = 0.05. Of 227 women surveyed, 54 were classified "higher risk". Counseling prevalence was similar (52%) for all ethnic groups, but higher (72%, P<0.001) for "higher risk" women. On average, women awaiting screening/diagnostic mammography were somewhat worried (median LS = 4). Worry was significantly higher (P<0.05) in "higher risk" women (LS = 5), and in women living outside Honolulu (LS = 6). Counseling by primary care physicians (PCP) did not correlate with lower worry scores. It was concluded that most women awaiting mammography are not unduly anxious. Additionally, the findings showed a correlation between a woman s concern about developing cancer with known risk factors and rural residence. [ABSTRACT FROM AUTHOR]

The article focuses on the use of the Cross-Cultural Care Survey developed by J. S. Weissman et al as a tool to measure cultural competency in graduate medical education at the University of Hawaii's School of Medicine in Honolulu. The survey was distributed to all residents regardless of their years in training. A shorter version of the survey was made to increase the response rates among several specialties. It suggests amending the survey for use with practicing physicians, medical students and other medical workers and providers.

The article discusses the highlights of the 2015 Cross-Cultural Care Conference: Collaborative and Multidisciplinary Interventions as a forum for discussing cross-cultural training and treatment. Speakers include Harvard scholar Dr. Joseph Betancourt who talked about culture in healthcare centered on patients while the Dean's Panel include Nursing Dean Mary Boland and Public Health director Kathryn Fraun. First-time speaker Tawara Goode discussed mentoring and training of minority students.

The article discusses the highlights of the 3rd Cross-Cultural Health Care Conference conducted by the John A. Burns School of Medicine (JABSOM) Department of Surgery on February 8-9, 2013 at the Ala Moana Hotel in Hawaii. Danny Takanishi, Robert Like and Keawe Kaholokula are some of the speakers at the conference. Topics discussed include methods of conducting community participatory research with native populations and palliative care for Marshall Islanders in Hawai'i.

The Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS) curriculum was developed to improve surgical resident cultural dexterity, with the goal of promoting health equity by developing cognitive skills to adapt to individual patients' needs to ensure personal, patient-centered surgical care through structured educational interventions for surgical residents. Funded by the National Institute of Health (NIH)'s National Institute on Minority Health and Health Disparities, PACTS addresses surgical disparities in patient care by incorporating varied educational interventions, with investigation of both traditional and nontraditional educational outcomes such as patient-reported and clinical outcomes, across multiple hospitals and regions. The unique attributes of this multicenter, multiphased research trial will not only impact future surgical education research, but hopefully improve how surgeons learn nontechnical skills that modernize surgical culture and surgical care. The present perspective piece serves as an introduction to this multifaceted surgical education trial, highlighting the rationale for the study and critical curricular components such as key stakeholders from multiple institutions, multimodal learning and feedback, and diverse educational outcomes., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To better prepare general surgery residents for handling the business aspects of healthcare, this project evaluation reports on the implementation of a business of healthcare curriculum (BHC) in a general surgery residency program. We evaluated (pre and post curriculum) self-perceived knowledge and attitudes toward common business topics., Design: General surgery residents were administered a 13-item survey (7 Likert-type and 3 open-ended items assessing self-perceived knowledge and attitudes toward BHC, and 3 demographic questions) prior to the start of the curriculum. The curriculum was comprised of four core sessions, which included didactic lectures and group projects, including the creation of a business plan. At the conclusion of the curriculum, a post-test with the same items was administered. A total of 21 residents completed both the pre and post-tests., Setting: The BHC was a mandatory part of the general surgery residency program and was conducted in Honolulu, Hawaii (University of Hawaii at Manoa)., Participants: All general surgery residents, PGY-1 to PGY-5, were required to participate in the curriculum., Results: Statistically significant increases in resident knowledge were found overall and specifically for healthcare reform legislation, differences between practice settings, financial matters, contracting and coding and billing for services. Additionally, responses to open-ended questions showed that residents had a positive attitude toward the curriculum and found it useful., Conclusions: General surgery residency programs can successfully create an impactful business of healthcare curriculum with minimal cost if volunteers and existing resources are utilized., (Copyright © 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Cultural competency training provides participants with knowledge and skills to improve cross-cultural communication and is required for all graduate medical education (GME) training programs., Objective: The authors sought to determine what cultural competency curricula exist specifically in GME., Methods: In April 2020, the authors performed a scoping review of the literature using a multidatabase (PubMed, Ovid, MedEdPORTAL) search strategy that included keywords relevant to GME and cultural competency. The authors extracted descriptive data about the structure, implementation, and analysis of cultural competency curricula and analyzed these data for trends., Results: Sixty-seven articles met criteria for inclusion, of which 61 (91%) were focused exclusively on residents. The most commonly included specialties were psychiatry (n=19, 28.4%), internal medicine (n=16, 23.9%), and pediatrics (n=15, 22.4%). The shortest intervention was a 30-minute online module, while the longest contained didactics, electives, and mentoring programs that spanned the entirety of residency training (4 years). The sample sizes of included studies ranged from 6 to 833 participants. Eight (11.9%) studies utilized OSCEs as assessment tools, while 17 (25.4%) conducted semi-structured interviews or focus groups. Four common themes were unique interventions, retention of learning, trainee evaluation of curricula, and resources required for implementation., Conclusions: Wide variation exists in the design, implementation, and evaluation of cultural competency curricula for residents and fellows., Competing Interests: Conflict of interest: The authors declare they have no competing interests.

Objective: Sociocultural differences between patients and physicians affect communication, and suboptimal communication can lead to patient dissatisfaction and poor health outcomes. To mitigate disparities in surgical outcomes, the Provider Awareness and Cultural dexterity Toolkit for Surgeons was developed as a novel curriculum for surgical residents focusing on patient-centeredness and enhanced patient-clinician communication through a cultural dexterity framework. This study's objective was to examine surgical faculty and surgical resident perspectives on potential facilitators and barriers to implementing the cultural dexterity curriculum., Design, Setting, and Participants: Focus groups were conducted at 2 separate academic conferences, with the curriculum provided to participants for advanced review. The first 4 focus groups consisted entirely of surgical faculty (n = 37), each with 9 to 10 participants. The next 4 focus groups consisted of surgical residents (n = 31), each with 6 to 11 participants. Focus groups were recorded and transcribed, and the data were thematically analyzed using a constant, comparative method., Results: Three major themes emerged: (1) Departmental and hospital endorsement of the curriculum are necessary to ensure successful rollout. (2) Residents must be engaged in the curriculum in order to obtain full participation and "buy-in." (3) The application of cultural dexterity concepts in practice are influenced by systemic and institutional factors., Conclusions: Institutional support, resident engagement, and applicability to practice are crucial considerations for the implementation of a cultural dexterity curriculum for surgical residents. These 3 tenets, as identified by surgical faculty and residents, are critical for ensuring an impactful and clinically relevant education program., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: Disparities in surgical care persist. To mitigate these disparities, we are implementing and testing the Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS), a curriculum to improve surgical residents' cultural dexterity during clinical encounters. We analyzed baseline data to look for concordance between residents' self-perceived cultural dexterity skills and patients' perceptions of their skills. We hypothesized that residents would rate their skills in cultural dexterity higher than patients would perceive those skills., Methods: Prior to the implementation of the curriculum, surgical residents at 5 academic medical centers completed a self-assessment of their skills in culturally dexterous patient care using a modified version of the Cross-Cultural Care Survey. Randomly selected surgical inpatients at these centers completed a similar survey about the quality of culturally dexterous care provided by a surgery resident on their service. Likert scale responses for both assessments were classified as high (agree/strongly agree) or low (neutral/disagree/strongly disagree) competency. Resident and patient ratings of cultural dexterity were compared. Assessments were considered dexterous if 75% of responses were in the high category. Univariate and multivariate analysis was conducted using STATA 16., Results: A total of 179 residents from 5 surgical residency programs completed self-assessments prior to receiving the PACTS curriculum, including 88 (49.2%) women and 97 (54.2%) junior residents (PGY 1-2s), of whom 54.7% were White, 19% were Asian, and 8.9% were Black/African American. A total of 494 patients with an average age of 55.1 years were surveyed, of whom 238 (48.2%) were female and 320 (64.8%) were White. Fifty percent of residents viewed themselves as culturally dexterous, while 57% of patients reported receiving culturally dexterous care; this difference was not statistically significant (p = 0.09). Residents who perceived themselves to be culturally dexterous were more likely to self-identify as non-White as compared to White (p < 0.05). On multivariate analysis, White patients were more likely to report highly dexterous care, whereas Black patients were more likely to report poorly dexterous care (p < 0.05)., Conclusions: At baseline, half of patients reported receiving culturally dexterous care from surgical residents at 5 academic medical centers in the United States. This was consistent with residents' self-assessment of their cultural dexterity skills. White patients were more likely to report receiving culturally dexterous care as compared to non-White patients. Non-White residents were more likely to feel confident in their cultural dexterity skills. A novel curriculum has been designed to improve these interactions between patients and surgical residents., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: Various tools have been utilized for cultural competency training in residency programs, including cultural standardized patient examinations. However, it is unknown whether residents feel the training they received has a long-term impact on how they care for patients. The purpose of this study was to assess whether surgical residents who participated in a cultural standardized patient examination view the experience as beneficial. Methods: Surgical residents who completed a standardized patient examination from Fall 2009 to Spring 2015 were asked to complete a 13-question survey assessing the following: (1) did participants feel prepared when dealing with patients from different cultural backgrounds, (2) did they feel the standardized patient experience was beneficial or improved their ability to care for patients, and (3) did they perceive that cultural competence was important when dealing with patients. Results: Sixty current/former residents were asked to participate and 24 (40%) completed the survey. All agreed cross-cultural skills were important and almost all reported daily interaction with patients from different cultural backgrounds. Sixteen participants (67%) reported the cultural standardized patient examination aided their ability to care for culturally dissimilar patients, and 13 (54%) said the training helped improve their communication skills with patients. Thirteen (54%) reported they would participate in another cultural standardized patient examination. Conclusion: Development of effective cultural competency training remains challenging. This study provides some preliminary results that demonstrate the potential lasting impact of cultural competency training. Participants found the skills gained from cultural standardized patient examinations helpful., Competing Interests: No competing financial interests exist.

Objective: Cultural competency(CC) in surgical residency curricula is not the novel idea it was fourteen years ago when the ACGME challenged program directors to teach and assess six core competencies. CC is recognized as a component of "patient care", "professionalism", and "interpersonal and communication skills." The results of five programs (2004-2012) with CC curricula were identified in a 2013 paper by Ly and Chun. The primary objective of this paper is to provide the current status of CC curricula in general surgery residency programs., Design: Three sources were used for this study. First, a four question survey on the current status of CC education was sent to program directors of ACGME-accredited surgery residency programs. Second, the lead authors from five programs previously reported in the 2013 paper were interviewed. Third, the survey mentioned above was resent to 52 residency programs who implemented New York University's (NYU) SPICE program, which has a CC component., Participants: Participants for the survey consisted of program directors of ACGME-accredited surgery residency programs. The interviews were conducted with the corresponding authors from the previous study by Ly and Chun., Results: Of the 256 surveyed, nine responded; seven stated that CC is not taught formally at their institution while four stated that they do not feel any part of CC curricula is missing from their program. Due to the low response rate, we identified and conducted interviews with general surgery residency programs with CC curricula. Of the five programs contacted, only three remain active and utilize Objective Structured Clinical Examinations (OSCEs) to teach cultural competency. One of the three, the SPICE program at NYU, has expanded to 52 other residency programs in the US., Conclusions: Although the importance of CC has been identified in general surgery, formal curricula and documentation of implementation remains elusive., (Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Recent articles have documented the importance of cultural competency in surgery. Surgical residency programs have used the Objective Structured Clinical Examinations or cultural standardized patient examinations as a training tool. Past studies evaluating cultural competency have noted the importance of including an observational (control) arm, which would allow for a more objective assessment of a resident's competency in this area. The purpose of our article is to present the results of a follow-up study to a pilot cultural standardized patient examination for surgery residents., Methods: All first-year surgery residents were required to participate in the videotaped cultural SP examination as part of the general surgery residency curriculum. Two measures were used to assess resident performance. On the day of the examination, the Cross-Cultural Care Survey was administered. The examination was assessed by the residents themselves, faculty observers, and standardized patients, using a written checklist that was developed to evaluate residents on all 6 Accreditation Council for Graduate Medical Education competencies., Results: The current study includes 20 first-year surgery residents from academic years 2011 to 2012 and 2012 to 2013. The examination of pretest differences in groups found that students born outside of the United States had significantly higher scores on attitude (t = -2.68, df = 18, p = 0.02), but no statistically significant differences were found in skillfulness or knowledge or in the overall rating scale. For the overall rating scale, change from pretest to posttest was statistically significant (t = -2.25, df = 18, p = 0.04). Further analysis revealed that students who were born in the United States demonstrated a significant increase in ratings (t = -3.08, df = 10, p = 0.01) whereas students who were not born in the United States showed little change (t = -0.35, df = 7, p = 0.74). These results show that the means in attitude scales changed little for all groups, but both white and US-born students showed greater improvement on skillfulness and knowledge., Conclusions: Training and measurement of cross-cultural health care skills remains challenging. However, studies like these provide a good starting point from which to build., (© 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.)

Background: This study was an assessment of the professionalism curriculum at a community-based medical school from the perspective of undergraduate medical students., Aims: The goal of this study was to ascertain the perspectives of faculty and students on their interpretations of professionalism and its role in medical education to improve and expand existing professionalism curricula., Method: An online survey was created and sent to all students (n = 245) and selected faculty (n = 41). The survey utilized multiple choice and open-ended questions to allow responders to provide their insights on the definition of professionalism and detail how professionalism is taught and evaluated at their institution. A content analysis was conducted to categorize open-ended responses and the resulting themes were further examined using SPSS 20.0 for Windows (IBM Corp., Armonk, NY) frequency analyses., Results: Students and faculty respondents were similar in their definitions of medical professionalism and their perceptions of teaching methods. Role modeling was the most common and preferred method of professionalism education. Responses to whether evaluations of professional behavior were effective suggested both students and faculty are unclear about current professionalism assessments., Conclusion: This study showed that a cohesive standardized definition of professionalism is needed, as well as clearer guidelines on how professionalism is assessed.

Background: While it is evident that a surgeon must master medical knowledge and technical skill, there are other "soft skills" that are essential to a successful surgeon. One of these skills is professionalism. The challenge in surgical education lies in developing an effective professionalism curriculum and a related method of evaluation., Objective: Our review updates the literature and provides recommendations for improving instruction and evaluation of professionalism., Design: A literature review was conducted using PubMed, Google Scholar, and Web of Knowledge. We restricted our search to documents published from 2009 to 2012 that address methods of teaching and tools for assessing professionalism in surgical education., Results: Sixty-three documents were reviewed, with 14 fitting our search criteria for professionalism in surgical education completely. Other articles focused on the topics of professionalism in surgery, medical professionalism, and professionalism education in medical specialties other than surgery., Conclusions: Development of a professionalism curriculum for surgical residents might begin with defining professionalism in terms of tangible behaviors. The program might also include a precurriculum preparatory course and simulation-based training. Residency programs must also maintain professionalism among its faculty. Assessment in the form of multisource feedback that is consistent with observable behavioral definitions of professionalism should also be considered in evaluating resident professionalism., (Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Although cultural competency is not a new concept in healthcare, it has only recently been formally embraced as important in the field of surgery. All physicians, including and especially surgeons, must acknowledge the potential influence of culture in order to provide effective and equitable care for patients of all backgrounds. The Accreditation Council for Graduate Medical Education (ACGME) recognizes cultural competency as a component of "patient care," "professionalism," and "interpersonal and communication skills.", Methods: A systematic literature search was conducted using the MEDLINE, EBSCOhost, Web of Science, and Google Scholar databases. All publications focusing on surgical residents and the assessment of patient care, professionalism, interpersonal and communication skills, or specifically cultural competency and/or were considered. This initial search resulted in 12 articles. To further refine the review, publications discussing curricula in residencies other than surgery, the assessment of technical, or clinical skills and/or without any explicit focus on cultural competency were excluded., Results: Based on the specified inclusion and exclusion criteria, 5 articles were selected. These studies utilized various methods to improve surgical residents' cultural competency, including lectures, Objective Structural Clinical Examinations (OSCE), and written exercises and evaluations., Conclusions: A number of surgical residency programs have made promising strides in training culturally competent surgeons. Ultimately, in order to maximize our collective efforts to improve the quality of health care, the development of cultural competency curricula must be made a priority and such training should be a requirement for all trainees in surgical residency programs., (Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Cultural competency and cross-cultural care issues in surgery resident education are areas of recognized need. The Accreditation Council for Graduate Medical Education (ACGME) has developed 6 core competencies addressing training to provide high quality care. Of these, cultural training is addressed under 3: patient care, professionalism, and interpersonal and communication skills. Our study sought to develop a measurable tool-a cultural standardized patient (SP) examination-that integrates cross-cultural care issues within the core competencies., Methods: All first year surgery residents (PGY-1) were required to participate in the videotaped cultural SP examination as part of the general surgery residency curriculum. Two measures were utilized to assess resident performance. On the same day, we administered a Cross-Cultural Care Survey. The SP examination was assessed by trained surgery teaching faculty using a written checklist that was developed to evaluate residents on all 6 ACGME competencies., Results: Of the 26 eligible participants over 2 years, we were able to analyze the pre- and post-test results for 24 residents. The post-test score of the "attitude toward cross-cultural care" subscale of the Cross-Cultural Care Survey was significantly lower than the pre-test score (p = 0.012; Wilcoxon signed-ranks test). There were significant differences by ethnicity on all 3 subscales of the Cross-Cultural Care Survey (attitude = p < 0.05, knowledge = p < 0.01, skills = p < 0.05) on the pre-test. However, only the knowledge subscale scores remained significantly different between ethnicities on the post-test (p < 0.01)., Conclusions: After additional assessment, evaluation, and refinement, our goal is to incorporate cross-cultural health care training as a permanent part of our curriculum. Our hope is that efforts to provide training in cross-cultural healthcare leads to high quality care and positive outcomes for the patient. This will not only enhance our training program, but may also become a useful tool for other surgery residency programs., (Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

In response to the growing diversity of the United States population and concerns with health disparities, formal training in cross-cultural care has become mandatory for all medical specialties, including surgery. The aim of this study was to assess the readiness of a general surgery residency program to incorporate cultural competency initiatives into its curriculum. Eighteen surgical teaching faculty (at a community-based hospital with a university affiliation) voluntarily participated in a qualitative study to share their views on cultural competency and to discuss ways that it could potentially be incorporated into the curriculum. Reflective of current definitions of cultural competency, faculty viewed the term culture broadly (i.e., beyond race and ethnicity). Suggested instructional methods varied, with some noting that exposure to different cultures was helpful. Others stated the importance of faculty serving as role models. Most faculty in this study appear open to cultural training, but desire a clear understanding of what that would entail and how it can be taught. They also acknowledged the lack of time to address cultural issues. Taking into consideration these and other concerns, planned curricular interventions are also presented.

Cultural competence education is relatively new in the United States, particularly in the area of graduate and post-graduate medical education. There is, however, wide acceptance that an understanding of the role culture plays in the treatment and care of patients is critical. Numerous studies and a variety of commentaries document this importance, but valid, uniform evaluation methods for assessing the efficacy of these efforts is lacking. This review discusses existing evaluation efforts and makes suggestions regarding future development of such tools.