Improving Surgical Residents' Performance on Written Assessments of Cultural Competency

Krajewski, Aleksandra; Rader, Christine; Voytovich, Anthony; Longo, Walter E.; Kozol, Robert A.; Chandawarkar, Rajiv Y.

doi:10.1016/j.jsurg.2008.05.004

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Volume 65, Issue 4 , Pages 263-269, July 2008

Improving Surgical Residents' Performance on Written Assessments of Cultural Competency

Aleksandra Krajewski, BSN
- Division of Plastic Surgery, University of Connecticut School of Medicine, Farmington Connecticut
Christine Rader, MD
- Department of Surgery, University of Connecticut School of Medicine, Farmington Connecticut
Anthony Voytovich, MD
- Department of Medicine, University of Connecticut School of Medicine, Farmington Connecticut
Walter E. Longo, MD
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
Robert A. Kozol, MD
- Department of Surgery, University of Connecticut School of Medicine, Farmington Connecticut
Rajiv Y. Chandawarkar, MD
- Division of Plastic Surgery, University of Connecticut School of Medicine, Farmington Connecticut
- Correspondence: Inquiries to Rajiv Y. Chandawarkar, MD, University of Connecticut Health Center—MC 1601, 263 Farmington Ave, Farmington CT 06030-1601; fax: (860) 679-7905

published online 10 July 2008.

Context

The pressure to implement cultural-competency training at the level of GME is high. The rapidly diversifying American population and the ACGME demand it, and cultural competency is recognized as a core competency under “Professionalism.”

Objectives

The objectives for this study were (1) to assess residents' baseline levels of cultural competence, (2) define barriers to skill-acquisition, and (3) examine efficacy of educational programs in improving cultural competence.

Setting & Participants

In all, 43 residents from the University of Connecticut School of Medicine participated in a prospective, Institutional Review Board (IRB)–approved study.

Design

During Step 1 (pretest), baseline performance was recorded using 3 assessments: (1) Healthcare Cultural Competency Test (HCCT), (2) Cultural skills acquisition (CSA), and (3) Clinical Scenarios Test (CSE). During Step 2 (Educational Intervention), a 2-part lecture that focused on principles of cultural competency and continued self-learning was presented. Last, for Step 3 (posttest), the post-program evaluation was administered as in Step 1.

Main Outcome Measures

Answers for Step 1 (pretest) and Step 3 (posttest) were compared using a paired t-test for HCCT and CSE and the chi-square test for CSA.

Results

Thirty-five replies were evaluated. Every resident performed better on the posttest than the pretest. Specifically, participants showed 88% improvement in their scores on the HCCT (pretest: 360, posttest: 696; p < 0.01), 2-fold improvement on the CSA (pretest: 6, posttest: 12; p < 0.009), and 40% improvement in CSE (pretest mean score = 23.3, posttest = 34.6; p < 0.01). Commonly identified barriers to learning included inadequate teaching tools and absence of formal training.

Conclusions

Surgery residents tested for 3 aspects of cultural competence prior to and after teaching sessions showed marked improvement on all 3 assessment measures after this brief intervention.

Key Words: cultural competency, ACGME Outcomes Project, Professionalism, transcultural health care

Competency: Patient Care, Professionalism, Interpersonal & Communication Skills