Creation and Evaluation of a Health Equity Certificate Program for Standardized Patients.

Purpose: Standardized patients (SPs), who are trained in feedback and communication, are used nationally in undergraduate medical education training.1,2 Medical school curricula use simulated medical cases to meet requirements to address health care disparities in diversity, equity, and inclusion.3 Within these encounters, bias exists between the SP and the student.4 At the University of Colorado, with the implementation of an Opioid management communication curriculum, the SPs expressed concerns that their training was insufficient to conduct simulations that included feedback and portrayal of complex health equity issues. Therefore, we created a curriculum for SPs to improve health equity skills in recognizing and mitigating bias to portray patients and coach learners. Program certification was given to graduates by the medical school on completion. Applying a phenomenological qualitative approach, we evaluated the SP experience after the certificate program. Approach: Kern’s model for curricular design was used to create the curriculum employing multiple educational strategies (e.g., Johari Window model, socioecological model) as the pedagogy for diversity, equity, and inclusion is unevolved.5 Sixteen hours of hybrid virtual and in-person training included implicit association tests (IATs), vocabulary tests, small group discussion, perspective taking, watching recorded videos of patients who have experienced health inequities, peer role play, and 3 practice cases using volunteer medical students as mock learners. The content delivered tools to create inclusive learning spaces and decrease racism, discrimination, and microaggressions. The course was offered to advanced SP coaches who had received additional communication training from certified educators. After completion of the course, participants were invited to participate in a semistructured, facilitated focus group. Discussion prompts focused on 2 domains: (1) understanding what aspects of the course were valuable to your work as an SP and (2) understanding what aspects of the course were effective in the delivery of course content. A facilitator with qualitative research expertise facilitated all groups and was not otherwise involved in the program. The transcripts were transcribed and reviewed for clarity. Three coders, through an inductive coding process and consensus discussion, created a common set of codes that were applied through a constant comparative method. Outcomes: Twenty SPs completed 16 hours of the curriculum. Four focus groups were conducted with 15 of 20 (75%) SPs participating. The following themes emerged from the codes through consensus discussion. SPs described greater ability to recognize bias, use health-equitable vocabulary, and identify health disparities in clinical scenarios. SPs valued listening to stories and perspectives that better equipped them to portray a variety of patient populations with less stereotyping. SPs had a clearer understanding of learner goals and how to facilitate rewinds using effective feedback. The safe training environment was crucial to self-discovery and fostering a growth mindset in participants. The training was perceived as essential and recommended incorporation for all SPs within the institution. SPs also desired the opportunity for advanced training. Significance: The Health Equity Certificate program was well received by the SP participants who felt it gave them tools to address health inequities and the confidence to better portray patients who are known to encounter health care disparities. We identified a clear gap in SP instruction as our SPs were previously trained in communication, coaching, and feedback that did not consider their own biases and experiences with health inequities. Proven valuable to previously well-trained SPs, it is likely that many institutions would benefit from SP certification in health equity to improve health-professions student learning in scenarios that involve issues of racism, discrimination, and microaggression. We must train the trainers for health equity issues as our future doctors must have the necessary tools for decreasing health care disparities.