Creation, Implementation, and Outcomes of a Formative Simulation Course for Promoting Healthy Equity Education in Neurology: A Pilot Study
Javier Suarez1, Daniel Harrison2, Altaf Saadi3, Jose McFaline-Figueroa4
1University of Minnesota, 2Neurology, Mass General Brigham, 3Massachusetts General Hospital, Harvard Medical School, 4Dana-Farber Cancer Institute
Objective:
Use simulation as a tool to teach best practices for the use of medical interpreters during an acute stroke and for addressing financial instability as a major driver of medication non-adherence.
Background:
Simulation-based medical training is a rapidly emerging technique in neurology graduate medical education and has been used to improve technical, clinical, and communication skills in both low and high-acuity contexts. However, there is a paucity of simulation curricula, both within and outside neurology, that explicitly address patient social issues to promote health equity.
Design/Methods:
We created two case-based simulation sessions designed to improve neurology residents’ confidence in managing patients with social needs as contributors to their morbidity. The cases used patient actors in a simulated clinical environment. Residents completed anonymous pre- and post-intervention surveys with demographics, confidence ratings, and knowledge questions. Descriptive statistics were used to analyze survey responses.
Results:
Twelve PGY-2 adult neurology residents and 1 PGY-3 child neurology resident (n=13) participated in the simulation sessions. Following the sessions, self-rated confidence in caring for patients with financial insecurity (22% vs 69%), knowledge of outcomes for patients with financial insecurity (29% vs 69%), and knowledge of outcomes for patients with a language preference other than English (LPOE, 21% vs 67%) increased significantly with SIM training. Self-rated confidence in using an interpreter in a clinical context (72% vs 84%) and caring for patients with LPOE (72% vs 81%) also increased, though to a lesser degree.
Conclusions:
We demonstrate that simulation is both feasible and effective in teaching health equity topics in neurology. Future studies should focus on assessing whether health equity simulation can impart lasting learner knowledge and behavior changes, as well as improve patient outcomes.