Developing Awareness and Allies: Simulating Difficult Conversations about Microaggressions for Faculty and Students.

OBJECTIVES: Discrimination and bias in clinical training often take the form of microaggressions, which, albeit unintentional, are detrimental to the learning environment and well-being of students. Although there are a few reports of medical schools training students to respond to microaggressions, none have included a complementery student-led faculty training module. The aim of this study was to develop and evaluate a case-based approach to improving student resilience and increasing faculty awareness of microaggressions in the clinical setting. METHODS: We created four realistic cases of microaggressions and uncomfortable conversations, based on students' experiences on the wards, to implement training for incoming third-year students and their core faculty. Standardized patients were trained to effectively portray discriminatory faculty, residents, and patients. Institutional review board-approved surveys were administered and statistically analyzed to evaluate for efficacy. RESULTS: Students had greater mean confidence scores for responding to microaggressions immediately and at 6 months after the sessions (P < 0.05). Faculty showed improved mean confidence and understanding of the definition of a microaggression (P < 0.05). CONCLUSIONS: This approach had results similar to other studies, with the additional benefit of training faculty with the same scenarios. We believe that this method helped bridge the gap between students' notions of discrimination and faculty understanding of microaggressions.

Medical Student Choices Regarding Ventilator Allocation for People With Disabilities.

In the COVID-19 pandemic, concerns exist that ventilator triage policies may lead to discrimination against people with disabilities. This study evaluates whether preclinical medical students demonstrate bias towards people with disabilities during an educational ventilator-allocation exercise. Written student responses to a triage simulation activity were analyzed to describe ventilator priority rankings and to identify themes regarding disability. Disability status was not cited as a reason to withhold a ventilator. Key themes observed in ventilator triage decisions included life expectancy, comorbidities, and social worth. Although disability discrimination has historically been perpetuated by health care professionals, it is encouraging that preclinical medical students did not demonstrate explicit bias against people with disabilities in ventilator triage scenarios.

Ethics Education in COVID-19: Preclinical Medical Students' Approach to Ventilator Allocation.

Introduction COVID-19 has confronted clinicians with a potential need to ration ventilators. There is little guidance for training medical students to make such decisions in future practice. How students would make ventilator triage decisions remains unknown. Methods One hundred fifty-three medical students in 18 problem-based learning groups participated in a ventilator-rationing exercise in April 2020 as part of an ethics curriculum adapted in response to the COVID-19 pandemic. Students were provided with a prompt requiring fictional patients to be prioritized for ventilators in the face of scarce resources. The authors reviewed group responses, tallied triage criteria, and identified approaches to triage decisions. Results The most common triage criteria were patient comorbidities, clinical status, age/life stage, prognosis, life expectancy, and an individual's role in pandemic response. Additional criteria included quality of life, ventilator availability, public perception, and patient need. Students approached triage decisions by developing systems for triage, appealing to empirical evidence and academic literature, making value judgments, and identifying adjuncts and alternatives to triage. Discussion With minimal input from educators, students learned key ethical principles in triage medicine, recapitulated approaches to triage described in the clinical and bioethics literature, and suggested methods for tolerating distress of complex ethical decisions. Medical education should equip students to critically consider bioethical concerns in triage and prepare for possible moral distress during public health crises.

'What a Pretty Assistant You Have': Addressing Sex-Based Harassment by Patient Offenders in Undergraduate Medical Training.

Sex-based harassment remains a concern in the medical workplace environment and is negatively associated with physical and mental health complications. Presently, undergraduate medical education fails to provide students with the appropriate toolset to successfully handle sex-based harassment by patient offenders. Through peer discussion and personal experience from a medical student perspective, herein we suggest strategies for individuals at all levels of medical training to help mitigate these uncomfortable situations. Simulation-based training and implementation of frameworks regarding microaggressions are crucial components of the medical curricula which must be incorporated expediently to create cultural change and help combat pre-existing historical precedents.

Competing theories of multialternative, multiattribute preferential choice.

In accounting for phenomena present in preferential choice experiments, modern models assume a wide array of different mechanisms such as lateral inhibition, leakage, loss aversion, and saliency. These mechanisms create interesting predictions for the dynamics of the deliberation process as well as the aggregate behavior of preferential choice in a variety of contexts. However, the models that embody these different mechanisms are rarely subjected to rigorous quantitative tests of suitability by way of model fitting and evaluation. Recently, complex, stochastic models have been cast aside in favor of simpler approximations, which may or may not capture the data as well. In this article, we use a recently developed method to fit the four extant models of context effects to data from two experiments: one involving consumer goods stimuli, and another involving perceptual stimuli. Our third study investigates the relative merits of the mechanisms currently assumed by the extant models of context effects by testing every possible configuration of mechanism within one overarching model. Across all tasks, our results emphasize the importance of several mechanisms such as lateral inhibition, loss aversion, and pairwise attribute differences, as these mechanisms contribute positively to model performance. Together, our results highlight the notion that mathematical tractability, while certainly a convenient feature of any model, should neither be the primary impetus for model development nor the promoting or demotion of specific model mechanisms. Instead, model fit, balanced with model complexity, should be the greatest burden to bear for any theoretical account of empirical phenomena. (PsycINFO Database Record