P3.184: Ethical and Practical Challenges Managing Racist Patients: A Simulation Case for Medical Education

Background: When healthcare providers experience mistreatment or discrimination from patients, it creates difficult and emotionally charged situations. Therefore, it is necessary for providers to understand methods to counteract these behaviors, transform the interaction into a productive encounter, and de-escalate as needed. Our main objective was to determine the effectiveness of a novel simulation case to teach providers about mitigation techniques they can employ when faced with explicit bias. Additional objectives included enhancing providers' confidence in recognizing and addressing explicit bias, such as racism, in the emergency department (ED) and increasing their familiarity with institutional policies on bias.

Methods: We designed a simulation case highlighting a patient’s racism during routine care in the ED. The case was conducted with emergency medicine (EM) attendings and residents, pediatric emergency medicine (PEM) attendings and fellows, and advanced practice providers (APPs) from one large urban academic hospital. A structured debrief followed, which included a discussion of racism, mitigation techniques, and hospital policies on explicit bias. Afterwards, all participants completed an anonymous online survey using 5-point Likert scales, which included questions about case quality, relevance, and their subsequent confidence regarding the learning objectives. Participant responses to the open-ended qualitative questions about significant takeaways from the case were also coded for themes.

Results: Of the 39 participants (8 attendings, 28 trainees, 3 APPs), all agreed or strongly agreed that the case was relevant to their work and was effective in teaching bias and communication skills. Additionally, 97% agreed or strongly agreed that it was realistic and that the debrief fostered a safe learning environment. After participation, 97% felt confident or very confident in their ability to recognize potential racial bias in the emergency department, 95% in their ability to address explicit bias when it occurs, and 92% in explaining institutional policies regarding explicit bias (Table 1). Major takeaways from the case coded into themes included strategies for intervention, empowerment to act, and available resources (Table 2).

Conclusion: This simulation-based medical education initiative effectively improved participants’ ability to recognize and address explicit patient bias in the emergency department. High participant ratings for realism, relevance, and effectiveness highlight the value of integrating such cases into medical education. Additionally, the fact that participants reported increased confidence in mitigating racial bias and upholding institutional policies underscores its potential impact on fostering preparedness for real-world encounters in the ED.