P3.188: Standing up for the “Whimpy White Boy:” A novel upstanding simulation-based curriculum for medical trainees in the Neonatal Intensive Care Unit.

Background: Disparities persist in neonatal intensive care unit (NICU) outcomes, with growing evidence that bias and discrimination contribute to these inequities. Despite awareness, gaps remain in establishing effective training strategies to mitigate biases within clinical practice, especially in high-stress environments like the NICU. Traditional methods of implicit bias training (e.g., lectures, online modules) often fail to effectively change behaviors. Simulation offers a platform for implicit bias training and has been shown to enhance learners’ retention and increase their comfort level with applying the techniques in real time. The primary objective was to co-develop, implement, and evaluate a simulation-based communication curriculum, aimed at improving the medical trainees' ability to recognize and address bias in the NICU using upstander frameworks.

Methods: Kern’s Six Steps of Curriculum Development, was used as the framework for the development of the curriculum. Following the needs assessment, a simulation-based format was selected. The primary learning objectives were developed: 1) recognize the presence of bias in a clinical setting and 2) apply upstander skills. and clinical scenarios were co-designed with NICU parents to reflect real-world interactions. The cases were then iteratively refined in collaboration with simulation experts prior to integration into a simulation design template. Each one-hour session included a 10-minute group pre-brief, a 12-minute individual low-fidelity simulation exercise, and a 20-minute facilitated group debrief. During the pre-brief, participants reviewed definitions and examples of bias in addition to the 6 D’s upstander framework (Direct, Distract, Delegate, Delay/Defer, Display Discomfort, and Debrief). Evaluation tools were designed using Kirkpatrick’s Hierarchy of Learning. The pre- and post-intervention surveys included both quantitative Likert-style items and qualitative free-response questions aimed at addressing Kirkpatrick level 2 learning. The follow-up survey will be sent 2-8 weeks following the intervention aimed at addressing Kirkpatrick level 3 learning via questions centered around changes in bias awareness and behavior following participation in the curriculum.

Results: Following IRB-approval in March 2025, the curriculum has been piloted and implemented with pediatric and family medicine residents and/or neonatal nurse practitioners (NNPs). Preliminary data from early participants indicate that participants find this curriculum "realistic" and "applicable" to the clinical workplace. Many felt like their participation in the curriculum will make them more likely to address bias in the clinical environment.

Conclusion: Bias, in its many forms, continues to drive disparities in neonatal patient outcomes. We successfully co-developed an upstander simulation curriculum specific to the NICU clinical setting that is both feasible and impactful approach to addressing bias in the clinical learning environment and can enhance one’s ability to identify bias and promote upstander behavior in clinical settings. This curriculum serves as a model for incorporating equity-focused education and training. Next steps include expanding implementation across specialties (e.g., PICU, ED) in both academic and community settings.