Use of Simulated Patient Encounters to Teach Residents to Respond to Patients Who Discriminate Against Health Care Workers
- 9 Downloads
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.
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.
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.
KEY WORDSmedical 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.
- 1.Chen PW. When the patient is racist [Internet]. New York: The New York Times. 2013 [cited 2018 Dec 4]. Available from: https://well.blogs.nytimes.com/2013/07/25/when-the-patient-is-racist/ Google Scholar
- 2.Novick DR. Racist patients often leave doctors at a loss [Internet]. Washington DC: The Washington Post. 2017 [cited 2018 Dec 4]. Available from: https://www.washingtonpost.com/opinions/racist-patients-often-leave-doctors-at-a-loss/2017/10/19/9e9a2c46-9d55-11e7-9c8d-cf053ff30921_story.html?utm_term=.131b470f054b Google Scholar
- 3.Trogen B, Caplan A. When a patient is a bigot, what can a doctor do? [Internet]. Chicago: Chicago Tribune. 2017 [cited 2018 Dec 4]. Available from: http://www.chicagotribune.com/news/opinion/commentary/ct-doctors-bigot-patients-discrimination-perspec-20170629-story.html Google Scholar
- 4.Reddy S. How doctors deal with racist patients [Internet]. New York: Wall Street J. 2018 [cited 2018 Dec 4]. Available from: https://www.wsj.com/articles/how-doctors-deal-with-racist-patients-1516633710 Google Scholar
- 10.Crutcher RA, Szafran O, Woloschuk W, Chatur F, Hansen C. Family medicine graduates’ perceptions of intimidation, harassment, and discrimination during residency training. BMC Med Educ. 2011 [cited 2018 Dec 4]; Available from: https://bmcmededuc.biomedcentral.com/track/pdf/10.1186/1472-6920-11-88
- 16.Nelson WA, Huang A. Discrimination and patient-centered care. Healthcare Exec 2017; 32:54–56.Google Scholar
- 17.Warshaw R When the target of bias is the doctor [Internet]. Washington, DC: AAMCNews. 2017 [cited 2018 Dec 4]. Available from: https://news.aamc.org/patient-care/article/target-bias-doctor/ Google Scholar