Jennifer Tjia, MD
In partnership with the Worcester community, researchers at UMass Medical School are launching an intervention to reduce health disparities in hypertension control among minority and lower socioeconomic status patients by training health care providers to be more conscious of their own implicit biases while treating them.
“Accumulating evidence shows that well-meaning providers can harbor implicit biases that affect patient interactions, clinical decision-making, and health outcomes,” said Jennifer Tjia, MD, MSCE, associate professor of quantitative health sciences, and principal investigator of Community-engaged Simulation Training for Blood Pressure Control (CONSULT-BP), which will focus on medical residents and nurse practitioner students. “Implicit bias is the attitude or emotion that occurs when individuals unconsciously and without personal awareness classify others as a member of a group and apply stereotypes.”
Funded by a $3.8 million, 5-year grant from the National Institute of Minority Health and Health Disparities (NIMHD), the CONSULT-BP program will adapt and test a theory-based, awareness, exposure and skill-building intervention, applied in the safety of a simulation-based learning center, to improve providers’ interaction skills with patients from minority groups and lower socioeconomic status. The trainees will come from the Graduate School of Nursing and the internal medicine and family medicine residencies. Intervention partners include the interprofessional Center for Experiential Learning and Simulation (iCELS), the Center for Health Impact (formerly Central Mass AHEC), the University of Washington and Project Implicit.
Dr. Tjia said community advisors will be hired to help design the training curriculum. The study team will use online self-assessments of implicit bias to raise clinicians’ bias self-awareness and to examine the effect of bias on knowledge and skill development. Community members will be hired to act as standardized patients to conduct face-to-face, simulated clinical encounters with medical residents and nurse practitioner students. The educational intervention is a program of two, 90-minute sessions, spaced 5 weeks apart that combine online learning with in-person skill and simulation practice.
To understand how much training is required to improve clinical skills and patient outcomes, researchers will assess the effect of CONSULT-BP by conducting two, sequential, randomized trials. The first will evaluate the effectiveness of one-time CONSULT training on outcomes, while the second will evaluate the effect of repeat, booster training on outcomes. The primary outcome for both trials will be patient blood pressure control. In all, more than 200 health care health care providers will undergo the training.
“The CONSULT-BP model of community-engaged medical education is important because it brings the community’s voice into the process of training the clinicians who will ultimately serve them. This has the potential to affect clinicians early in their training, which can potentially magnify clinical outcome effects to the lifespan of their health care delivery career.”