A group of patient stakeholders and experts from across the Harvard community and the U.S. gathered in the Shapiro Boardroom for the PACTS Development Workshop.

Cultural dexterity – the ability to navigate interactions with people of different beliefs and backgrounds – is a critical skill that could help clinicians address health care disparities and improve outcomes for patients. Standardized, replicable educational programs to improve cultural dexterity have been developed for physicians working in most specialties, but no such program exists for surgeons, who often treat patients in acute, life-threatening situations. A project spearheaded by researchers at the Center for Surgery and Public Health (CSPH) aims to change that.

The Provider Awareness and Cultural Dexterity Toolkit for Surgeons (PACTS) Project, funded by the Harvard Surgical Affinity Research Collaborative, is led by Adil Haider, MD, MPH, Kessler Director of CSPH, in collaboration with Matthew Hutter, MD, MPH, of Massachusetts General Hospital, Jennifer Tseng, MD, MPH, of Beth Israel Deaconess Medical Center, and Konstantinos Papadakis, MD, of Boston Children’s Hospital. The PACTS Project has three phases:

• Phase One: Qualitative, in-depth interviews with patients and surgeons to ascertain barriers to equitable provision of culturally competent surgical care
• Phase Two: Curriculum Development Workshop to discuss and incorporate findings from Phase One into a comprehensive curriculum
• Phase Three: Deployment of a pilot PACTS curriculum across multiple Harvard teaching hospitals

The interviews conducted in Phase One revealed many salient issues, including the need for a curriculum that addresses language barriers, differing cultural beliefs and a lack of formal training to navigate interactions with patients who may have different expectations or hopes. These issues and many others were discussed during the PACTS Development Workshop, held on Oct. 20. Attended by a group of patient stakeholders and experts from across the Harvard community and the U.S., the day-long workshop centered around how to make cultural dexterity training for surgeons a reality. The workshop focused on answering such questions as: When is the optimal time to teach cultural dexterity—as part of medical school or during residency? How could training be standardized yet individualized enough for a wide array of hospitals, each with different geographic locations, patient populations, etc.? What format should the training take, and how long should it last?

“The goal of the PACTS Development Workshop was to gather a group of physicians, researchers, experts and patients and share the qualitative findings from the first phase of the project, which we finished in September,” explained Navin Changoor, MD, a fellow at CSPH, surgical resident at Howard University Hospital and a native of Trinidad and Tobago. Changoor personally conducted the interviews in Phase One of the project. “The findings helped identify the needs of surgical residents and faculty and will determine where to go from here as we develop and test this curriculum.”

To ensure the project is patient-centered, patients play a crucial role in the decision-making process in every phase, including the workshop; there were four patient participants and one patient experience representative who actively participated.

“It’s critically important to incorporate the patient perspective in a project like this, which is designed to improve patient-provider communication and enhance the patient experience at the Brigham and beyond,” said Haider.

The workshop was well-received by researchers and patients alike.

“The participants were diverse and respectful in sharing their knowledge and expertise, which resulted in meaningful, thought-provoking discussions. We all left that afternoon with a much richer meaning of cultural dexterity and its impact on ourselves and those we interact with daily,” said Martie Carnie, senior patient advisor for BWH’s Center for Patients and Families.

With the second phase complete, the PACTS Project team is now in the process of submitting applications for extramural funding from the National Institutes of Health (NIH) and Patient-Centered Outcomes Research Institute (PCORI) for a multi-center trial to be conducted at several Harvard teaching hospitals. The eventual goal is to implement the curriculum nationwide.