Presentation
Designing and Implementing Interprofessional Unconscious Bias Training Through Medical Simulation
DescriptionBackground:
Unconscious bias in healthcare can have serious, negative impacts on patient outcomes and healthcare provider wellbeing. Implicit biases among healthcare providers can lead to disparities in treatment quality, patient communication, and access to care. Although these biases are often unintentional, they can impact clinical decision-making, perpetuate health inequities, and create barriers to patient trust. Healthcare organizations have a critical responsibility to employ effective unconscious bias training to mitigate these effects and ensure psychologically safe environments for all patients regardless of their race, gender identity, sexual orientation, religion, disability, or socioeconomic status.
Effective unconscious bias training can present unique challenges in large healthcare organizations. Standard approaches, which typically involve asynchronous online modules, fail to engage participants and foster real-world skill development. Recognizing this challenge, Cedars-Sinai developed the “Inclusive Care and Bias Reduction Simulations”, educational experiences which provide immersive, interactive, learning designed to go beyond surface-level training. This program integrates lectures, hands-on simulation, and facilitated group debriefs to create a comprehensive educational experience. In this presentation, we aim to discuss the development of our training, its impact on learning, and opportunities to improve in the future.
Methods:
A multi-disciplinary team of seasoned DEI educators and simulation professionals met to develop an interactive learning experience including a lecture, interactive simulation, and a facilitated group debrief. The education was delivered to members of the community whose feedback enabled further refinement. A 90-minute simulation session was developed to equip attendees with tools for supporting transgender and nonbinary patients and cover topics such as understanding pronouns, creating a safe and identity-affirming environment, and interventions for service recovery. The course structure involves a review of simulation objectives; pronoun & service recovery education; an immersive, role-playing scenario where learners have the opportunity to practice skills learned; debrief of simulation; review of how to view and document pronouns, preferred name, and overview of the Sexuality and Gender Identity SmartForm (For clinical participants). Four learning objectives were identified: (1) determine an assessment to identify a patient’s correct name and pronouns; (2) use the patients correct name and pronouns when communicating; (3) demonstrate supportive behaviors while caring for a transgender patient; (4) demonstrate techniques to establish a safe space for a transgender patient.
Learners: Learners included new graduate nurses who were required to complete this training.
The effectiveness of the training was measured via a pre/post survey. The survey included 5 questions using a five-point Likert scale (1= Strongly Disagree to 5 = Strongly Agree). Questions focused on participant confidence in knowledge of different pronouns, comfort asking patients about pronouns, comfort using patients correct pronouns, comfort with performing service recovery when using incorrect pronouns, and comfort with notifying a colleague in a timely and a polite manner when they use an incorrect pronoun. Two open-ended questions were also asked: (1) What are the barriers that will prevent you from using your patient’s correct pronouns? (2) What are the barriers that will prevent you from providing service recovery to your transgender patients? In the post-intervention survey two additional Likert-style questions were administered: (1) After participation in this simulation, I feel prepared to establish a safe and supportive environment when caring for transgender patients; (2) I would like to participate in more simulations that promote diversity, equity, and inclusion I
Results:
78 new graduate nurses participated in the required training. Upon review of the data, there was a statistically significant improvement in healthcare professionals' comfort and confidence following the educational intervention. Specifically, participants showed a significant increase in their confidence with knowledge of different pronouns (Pre-intervention Mean = 3.71, Post-intervention Mean = 4.47; t(77) = -7.03, p < .001), as well as in their comfort with asking patients about their pronouns (Pre-intervention Mean = 4.04, Post-intervention Mean =4.49; t(77) = -5.06, p < .001). Comfort with using patients' correct pronouns also improved significantly (Pre-intervention Mean = 4.28, Post-intervention Mean = 4.51; t(77) = -3.07, p < .01), as did comfort with performing service recovery after using an incorrect pronoun (Pre-intervention Mean = 3.90, Post-intervention Mean = 4.49; t(77) =-5.35, p < .001). Finally, there was a notable increase in participants' comfort with notifying a colleague about incorrect pronoun use (Pre-intervention Mean = 3.99, Post-intervention Mean = 4.46; t(77) = -4.77, p < .001). We will discuss results related to open-ended responses during the presentation.
Discussion: The results underscore the success of the Inclusive Care and Bias Reduction Simulations in fostering greater confidence and comfort among healthcare professionals when engaging with gender-diverse patients. These improvements in communication and service recovery practices are crucial for creating a more inclusive and respectful healthcare environment, helping reduce the psychosocial harm often experienced by transgender and nonbinary patients. The intervention highlights the value of experiential learning in addressing unconscious bias and building empathy in clinical practice.
Unconscious bias in healthcare can have serious, negative impacts on patient outcomes and healthcare provider wellbeing. Implicit biases among healthcare providers can lead to disparities in treatment quality, patient communication, and access to care. Although these biases are often unintentional, they can impact clinical decision-making, perpetuate health inequities, and create barriers to patient trust. Healthcare organizations have a critical responsibility to employ effective unconscious bias training to mitigate these effects and ensure psychologically safe environments for all patients regardless of their race, gender identity, sexual orientation, religion, disability, or socioeconomic status.
Effective unconscious bias training can present unique challenges in large healthcare organizations. Standard approaches, which typically involve asynchronous online modules, fail to engage participants and foster real-world skill development. Recognizing this challenge, Cedars-Sinai developed the “Inclusive Care and Bias Reduction Simulations”, educational experiences which provide immersive, interactive, learning designed to go beyond surface-level training. This program integrates lectures, hands-on simulation, and facilitated group debriefs to create a comprehensive educational experience. In this presentation, we aim to discuss the development of our training, its impact on learning, and opportunities to improve in the future.
Methods:
A multi-disciplinary team of seasoned DEI educators and simulation professionals met to develop an interactive learning experience including a lecture, interactive simulation, and a facilitated group debrief. The education was delivered to members of the community whose feedback enabled further refinement. A 90-minute simulation session was developed to equip attendees with tools for supporting transgender and nonbinary patients and cover topics such as understanding pronouns, creating a safe and identity-affirming environment, and interventions for service recovery. The course structure involves a review of simulation objectives; pronoun & service recovery education; an immersive, role-playing scenario where learners have the opportunity to practice skills learned; debrief of simulation; review of how to view and document pronouns, preferred name, and overview of the Sexuality and Gender Identity SmartForm (For clinical participants). Four learning objectives were identified: (1) determine an assessment to identify a patient’s correct name and pronouns; (2) use the patients correct name and pronouns when communicating; (3) demonstrate supportive behaviors while caring for a transgender patient; (4) demonstrate techniques to establish a safe space for a transgender patient.
Learners: Learners included new graduate nurses who were required to complete this training.
The effectiveness of the training was measured via a pre/post survey. The survey included 5 questions using a five-point Likert scale (1= Strongly Disagree to 5 = Strongly Agree). Questions focused on participant confidence in knowledge of different pronouns, comfort asking patients about pronouns, comfort using patients correct pronouns, comfort with performing service recovery when using incorrect pronouns, and comfort with notifying a colleague in a timely and a polite manner when they use an incorrect pronoun. Two open-ended questions were also asked: (1) What are the barriers that will prevent you from using your patient’s correct pronouns? (2) What are the barriers that will prevent you from providing service recovery to your transgender patients? In the post-intervention survey two additional Likert-style questions were administered: (1) After participation in this simulation, I feel prepared to establish a safe and supportive environment when caring for transgender patients; (2) I would like to participate in more simulations that promote diversity, equity, and inclusion I
Results:
78 new graduate nurses participated in the required training. Upon review of the data, there was a statistically significant improvement in healthcare professionals' comfort and confidence following the educational intervention. Specifically, participants showed a significant increase in their confidence with knowledge of different pronouns (Pre-intervention Mean = 3.71, Post-intervention Mean = 4.47; t(77) = -7.03, p < .001), as well as in their comfort with asking patients about their pronouns (Pre-intervention Mean = 4.04, Post-intervention Mean =4.49; t(77) = -5.06, p < .001). Comfort with using patients' correct pronouns also improved significantly (Pre-intervention Mean = 4.28, Post-intervention Mean = 4.51; t(77) = -3.07, p < .01), as did comfort with performing service recovery after using an incorrect pronoun (Pre-intervention Mean = 3.90, Post-intervention Mean = 4.49; t(77) =-5.35, p < .001). Finally, there was a notable increase in participants' comfort with notifying a colleague about incorrect pronoun use (Pre-intervention Mean = 3.99, Post-intervention Mean = 4.46; t(77) = -4.77, p < .001). We will discuss results related to open-ended responses during the presentation.
Discussion: The results underscore the success of the Inclusive Care and Bias Reduction Simulations in fostering greater confidence and comfort among healthcare professionals when engaging with gender-diverse patients. These improvements in communication and service recovery practices are crucial for creating a more inclusive and respectful healthcare environment, helping reduce the psychosocial harm often experienced by transgender and nonbinary patients. The intervention highlights the value of experiential learning in addressing unconscious bias and building empathy in clinical practice.
Event Type
Oral Presentations
TimeMonday, March 3110:30am - 10:52am EDT
LocationPier 9
Simulation and Education (SE)