A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents' Knowledge, Cross-Cultural Care, Skills, and Beliefs: The Provider Awareness and Cultural Dexterity Training for Surgeons (PACTS) Trial

Douglas S. Smink; Gezzer Ortega; Brittany M. Dacier; Emil R. Petrusa; Yu Jen Chen; Namra Q. Shaikh; Benjamin G. Allar; Maria B.J. Chun; Alexander R. Green; Katharine E. Caldwell; Rachel B. Atkinson; Emma Reidy; Olubode A. Olufajo; L. D. Britt; Molly A. Brittain; Jorge Zárate Rodriguez; Sandra M. Swoboda; Edward E. Cornwell; Kenneth A. Lynch; Paul E. Wise; David T. Harrington; Tara S. Kent; John T. Mullen; Pamela A. Lipsett; Adil H. Haider

doi:10.1097/SLA.0000000000006408

A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents' Knowledge, Cross-Cultural Care, Skills, and Beliefs: The Provider Awareness and Cultural Dexterity Training for Surgeons (PACTS) Trial

Douglas S. Smink, Gezzer Ortega, Brittany M. Dacier, Emil R. Petrusa, Yu Jen Chen, Namra Q. Shaikh, Benjamin G. Allar, Maria B.J. Chun, Alexander R. Green, Katharine E. Caldwell, Rachel B. Atkinson, Emma Reidy, Olubode A. Olufajo, L. D. Britt, Molly A. Brittain, Jorge Zárate Rodriguez, Sandra M. Swoboda, Edward E. Cornwell, Kenneth A. Lynch, Paul E. WiseDavid T. Harrington, Tara S. Kent, John T. Mullen, Pamela A. Lipsett, Adil H. Haider

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Pages (from-to)	403-413
Number of pages	11
Journal	Annals of Surgery
Volume	280
Issue number	3
DOIs	https://doi.org/10.1097/SLA.0000000000006408
Publication status	Published - 1 Sept 2024
Externally published	Yes

Keywords

cultural dexterity
health equity
surgical disparities
surgical education

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Dive into the research topics of 'A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents' Knowledge, Cross-Cultural Care, Skills, and Beliefs: The Provider Awareness and Cultural Dexterity Training for Surgeons (PACTS) Trial'. Together they form a unique fingerprint.

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Smink, D. S., Ortega, G., Dacier, B. M., Petrusa, E. R., Chen, Y. J., Shaikh, N. Q., Allar, B. G., Chun, M. B. J., Green, A. R., Caldwell, K. E., Atkinson, R. B., Reidy, E., Olufajo, O. A., Britt, L. D., Brittain, M. A., Zárate Rodriguez, J., Swoboda, S. M., Cornwell, E. E., Lynch, K. A., ... Haider, A. H. (2024). A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents' Knowledge, Cross-Cultural Care, Skills, and Beliefs: The Provider Awareness and Cultural Dexterity Training for Surgeons (PACTS) Trial. Annals of Surgery, 280(3), 403-413. https://doi.org/10.1097/SLA.0000000000006408

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title = "A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents' Knowledge, Cross-Cultural Care, Skills, and Beliefs: The Provider Awareness and Cultural Dexterity Training for Surgeons (PACTS) Trial",

abstract = "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.",

keywords = "cultural dexterity, health equity, surgical disparities, surgical education",

author = "Smink, {Douglas S.} and Gezzer Ortega and Dacier, {Brittany M.} and Petrusa, {Emil R.} and Chen, {Yu Jen} and Shaikh, {Namra Q.} and Allar, {Benjamin G.} and Chun, {Maria B.J.} and Green, {Alexander R.} and Caldwell, {Katharine E.} and Atkinson, {Rachel B.} and Emma Reidy and Olufajo, {Olubode A.} and Britt, {L. D.} and Brittain, {Molly A.} and {Z{\'a}rate Rodriguez}, Jorge and Swoboda, {Sandra M.} and Cornwell, {Edward E.} and Lynch, {Kenneth A.} and Wise, {Paul E.} and Harrington, {David T.} and Kent, {Tara S.} and Mullen, {John T.} and Lipsett, {Pamela A.} and Haider, {Adil H.}",

year = "2024",

month = sep,

day = "1",

doi = "10.1097/SLA.0000000000006408",

language = "English",

volume = "280",

pages = "403--413",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "3",

}

Smink, DS, Ortega, G, Dacier, BM, Petrusa, ER, Chen, YJ, Shaikh, NQ, Allar, BG, Chun, MBJ, Green, AR, Caldwell, KE, Atkinson, RB, Reidy, E, Olufajo, OA, Britt, LD, Brittain, MA, Zárate Rodriguez, J, Swoboda, SM, Cornwell, EE, Lynch, KA, Wise, PE, Harrington, DT, Kent, TS, Mullen, JT, Lipsett, PA & Haider, AH 2024, 'A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents' Knowledge, Cross-Cultural Care, Skills, and Beliefs: The Provider Awareness and Cultural Dexterity Training for Surgeons (PACTS) Trial', Annals of Surgery, vol. 280, no. 3, pp. 403-413. https://doi.org/10.1097/SLA.0000000000006408

A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents' Knowledge, Cross-Cultural Care, Skills, and Beliefs: The Provider Awareness and Cultural Dexterity Training for Surgeons (PACTS) Trial. / Smink, Douglas S.; Ortega, Gezzer; Dacier, Brittany M. et al.
In: Annals of Surgery, Vol. 280, No. 3, 01.09.2024, p. 403-413.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents' Knowledge, Cross-Cultural Care, Skills, and Beliefs

T2 - The Provider Awareness and Cultural Dexterity Training for Surgeons (PACTS) Trial

AU - Smink, Douglas S.

AU - Ortega, Gezzer

AU - Dacier, Brittany M.

AU - Petrusa, Emil R.

AU - Chen, Yu Jen

AU - Shaikh, Namra Q.

AU - Allar, Benjamin G.

AU - Chun, Maria B.J.

AU - Green, Alexander R.

AU - Caldwell, Katharine E.

AU - Atkinson, Rachel B.

AU - Reidy, Emma

AU - Olufajo, Olubode A.

AU - Britt, L. D.

AU - Brittain, Molly A.

AU - Zárate Rodriguez, Jorge

AU - Swoboda, Sandra M.

AU - Cornwell, Edward E.

AU - Lynch, Kenneth A.

AU - Wise, Paul E.

AU - Harrington, David T.

AU - Kent, Tara S.

AU - Mullen, John T.

AU - Lipsett, Pamela A.

AU - Haider, Adil H.

PY - 2024/9/1

Y1 - 2024/9/1

N2 - 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.

AB - 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.

KW - cultural dexterity

KW - health equity

KW - surgical disparities

KW - surgical education

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U2 - 10.1097/SLA.0000000000006408

DO - 10.1097/SLA.0000000000006408

M3 - Article

C2 - 38921829

AN - SCOPUS:85201104966

SN - 0003-4932

VL - 280

SP - 403

EP - 413

JO - Annals of Surgery

JF - Annals of Surgery

IS - 3

ER -

Smink DS, Ortega G, Dacier BM, Petrusa ER, Chen YJ, Shaikh NQ et al. A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents' Knowledge, Cross-Cultural Care, Skills, and Beliefs: The Provider Awareness and Cultural Dexterity Training for Surgeons (PACTS) Trial. Annals of Surgery. 2024 Sept 1;280(3):403-413. doi: 10.1097/SLA.0000000000006408

A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents' Knowledge, Cross-Cultural Care, Skills, and Beliefs: The Provider Awareness and Cultural Dexterity Training for Surgeons (PACTS) Trial

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Keywords

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