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

  • Ellen H. EisenbergEmail author
  • Kelly A. Kieffer
Innovation and Improvement: Innovations in Medical Education



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.


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.


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


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.


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.


medical education-graduate medical education-simulation medical education-communication skills 



The authors are the sole contributors to the writing and preparation of this manuscript.


The work described was supported by an internal grant from the Dartmouth-Hitchcock Medical Center Department of Medicine Advisory Council for Education.

Compliance with Ethical Standards

Conflict of Interest

Dr. Kelly Kieffer received an honorarium in January 2017 from Medscape for an educational video supported by Abbvie and Pfizer. Dr. Ellen Eisenberg reports no potential conflicts of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Department of MedicineGeisel School of Medicine at DartmouthHanoverUSA
  2. 2.Section of General Internal MedicineDartmouth-Hitchcock Medical CenterLebanonUSA

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