Dismantling Structural Racism in Black Maternal Health Care Through Simulation
Evidence clearly shows many factors that have led to a higher mortality rate for black women during childbirth including provider dismissiveness of black womens’ health concerns and a higher risk for the use of unnecessary interventions. To support students’ understanding of these factors, the effect of other social determinants of health and the resulting impact on patient outcomes we developed a simulation case for interprofessional teams of students to address the needs of a black woman in her later stages of pregnancy.
In this simulation, students interact with a pregnant patient and her partner (played by standardized patients) to develop a client centered birth care plan that considers medical risk factors as well as patient concerns. After the simulation, all participants complete a competency-based behavioral observation tool designed to provide a real time 360° evaluation of teamwork. Students also complete an electronic program evaluation.
We implemented this case in a pilot simulation. Evaluation results showed students demonstrated progress toward program goals: increasing awareness of bias in black maternal health, providing client-centered care, engaging in teamwork and collaborative decision making, and recognizing value of each care team member. Students also discussed strategies to further develop their skills to address biases in health care. Standardized patients and simulation observers identified opportunities for improvement of collaborative decision making to enhance patient centered care.
Data from the pilot supports the use of this program and similar ones in health care education to address issues surrounding healthcare biases and inequities.
Interprofessional simulated learning activities such as this are critical for training future health care professionals to address biases to provide quality healthcare to all individuals. Students in this pilot simulation reported increased awareness and sensitivity of issues impacting black maternal healthcare which supports continued use of this program. In addition, students identified areas for programmatic improvement that these authors will incorporate to improve future outcomes.