The Impact of an Interactive Unconscious Bias Training on Perioperative Learners.

Background: Providers' unconscious biases reinforce health disparities through negative direct patient care and interactions with colleagues. Objective: We created a workshop grounded in Critical Race Theory and the importance of different intersectionalities to improve medical trainees' self-assessment of their implicit biases in curated facilitated spaces. Methods: A total of 44 UCSF first-year clinical anesthesiology residents (CA-1) (95% response rate) and 23 surgery residents in their research year (77% response rate) participated in this workshop over 4 separate sessions in September 2020 and 2021. Quantitative data from a pre-/post-workshop survey was analyzed via a paired t test to evaluate our workshop's effectiveness. Feedback on efficacy was obtained by coding themes from our survey's open-ended questions. Results: The workshop was evaluated positively by a total of 65 of 67 participants in the post-workshop survey. On a 5-point Likert scale, participants self-reported they agreed that their unconscious biases affect their clinical interactions from a pre-workshop mean of 3.3 (SD ± 1.32) to a post-workshop mean of 3.9 (SD ± 0.87, P = .008). Conclusion: Our findings suggest that this workshop was effective for perioperative residents and can be extrapolated to all residents by tailoring the workshop to their respective work environments.

Tools for Addressing Microaggressions: An Interactive Workshop for Perioperative Trainees.

Introduction: Graduate trainees from diverse backgrounds may experience discrimination, mistreatment, and microaggressions. While the ability to identify and respond to microaggressions is a much-needed skill for all emerging trainees, limited training workshops exist for residents, especially within perioperative medicine. To embody the principles of diversity, equity, inclusion, and anti-racism (DEIA), we aimed to empower trainees in the perioperative environment with several strategies for addressing microaggressions to bridge this training gap. Methods: Based on critical race theory, transformative learning, minority stress theory, and the structural theory of gender and power, this workshop was developed with the primary aim of educating trainees on microaggressions, amplifying the role of allyship, and providing tools to respond to microaggressions as an ally. We used a mixed methods approach to examine participants' pre/post self-evaluations of microaggression intervention tools and the overall effectiveness of the workshop. Results: The postsurvey captured the experiences of 54 trainees, including 37 of 44 (84%) first-year clinical anesthesia residents and 14 of 24 (58%) surgery residents. The facilitator and course feedback was remarkably positive. Paired t test analyses on participants' pre- and postsurvey responses demonstrated a statistically significant increase in knowledge of microaggressions. This workshop also significantly increased learners' self-reported tools for responding to microaggressions. Discussion: Overall, these promising findings suggest that the strategies presented in this workshop could be applied across other graduate medical education programs. Institutions may wish to customize workshop elements, such as the case scenarios, and the workshop can also be incorporated within a DEIA curriculum.

Cone Structure Persists Beyond Margins of Short-Wavelength Autofluorescence in Choroideremia.

Purpose: We studied the relationship between structure and function of the choriocapillaris (CC), retinal pigment epithelium (RPE), and photoreceptors in patients with choroideremia (CHM). Methods: Six CHM patients (12 eyes) and four normal subjects (six eyes) were studied with fundus-guided microperimetry, confocal and nonconfocal adaptive optics scanning laser ophthalmoscopy (AOSLO), near-infrared and color fundus photos, short wavelength fundus autofluorescence (SW-AF), and swept-source optical coherence tomography (SS-OCT) and angiography (SS-OCTA) images. Cone spacing was represented using Z-scores (standard deviations from the mean at that eccentricity). CC flow voids were defined using a threshold of 1 SD below the normal mean. Results: Cone spacing Z-scores were not significantly correlated with distance from the borders of preserved RPE, determined using either the SS-OCT or SW-AF scans. Cone spacing Z-scores were significantly correlated with CC flow voids and retinal sensitivity. Flow voids were abnormal in regions of preserved RPE and increased progressively from within -2° of the preserved area to +2° beyond the border. Visual sensitivity decreased as CC flow voids increased approaching and beyond the border of preserved structure. Conclusions: In CHM, cone spacing Z-scores correlated with CC flow voids, and were negatively correlated with retinal sensitivity, suggesting cone degeneration accompanied reduced CC perfusion. Functional cones were found outside the presumed borders of preserved outer-retina/RPE as defined by SW-AF, but not outside the borders determined by SS-OCT. The use of SW-AF to identify the border of preserved structures may underestimate regions with cells that may be amenable to treatment.