Tjia Jennifer, Pugnaire Michele, Calista Joanne, Eisdorfer Ethan, Hale Janet, Terrien Jill, Valdman Olga, Potts Stacy, Garcia Maria, Yazdani Majid, Puerto Geraldine, Okero Miriam, Duodu Vennesa, Sabin Janice
Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA.
Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, USA.
J Med Educ Curric Dev. 2023 Jun 5;10:23821205231175033. doi: 10.1177/23821205231175033. eCollection 2023 Jan-Dec.
To describe the development and refinement of an implicit bias recognition and management training program for clinical trainees.
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.
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.
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.
描述一项针对临床实习生的内隐偏见识别与管理培训项目的开发与完善过程。
在一项由美国国立卫生研究院资助的旨在解决高血压管理中医疗保健差异的临床试验背景下，一所学术医疗中心的研究与教育教员采用参与式行动研究方法，让当地社区成员参与开发和完善一个“知识、意识和技能培养”的偏见识别与缓解项目。该项目针对医学住院医师和护理实践博士学生。两阶段培训的内容包括：关于医疗保健差异、种族主义和内隐偏见的教学；进行内隐联想测验（IAT）以提高对个人内隐偏见的认识；开展缓解偏见沟通的技能培养；以及在与当地社区标准化病人（SP）进行模拟互动的案例场景中进行技能练习。
第一年的试验招募了n = 65名跨专业参与者。在整个设计和实施过程中参与的社区合作伙伴和标准化病人报告了总体积极的体验，但标准化病人表示在模拟互动后的面对面汇报过程中需要教员提供更多支持，以平衡权力动态。第一年的实习参与者表示，在两个培训课程的每一个中，面对面教学、内隐联想测验和标准化病人模拟的密集安排让他们感到不适。作为回应，作者对培训项目进行了完善，将教学课程与内隐联想测验管理和标准化病人模拟分开，并增加了安全空间以及实习生和标准化病人的自主权。最终的项目包括更多聚焦身份、种族和民族的互动讨论，以及应对与结构性种族主义相关的当地卫生系统挑战的策略。
开发和实施一个利用与标准化病人进行模拟学习的偏见意识和缓解技能培训项目，并与当地社区成员合作，根据当地患者群体的经验调整内容是可行的。需要进一步研究来衡量在其他地方复制这种方法的成功程度和影响。
