Forum - November 2008

The correct answer is “D.” The patient has given you a sign of respect by bowing. You should acknowledge her with a similar gesture, such as a slight bow or nod.

The preceding scenario is regarding care for “Madame Lao,” a fictitious Asian woman who is seeking treatment for her arthritic knee from an orthopaedic surgeon. Lao is one of 18 patient case studies representing various cultures depicted in the Cultural Competency Challenge CD-ROM, developed by the American Academy of Orthopaedic Surgeons.

The interactive CD quiz is a component of the academy’s Culturally Competent Care Education Initiative that is helping orthopaedic surgeons and residents across the United States provide the best care possible for their patients.

“Our members recognize that by understanding the diversity of the populations they’re serving, they can provide better patient care, resulting in better patient outcomes,” says Karen L. Hackett, FACHE, CAE, chief executive officer of AAOS. “It’s not just about the fractured femur — it’s about treating the whole person.”

LONG-TERM COMMITMENT

Since the mid-1990s, AAOS has been a long-time champion of increasing diversity within the orthopaedic profession and among its members and leaders, along with helping orthopaedic surgeons communicate effectively with their patients in a manner that is respectful to the patient’s cultural background. The AAOS Web site, www.aaos.org/diversity, contains a history of the academy’s diversity initiatives, grassroots recruitment and mentoring programs, residency and health disparities research, the AAOS Diversity Award and educational resources for providing culturally competent care.

“The academy is committed to diversity,” Hackett says. “It’s so important that ‘fostering diversity’ is one of our nine strategic goals.”

Key to achieving that goal is the work of the AAOS Diversity Advisory Board (DAB), whose mission is “to educate our fellows on the impact of diversity and culturally competent care in their practices and society (and to promote the growth of diversity among orthopaedic surgeons).”

To ensure that diversity is always at the forefront, the DAB reports directly to the AAOS Board of Directors. Moreover, all new business plans are reviewed by the DAB for a diversity perspective, according to Hackett.

E. Anthony Rankin, MD, president of AAOS and the first black person to hold the post, also emphasized the leadership link: “The academy’s diversity committees have always reported directly to the board; otherwise the initiatives would have fizzled.”

One of the results of the DAB’s efforts is the academy’s Culturally Competent Care Education Initiative, providing practical tools and tips for communicating with and treating patients from culturally diverse backgrounds.

There are three components in the initiative: an interactive, case-study quiz in CD-ROM format for self-study, a companion guidebook with background information to familiarize physicians with cultural differences organized for group discussion and a grand-rounds seminar targeted to orthopaedic residents. (Grand rounds are interactive meetings between medical residents and experienced physicians in which they discuss unusual patient cases.)

However, what is now a three-part initiative started off on a much smaller scale.

ABOUT AAOS

Founded in 1933, the American Academy of Orthopaedic Surgeons provides education and practice management services for more than 31,000 orthopaedic surgeons and allied health professionals. For more information, visit www.aaos.org.

FROM KIOSK TO CD

In 2004, the academy’s first priority was to make learning about culturally competent care attractive and compelling to members. The DAB came up with the idea of offering a computer-based quiz that would provide instant feedback with a tally of correctly answered questions.

Appealing to their colleagues’ “inherent competitiveness and familiarity with test-taking, DAB members, additional physicians and nurses, volunteered their time to develop a series of case studies and questions based on various cultures,” says Maureen Geoghegan, an AAOS staff liaison to the DAB. “The volunteers who worked on developing the case studies drew upon their knowledge and experience, patient base and their own ethnicity.” For example, the case study of Maria Luisa Salcedo from Mexico was provided by 2003-07 DAB chair and longtime diversity advocate Ramon L. Jimenez, MD.