Simulation Training to Interrupt Microaggressions.

ABSTRACT: Microaggressions in health care occur frequently and negatively impact the well-being of trainees. High-realism simulation can effectively train health care providers to communicate in emotionally difficult situations. In 2023, we developed and piloted 4 simulation scenarios for pediatric residents centered on addressing microaggressions in the clinical environment that built on an existing didactic curriculum. These scenarios included single and intersecting forms of oppression including racism, sexism, ableism, ethnocentrism, and weight bias. We also trained faculty, who had no prior simulation debriefing experience, to facilitate and debrief the simulation sessions. Thirty-three residents participated and reported an increase in confidence immediately following the simulation training; this increase was sustained at 3 months. Faculty participants reported increased empathy for residents, recognition of microaggressions, and confidence facilitating conversation after microaggressions that occur both in the simulated setting and in real life. High-realism simulation holds promise as a way to bridge the gap between classroom and real-life interruption of microaggressions, a necessary skill to improve the health care environment for learners and patients.

Patient and Clinician Characteristics That Predict Breast Cancer Screening Behavior in 40-49-Year-Old Women.

Guidelines recommend that clinicians practice shared decision-making (SDM) with women in their 40s to discuss breast cancer screening. Traditionally, SDM includes discussion of values and preferences to help determine a decision that is congruent with what the patient desires. We analyzed 54 women's breast cancer screening decisions after a SDM conversation with their clinician. We looked at both patient and clinician characteristics that predicted whether or not a woman would get a screening mammogram. Women with a family history of breast cancer or who had a previous abnormal mammogram had higher rates of screening. Screening rates also varied widely between clinicians, raising the question of whether clinician attitudes impacted the SDM conversation.