P3D192: Addressing Biased Families of Pediatric Patients: A Simulation-based Pilot Training Program for Residents

Background: Residents often witness and experience discriminatory behavior in the clinical learning environment from patients and their families. There have been increasing calls for curricula to teach trainees how to appropriately respond to discriminatory behavior during clinical encounters. Pediatricians must navigate family dynamics, including addressing biases, while modeling appropriate behavior in front of a pediatric patient.

Methods: We developed a pilot program to train pediatric residents using a standardized patient as the biased parent of a pediatric manikin patient. A didactic session to provide a communication framework was conducted before the simulation-based workshops and a scripted language tool for de-escalation was provided. Each simulation-based workshop included three brief, escalating scenarios of discriminatory behavior towards a member of the medical team. During these scenarios, residents were required to explore the bias, build rapport, and develop a therapeutic alliance with the parent and patient while establishing a safe learning environment for all team members. The residents had the added responsibility to model appropriate anti-biased behavior in front of an observant pediatric patient. After each simulation, learners debriefed with a trained facilitator, peers, and the standardized patient. Program evaluation was conducted by anonymous pre- and post-workshop surveys.

Results: Sixteen residents completed the simulation-based curriculum in March 2023, representing 80% of the residency program. In the pre-workshop survey, 40% of residents reported feeling confident navigating family discriminatory behavior while modeling appropriate behavior in front of pediatric patients, and 31% of residents agreed or strongly agreed that they had the tools and language to respond to discriminatory behavior in the clinical setting. After the workshop, the proportion of residents who agreed or strongly agreed to both questions increased to 100%. Qualitative feedback from participants was positive and requests were made to repeat the workshop annually.

Conclusion: This pilot program demonstrated an effective training method to educate learners to address patients’ family members who direct discriminatory behavior towards a member of the healthcare team. Participants reported having the tools and language, and feeling more confident to address discriminatory behavior in front of an observant pediatric patient. Strengths of the program included use of a trained standardized patient and the inclusion of the pediatric manikin patient in the scenario to reflect realistic pediatric clinical encounters.