Managing Patient Bias: Teaching Residents to Navigate Racism and Bias in the Workplace

Newcomb, Anna B.; Rothberg, Shira; Zewdie, Monica; Duval, Margaret; Liu, Chang; Mohess, Denise; Kapadia, Muneera R.; Kou, Maybelle; Switzer, Barbara E; Port, Courtney; Dort, Jonathan

doi:10.1016/j.jsurg.2021.06.007

Cited by 15 publications

(11 citation statements)

References 6 publications

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“…After a needs assessment and gap analysis described previously [ 21 ], combined with an appraisal of our resources, we identified opportunities to formalize instruction in patient-centered telehealth communication skills. Second year medical students were recruited from local medical schools via email by classmates who were performing as teaching assistants (TAs).…”

Section: Methodsmentioning

confidence: 99%

“…Even so, students often hone their skills at the bedside through modeling of mentor residents and attendings, resulting in inconsistent training and subjective judgments [ 16 – 18 ]. Simulation and role play have advantages in medical education including sharpening skills before engaging with patients, providing video-recording for learner review and assessment, and receiving professionally mediated feedback following practice [ 19 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Implementation of a skills-based virtual communication curriculum for medical students interested in surgery

et al. 2022

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Background Communication skills are essential to providing patient-centered care. The need for standardized communication skills training is at the forefront of medical school and residency education. We aimed to design and implement a curriculum teaching virtual communications skills to medical students. The purpose of this report is to describe our experience and to offer guidance for training programs developing similar curricula in the future. Methods The curriculum was presented in weekly modules over 5 weeks using Zoom technology. We focused on proven strategies for interacting with patients and other providers, adapted to a virtual platform. Skill levels during role-play were assessed by the Simulated Participants and students observing the simulation using the 14-item, physician specific Communication Assessment Tool (CAT). The primary outcome of the CAT is the percentage of “excellent” for each item ranked both years. Participants provided feedback on what worked well or how the module could be improved in open-ended responses. Results Twenty-eight and 25 students registered for the course in Year 1 and Year 2, respectively. Students’ post-session confidence in their ability to perform target skills was statistically higher than their pre-session scores in most sessions. Modules with the lowest pre-session confidence for both years were “Disclosing a Medical Error” and “Responding to Patient Bias.” The mean percentage of students receiving “excellent” scores on individual CAT items ranged from 5 to 73% over the course of both years. Verbal and written feedback in Year 1 provided direction for the curriculum developers to improve the course in Year 2. Conclusions Developing and implementing a new education curriculum is a complex process. We describe an intensive curriculum for medical students as we strive to allow students extra “clinical” time during COVID-related restriction. We believe continued focus on patient and family communication skills will enhance patient care. Supplementary Information The online version contains supplementary material available at 10.1007/s44186-022-00054-9.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Implementation of a skills-based virtual communication curriculum for medical students interested in surgery

et al. 2022

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“…48 Without learning and engaging in dialogue about race, healthcare practitioners are ill-prepared to address healthcare disparities and champion change. 49 In 2021, the American Association of Colleges of Nursing (AACN) released the latest edition in its Essentials series, which refl ects academic nursing's shift toward a competency-based curriculum. 15 The edition introduces 10 domains that the AACN and its member colleges deem essential for nursing education and practice at all levels, and within each critical domain, it identifi es relevant critical competencies.…”

Section: Application Of the Phcr Framework To Educationmentioning

confidence: 99%

“…Bennett et al posit that storytelling is a fundamental catalyst for conversation exploring the “unseen and unknown.”48 Students and educators must engage in self-reflection, examine personal biases, and be trained to respond to racial biases and microaggressions in the workplace 48. Without learning and engaging in dialogue about race, healthcare practitioners are ill-prepared to address healthcare disparities and champion change 49…”

Section: Practical Recommendations For the Futurementioning

confidence: 99%

The impact of systemic racism on health outcomes among Black women

James-Conterelli

Dunkley

McIntosh

et al. 2023

The Nurse Practitioner

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he COVID-19 pandemic heightened the world's awareness of disparities, particularly in healthcare. 1 The combination of inadequate healthcare systems and deep-rooted structural racism has been the center of recent discussion.Immediate action is necessary to address the causes of disparate health outcomes. The evidence is clear that Black people are most affected and are the fi rst-line casualties in all areas of mortality and morbidity from birth to death. 1

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“…This affects the dialogue poorly, leading to poor adherence of medical advice by patients of color. Multiple modules integrated within the residency program, such as low-cost, high-impact anti-bias modules and ask-tell-ask model of communication have shown to improve racial consideration among residents when conversing with their patients [ 7 , 10 ]. However, the impact of biases pertaining to gender and socioeconomic status still needs to be understood.…”

Section: Introductionmentioning

confidence: 99%

Disparities in patient-resident physician communication and counseling: A multi-perspective exploratory qualitative study

Merchant,

Shaikh,

Afzal

et al. 2023

PLoS ONE

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Effective communication between physicians and patients plays an integral role in clinical care. Gaps in a physician’s ability to ensure effective communication, especially with patients from diverse backgrounds, are known causes of medical errors. This study explores the potential biases and disparities in patient-resident communication, which may influence a patient’s quality of care. This exploratory qualitative study was conducted at the largest academic medical center in Pakistan. Purposive sampling was used to approach participants from surgery, medicine, obstetrics and gynecology, pediatrics and family medicine. Faculty, fellows and residents working in these departments and medical students in their fourth and fifth years of undergraduate education with prior experience of at least one month in these specialties during their clinical rotations were included. Focus group discussions (FGDs) lasting 45–60 minutes were conducted with each cohort of healthcare professionals separately, using a semi-structured interview guide. Sixty participants (19 males and 41 females, mean age: 32.9, SD: 10.9) took part in the study. Thematic analysis revealed five major themes. Four themes focused on residents’ biases and patient disparities hindering patient-resident communication: (1) patient-resident gender discordance (2) ethnicity and language barriers, (3) differing social class of the patient, and (4) challenging patient-resident interactions (patients resistant to treatment, exceedingly inquisitive and those with multiple attendants, etc.). The fifth theme identified the need for a communication skills curriculum in postgraduate medical education. Opposite gender and discordant socioeconomic/cultural backgrounds of patients pose a challenge to effective patient-physician communication. Self-identification and awareness of residents’ biases when interacting with patients can ensure their active elimination and improve their communication skills. Integrating these components in a standardized curriculum within postgraduate programs can enable resident-physicians to provide the same level of care and communicate more efficiently with patients of all backgrounds.

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Managing Patient Bias: Teaching Residents to Navigate Racism and Bias in the Workplace

Cited by 15 publications

References 6 publications

Implementation of a skills-based virtual communication curriculum for medical students interested in surgery

Implementation of a skills-based virtual communication curriculum for medical students interested in surgery

The impact of systemic racism on health outcomes among Black women

Disparities in patient-resident physician communication and counseling: A multi-perspective exploratory qualitative study

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