Use of Simulated Patient Encounters to Teach Residents to Respond to Patients Who Discriminate Against Health Care Workers

Abstract

Background: Previous studies indicate that medical trainees frequently experience discrimination by patients. Little is known about effective strategies to teach trainees to respond to this discrimination.

Aim: To create a workshop for first-year residents utilizing standardized patients to improve skills in responding to patients exhibiting discrimination towards members of the health care team.

Setting: The Patient Safety Training Center at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.

Participants: First-year residents in the Internal Medicine Residency Program.

Program description: An introductory didactic session including a communication skills framework was followed by simulated encounters with four standardized patients. Learners received feedback from a trained facilitator, peers, and the standardized patients.

Program evaluation: One hundred percent of the 19 learners who participated agreed that the simulated exercises were realistic and improved their readiness to address patient bias. The proportion of learners who reported being somewhat or very confident in their preparedness to respond to patients exhibiting discrimination increased from 74% before the workshop to 100% (p = 0.07) after the workshop.

Discussion: A workshop incorporating standardized patients may improve resident confidence in responding to patients with discriminatory behaviors. The workshop could be modified to incorporate other learners and staff, or for inter-disciplinary training.

Keywords: medical education-communication skills; medical education-graduate; medical education-simulation.

Figure 1

Participants’ reported confidence in responding to discriminatory patients. Self-reported confidence in responding to patients expressing discrimination towards self (a) and another member of the team (b) before and after the workshop; n = 19 for both questions.