Training medical providers to serve diverse deaf patients: Age-based intervention effects in a randomized trial

Deaf American Sign Language users are severely underserved in the U.S. healthcare system. To address longstanding inaccessibility and mistrust, our Deaf community-led team produced a film to train providers to better serve Deaf patients - Vital Signs.

We conducted a two-arm randomized controlled trial to evaluate preliminary efficacy of Vital Signs among healthcare providers and health professions students.

Participants were randomly assigned to review Vital Signs or intervention as usual - standard written guidance about working with Deaf patients. Intervention completers were invited to participate in a simulation with a Deaf standardized patient. Three Deaf team members were trained to review simulation recordings and complete validated patient self-report measures of provider behavior: Healthcare Provider Cultural Competency; Ask, Understand, and Remember Assessment; and Wake Forest Physician Trust Scale.

Of 208 enrolled participants, 52 completed all study components and were included in final analyses. A clear pattern of results emerged - participant age influenced learning and behavior change in response to different training strategies. Participants aged 33+ who viewed Vital Signs scored higher on content knowledge compared to same-aged peers who reviewed training as usual, but worse across measures of cultural competency, communication skill, and trust-building. An opposite pattern emerged for participants younger than 33 years - those who watched Vital Signs exhibited greater cultural competence, communication skill, and trust-building abilities than same-aged peers who reviewed standard written guidance.

Future steps include an implementation trial of various Vital Signs training configurations, evaluating strategies for training health professions students versus experienced providers.