JMIR Publications

ABSTRACT

Unconscious bias is an established contributor to poor patient safety and healthcare outcomes, due to alteration in clinical judgement and behaviours toward patients, undesirable team dynamics and conflicts. In this study, video-based simulation was used to address unconscious bias at the University Hospitals Bristol and Weston NHS Trust (UHBW), UK. Simulation provides a vehicle to introduce Equality, Diversity and Inclusion (EDI) into healthcare education. Filmed simulation provides a standardised, repeatable scenario while protecting learners’ psychology especially when discussions centre on sensitive topics. Meanwhile, the benefits of observation alongside guided debriefing in self-efficacy, confidence and reflective practice are well established in current literature. A filmed scenario, demonstrating unconscious bias towards female gendered team leader in a paediatric emergency case, was shown to multiple small groups of learners with varying clinical backgrounds. All 66 participants observed the filmed scenario followed by a standard simulation debrief. 55 participants completed both the quantitative pre-learning survey and qualitative post-learning survey to demonstrate baseline bias awareness, reflections and key themes that resonated most with them. A mixed-methods themed analysis using pre-and-post course survey data was conducted to evaluate whether video-based simulation is an effective and psychologically safe educational tool for demonstrating and raising unconscious bias awareness. The data was analysed to assess changes in awareness and attitudes towards unconscious bias post-intervention. Survey responses were evaluated to investigate perception of video-based simulation as an effective educational tool in improving clinical decision making through enhancing recognition and understanding of bias. Thematically, most responses highlighted the importance of: increased awareness of unconscious bias, enhancement of communication strategies and recognition of structural inequities in healthcare. Learner’s reflections reported that film observation with guided debrief improved attitudes towards unconscious bias, enhanced professional confidence and encouraged strategies for addressing bias in clinical practice. None reported negative experience from the intervention, demonstrating the psychological safety of filmed simulation. Overall, it was demonstrated that filmed simulation is an effective and feasible educational tool for healthcare EDI training, to promote inclusive workplace cultures. This study was limited in being a single centre-based study, with potential for variability in experience due to changing facilitators, and difficulty in assessing the long-term impact of these results. Further research is recommended to investigate how perceived learning and attitudinal changes translate into improvement in patient care and outcome.