Interprofessional Debrief on Racism, Equity, and Microaggressions (I-DREAM): Using Simulation to Change Awareness, Attitudes, and Abilities Across an Institution

Abstract

Purpose: Effective diversity, equity, and inclusion (DEI) education is imperative to combat bias across health care organizations. The authors evaluated the effectiveness of interprofessional, simulation-based DEI training in improving clinicians' awareness, attitudes, and abilities regarding bias, racism, inclusion, microaggressions, and equity in the workforce.

Method: From October 2021 to June 2022, interprofessional clinicians at Children's National Hospital in Washington, DC, completed the Interprofessional Debrief on Racism, Equity, and Microaggressions (I-DREAM) training. Participants underwent small group training that included debriefing prerecorded simulations depicting language barriers, microaggressions, and other biased interactions. They were offered optional surveys before training, after training, and at 3-month follow-up. Participants' awareness and attitudes of the events were assessed. Additional data were collected from monthly use of telephone interpreter services.

Results: A total of 1,811 interprofessional participants completed the I-DREAM training. Through user-generated codes, 759 presurveys and postsurveys and 276 presurveys and 3-month follow-up surveys were linked. Among these participants, 451 (60%) witnessed bias events before training and 629 (83%) after training (odds ratio [OR], 9.37; 95% CI, 5.77-15.22; P < .001), and 278 (37%) reported personally experiencing these events before training vs 496 (66%) after training (OR, 7.86; 95% CI, 5.45-11.33; P < .001). Participants reporting confidence responding to bias events increased from 388 (45%) to 556 (73%) (OR, 3.28; 95% CI, 2.52-4.27; P < .001). At 3 months, 199 participants (72%) continued to express confidence in responding (OR, 3.98; 95% CI, 2.56-6.18; P < .001). Use of language interpretation increased during training (mean difference in calls per month, 261; 95% CI, 124-398; P < .001; mean difference in minutes per month, 2,249; 95% CI, 616-3,882; P = .009).

Conclusions: I-DREAM training was associated with improved clinicians' awareness of bias events in the workplace, confidence in ability to respond to these events, and delivery of language-equitable care.