博物馆的一天体验式偏见干预。

IF 4.9 1区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Medical Education Pub Date : 2024-08-30 DOI:10.1111/medu.15510
Stephanie M. Davidson, Izabela Milaniak, Sarah H. Arshad, Melissa Xanthopoulos
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引用次数: 0

摘要

隐性偏见会影响医疗服务的提供。临床医生必须深入了解自己的偏见,才能提供公平的医疗服务,并减少影响其判断的因素。这种培训应及早开始;然而,让医学学员参与偏见教育具有挑战性。传统的教学教科书告诉我们,偏见是 "坏 "的,会对临床护理产生负面影响。对于如何自省地审视自己的偏见,或如何应对这一令人不安的、情绪化的过程(这可能会威胁到自己作为一名公平医生的身份),则关注较少。如果没有建立洞察力或管理这种不适的工具,医生可能会采取回避的做法,从而对自己的偏见行为视而不见。然而,对学习的评估受到社会期望值的阻碍,因为受训者往往担心人们对其知识和技能的看法。创新教育可以创造心理上更安全的教育空间,让受训者能够更轻松、更坦诚地进行反省学习。本项目的重点是利用艺术博物馆的环境,为儿童和青少年精神病学研究员在文化精神病学课程期间创造更安全的教育空间。连续两批学员参与了以博物馆为基础的活动,这些活动旨在激发学员对偏见的认知和情感体验。学员们参与的活动对他们的直接视角提出了挑战,例如,在只观看部分艺术品的情况下对其进行解读。小组讨论围绕确定不同的观点、与不完整的信息作斗争以及深入思考如何将这些概念应用到病人护理中展开。为了评估学习体验,我们在学习前、学习后和学习后约一个月收集了调查和焦点小组数据。所有参与者都表示,这次经历提高了他们通过反思、反省和解释活动处理个人偏见的能力。所有参与者都向其他培训项目推荐了这一体验,包括建议将体验时间延长至一整天,并将体验时间提前至培训年。面临的一个挑战是,根据最佳意愿1 问卷的评估,所有学员在测试前的偏见意识测量中得分都很高。这限制了我们对培训如何提高偏见意识及其影响进行评估的能力。另一方面,在这种情况下,"正确 "答案是显而易见的,而社会期望值也是显而易见的,因此,限制李克特量表调查的范围也是意料之中的。定性数据更能说明问题。研究员们表示,在艺术作品中进行有偏见的解释时,他们更容易接受这种不适感。利用艺术作品促进讨论时,学员们承认只掌握了信息的一部分,这让他们能够安全地反思这如何反映临床情况,并指出谦逊、好奇心以及在医学决策时容忍痛苦和模糊性的重要性。定性回答的主题包括加深了解偏见如何影响:捕捉患者体验的能力、临床决策、患者体验和健康结果。一个月后,学员们报告说,他们更加努力地反思自己的偏见对临床的影响,在与同行和主管讨论困难时刻时也更加从容。以博物馆为基础的活动是促进有关偏见的体验式学习的一种新颖而有效的方法:构思;调查;获取资金;写作--原稿;方法论;可视化;写作--审阅和编辑;正式分析;项目管理;数据整理;资源。Izabela Milaniak:写作--原稿;写作--审阅和编辑;正式分析。Sarah H. Arshad:构思;写作--原稿;方法论;可视化;写作--审阅和编辑;调查;资金获取。Melissa Xanthopoulos:构思;撰写 - 初稿;获取资金;方法论;可视化;撰写 - 审核和编辑;正式分析;数据整理;监督。
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Day at the museum: An experiential bias intervention

Implicit biases affect health care delivery. Clinicians must gain insight into their own biases to provide equitable care and mitigate factors affecting their judgement. This training should begin early; however, engaging medical trainees in bias education is challenging. Traditional didactics provide a textbook understanding that bias is ‘bad’ and has negative impacts on clinical care. Less attention is given to how to introspectively examine one's own biases, or coping with this unnerving, emotional process that may threaten one's identity as an equitable physician. Without tools to build insight or manage this discomfort, physicians may practice avoidance that blinds them to their own biased behaviour. However, evaluation of learning is hampered by social desirability, as trainees often worry about perception of their knowledge and skills. Innovative education can create psychologically safer educational spaces where trainees can more readily and honestly engage with introspective learning.

This project focused on using an art museum setting to create a safer educational space for child and adolescent psychiatry fellows during their cultural psychiatry curriculum. Two consecutive cohorts of fellows engaged in museum-based activities designed to prime cognitive and emotional experiences around bias. Fellows engaged in activities that challenged their immediate perspectives, for example, interpreting artwork while only viewing parts of it. Facilitated group discussions centred around identifying different perspectives, struggling with incomplete information and deepening reflections on how these concepts apply to patient care. To assess the learning experience, survey and focus group data were collected prior to, immediately after, and approximately 1 month post. This study was exempt from IRB review.

All participants reported this experience enhanced their ability to process personal biases through reflective, reflexive and interpretive activities. All participants recommended this experience to other training programmes, including recommendations to expand to a full day and move it earlier in the training year. One challenge was that all fellows scored high on pre-test measures of bias awareness as assessed by the Best Intentions1 Questionnaire. This limited our ability to evaluate how the experience increased awareness of bias and its impact. On the other hand, restriction of range on a Likert scale survey is expected in this context, where the ‘right’ answer is obvious and social desirability is primed. The qualitative data were much more revealing. Fellows expressed that it was significantly easier to sit with the discomfort of making biased interpretations when it applied to artwork. Using art to facilitate discussions, participants acknowledged having only a snapshot of information, which allowed them to safely reflect on how this mirrors clinical situations, noting the importance of humility, curiosity and tolerance of distress and ambiguity while making decisions in medicine. Themes in qualitative responses included deepening understanding of how biases impact: the ability to capture a patient's experience, clinical decision-making, patient experience and health outcomes. One month post, fellows reported increased efforts to reflect on their biases' clinical impact and increased comfort in discussing difficult moments with peers and supervisors. Museum-based activities are a novel and effective approach to facilitate experiential learning about bias.

Stephanie M. Davidson: Conceptualization; investigation; funding acquisition; writing – original draft; methodology; visualization; writing – review and editing; formal analysis; project administration; data curation; resources. Izabela Milaniak: Writing – original draft; writing – review and editing; formal analysis. Sarah H. Arshad: Conceptualization; writing – original draft; methodology; visualization; writing – review and editing; investigation; funding acquisition. Melissa Xanthopoulos: Conceptualization; writing – original draft; funding acquisition; methodology; visualization; writing – review and editing; formal analysis; data curation; supervision.

No authors report any conflicts of interest.

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来源期刊
Medical Education
Medical Education 医学-卫生保健
CiteScore
8.40
自引率
10.00%
发文量
279
审稿时长
4-8 weeks
期刊介绍: Medical Education seeks to be the pre-eminent journal in the field of education for health care professionals, and publishes material of the highest quality, reflecting world wide or provocative issues and perspectives. The journal welcomes high quality papers on all aspects of health professional education including; -undergraduate education -postgraduate training -continuing professional development -interprofessional education
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