International Journal of Healthcare Simulation

Background:

Outcomes for Graduates mandates that newly qualified doctors should be able to recognise and manage their own Implicit Biases and the impact it has on individuals/groups [1]. Implicit bias (IB) refers to attitudes unconsciously affecting our understanding, actions, and decisions. Implicit Bias Recognition and Management (IBRM) strategies have included using online tests, lectures/workshops, and more recently simulation-based education (SBE) [2]. Literature suggests that SBE offers an approach that will lead to a change in perspectives for IB but more evidence is needed to ascertain whether SBE is an acceptable and effective method for medical students [3]. This study aims to firstly compare SBE to workshop-based teaching and secondly to explore medical students’ views and experiences of an SBE session aimed to support their recognition of implicit bias.

Methods:

This mixed method study is a pilot head-to-head trial of the two IBRM strategies followed by qualitative analysis of SBE. Following voluntary recruitment and consent of fourth- and fifth-year medical students (n=18), covariate adaptive randomization is used to assign them to a group. Both the SBE scenario (simulated ward round) and the interactive workshop were designed using learning objectives and constructive alignment theory. During the simulated ward round, a series of events demonstrating escalating IB were witnessed, and student experience and recognition were explored during the debriefing. The 1-hour interactive workshop covered theory (definitions, impact of IB and microaggressions, and challenges to confronting) followed by two case-based discussions. Post-session participant questionnaires (5-point Likert scale and free-text questions) are collected and analysed quantitatively using averages and Mann-Whitney U test. Following interviews, free-text responses and transcripts are coded by independent researchers into transformative learning framework using template analysis via Qualitative software NVivo. Ethical approval has been sought (SERB/2021/12/2236).

Results:

The preliminary results from this pilot (n=6) suggest that the workshop is better than SBE at raising awareness (4.3 Vs 2.7). Qualitative feedback suggests that SBE provided a powerful experience (Table 1).

Table 1:

An extract sample of results to date, exploring medical students’ view on participating in simulation-based education to explore recognition of IB

Conclusion:

At present, participant numbers from the pilot are too small to make meaningful conclusions. Ongoing recruitment and post-session semi-structured interviews with students will help to inform which method is better at short-term awareness raising, however further follow-up will be required to identify longer-term impact. This will guide instruction on IBRM for medical students and whether witnessing IB events can be embedded in their current simulation curriculum.

References

1. General Medical Council. Outcomes for Graduates. 2018. https://www.gmc-uk.org/media/documents/dc11326-outcomes-for-graduates-2018_pdf-75040796.pdf [Accessed on 26/10/2021].

2. Sukhera J, Watling C. A framework for integrating implicit bias recognition into health professions education. Academic Medicine. 2018;93(1):35–40.

3. Vora S, Dahlen B, Adler M, Kessler DO, Jones VF, Kimble S, Calhoun A. Recommendations and guidelines for the use of simulation to address structural racism and implicit bias. Simulation in Healthcare. 2021;16(4):275–284.