Bias at the Bedside: A Roleplay-Based Workshop for Responding to Biased Comments in a Teaching Hospital
What’s the Question?
Respect for diverse identities, including race, ethnicity, gender identity, sexual orientation, cultural and religious background, and age, is extremely important in a medical setting. Patients and families are frequently cited as the individuals most often making biased comments in teaching hospital settings (the setting of focus for this study), and experiences of mistreatment are correlated with provider burnout.
Strategies for responding to biased comments from patients and families have been taught via webinars, scenario-based workshops, and reenactments. None of these, however, have asked participants to practice responding in real time, and most also haven’t specifically confronted the challenge of addressing incidents of bias from patients with mental health conditions, whose mental status could be compromised due to mania, psychosis, delirium, or intoxication.
Given that, what might be a more effective approach to teaching staff skills on how to effectively respond to biased comments from patients and families?
How Was This Study Conducted?
The authors of this paper put together a workshop for teaching hospital personnel using the “ERASE” framework:
E: expect mistreatment will happen
R: recognize when mistreatment occurs
A: address the situation in real time
S: support the trainee after the event
E: establish a positive culture
The workshop aimed to teach participants the impact of bias incidents on trainees, institutional culture, and patient care; how to recognize the different types of bias that might occur in a clinical setting; and ways to respond to bias incidents in a professional manner both during and after the event.
To encourage adult learning, the workshop used a flipped classroom approach, with participants watching a short video introducing specific strategies for responding to different types of bias. Participants then attended a 60-90 minute workshop, with different sessions for faculty and multidisciplinary staff and for residents. The workshop moderator put attendees into small groups and led them through a variety of role-play exercises, each involving a patient, a trainee, and a supervisory clinician.
What Did Researchers Find Out?
Trainers conducted 16 hybrid sessions of the workshop, including two at other institutions. They also invited participants to fill out anonymous pre- and post-workshop surveys based on the learning objectives of the workshop.
Survey results found that metrics for four confidence items (confidence in ability to describe impact, recognize bias, respond in real time, and respond after a bias incident) increased significantly between the pre- and post-test. Participants identified the roleplays as being more useful than didactic or lecture-style content, saying that being able to practice the skills they were learning deepened their understanding of bias and increased their confidence about intervening. They also noted the importance of having a “safe space” for practicing skills and talking about bias, which can be a sensitive issue for many individuals.
When asked about ways to improve the workshops, some respondents wanted more time for practicing skills, while others expressed time and mental energy as potential barriers to longer workshops.
What are the Implications for the Workforce?
Though this program focused on a teaching hospital setting, bias training and learning how to respond in real time to implicit or explicit bias incidents is a vital skill for everyone in every setting. Many organizations have been providing education for staff about diversity, equity, and inclusion-related topics, but those sessions are often more didactic than interactive. The success of this program suggests that creating a “safe space” for attendees to actually practice the skills they are learning through roleplays can be more effective.
Need help getting a copy of this article? Contact Meg Brunner: firstname.lastname@example.org