136 - Mitigating Bias & Preventing Harm: A Pediatric Emergency Medicine Simulation Case

Poster Number: 136
Publication Number: 136.217

Hannah Barber Doucet, Hasbro Children's Hospital at Rhode Island Hospital, Providence, RI, United States; Taneisha Wilson, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Robyn Wing, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Lauren S. Vrablik, Brown Emergency Medicine, Barrington, RI, United States

Background: Many educational interventions have been proposed to combat provider bias and racism, but few have been thoroughly studied, and even less have been proven effective. Simulation offers a new potential frontier for combating racial bias.

Objective: To determine the effectiveness of a novel simulation case to teach participants about racial bias and potential mitigation techniques in pediatric emergency medicine.

Design/Methods: A simulation case which highlighted a consultant’s racial bias in the pediatric emergency department was run with emergency medicine residents from two different training programs, pediatric emergency medicine fellows, and attendings. A debrief followed the case, which included a discussion of racism and implicit bias in patient care and suggested mitigation techniques, such as the Affirm Counter Transform tool. All participants took an anonymous online survey at the conclusion of the session, which included questions about the case quality and participant confidence in attaining the case learning objectives using 5-point Likert scales. Participants also answered qualitative open ended questions about major take-aways from the case, which were coded for themes.

Results: A total of 62 participants filled out the survey. 98% agreed the case was relevant to their work; 97% agreed the case was realistic, and 95% agreed that the case was effective in teaching bias communication skills. All participants agreed that the debrief created a safe environment and promoted reflection/discussion. After the case, 90% felt confident or very confident that they could recognize potential racial bias in the care of a patient; 79% felt confident or very confident that they could use the Affirm Counter Transform tool to raise concern about bias in patient care, and 89% felt confident or very confident that they could ensure patient management is not influenced by racial bias. In qualitative analysis of major take-aways from the case (n=43), the major themes were improved assessment of bias – either self bias, or that of colleagues (53%) -and bias mitigation techniques (40%).Conclusion(s): A novel racial bias simulation case was effective in the short term in educating physicians in the pediatric emergency department about racial bias and strategies for confronting bias in patient care. Future research will include analysis of similar simulations given to differing audiences, ongoing trainee skills building in a series of simulations, and assessment of the long-term impacts of this education modality.
Table 1. Participant Feedback on Relevance to Training and Simulation Case Qualitya. On a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree).
Table 2. Participant Feedback on Self-Confidence in Relation to Learning Objectivesb. On a 5-point Likert scale (1 = very not confident, 2 = not confident, 3 = neutral, 4 = confident, 5 = very confident).