VIDEO BASED SIMULATION TO PROMOTE CULTURAL AGILITY AMONG DOCTOR OF PHYSICAL THERAPY STUDENTS

S. Kiami¹, S. Larrieux¹

Background: Racial and ethnic disparities in healthcare within the US are widely reported in the literature and highly persistent. In our increasingly diverse society, the prevalence of health disparities among minority and marginalized groups is concerning.  Teaching future clinicians to be culturally agile has been touted as one means of reducing disparities. However, teaching these concepts is challenging due to their multifaceted and complex nature, and lack of consensus in the literature regarding optimal pedagogy. Research has shown that simulation based learning experiences (SBLE) promote development of interprofessional communication skills, clinical skills, patient safety and discharge planning among Doctor of Physical Therapy (DPT) students, however there is a paucity of evidence on the use of this pedagogy to teach cultural awareness.

Purpose: The authors sought to develop interprofessional SBLE to foster cultural agility due to the demonstrated effectiveness of this pedagogy on other domains of student education. Further, the simulated patient-provider interactions were videotaped to avoid potential pitfalls of SBLE described previously in the literature including the need to have faculty trained in medical simulation present, time and scheduling constraints, cost, and additional resources. 

Methods: Patient-provider interactions involving language barriers, religious preferences, gender identity, racial bias and ageism were developed. Two scripts were written for each vignette; one demonstrating a culturally insensitive interaction and the other portraying a culturally agile approach to care. Professional standardized patients were hired and coached, and the 2 scenarios for each vignette were videotaped in a high fidelity simulation lab by Academic Technology Services staff members. Videos were shown in class with faculty guided discussion after the insensitive scenario to promote awareness of bias, and how neglecting cultural issues can negatively impact the patient-provider relationship and outcomes.

Results: Students were engaged by the SBLE videos, and actively participated in the discussions. Many shared examples of culturally inappropriate interactions they had observed in the clinical setting. Rich discussions ensued about the influence of personal bias on perception, formation of assumptions and communication that negatively influence care and outcomes. Overall, there was agreement that clinicians must be aware of their own biases that can result in a barrier between patients and providers leading to subpar  patient outcomes.

Conclusion(s): Creating SBLE involving cultural issues which impact care is feasible and appears impactful. Videotaping the SBLE allows for use among multiple cohorts of students thereby optimizing valuable resources. While video simulation pedagogy was found to have an impact on students’ cultural beliefs and attitudes, research is required to determine if this method is efficacious and superior to other traditional teaching methods.

Implications: The U.S. population is aging; 20% of people are predicted to be over the age of 65 by 2030.  Additionally, by 2045 changes in US demographics are expected to result in a minority majority population.  This shift in demographics means more people will experience disparities unless measures are taken to improve clinicians’ ability to provide culturally agile care.  Physical therapy educators must gain a better understanding of optimal educational methods to foster development of clinicians’ cultural agility to improve outcomes for all patients.

Funding, acknowledgements: N/A

Keywords: Cultural Agility, Simulation Based Learning Experiences, Racial/ethnic Disparities

Topic: Education: methods of teaching & learning

Did this work require ethics approval? Yes

Institution: Northeastern University Institutional Review Board approval per IRB# 17-12-20

Committee: N/A

Ethics number: N/A