Using Simulated Encounters with Standardized Patients to Teach Medical Students to Address Implicit Biases and Microaggressions in the Clinical Setting

Abstract Purpose Structural obstacles in healthcare related to social, economic, and political factors contribute to inequities in patient care. Combined didactic and experiential learning may be more effective to teach medical students how to address implicit bias and microaggression in the clinical setting. Methods Rising third year medical students at New York Medical College participated in a student-led implicit bias and microaggression training program, including experiential learning through standardized patient (SP) encounters and self-reflection via student-led debrief sessions. The SP encounters simulated instances of xenophobia and perceived language barriers in a hospital setting, in which students were expected to address microaggressions in real time utilizing the VITALS (Validate, Inquire, Take time, Assume the best, Leave opportunities, Speak up for others) framework. Results 200 students participated in the program. Survey responses on attitudes regarding implicit bias and microaggressions were collected prior to participating in the program (T1), after the VITALS video presentation (T2), and after the SP encounter and debrief sessions (T3). Students felt more likely to interrupt a microaggression from T1 to T3. Conclusions Our implicit bias training, equipped students with the tools and practice needed to interrupt microaggressions in the clinical setting. Practice Points Combined didactic and experiential learning may be more effective than didactics alone for teaching medical students how to address implicit bias and microaggression in the clinical setting. Students overestimated their comfort level to interrupt a microaggression after watching the training video alone, underscoring the importance of experiential learning. Students valued the opportunity to practice interrupting microaggressions in a safe space with the SPs. The SP encounter positively impacted students’ likelihood to interrupt a microaggression in the future. Students felt more comfortable interrupting a microaggression from a peer than from a person in power.