561 - Development and Implementation of a Simulation Curriculum Focusing on Bias and Health Disparities for Pediatric Residents

Poster Number: 561
Publication Number: 561.23

Mariana Nino de Guzman Ramirez, University of Colorado School of Medicine, Denver, CO, United States; Kathryn Kalata, University of Colorado School of Medicine, Denver, CO, United States; Adam Rene Perez. Rosenbaum, University of Colorado School of Medicine, Denver, CO, United States; Keren Eyal, Children's Hospital Colorado, Denver, CO, United States; John M. Guerrieri, University of Colorado School of Medicine, Denver, CO, United States; Kathryn A. Walsh, Denver Health / University of Colorado / Children's Hospital Colorado, Denver, CO, United States; Amy Sass, University of Colorado School of Medicine, Aurora, CO, United States

Background: Implicit biases within the health care system contribute to pediatric health disparities. There are few opportunities to practice identifying and responding to bias and microaggressions in clinical scenarios during pediatric residency training. Participating in simulation modules that address these topics could improve residents’ cultural humility and mitigate disparities.

Objective: After undergoing a simulation curriculum to practice navigating bias and discrimination, pediatric residents will have improved perceived knowledge, skills, and attitudes about health disparities, implicit biases, managing microaggressions and practicing cultural humility.

Design/Methods: Kolb’s experiential learning theory conceptual framework was used to develop the curriculum. A needs assessment was conducted through focus groups with residents, faculty, and families who receive care at our home institutions to inform learning objectives and develop simulation scenarios (Table 1). A facilitator guide and instructions for standardized patients were created and reviewed prior to the workshop. Five-point Likert scale questions were used to assess changes in residents’ knowledge, skills, and attitudes about health disparities, implicit biases, managing microaggressions, and practicing cultural humility through participation in the workshop. Two-sided binomial distribution analysis was used to assess the change in proportional agreement before and after training.

Results: Focus groups produced a variety of themes that helped to shape curriculum learning objectives. Themes included difficulty navigating power dynamics, disparities in care for families with limited English proficiency, and the stigmatization of families who are labeled as “difficult”. Of the 63 residents who participated in the simulations, 48 completed the pre-survey, 39 completed the post-survey and 36 were available for matched pair analysis.  95% of residents agreed that the training improved their comfort with addressing these clinical scenarios. Additional results are summarized in Table 2.

Conclusion(s): This novel curriculum improved residents’ experience and comfort with addressing bias and microaggressions in an interprofessional team. It also showed that simulation curricula can be used to improve pediatric residents’ knowledge and attitudes about health disparities, implicit biases, microaggressions, and cultural humility. More research is needed to understand the long-term impact of such curricula on pediatric resident training and on patient outcomes and quality of care.

Partial funding by the “Center for Health Care Strategies".