The PACTS Trial: Provider Awareness and Cultural dexterity Toolkit for Surgeons

Racial disparities in surgical care impact millions in the US each year. Compared to whites, black patients are more likely to experience negative outcomes across a wide range of procedures. The National Institutes of Health and American College of Surgeons’ summit on surgical disparities identified improving patient-provider communication through the development of cross-cultural training programs as the first priority in their national agenda for surgical disparities research. The Institute of Medicine recommends cultural competency training as a solution to address healthcare disparities, and medical schools are now required to incorporate cultural competency training as part of their curricula. However, there is limited evidence that such programs effectively impact clinical outcomes or health disparities. Furthermore, medical students and residents continue to feel unprepared to treat culturally diverse patients, and surgical training does not have any formalized cultural competency curriculum.

Based on extensive research with surgeons, patients, and experts, we developed a cultural dexterity curriculum called PACTS (Provider Awareness and Cultural dexterity Toolkit for Surgeons) that incorporates novel educational approaches such as a flipped classroom model, spaced-education, and performance tracking to improve knowledge, skills and attitudes related to provider-patient trust, working with patients of limited English proficiency, informed consent, and pain management. The trial includes implementation of the curriculum at eight surgical residency programs to examine the change in resident and patient outcomes using surveys and a simulated clinical encounter prior to the intervention. The PACTS Trial utilized a crossover trial design, so that half of the sites received the curriculum in one year, and the remaining half in the following year.

We will examine whether the PACTS curriculum results in improvements in resident knowledge, attitudes and skills, patient satisfaction and clinical outcomes compared to the standard residency curriculum. If the curriculum demonstrates improvements, the research team will work with representatives of national organizations to disseminate the program to surgical residency programs nationally. Such training will improve the communication skills of the next generation of surgeons and serve as an important step for mitigating surgical disparities.

PI(s): Doug Smink, MD, MPH & Adil Haider, MD, MPH


Emma Reidy (

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Participating Trial Sites

  • Beth Israel Deaconess Medical Center
  • Brigham and Women’s Hospital
  • Brown Alpert Medical School
  • Howard University College of Medicine
  • Washington University in St. Louis School of Medicine
  • Massachusetts General Hospital
  • Eastern Virginia Medical School
  • Johns Hopkins School of Medicine