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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.

Background: Despite recognition of racial/ethnic surgical disparities, few studies have considered the role of surgical residents. This study aimed to elucidate whether disparities in postoperative outcomes are associated with the presence/level of surgical residents involved in procedures., Methods: Patients who were classified as having laparoscopic cholecystectomy, laparoscopic appendectomy, and open hernia repair in the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program database were compared by level of provider (junior residents postgraduate year 1-2, senior residents, attending alone) for differences in patient demographics, clinical case-mix, and postoperative outcome information by the use of descriptive statistics and multivariable logistic regression., Results: A total of 196,770 patients met inclusion criteria. Attendings performed 43.0% of operations alone (senior residents 37.5%, junior residents 20.1%), They operated on 44.1% white, 30.1% black, and 43.9% Hispanic patients compared with 35.5%, 48.7%, and 41.3% and 20.4%, 21.3%, and 14.8% for senior and junior residents, respectively. Compared with attendings alone, senior residents were more likely to operate on black patients (adjusted odds ratio [OR] 2.02, 95% confidence interval [95% CI] 1.95-2.09) and have major (OR 1.13, 95% CI 1.06-1.21) and minor complications (OR 1.20, 95% CI 1.11-1.31). Junior residents also were more likely to operate on black patients but did not experience significantly worse outcomes., Conclusion: Greater risk-adjusted odds of complications among patients treated by senior residents need to be carefully weighed given the group's higher likelihood of operating on minority patients., (Copyright © 2015 Elsevier Inc. All rights reserved.)