Research
Improving Surgical Access, Treatment, and Outcomes
In 2008, the Center for Surgery and Public Health convened an invitational conference on Disparities in Surgical Care: Access to Outcomes. One of the first of its kind for surgery, this symposium brought together experts from around the world to raise awareness of disparities in surgical care and to discuss how to translate research into practice change to alleviate those disparities in access and outcomes.
Since then, CSPH has merged research with advocacy, serving as a leading voice in setting national research agendas and bringing needed focus and funding to critical research areas. Joined by the National Institutes of Health and the American College of Surgeons, a 2015 symposium organized by CSPH resulted in the first national research agenda focused on surgical disparities. CSPH has since partnered with global, national, state, and local partners to implement this agenda through advocacy, research, and clinical practice change.
Projects
Building on work capturing and understanding surgical disparities data, CSPH received an NIH–NIMHD grant for the study, “Evaluation of Cultural Dexterity Training Program for Surgeons: The PACTS Trial.” The study focuses on improving cross-cultural care, which refers to a physician’s ability to care for patients from a culture or background different from their own, and reducing healthcare disparities. The multi-center trial is being conducted at eight academic medical centers across the U.S. to evaluate the effectiveness of a novel curriculum called the Provider Awareness and Cultural Dexterity Toolkit for Surgeons (PACTS) in improving surgical residents’ knowledge, attitudes, and skills in caring for patients of different cultural backgrounds.
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
PI(s): Doug Smink, MD, MPH & Adil Haider, MD, MPH
In 2017, 66 million people in the US spoke a language other than English at home, 40% of whom experienced limited English proficiency (LEP). According to the US Census, over 27 million (1 in 12) people speak English “less than very well”. To communicate with their healthcare providers, patients with LEP must often use formal and informal interpreter services, including qualified medical interpreters (in-person or via video or phone), health providers’ second language skills, ad hoc interpreters (i.e. family members, other hospital staff), and body gestures. Language discordant care can lead to patients having a decreased understanding of disease and treatment resulting in worse medication adherence, failed shared decision-making, and overall worse satisfaction with care. It can also result in worse presentation for surgery and outcomes after surgery, longer hospital stays, and increased re-admission. Ultimately, language discordance undermines patient-provider communication and plays a central role in healthcare disparities.
This study will evaluate whether an immediate mobile application enables language-concordant communication for primary Spanish-speaking patients with LEP.
Funded by the NIMHD, the Metrics for Equitable Access and care in SURgery (MEASUR) project is a collaboration led by the American College of Surgeons in conjunction with Brigham and Women’s Hospital, the National Quality Forum, and the University of California – Los Angeles. Through research and expert consensus, we will identify and develop measures that capture disparities in access and across the five phases of surgical care. These disparities-sensitive metrics will facilitate the development of targeted interventions aimed at eradicating surgical disparities. The project’s vision is to ensure optimal access and equitable healthcare, for all surgical patients, in every setting, across the entire continuum of care.
SCALPEL (Surgeons’ Comprehensive AI Lab Program for Equity and Learning) is a multi-institution project led by Dr. Gezzer Ortega that uses artificial intelligence to help train surgeons to deliver more compassionate, less biased care, with a particular focus on older adults from diverse cultural, language, and socioeconomic backgrounds. Building on the Center’s PACTS cultural-dexterity curriculum, the team is developing “PACTS-AI,” an on-demand training platform where surgical residents practice realistic patient conversations with AI-generated standardized patients. Learners can rehearse emotionally complex encounters as often as they need and receive instant feedback from an AI “coach.” To test whether it works, the study compares residents trained on the AI platform against those receiving standard training, and compares users before and after receiving the training on the AI platform, measuring their communication and empathy during simulated patient visits. The goal is to build clinicians’ confidence, reduce harmful bias, and improve surgical care for all patients, while offering an accessible option when in-person actor-based training is not available.