Simulation-based learning for ethical skills development in the context of diversity on resident education:

A mixed-methods study from a critical, queer, and disability approach.

M. Montaño Fernández, C. Consejo y Chapela, L. Zerón Gutierrez, A. Sepúlveda Vildósola, Ú. Sánchez Solano, M. Uribe Arizmendi, A. Ceron Apipilhuasco

September 2019

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I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization.

Je n’ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d’appareils médicaux ou un cabinet de communication.

• In Mexico one of the principal causes for human rights violation is minorities and diverse group discrimination, that can be reproduced in the clinical environment.

• This can lead to a lack of a quality care and dignified patient centred care.

• It also has an effect on medical education environments.

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Our research Problem statement 1: Minorities and diverse group discrimination at the learning clinical scenario.

• In 2018 a study made by the Mexican Social Security Institute, showed that the main discrimination causes at the medical care scenario where:

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Principle causes of discrimination complains. 2018

Religion beliefs.

Female gender.

Sexual orientation and gender identity/expression.

Disabilities

HIV infection.

• Personal believes, social and cultural practices immersed in specific power relations determine the shape of organizational culture and organizational behaviour.

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Our Research Problem Statement 2: Hospital organizational culture and behaviour in the reproduction of discrimination.

Because role models are shaped in the context of organizational behaviour.

Culture and organizational behaviour could determine the reproduction of discrimination and exclusion, during medical

training.

Consejo y Chapela, Carolina. Ética y poder: formación de residentes e internos. Revista Médica del Instituto Mexicano del Seguro Social, vol. 43, núm. 1, 2005, pp. 1-3 Consejo y Chapela, Carolina. Injusticia epistémica durante el proceso de formación médica en el contexto hospitalario. Revista Médica del Instituto Mexicano del Seguro Social, Vol. 55,

Núm. 3 (2017)

• Ethical competencies development are mandatory in the context of diversity, in residency education for patient centred care in diversity scenarios.

• We believe that simulation-based learning strategies can be used for developing resident ethical skills as a fundamental part of a professional role, in the context of equity and diversity.

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Our Research Problem statement 3:

Consejo y Chapela, Carolina. Ética y poder: formación de residentes e internos. Revista Médica del Instituto Mexicano del Seguro Social, vol. 43, núm. 1, 2005, pp. 1-3

• For the purpose of our study we define as “Ethical dimensions of the professional role” as those dimensions that refer to the rational capacity that allows a professional to recognise their responsibility towards “the other´s” whoever they interact with, including patients and colleges.

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Our Purpose.

• The purpose of this mixed methods study was to develop a theoretical framework, to determine de content for a simulated scenario, to develop and evaluate the ethical dimensions of the professional role, addressing equity and diversity.

8 Creswell, John W. Poth, Cheryl N. Qualitative inquiry and Research Design: Choosing among Five Approaches. 4ed SAGE. CA. 2018.

Our Purpose.

Buke, Johnson R. Onwuegbuzie, Anthony J. Turner, Lisa A. Toward a Definition of Mixed Methods Research. Journal of Mixed Methods Research. 2007 1(2)112-133

Do no harm.

Act with justice

Act with beneficence

Protect and

promote others

autonomy

Take care of others

dignity and integrity

Protect and

empower others ho

are vulnerable

• This responsibility is centred in bioethical principles:

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Professional responsibility towards “the other´s”

This capabilities need to be present in the sense of being a professional but also in the act of demonstrating professional

behaviours.

• Mixed Methods with phenomenological and action research.

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Methods

•Action research with a critical, queer, and disability interpretative lens, provided knowledge about social constructions, experiences and interpretations for: Scenario elaboration. Contents for the evaluation tool.

Cualitative approach

•Standarization of scenario and validation of the evaluation tool .

Cuantitative approach Se

cuen

tial a

nd e

xplo

rato

ry .

(Cua

ntita

tive

anid

ated

in c

ualit

ativ

e )

Reaction Learning

Behaviour Results:

Organizational system or learning

environment

CHANGE

Hays, Danica G. Qualitative Inquiry in Clinical and Educational Settings. The Guilford Press. NY 2012. Cruess K Richard. Teaching Medical Professional Identity. 2ed. Cambridge University Press. 2ed. Cambridge 2016. Creswell, John W. Poth, Cherly N. Qualitative inquiry research and design, Choosing from five approaches. SAGE 4ed Thousand Oaks CA. 2018.

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My name is Carla not Luis.

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Scenario Debriefing

REFLECTIVE PROCESS

REEVALUATING EXPERIENCE

ATTENDING TO FEELINGS

RETURNING TO EXPERIENCE

At the Debriefing Room, residents watched the recorded scenario and talked about three elements critical to reflexive process: Their experience, feelings and reactions.

Boud D Keogh. Walker, D . Promoting reflection in learning; a model. En: Bound D. t al. Ed. Reflection. Turning experience into learning. Kogan. London UK 1989 p 18-40 Cruess K Richard. Teaching Medical Professional Identity. 2ed. Cambridge University Press. 2ed. Cambridge 2016.

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Professional Role Assessment of ethics an equity dimensions at diversity scenarios.

•After participating in the simulated scenario, they answered individually and as a group 10 discussion generating questions.

•The questions where oriented to identify the presence of dignity, power abuse, inequity, gender and different forms of violence.

•They elaborated concept categories which resume their discussion.

They recognised actions that could prevent, enhance or amend inequity and discrimination before, during and after the event they experienced.

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Professional Role Assessment of ethics an equity dimensions at diversity scenarios. •We adapted a direct observational and Role Modelling Reflection Assignment Tool from the “CANMEDS Teaching

and Assessment Tools Guide”, to propose our one tool for resident ethical and professional capacities evaluation on the context of diversity and inclusion:

Abscent

On development

Improved

Fully present

Excellent (Reference)

The instrument was applied through all the activities

Capacity to identify the existence and importance

of role models

Self-awareness of values beliefs and their association

with practices and representations.

Capacity to traduce knowledge to actions

oriented to make a change

Recognise the importance to act under the bioethical

principles: Do no harm beneficence, justice, dignity, integrity and

respect for autonomy.

Recognised the right of people to have a life free

of violence and discrimination

Snell, Linda. Professional. In: Takahashi, Glover. Ed. CANMEDS Teaching and Assessment Tools Guide. Royal College of Physicians. 2018

• There was a fully present capacity > To identify the existence and importance of role models.

• We found that there was a significant emprovement in: > The capacity to recognize the value of acting under bioethical

principles. > The importance of recognising the right of people to have a life

free of violence and discrimination. • We found that residents have difficulties

> To traduce knowledge to actions oriented to make a change. > Self-awareness of values beliefs and their association with their

one practices and representations. 15

Interpretation of results (Cualitative data).

The qualitative phase of our research provided us knowledge about social constructions, experiences and interpretations for establishing a simulated scenario intended to assess ethical competences as part of the Professional Role for diversity learning scenarios.

It helped to provide adjusted contents for the construction of an evaluation tool, to be validated in a quantitative phase.

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Conclusions.

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