Forum theatre for training residents to be allies.

BACKGROUND: Residents are commonly targets and bystanders of workplace discrimination, yet little is known about how best to train residents to manage these incidents. We sought to train residents to respond effectively to being a target or bystander of discrimination. APPROACH: We used a novel, 75-min theatrical role-playing intervention called Theatre for Healthcare Equity (T.H.E.) to teach 71 internal medicine residents between December 2017 and February 2018. In T.H.E. residents took turns acting as either a 'resident' target or a 'student' bystander in a simulated scenario of discrimination. A facilitator led follow-up discussions including group reflection and development of learning scripts to help with difficult situations. A post-graduation survey was sent in November 2021 to assess residents' retention of knowledge, attitudes and potential application in practice. EVALUATION: T.H.E. was well received by residents, though survey response rates were low. All respondents to a post-session survey reported having acquired knowledge and skills to help them respond to incidents of bias and discrimination. Most respondents to the post-graduation survey nearly 4 years later remembered T.H.E.; seven wrote reflective narrative responses indicating that T.H.E. had raised awareness of these issues, empowered them to speak up on behalf of colleagues and validated their emotional reactions to hurtful speech from patients. We describe an incident in which a former resident attributed his ability to serve as an effective bystander ally to participating in T.H.E. years earlier. IMPLICATIONS: T.H.E. was an efficient, well-received intervention that some of our residents found to have been helpful years later. We continue to use T.H.E. as the basis for periodic ongoing allyship training for residents and teaching faculty to improve the inclusiveness of our clinical learning environment.

Humidification Practices of Extremely Preterm Neonates: A Clinical Survey.

Extremely preterm neonates are at risk of morbidity and mortality related to their underdeveloped skin barrier. Humidified incubators are typically used in their care, but there is a paucity of literature to inform the standardization of specific evidence-based humidification practices in the NICU. A brief, voluntary, anonymous survey was distributed to our home institution and numerous national and international external institutions. Survey questions pertained to institutional humidification guidelines and were qualitatively analyzed. We received 89 responses from the home institution and 42 responses from the external institutions. Within the home institution, despite the presence of a guideline, individual practitioners reported varying practices in the starting levels of humidity and length of time spent in humidity. The results also demonstrated significant variability in individual humidification practices between the external institutions. There is no standard humidification guideline for extremely preterm neonates being cared for in the NICU. Further research is required to provide appropriate evidence on which to base clinical guidelines for the management of extremely preterm neonates to prevent morbidity and mortality in this population.

Using Forum Theater as a Teaching Tool to Combat Patient Bias Directed Toward Health Care Professionals.

Introduction: Health care professionals who identify as members of underrepresented and racial minority groups may experience bias from patients and patient families. These occurrences disrupt the educational and therapeutic environments, distress the targeted individuals and allies, and create potential legal liability. Yet there are few educational opportunities for individuals to brainstorm and implement strategies for responding professionally during such instances. Methods: Presented first as a grand rounds, then an invited workshop, and finally an invited series, this educational activity was developed in a stepwise manner over the course of a year. Each format was sequentially modified based on feedback from participants-more than 200 physicians and other health care professionals-using evaluation forms that were voluntary and anonymous. The educational activity used an adaptation of forum theater, in which participants role-played an instance of oppression with a goal of altering the ultimate outcome. This approach provided participants with the opportunity to develop and rehearse responses to workplace bias in a way that preserved the provider-patient relationship. Results: Feedback for these educational sessions was overwhelmingly positive. Participants noted the importance of acknowledging and addressing bias in the workplace and encouraged facilitators to expand the sessions in length, frequency, and scope. Discussion: Forum theater is a methodology that can be employed in health care to teach appropriate and authentic responses to expressed patient bias while maintaining the therapeutic relationship. The positive reception from participants in our preliminary sessions established a strong foundation for future improvements to this work.