Program meets an unfulfilled need in resident training programs

How did a randomly selected group of 3,500 resident physicians in their final year of training rate their ability to deliver culturally competent care? Pretty low, according to a study published in the Journal of the American Medical Association by Weissman and associates in 2005. Residents scored their level of cultural competency far below their preparedness in other clinical and technical areas, noting that they had received little training, formal evaluation, or exposure to role models to teach them about cultural competency.

The AAOS Diversity Advisory Board, chaired by Ramon L. Jimenez, MD, is working to solve this problem. Its free program, Culturally Competent Care: An Orthopaedist’s Responsibility, aims to make residents more effective at communicating with patients of various ethnicities, races, cultures, and beliefs, with the goal of increasing patient safety, satisfaction, and successful outcomes.

The Accreditation Council for Graduate Medical Education supports the idea that residents “demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities” as part of the stated core competencies. Furthermore, with several states considering and/or passing legislation requiring physicians to obtain education in culturally competent care, this training will be a necessity for residents as they begin their practices.

Dr. Jimenez, who has presented many seminars on cultural competency, explains that the program employs a “grand rounds” format, using both didactic and interactive components. As part of the interactive component, presenters discuss various patient scenarios that require cultural competence. At the end of the 60- to 90-minute session, participants receive a free Cultural Competency Challenge CD-ROM and Culturally Competent Care Guidebook, created by the AAOS, to learn more about cultural competency through case studies and other information included in these resources.

“We tailor the presentations according to the part of the country we’re in, the demographics of the population, and the needs and requests of each residency program,” says Dr. Jimenez. “For instance, I’m going to present a seminar at Stanford University, which is in northern California. Because the area includes large populations of people of Latino and Asian descent, as well as a significant Muslim population, we will gear the program toward treating patients of those backgrounds.”

The program also stresses what Dr. Jimenez considers to be “the four basic ingredients” of culturally competent care: curiosity, awareness, sensitivity, and communication.

“We don’t expect the residents, physicians, and other healthcare professionals attending this program to learn all the nuances about every different ethnicity, race, and belief,” says Dr. Jimenez. “However, if you have those four ingredients, you can use them to treat anyone in a culturally competent manner.”

Having a positive impact
Diversity Advisory Board member Raj Rao, MD, professor and director of spine surgery in the department of orthopaedic surgery at the Medical College of Wisconsin (MCW), has presented the seminar at MCW and to attendees of the Orthopaedic CME Summit held last November at AAOS headquarters in Rosemont.

“Participants find the program to be stimulating and informative. Program directors generally recognize the inadequacy of education on this topic and encourage these presentations,” says Dr. Rao, adding that he has been asked to repeat the program at MCW in the next 1 to 2 years.

B. Sonny Bal, MD, MBA, associate professor of orthopaedic surgery at the University of Missouri School of Medicine, invited the AAOS to present the seminar to orthopaedic residents at the university. Dr. Bal believes that cultural competency training provides residents with important skills.

“The changing demographics of our society are well-known,” says Dr. Bal. “Cultural competence is part of the common sense that our future doctors need if they are to have successful practices.”

Dr. Bal says that the cultural competency seminar presented by Dr. Jimenez benefited the residents by increasing their understanding of the different needs and perceptions of various cultural groups and emphasizing effective communication skills that can lead to patient satisfaction. In addition, the seminar made it clear that cultural competency training has practical value, rather than just being an issue of “political correctness.”

“Our residents felt that the presentation was very valuable,” says Dr. Bal.

Dirk H. Alander, MD, associate professor of orthopaedic surgery at the Saint Louis University School of Medicine, also felt that the program benefited the orthopaedic residents at his institution.

“There’s no doubt in my mind that cultural competence is going to become more and more important in the future,” says Dr. Alander. “Even though we’re located in an urban area and are definitely not culturally isolated, the residents learned a lot from the presentation.”

How to participate
The Diversity Advisory Board presented several sessions on cultural competency in 2007 and plans on presenting the program to between 15 and 20 groups in 2008. Residency program directors or others who are interested in scheduling an AAOS culturally competent care seminar for orthopaedic residents at their institution should e-mail the AAOS at diversity@aaos.org

In addition, be sure to visit the Culturally Competent Care exhibit in Academy Row (booth # AR1) at the 2008 AAOS Annual Meeting to speak with Diversity Advisory Board members about the Academy’s initiatives in diversity and to receive a free copy of the Cultural Competency Challenge CD-ROM and Culturally Competent Care Guidebook.

This project is funded in part by a charitable contribution from Zimmer, which has provided ongoing support to the AAOS Culturally Competent Care initiative.

Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org