PM2081: Implicit Bias Training Using a Forum Theatre Approach in a General Academic Pediatrics Department

Background: Bias is an aspect of human cognition difficult to recognize. Research has shown confrontation can lead to changes in behavior especially as it relates to issues of discrimination. Recognition and open communication about diversity, equity, and inclusion (DEI) and bias are important clinical and professional skill for pediatric clinicians. Using a Forum Theatre approach can give participants language and experiences that they can draw upon later within the workplace setting. We sought to evaluate the need for DEI training in an academic pediatric department and participant experiences after such training.

Methods: We conducted a 60-minute an interactive online workshop targeting faculty physicians with an academic general pediatrics department. The workshop applied a Forum Theatre strategy for participant engagement, featuring two facilitators who encouraged participants to role play clinical scenarios exploring bias in race, culture, language, gender, and socioeconomic class. A short anonymous questionnaire was administered at the end of training to assess participant previous experience with DEI trainings, exposure to DEI issues in the workplace setting, and comfort with confrontation before and after training.

Results: A total of 37 pediatricians took part in the web-based training, of whom 14 (38%) submitted post-participation surveys and 12 (32%) provided complete responses. Most participants (N=13, 93%) reported prior DEI training. Patients were the most common cause of uncomfortable situations with DEI, with 72% of respondents reporting patients triggering such events at least “a few times a year.” Peers, trainees/supervisees, and supervisors were less likely to be sources of uncomfortable DEI situations, with 33%, 36%, and 8% of respondents reporting individuals with these relationships triggering uncomfortable DEI events with this frequency. Participants who reported they would definitely or likely initiate difficult DEI conversations improved from 12% to 75% after the workshop (Figure 1). More respondents also reported improved comfort with responding to a difficult DEI conversation from 25% pre-training versus 81% post-training (Figure 2). Participants expressed appreciation for the opportunity to practice difficult DEI conversations and training regarding specific language to use in these situations.

Conclusion: Patients, peers, and trainees appeared to be the most common source of uncomfortable DEI situations for pediatricians. Although most workshop participants reported prior DEI training, the majority of participants felt uncomfortable managing confrontation and response to bias. A DEI training workshop employing a Forum Theatre strategy — including pragmatic strategies reinforced via role-play in clinical scenarios — was felt to be useful by participants and was associated substantial improvement from precontemplative/contemplation to preparation/action in pediatricians’ willingness to initiate and engage in difficult DEI conversations.