64. Using Standardized Patient Encounters to Prepare Medical Students to Address Microaggressions in a Clinical Setting

Abstract

PURPOSE: Health inequities result from structural obstacles related to social, economic, and political factors. To address these, anti-racism and anti-bias training in all levels of medical education are necessary. This study aims to evaluate the comfort of medical students in broaching difficult conversations to address microaggressions, and assess how that differs in a professional setting to those in power versus a personal setting. METHODS: Third-year NYMC medical students received optional training in implicit bias and microaggressions, through a 12-minute lecture, followed by two unique standardized patient encounters and educational debriefs highlighting specific microaggressions in clinical settings. Pre- and post-intervention surveys included 16 Likert-scale questions and were distributed through Qualtrix. Responses were converted to a numeric scale and groups were compared using the Wilcoxon rank-sum test with significance set to p<0.05. RESULTS: There were 210 participants; the response rate was 96.2% (n=202) for pre-intervention and 94.3% (n=198) for post-intervention surveys. Prior to enrolment, most students stated they recognized internal implicit biases and stereotypical beliefs about social identity groups (87.1%), and felt comfortable communicating empathy and concern for anyone regardless of social identity group (>67.3%%). Most students felt comfortable speaking up to counteract microaggressions in a personal setting (73.8%), but not a professional setting (26.2%). After participating in the program, students were significantly more likely to recognize internal implicit biases and stereotypical beliefs (91.6%, p=0.025), to communicate empathy and concern regardless of social identity group (>71.8%, p<0.022), and to speak up to counteract microaggressions in a personal setting (89.1%, p<0.001) and professional setting with power differential (40.1%, p=0.033). CONCLUSION: The use of a lecture component, followed by standardized patients with immediate educational debrief, significantly improves trainee recognition of internal implicit bias, communication across social identity group, and countering microaggressions in personal settings. Trainees were significantly more likely to counteract microaggressions in a professional setting with power differential, but even after the intervention, fewer than half of trainees felt comfortable.