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.”
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
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
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
However, what is now a three-part initiative started off on a
much smaller scale.
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
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.
Supported by an educational grant from orthopaedic equipment manufacturer Zimmer, Inc., the AAOS developed an inter-