Hands on for Health Equity: Simulation and Spaced Reflection in Graduate Medical Education.

Area of Science:

• Medical Education
• Health Equity Research
• Simulation-Based Learning

Background:

• Advancing health equity requires clinicians to address structural disparities and mitigate bias.
• Existing health equity education often lacks experiential components and interdisciplinary integration.
• There is a need for effective, longitudinal interventions to prepare residents for complex clinical challenges.

Purpose of the Study:

• To describe an institution-wide, longitudinal simulation-based health equity educational intervention for first-year residents.
• To evaluate the impact of experiential learning on structural determinants of health (SDOH) and bias mitigation.
• To assess changes in residents' cultural humility, communication skills, and confidence in addressing health disparities.

Main Methods:

• First-year residents participated in simulated patient encounters with standardized patients (SPs).
• Intervention included SP feedback, narrative reflection, group debriefing using visual arts, and a 3-6 month follow-up metacognitive activity.
• Surveys measured self-reported impacts on clinical decision-making, communication, SDOH understanding, and cultural humility.

Main Results:

• A statistically significant improvement in cultural humility and confidence was observed immediately post-simulation.
• Residents reported enhanced skills in addressing stigmatizing language, bias, and SDOH during patient encounters.
• Most improvements, including positive impacts on patient interactions, were sustained at the 3-6 month follow-up.

Conclusions:

• Simulation-based health equity education can effectively enhance residents' skills in addressing disparities.
• The intervention demonstrates a model for interdisciplinary, experiential learning in health equity.
• Replication with site-specific cases can foster organizational commitment to patient needs and equity.