Implicit Bias Training for Anesthesia Simulation Education Faculty

Health Care Problem: Anesthesiology is a specialty in which there may be limited interaction with patients (while they are awake), and thus, implicit bias training is often overlooked. The RSS activity titled “Anesthesia Simulation Training Faculty Development RSS” seeks to develop MD simulation training faculty whose teaching focus is patient safety in crisis situations. The learners in this series are practicing TPMG Anesthesiologists who are also faculty of our accredited simulation activity which meets criteria for the MOCA 2.0 Part IV Quality Improvement. Through modeling, demonstration, live debriefing practice and other methods, this series aims to develop the teaching skills of our expert MD faculty with an equity an inclusion lens.  Cultural Linguistic Competency and Implicit Bias education was an important component of this activity because (1) Some anesthesiologist faculty learners had previously received little or no in-depth training on this subject, (2) there is high potential for exponential impact among these learners because they went on to design and deliver training to other anesthesiologists in the simulation lab. The biases and disparities that were covered in the series were: (1) biases related to individual patient characteristics (race, age, obesity, non-compliance, smoking status, disability, language), (2) gender disparities in post-operative outcomes, (2) racial disparities in post-operative outcomes, (3) disparities in maternal/child outcomes. By prioritizing Cultural Linguistic Competency (CLC) and Implicit Bias (IB) throughout this RSS activity, practicing anesthesiologists addressed their own implicit bias while also serving as catalysts for change in the other anesthesiologists who they teach in their simulation courses.

Educational Strategy: There were four sessions in this RSS Activity:

 Session #1: Recommendations and Guidelines for Addressing Structural Racism and Implicit Bias in Simulation Learning – Part 1

 Strategies:

1.       Learner Quiz about basics of implicit bias

2.       Brief didactic segment on implicit bias to follow up on the quiz
 
3.       Group Discussion – Moderated: “Where are there disparities in anesthesiology? 

4.       Didactic segment with discussion: Racial disparities in surgical care and outcomes

5.       Recommendations and Guidelines for scenario development, and debriefing.

Session #2: Recommendations and Guidelines for Addressing Structural Racism and Implicit Bias in Simulation Learning – Part 2

Strategies:

1.       

Discussion: How might IB surface in the practice of anesthesiology? 
2.       Demonstration of a real simulation scenario debrief with IB prompts 

3.       Sample language for debriefing prompts that stimulate discussion around bias

 

Session #3: Practical Tips for Teaching our Colleagues

Focused on evidence-based teaching with segment on difficult debriefing situations, creating psychological safely, encouraging learner self-reflection, creating a psychologically safe learning environment. The strategies used were: Didactic segment, Facilitated group discussion

Session #4: Contributions and Disparities in Maternal Outcomes & Teamwork

Strategies:

1.       Poll: What are your core values as a physician?

2.       Didactic: US Life Expectancy by Ethnicity, Racial disparities in infant mortality, Maternal outcomes disparities based on race, Pregnancy related mortality by race/ethnicity (national, California)

3.       Didactic/Discussion - How to cultivate a nonjudgmental mindset. “How can we make a difference in disparities?”, "How pattern-matching heuristics can lead to diagnostic error in anesthesia practice"


Patient-Level Outcome(s) Measured: Learners were encouraged to identify high risk areas for implicit bias to impact interpersonal dynamics within the OR team. There was facilitated discussion about how to design clinical training scenarios that allow for the possibility of learners to be influenced by an immediate “gut” reaction or unconscious stereotyping in the OR. The planners chose to highlight this aspect of CLC and IB education in this series because there is evidence in the literature that communication and teamwork, learned during in the high fidelity simulated environment, are transferred to the clinical setting, and may translate to improved patient outcomes. 

Outcomes

A post-program evaluation was administered immediately after each session. Our evaluations showed that 13 out of 27 completed the post program survey and claimed CME credit. Of the 13 responses we received from learners, 100% of them indicated they planned to make practice changes as a result of having attended the session. Examples of planned changes include:

 

• Review scenarios and debriefings for ways to incorporate potential bias

• Use open ended questions during debriefs to examine how bias could have affected care

• Continue asking questions and exploring my own implicit bias as well as how implicit bias might influence patient care.

• Outline intentions and goals, contributing to the creation of a psychologically safe environment

• Improving teamwork to improve disparities in maternal outcomes.

• Recognizing our African patients’ risks