Objective: The dynamics of labor are complex and can lead to unsatisfying experiences for birthing patients. Patient autonomy and decision capacity are questioned by a system rooted in paternalism and racism. Birthing people of color are particularly vulnerable to coercive and disrespectful behavior by healthcare professionals and suffer from disparities in maternal outcomes. We developed a longitudinal curriculum to explore the historical origins behind maternal disparities, introduce frameworks to address disparities, and provide various simulated experiences to practice shared-decision making techniques in the context of Labor and Delivery.
Methods: The elements include a didactic and case discussions in the core clerkship, followed by a standardized patient encounter in MS4 for students matched into OB/GYN residencies. Our goal in sharing this curriculum is to encourage other institutions to incorporate similar anti-racist techniques and evolve shared decision-making curricula within our specialty.
Results: We will review our curricular structure (5 min) and lead a small group case discussion, followed by a large group debrief (20 min). This will allow participants to explore their biases, patients\' lived experiences and recognize the impact of historical trauma on patient-physician interactions. They will discuss communication skills to improve shared decision-making. Thereafter, we will have a shared decision-making role playing exercise in small groups to challenge participants to practice anti-racist communication skills. Two participants will role-play the patient and physician, while the other participants assess their colleague using the Modified SDMQ-9 L&D Questionnaire (15 min). A large group debrief will take place to reflect on the simulation (10 min).
Conclusion/ Discussion: Labor and Delivery continues to be a place where patients are vulnerable to coercive and paternalistic medical practices. These practices reflect contemporary and historical systemic racism that puts birthing people of color at increased risk of poor maternal outcomes. In recent years there have been increased educational efforts to teach medical students the fraught history of racism in our specialty and how individual and systematic biases result in disparities. The ultimate goal of these educational efforts is to influence how these students will behave with patients, once they graduate into clinical practice. Our workshop demonstrates one way to build a longitudinal and interactive curriculum that includes not only on content delivery, but also simulation for students to practice communication strategies that challenge them to consider their own biases. Just has simulation for obstetric emergencies have become foundational exercises in OBGYN, so too should such emphasis be placed on simulation for patient communication that promotes equity.
Topics: Faculty Development Seminar, 2023, Student, Clerkship Director, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Simulation, Standardized Patient, Advocacy,