P3.O293: Disclosing Difficult News Amidst Inequity Driven Medical Mistrust— A Simulated Experience

Background: Medical mistrust and health inequities are intimately intertwined, particularly in minoritized populations. Though mistrust is perpetuated by pervasive structural and systemic inequities, biased and fractured patient-provider communication can further impede trust, especially when delivering difficult news. The Accreditation Council for Graduate Medical Education and American Board of Pediatrics entrusts institutions with implementing health equity curricula; however, there is a paucity of literature highlighting educational models that specifically address these areas.

Methods: A 90-minute virtual workshop on delivering difficult news and responding to medical mistrust was delivered at a Department of Pediatrics Diversity and Inclusion symposium at a large academic medical center using an interdisciplinary, mixed-modality educational model. Participants included medical students and residents in addition to subspecialty fellows, faculty, and nurse practitioners. Participants engaged in a 30-minute lecture on child health disparities, building therapeutic alliances, and effective communication strategies to deliver difficult news. Afterwards, participants were divided into virtual breakout rooms via Zoom to practice their skills in one of two standardized patient encounters: 1) parent notification of a child’s death; 2) parent notification of a newborn’s transfer to the NICU. Each breakout room was facilitated by 2 content experts- one in anti-racism practices and the other in delivering difficult news. The simulated encounter concluded with a debrief and appreciative inquiry exercises. Pre- and post- experience evaluations were administered to assess changes in knowledge, skills, and attitudes.

Results: 57 participants completed the surveys (23 pediatric faculty, 14 pediatric trainees, 17 medical students, and 3 nurse practitioners). 96% of participants felt comfortable participating in the seminar amongst others of mixed levels of training without fear of facing negative consequences and 100% of participants thought the overall educational value was excellent or good. Content areas assessed include the belief that mistrust hinders communication, ability to recognize mistrust, ability to foster mutual respect, ability to disclose difficult news, comfort disclosing difficult news, ability to respond to medical mistrust, and comfort sharing personal experiences with others.  Statistical analysis was conducted using Wilcoxon signed-rank test. Confidence in all domains increased significantly in post-surveys except for the belief that medical mistrust hinders effective communication and ability to recognize mistrust, as there was high pre-survey confidence in these areas (Figure 1).

Conclusion: An interdisciplinary, mixed-model educational classroom model is a feasible and acceptable method to deliver health equity curricula. A health equity-focused simulation can equip pediatric healthcare providers with tools to effectively and empathetically navigate family encounters during which they must disclose difficult news and respond to medical mistrust. This educational model can promote comfort in doing so and add to the creation of brave spaces. Furthermore, virtual platforms can be utilized as an innovative, interdisciplinary education tool to capture large audiences without comprising educational value or participant involvement.