Division of Trauma Acute Care Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia.
Division of Trauma Acute Care Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia.
J Surg Educ. 2021 Nov-Dec;78(6):1791-1795. doi: 10.1016/j.jsurg.2021.06.007. Epub 2021 Jul 18.
Racial inequities are infused within American society and healthcare systems; notable events in 2020 highlighted an urgent need for change. Many organizations were inspired to examine the impacts of systemic racism. The impact of physician bias on patient experiences and outcomes has been well documented; biased patient behavior is now becoming more openly discussed. In response to the current climate and painful effects of discrimination on healthcare and providers, we aimed to provide training for our surgical residents to more comfortably respond to bias in the workplace.
We designed and piloted a simulation-based communication module focused on managing bias with medical students. We incorporated feedback received from students, facilitators, faculty, and simulated patients (SPs) to create an anti-bias workshop for surgical residents. Additionally, we worked with the pediatric and emergency departments to develop training videos depicting bias incidents, standardize debriefing processes, and implement anti-bias workshops for their residencies.
Twenty students participated in the medical student pilot session. Student confidence increased in target skills; many noted this was their first exposure to the topic in a medical school course, and first opportunity to practice these skills. Sixteen surgical residents participated in an in-person module; learners self-identifying as "completely confident" increased in number significantly for "determining whether to respond" (p = 0.023), "knowing how to ensure follow up" (p = 0.041), and "self-care following an event" (p = 0.023).
Our low-cost, high-impact anti-bias module provided learners with tools and practice, suggesting that such an effort is feasible, affordable, and effective. Our interdepartmental trainings have inspired our institution to develop approved statements clinicians may use when responding to race-based discrimination; offering a uniform approach to race-based microaggression or abuse can create a shared mental model for all team members, especially for those vulnerable to biased comments.
种族不平等现象在美国社会和医疗体系中普遍存在；2020 年的一些重大事件凸显了改革的迫切需要。许多组织受到启发，开始审视系统性种族主义的影响。医生偏见对患者体验和结果的影响已得到充分证实；现在，有偏见的患者行为越来越受到公开讨论。针对当前的社会环境以及歧视对医疗保健和医护人员造成的痛苦影响，我们旨在为外科住院医师提供培训，使其能够更从容地应对工作场所的偏见。
我们设计并试点了一个基于模拟的沟通模块，旨在培训医学生管理偏见。我们整合了学生、促进者、教师和模拟患者（SP）提供的反馈，为外科住院医师创建了一个反偏见研讨会。此外，我们与儿科和急诊部门合作，制作了描述偏见事件的培训视频，规范了汇报流程，并为他们的住院医师实施了反偏见研讨会。
20 名医学生参加了试点课程。学生在目标技能方面的信心有所增强；许多人表示，这是他们在医学院课程中首次接触该主题，也是首次有机会练习这些技能。16 名外科住院医师参加了现场模块；在“确定是否回应”（p=0.023）、“了解如何确保跟进”（p=0.041）和“事件后自我保健”（p=0.023）方面，自认为“完全有信心”的学习者人数显著增加。
我们的低成本、高影响力的反偏见模块为学习者提供了工具和实践，表明这种努力是可行、负担得起且有效的。我们的跨部门培训激励我们的机构制定了临床医生在回应基于种族的歧视时可以使用的批准声明；为基于种族的微侵犯或虐待提供统一的应对方法，可以为所有团队成员创建一个共同的心理模型，特别是对于那些容易受到偏见言论影响的成员。
