Using Simulation-Based Learning with Standardized Patients (SP) in an Implicit Bias Mitigation Clinician Training Program

Jennifer Tjia; Michele Pugnaire; Joanne Calista; Ethan Eisdorfer; Janet Hale; Jill Terrien; Olga Valdman; Stacy Potts; Maria Garcia; Majid Yazdani; Geraldine Puerto; Miriam Okero; Vennesa Duodu; Janice Sabin

doi:10.1177/23821205231175033

Using Simulation-Based Learning with Standardized Patients (SP) in an Implicit Bias Mitigation Clinician Training Program

J Med Educ Curric Dev. 2023 Jun 5:10:23821205231175033. doi: 10.1177/23821205231175033. eCollection 2023 Jan-Dec.

Authors

Jennifer Tjia¹, Michele Pugnaire², Joanne Calista^{2

3}, Ethan Eisdorfer², Janet Hale⁴, Jill Terrien⁴, Olga Valdman², Stacy Potts², Maria Garcia⁵, Majid Yazdani⁵, Geraldine Puerto¹, Miriam Okero⁴, Vennesa Duodu¹, Janice Sabin⁶

Affiliations

¹ Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA.
² Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, USA.
³ Executive Director, Center for Health Impact, Worcester, MA, USA.
⁴ Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA, USA.
⁵ Department of Medicine, UMass Chan Medical School, Worcester, MA, USA.
⁶ Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, WA, USA.

Abstract

Objectives: To describe the development and refinement of an implicit bias recognition and management training program for clinical trainees.

Methods: In the context of an NIH-funded clinical trial to address healthcare disparities in hypertension management, research and education faculty at an academic medical center used a participatory action research approach to engage local community members to develop and refine a "knowledge, awareness, and skill-building" bias recognition and mitigation program. The program targeted medical residents and Doctor of Nursing Practice students. The content of the two-session training included: didactics about healthcare disparities, racism and implicit bias; implicit association test (IAT) administration to raise awareness of personal implicit bias; skill building for bias-mitigating communication; and case scenarios for skill practice in simulation-based encounters with standardized patients (SPs) from the local community.

Results: The initial trial year enrolled n = 65 interprofessional participants. Community partners and SPs who engaged throughout the design and implementation process reported overall positive experiences, but SPs expressed need for greater faculty support during in-person debriefings following simulation encounters to balance power dynamics. Initial year trainee participants reported discomfort with intensive sequencing of in-person didactics, IATs, and SP simulations in each of the two training sessions. In response, authors refined the training program to separate didactic sessions from IAT administration and SP simulations, and to increase safe space, and trainee and SP empowerment. The final program includes more interactive discussions focused on identity, race and ethnicity, and strategies to address local health system challenges related to structural racism.

Conclusion: It is possible to develop and implement a bias awareness and mitigation skills training program that uses simulation-based learning with SPs, and to engage with local community members to tailor the content to address the experience of local patient populations. Further research is needed to measure the success and impact of replicating this approach elsewhere.

Keywords: bias mitigation; clinician training; community engagement; curriculum; implicit bias; standardized patients.

Grants and funding

R01 MD011532/MD/NIMHD NIH HHS/United States