International Journal of Healthcare Simulation

Building upon the use of simulation to improve systems, as considered during last year’s conference ^[1], diversity and inclusion have been key topics of discussions and initiatives, with growing interest in the past years in the UK and many other countries worldwide. Why are we making such a big deal about this? Some may argue that if a patient has asthma, then we treat the asthma and that we should not treat anyone differently regardless of how different they may be from their socio-economical, cultural, gender, belief, and ethnic characteristics. This, in fact, is a misconception and patients with the same disease should be treated or approached differently, with care adjusted to their needs. This may mean that we need to adjust the type or amount of information or explanation regarding their condition. Nevertheless, our implicit bias makes us treat patients with the same disease differently. From under-prescribing pain relief in some ethnic groups to the discrimination against transgender people in healthcare ^[2,3]. Health and social care professionals are not immune to the biases and prejudices that exist in the wider population. What place does simulation have in all of this?

The simulation community has been attentive to the issues raised and must not shy away from exploring deeper these underlying issues that may impair adequate care. Sensitive to this need, diversity and inclusion are the themes of this year’s Association for Simulated Practice in Healthcare (ASPiH) annual conference. Many abstract submissions show how these topics can be meaningfully incorporated within simulation activities, scenario design, debriefings, and are applicable to various simulation modalities ^[4-7]. Simulation can provide one of the safest psychological contexts to unpack such topics in depth and from different perspectives, including that of simulated patients who may be involved and affected by the activity ^[8], or the perspective of colleagues of different backgrounds^[9]. People can (and do) admit to mistakes or misconceptions and people can (and do) discover ways to improve their performance by changing behaviours and attitudes. Creating safe environments to explore about inequalities and biases is critical. This generally promotes reflection related to the engagement and empathy of healthcare practitioners with their patients as well as their relatives, addressing more efficiently their needs, but also towards their co-workers, reinforcing the cooperation and unity within the healthcare teams. More and more health and social care workers have access and are being exposed to simulation activities. The significant impact of variation in treatment based on gender, ethnicity, sexual orientation, cultural differences, etc. means that simulation, with its orientation toward learning, can have a profound effect on how people are eventually cared for. The application of some form of simulation, using role play, has already been reported to show specific patient encounters illustrating implicit bias or best behaviour ^[10,11].

But diversity and inclusion are also highly relevant with regards to our colleagues in the clinical setting as well as within our simulation circle. We need to consider our own educational community of practice by being role models in terms of diversity and inclusivity. We hope to see a very diverse and inclusive groups of delegates attending the 2022 ASPiH Conference in Birmingham, 6-8^th November 2022, which has a vibrant and rich scientific programme as illustrated by the abstracts selected for publication in this special issue of the International Journal of Healthcare Simulation.

Acknowledgements

Thank you to everyone who responded to the call for abstracts for this year’s ASPiH conference. Thank you also to all the reviewers involved in the selection process as we couldn’t run the conference without you. Now is the time to start thinking about your contribution for next year!

References

1. Moneypenny M, Weldon SM, Hamilton C, Buttery A, Alinier G. ASPiH 2021 Conference–Moving upstream: using simulation to improve systems. International Journal of Healthcare Simulation. 2022;1(1):1–2.

2. Lee P, Le Saux M, Siegel R, Goyal M, Chen C, Ma Y, Meltzer AC. Racial and ethnic disparities in the management of acute pain in US emergency departments: Meta-analysis and systematic review. The American journal of emergency medicine. 2019;37(9):1770–7.

3. Drabish K, Theeke LA. Health impact of stigma, discrimination, prejudice, and bias experienced by transgender people: a systematic review of quantitative studies. Issues in mental health nursing. 2022;43(2):111–8.

4. Knickle K, Weir K, McNaughton N. Authoring and othering: examining bias in scenario design. International Journal of Healthcare Simulation. 2021;1(1):45–8.

5. Bignell A, Baxey E, Saunders A, Ortega-Vega M. Reducing Restrictive Practices- Using simulation education to tackle mental health stigma. International Journal of Healthcare Simulation. 2022. doi: 10.54531/WCNV4657 (In this current special issue)

6. Welsh H, Clay G, Fisher M, Ortega-Vega M, Virk K, Evans G. The Power and Influence of the Theatre on Immersive 360° Videos. International Journal of Healthcare Simulation. 2022. doi: 10.54531/CRTF6001 (In this current special issue)

7. Wadsworth J, Blair J, Millett R, Damberg K, Esposito M, Van Vuren E, Marshall E. Using a systems-based approach to explore the enablers and barriers to equality, diversity, and inclusion within a simulation-based education service. International Journal of Healthcare Simulation. 2022. doi: 10.54531/INKE9149 (In this current special issue)

8. Paul O, Connor DB. Fostering diversity in healthcare simulation. International Journal of Healthcare Simulation. 2022 Jul 29(null):1–2.

9. Kulkarni S, Tsigerides J, Sule Medha. Walk in Their Shoes - Immersive 360-degree VR experience of Diversity and Inclusivity in the NHS. International Journal of Healthcare Simulation. 2022. doi: 10.54531/LADH8978 (In this current special issue)

10. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 2017;18(1):1–8.

11. 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):275–84.