School of Public Health

Fighting racial bias: HSC video-based simulation helps health care leaders prepare to manage complex ethical dilemmas

September 28, 2021 • Uncategorized

Simulation has long been recognized as a highly effective andragogical tool for enhancing problem-solving and communication skills.

Actors in such simulations have been used since the 1960s to portray example patients and aid in training programs to assess diagnostic capabilities and empathy. While simulation through standardized patients, manikins, and video-based methods are commonplace in clinical programs, these approaches are not widely employed in health care management programs.

Some of the goals of video simulation in health care management education include teaching and assessing ethical decision-making, inclusive leadership, interprofessional teaming and use of effective communication skills.

The first health care management simulation chosen for development focused on racial bias because of the George Floyd murder case. That case awoke in many Americans a sense that there is a need for change across systems and institutions.

More than half of all health care professionals have reported experiencing or observing bias from patients related to race, ethnicity, age, gender or other personal characteristics.

Research has shown that among physicians, women were 41% more likely to experience bias about their gender than their male counterparts. Women were also more likely to hear comments about their age and weight.

Black and Asian physicians were more likely to hear biased comments regarding race and ethnicity.

Nurses, research has noted, may be even more vulnerable to abuse than physicians because of the extra time they spend with patients. Surveys have found that nurses and nurse practitioners were more likely to hear comments about their weight than other health care professionals.

Dr. Stephan Davis, Director of the Master of Health Administration (MHA) program at the HSC School of Public Health (SPH), and Dr. Arthur Mora, Chair, Health Behavior and Health Systems, worked with Karen Meadows, MSN, RN, Director of the HSC Simulation Center, to create a video-based simulation that was introduced to the graduating MHA students in their Organizational Leadership course this past spring.

Given the program’s commitment to educational scholarship, the video-simulation was also submitted as a presentation proposal and ultimately selected to be showcased at the virtual Association of University Programs in Health Administration Annual Meeting in June of 2021.

To develop and implement the video-based simulation in the midst of a pandemic was a challenging feat.

Karen Meadows reached out to the film and theater directors, Juan Cabrera and Claire Shaffer. After reviewing the script written by Dr. Davis, they put out a casting call for professional actors. The auditions were held virtually, and ultimately Bwayla Chisanga, Chase Crossno, and Gary Payne were selected for the roles of registered nurse, nurse manager, and healthcare consumer, respectively.

“The casting call attracted such great talent. We were fortunate to attract not only actors who were highly skilled but also extremely passionate about the project,” said Karen Meadows.

Following the casting decisions, a filming date was selected for the HSC simulation center.

Executing the filming while following social distancing and masking guidelines necessitated multiple takes of all scenes with two people, utilizing various camera angles and video editing to make segments look as realistic as possible. They wanted to show facial expressions and to portray pre/post-pandemic clinical environments.

Team members from the University Studio and Simulation Center, including Rens Bais, Lee Ann Cunningham, and Joshua Christian expertly managed the entire process.

Since delivering their AUPHA presentation entitled “Simulating Discrimination: A Safe Space to Learn the Harsh Realities of Healthcare, the MHA program has begun to receive inquiries regarding the video simulation being adopted at other institutions.

“When I reflect on the past year and a half, I believe it’s actually astounding that the team was able to pull this all together,” said Dr. Davis. Dr. Mora, Ms. Meadows and I had preliminary discussions regarding simulations for the MHA program pre-pandemic and prior to my arrival at HSC in May of 2020. I am so thankful to have been given this opportunity to be creative and innovative with the full support of the Simulation Center, University Studio, and School of Public Health to make it happen.”

“I see this as only the beginning of our work in health care management simulations”, Dr. Mora explained. “MHA graduates need to be prepared to address these types of complex ethical dilemmas as they enter into their future leadership careers in the industry.”