During a consultation with her obstetrician, Marilyn Hayes tells him about overwhelming feelings of fatigue and possible symptoms of postpartum depression, including anxiety. Hayes, a black woman, becomes increasingly frustrated as the white, male doctor, Richard Flynn, ignores her symptoms and ignores her wishes when she refuses to take medication. Hayes becomes visibly uncomfortable when Flynn touches her without her permission and makes remarks filled with black stereotypes, such as assuming that she is unmarried and that the baby’s father is uninterested in her and the baby.
While Hayes and Flynn are fictional characters depicted in the virtual reality videos, Hayes’ experience is similar to that of many Black women and women of color who interact with clinicians and their staff, the study found. Hayes’ and Flynn’s visits are the first in a series of three virtual reality training modules being developed to increase clinicians’ awareness of implicit bias and cultural competency in patient care.
“Ultimately, this virtual reality training system could be a practical tool for practicing communication with a wide variety of patients across many different types of health professions,” said Charlie Thompson, a professor of communications at the University of Illinois at Urbana-Champaign who studies doctor-patient communication and is one of the team members developing the virtual reality training series.
“There’s no reason why nurses can’t use this in a variety of health care settings, not just Black maternal health, but chronic pain or diabetes or other health issues where we know there are disparities based on markers of difference like race or class,” she said.
Thompson is the first author of a study on the project published in Health Communications. She and her co-authors, including University of Illinois professor Mardia Bishop, obstetrician-gynecologist Dr. Tiffani Dillard at Carle Foundation Hospital in Urbana, Illinois, and Dr. Joseph Morris of Creighton University School of Medicine in Omaha, Nebraska, are leading the team developing the module.
The first module focused on black maternal and child health and was tested in a pilot study with 30 medical students and residents. Before and after watching the exchange between Hayes and Flynn, study participants filled out a survey that explored doctors’ thoughts about the value of eliciting patients’ opinions about the causes of illness and its impact on their lives, and whether doctors could provide good medical care without listening to patients’ opinions.
“We know that health disparities for Black mothers impact and are associated with disparities for Black infants, including preterm birth and low birth weight, so to me, this is one of the most urgent needs when it comes to women’s and children’s health.”
Charlie Thompson, Professor of Communication, University of Illinois at Urbana-Champaign
In their interactions, students saw how prejudice and stereotypes about black people influenced Flynn’s communication — for example, Flynn concluded Hayes felt unsafe because her husband was violent, but didn’t recognize that as a symptom of depression, Bishop said.
“The video shows doctors asking questions about breastfeeding, incisions and healing throughout a postpartum visit. Throughout the video, viewers can see where doctors behave and communicate with implicit bias and the impact this has on patients,” Bishop said. “It can be difficult to recognize bias or realize that something you say or do may indicate bias. This video shows the many ways that implicit bias can creep into discussions with patients.”
Post-training surveys showed participants’ awareness of implicit bias, attitudes toward culturally appropriate communication and confidence in the effectiveness of their personal communications significantly improved following the training, Thompson said.
Two open-ended questions in the survey asked participants how they would provide more empathic and individualized care to Black postpartum women. Participants responded that they would strive to build trust with patients by prioritizing their concerns and feelings, increasing opportunities for patients to express themselves, and participating in shared decision-making. Participants stated that they would listen more carefully, pay more attention to their body language, demonstrate compassion and empathy, and pay attention to patients’ verbal and nonverbal cues.
Thompson said the second virtual reality training module (still in development, along with a third) will encourage self-reflection by helping medical students recognize their own biases and learn how to mitigate them. In the third module, students will practice intercultural communication skills through interactions with virtual patients.
The first module cost $40,000, but for universities and medical schools, virtual reality training is a cost-effective option because it eliminates the need to hire people to role-play with medical students, Morris said. “It’s a lot cheaper to produce one video and screen it 100 times than it is to hire 100 people to role-play with students,” he said.
Creighton University has awarded Morris a $100,000 grant to conduct the training on its Phoenix campus, which he said will expand the study’s sample population to about 300 medical students.
The HealthMaker Lab at Carle Illinois College of Medicine also funded the project, as did the JumpARCHES Fund through the University of Illinois Center for Healthcare Engineering Systems.
The paper’s co-author was Thenkrutsi Kesavadas, who was then the founding director of the Center for Medical Engineering Systems at the University of Illinois and is now vice chancellor for research and economic development at the University at Albany, SUNY.
Other co-authors include Manuel D. Pulido, a University of Illinois alumnus and professor of communications at California State University, Long Beach; Corey Zeinstra, an immersive technologies software engineer at Boeing; and MJ Salas, a graduate student at Rutgers University.
University of Illinois graduate students Deja D. Rollins, Emily A. Mendelson, Jia Yang, Emily R. Gerlikowski and Sarah V. Benevento also co-authored the study.
sauce:
University of Illinois at Urbana-Champaign
Journal References:
Thompson, CM, et al. (2024). Reducing Health Care Disparities: Development and Pilot Testing of a Virtual Reality Implicit Bias Training Module for Black Maternal Health Physicians. Health Communications. doi.org/10.1080/10410236.2024.2347000.
