131 - Development of an implicit bias and health disparities curriculum for the NICU: a Delphi study

Poster Number: 131
Publication Number: 131.217

Stephanie Mavis, Mayo Clinic Children's Center, Rochester, MN, United States; Catherine G. Caruso, Oregon Health and Science University, Portland, OR, United States; Nicolle F. Dyess, University of Colorado, Denver, CO, United States; Cara Beth Carr, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Heather French, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Rita Dadiz, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Margarita M. Vasquez, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, United States; Lindsay Johnston, Yale School of Medicine, New Haven, CT, United States; Susan Izatt, Duke University, Durham, NC, United States; Allison H. Payne, Case Western Reserve University, Cleveland, OH, United States; Maria Krakauer, Vanderbilt Children's Hospital, Nashville, TN, United States; Patricia Chess, University of Rochester, Rochester, NY, United States; Elizabeth Bonachea, Nationwide Children's Hospital, Dublin, OH, United States; Megan Gray, University of Washington School of Medicine, Seattle, WA, United States

Background: The Neonatal Intensive Care Unit (NICU) is a unique clinical environment where implicit bias (IB) and systemic racism contribute to social and health disparities for both infants and their families. Existing IB and health disparities (HD) curricula are often aimed at adult medicine providers.

Objective: We aimed to delineate the essential curricular components of a national IB and HD curriculum specific to neonatal medicine providers using a modified Delphi of national experts in these fields.

Design/Methods: The initial Delphi questionnaire was created after a literature review of IB/HD curricula. We used purposive and snowball sampling to identify experts meeting two broad criteria: 1) content expertise in IB and/or HD and 2) educational relationship to neonatal medicine learners/providers. Delphi experts provided Likert-scale responses for inclusion of each proposed curricular component as well as free-text responses for explaining their rationale, rewording existing items or suggesting new ones. Consensus was defined a priori as 70% of experts responding as “strongly agree” or “agree” with item inclusion. Subsequent rounds addressed items reaching indeterminate consensus or expert-suggested items. Summarized responses and comments were provided to participants after each round.

Results: Twenty-four invited experts participated in Round 1, with 18 (75%) participating in Round 2 and 15 (62%) in Round 3. Figure 1 details the flow of curricular items throughout the Delphi. After three Delphi rounds, consensus was reached for inclusion of 66 of the 82 total items posed to the expert group: 9 goals, 23 objectives, 26 teaching methods/strategies, and 8 educator considerations (Tables 1 and 2). Objectives related to concepts of bias and the self, the impact of race in society, ideas surrounding power and privilege, and clinician skills and behaviors. Educational strategies related to general teaching and facilitation strategies, use of the IAT, and incorporation of strategies to reduce bias and respond to it. Consensus on critical educator principles related to unintended consequences of the curriculum, participant and educator factors that may influence curricular efficacy, and the ideal learning climate.Conclusion(s): Experts in IB/HD and neonatal medicine education reached consensus on many core components for an IB/HD curriculum. These will serve as critical foundational elements in the development of an equity in neonatal medicine national curriculum.
Curricular item flow through modified Delphi process
Curricular goals and objectives for an IB/HD curriculum in neonatal medicineThe 9 goals and 23 objectives reaching consensus in the modified Delphi for inclusion in final curriculum.