# Responding to Families Who Express Biases: An Adaptable Standardized Participant Communication Simulation to Train Upstander Pediatric Providers

## TL;DR

This paper introduces a simulation workshop to train pediatric providers to handle biased family members while maintaining patient care.

## Contribution

An adaptable anti-bias simulation workshop using standardized participants and a pediatric manikin to train healthcare providers.

## Key findings

- Participants showed significantly increased confidence in responding to discrimination after the workshop.
- The workshop met educational objectives for all 34 participants, including residents, faculty, and neonatology fellows.
- The simulation is now part of annual residency education due to its effectiveness and realistic clinical scenarios.

## Abstract

Pediatricians must navigate family dynamics, including addressing biases, while modeling appropriate behavior in front of a pediatric patient. We developed an adaptable anti-bias simulation workshop involving standardized participants (SP) as the biased parent of a pediatric manikin patient.

The workshop was originally designed for pediatric residents, and was adapted for faculty and neonatology fellows. The 60-minute simulation workshop included 3 short, escalating cases of discriminatory behavior toward a member of the medical team. Biased behavior included overt racism and transphobia. The participants were required to develop a therapeutic alliance with the parent, de-escalate the situation, and model appropriate anti-biased behavior in front of an observant pediatric patient. After each simulation, learners debriefed with the facilitator, peers, and the SP. Program evaluation was conducted by anonymous pre- and postworkshop surveys.

Thirty-four participants completed the workshops: 16 residents (80% of the residency), 13 faculty members, and 5 neonatology fellows. All participants met educational objectives during the simulation. In the preworkshop survey, 26% of participants agreed that they had the tools to respond to discriminatory behavior; after the workshop, 100% of participants agreed (P < .001). Confidence to appropriately respond to discrimination improved after the simulation. The workshop is now integrated into residency annual education.

We implemented our upstander simulation workshop to train learners to address patients’ families who direct discriminatory behavior toward health care team members. Strengths of the program included working with trained SPs and the inclusion of the pediatric manikin patient to reflect realistic clinical encounters.