Bias is commonplace in the health care environment and can negatively impact patients and their health outcomes. Simulation has long been shown to be an effective teaching tool for communication skills in health care, but it has rarely been used to deliver concrete behavioral skills that address issues of diversity, equity, and inclusion (DEI). This scoping review examines 23 published articles surrounding the use of simulation in health care education to impart behavioral skills that reduce bias and promote DEI. Included articles described various behavioral skills including communication, history-taking, and system/community-level advocacy. The most commonly used simulation modality to teach these skills included the use of simulated participants (16 articles, 70%). The main DEI topics addressed in the trainings included sexual orientation/gender identity, language, and culture/ethnicity. Based on findings from this review, the authors suggest recommendations for educators who are considering teaching DEI-related skills through simulation.
Patient advocacy and health equity are fundamental values that are linked in medical education. The definition of patient advocacy is the action by a physician, through professional work and expertise, to promote those social, economic, educational and political changes that ameliorate the suffering and threats to human health and well-being. 1 Health equity is the absence of avoidable, unfair or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification. 2 Physicians must be equipped to address social factors that affect health and recognize their roles as patient advocates to improve care and promote health equity. 3 Social determinants of health (SDH)-the environmental conditions in which people 'are born, grow, live, work and age'-account
Background The entrustable professional activity (EPA) assessment framework allows supervisors to assign entrustment levels to physician trainees for specific activities. Limited opportunity for direct observation of trainees hampers entrustment decisions, in particular for infrequently performed activities. Simulation allows for direct observation, so tools to assess performance of EPAs in simulation could potentially provide additional data to complement clinical assessments. Objective We developed and collected validity evidence for a simulation-based tool grounded in the EPA framework. Methods We developed E-ASSESS (EPA Assessment for Structured Simulated Emergency ScenarioS) to assess performance in 2 EPAs among pediatric residents participating in simulation-based team training in 2017–2018. We collected validity data, applying Messick's unitary view. Three raters used E-ASSESS to assign entrustment levels based on performance in simulation. We compared those ratings to entrustment levels assigned by clinical supervisors (different from the study raters) for the same residents on a separate tool designed for clinical practice. We calculated intraclass correlation (ICC) for each tool and Pearson correlation coefficients to compare ratings between tools. Results Twenty-eight residents participated in the study. The ICC between the 3 raters for entrustment ratings on E-ASSESS ranged from 0.65 to 0.77, while ICC among raters of the clinical tool were 0.59 and 0.57. We found no significant correlations between E-ASSESS ratings and clinical practice ratings for either EPA (r = -0.35 and 0.38, P > .05). Conclusions Assessment following an EPA framework in the simulation context may be useful to provide data points to inform entrustment decisions as part of resident assessment.
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