Including Standardized Patients With Diverse Gender Identities in Simulation Cases

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On this episode of the Academic Medicine Podcast, guests Luca Petrey and Laura Weingartner, PhD, MS, join hosts Toni Gallo and Research in Medical Education (RIME) Committee members Arianne Teherani, PhD, and Daniele Olveczky, MD, to discuss a new scoping review of the literature on the inclusion of standardized patient characters and actors with diverse gender identities in simulation cases.

This is the second episode in this year’s 3-part series of discussions with RIME authors about their medical education research and its implications for the field.

This episode is now available through Apple Podcasts, Spotify, and anywhere else podcasts are available.

A transcript is below.

Read the articles discussed in this episode: 

Read the complete collection of articles included in the 2022 RIME supplement at academicmedicine.org.

Transcript

Toni Gallo:

Hi everyone, I’m Toni Gallo, host of today’s episode. Every year Academic Medicine publishes the proceedings of the annual Research in Medical Education sessions that take place at the AAMC’s Learn Serve Lead meeting. This year, the RIME papers, including the one we’ll be talking about today, will be presented throughout the Learn Serve Lead meeting, which is taking place in person in Nashville, Tennessee, in November.

Toni Gallo:

The RIME papers are also available now to read for free on academicmedicine.org. As in previous years, I’ll be talking to some of the RIME authors on this podcast about their medical education research and its implications for the field. In September, I spoke to Drs Addie McClintock and Joshua Jauregui about their research into clinical teachers’ behaviors and how they support or harm student’s sense of psychological safety in the clinical learning environment. You can find that episode in our archive.

Toni Gallo:

For the second of this year’s RIME conversations, I’m joined by RIME Committee members, Dr. Arianne Teherani and Dr. Daniele Olveczky. And we’ll be talking to Luca Petrey and Dr. Laura Weingartner, who coauthored the paper “Gender Diverse Representation in Patient Simulation: A Scoping Review.” I’ll put the link to that paper in the notes for this episode. And with that, let’s do some introductions. Arianne, would you like to get us started?

Arianne Teherani:

Hi everyone, I’m Arianne Teherani. I am professor of medicine and an education scientist in the Center for Faculty Educators, and I co-lead the Equity and Justice in Education Initiative at the University of California, San Francisco, School of Medicine.

Daniele Olveczky:

Hello everyone. My name’s Daniele Olveczky. Clinically, I’m a geriatrician and a nocturnist, a hospitalist, and in my administrative role I have the honor of designing, implementing, and evaluating our strategic plan at Beth Israel Deaconess Medical Center in Boston where we really are on a rampage, for lack of a better word, of how do we really integrate anti-oppressive policies throughout our medical institution. So I was delighted to get a chance to discuss this paper, which is another aspect we should be thinking of when we consider topics in medical education.

Laura Weingartner:

Well, thank you. I am Dr. Laura Weingartner. I’m the director of research for health professions education at the University of Louisville School Medicine. So I work both in undergraduate medical education and also faculty development. I also use she/her pronouns.

Luca Petrey:

Hi, my name is Luca Petrey. I use they/them pronouns. I am a fourth-year medical student at the University of Louisville School of Medicine applying for OB/GYN this year.

Toni Gallo:

Well, I want to thank you all for being on the podcast today, and our discussion is really going to focus on the work that Luca, Laura, and their coauthors did to study the inclusion of standardized patient both characters and actors with diverse gender identities. So with that, I want to turn it over to Arianne and Daniele to get us started with some context for our discussion.

Arianne Teherani:

Thanks Toni. I have to say I was very excited about the study. I was the primary editor on this piece and I really enjoyed reading it a lot. It was well done. It had important implications for clinical education, particularly focused on equities, representation, and inclusion. Daniele, anything you’d like to add?

Daniele Olveczky:

No, I think that sums it up. I think it’s really important that as we educate the next generation, we really educate with authenticity and that’s I think one of the most important takeaway points on this paper for me because our students can smell inauthenticity. That’s the hidden curriculum actually.

Arianne Teherani:

Thanks Laura and Luca. So you explained that your work was driven by an interest in authenticity as a core value of medical education and as necessary to address health disparities. Can you explain a little bit about the importance of authenticity and the role it played in your study?

Laura Weingartner:

Sure. So I think authenticity drives a lot of medical education in general, a lot of simulation work, especially, we’re trying to reproduce these clinical settings. But also in an educational setting where the people that are portraying patients have consented to be part of this training process. When we think about health disparities that gender diverse communities experience, it’s not all related to social determinants of health. A lot of those health disparities are driven by implicit and explicit biases and discrimination experienced in the health care system.

Laura Weingartner:

So when we are thinking …. A broader context to this work, when we’re thinking about how we’re training students to address some of these biases that are experienced, this is really where we want to go back to the community and understand what the community is experiencing and the best way to address those shortfalls and the gaps that we see in medical education.

Toni Gallo:

So maybe you can tell us a little bit about how you conducted your study with this lens in mind. How did you decide to go about studying the topic and a little bit about what your findings were?

Luca Petrey:

Absolutely. We decided to start with the basics by seeing what was out there. We started with a literature review, specifically looking for terms related to gender identity and patient simulation. We used variations of those search terms while conducting our original literature search. And we, from there, conducted a scoping review to get a broad overview of the work that has already been published as far as what people are doing to set up their simulations for transgender and non-binary patient simulation.

Laura Weingartner:

And I think what really drove us is we are doing this work in our program. We’ve done other studies talking with simulation programs about what they’re doing. And one of the big gaps that kept coming up is people talked about there not being best practices and there’s not a lot of institutional knowledge about gender affirming care since a lot of practicing physicians and medical educators may not have had that training when they were coming through the program themselves.

Laura Weingartner:

So when there is that generational gap or maybe the lack of expertise, not everywhere of course, there are lots of great experts in medical education that do this work, but we kept coming up against this barrier in simulation programs where they said they just don’t have the expertise. So we really wanted to replicate, if we were medical educators, simulation professionals looking for examples and things that could be modeled, what would we find? So that’s why we wanted to do a scoping review to see what was out there and really identify potential gaps that future research could address.

Toni Gallo:

And what did you find from your scoping review?

Laura Weingartner:

Sure. So we ultimately found 22 studies where standardized patient cases, patient simulation, represented diverse gender identities. So these would be transgender, non-binary, or other identities. When we looked both at who was being portrayed in the patient case and then also who was portraying the characters as well. Because if we go back to our conversation at the top of this interview where we talked about authenticity, we really wanted to know who was doing the portraying as part of this training. And ultimately … Do you want to talk a little bit about what we found?

Luca Petrey:

Absolutely. We found ultimately, like she said, 22 studies as far as patient cases that were portraying a specifically transgender or non-binary identity in a patient simulation. From these, we found that less than half of the studies were matched as far as the actor who was hired to portray a specific gender identity in the patient character.

Luca Petrey:

Of course, there were multiple cases within some of these studies, but the overall leaning was that there were less than the majority where specifically matched. While this is an interesting finding in that it shows us possibly difficulties with hiring practices or possibly just like we mentioned, a lack of expertise in what is the most appropriate thing to do. Like Dr. Weingartner mentioned there are no current standards of how to portray gender diverse people within patient simulation. And this is just a representation of what is published work out there.

Laura Weingartner:

Yeah, I think we see too there’s this lack of consistency in the literature of how these identities are portrayed by standardized patients, but there’s also lack of best practice. So there’s not a lot of evidence that are driving the decisions that are being made around casting or even the identities that are portrayed.

Laura Weingartner:

One of the other major findings that we had in this piece is that there was only one article of that set that portrayed a non-binary identity. So we are seeing a lot of trans women and a lot of trans men that are being identified in the literature, and then one case had genderqueer patient case being portrayed. And that case was actually from our program. So I think the implication for that is if you are a simulation educator and you are going to the literature and you’re going to replicate what you find, we’re going to see more and more trans cases being developed, which is great. But then we’re having that gap there around non-binary identities.

Laura Weingartner:

And we know at least from our program and some of the other work that we’ve done, non-binary patients experience a lot of microaggressions and a lot of biases in the health care system. It’s a binary system, especially thinking about what we’ve struggled with in our clinical skills training is getting away from honorifics before you know who the patient is. When you walk in the door, if you assume the person is using a miss or a mister, you’ve automatically gendered that patient. So that really affects our genderqueer, non-binary patients in a way that a binary patient case may not experience.

Laura Weingartner:

So there are some gaps there, certainly in the literature that are important to at least think about. Another thing we can think about as well, when we think about decision making around casting, one of our main findings, yes, is that there is this lack of evidence driving the decision making. There is no established best practice on who should be portraying these cases.

Laura Weingartner:

But I think one of the arguments that Luca and I and co-author Dr. Emily Noonan are trying to make is that the decision making should be purposeful. So there should be thought that’s going into why you were choosing a certain person to portray this character. How is that person being trained and what implications does that have and what messaging does that send to your student body?

Laura Weingartner:

So if you are casting cisgender people in trans and non-binary roles, what are you saying about gender identity as a characteristic of that patient? And how are you ensuring that the person is portraying that character authentically? And is that even possible? So it’s not necessarily that our work can answer those questions, but it’s certainly posing that as questions that we should be asking and doing further study on.

Daniele Olveczky:

So based on your findings, I think you spoke a lot about this now, but just to summarize it, what recommendations do you have for educators looking to develop more inclusive standardized patient encounters?

Luca Petrey:

Within our work, we came up with three goals for educators developing these programs. The first is always going to be work with transgender and non-binary community members. Without establishing those relationships between the university, the medical school, and the community, authentic portrayal will likely not be nearly as high quality, if even possible.

Luca Petrey:

So that is the first thing that is the most important, is to go to the community, develop those relationships, not only for potential casting purposes but also just for communication purposes and self education purposes. The second thing is to consider casting limitations and develop the format of your clinical simulation based around that. There will be some universities who have these either happenstance or intentional ties with community organizations and people who are transgender or non-binary who can be cast in those roles.

Luca Petrey:

In other places, there may not be as large of a population of people from those communities or the medical school itself may not have a good relationship with those communities. In those situations, it can be harder to cast a large number of transgender and non-binary standardized patients for these cases. So in that case by saying, consider your casting limitations and design appropriately, that suggests maybe not just a one-to-one student and standardized patient encounter. If you cannot feasibly do that, you could think about doing a group interview setting. You could think about having a transgender non-binary identified person come in and educate standardized patients on how to the best of their ability portray a transgender non-binary person faithfully and respectfully. That is what is meant by consider those casting limitations and develop appropriately.

Luca Petrey:

The last point of our recommendations was to, when you publish work in this area, it’s very important to report the gender identities of the characters in the cases that you write and also of the people that you hire to portray them. If more people who are publishing in this area of work specifically lay out the demographics of the cases and the people they hire to portray the cases that will give us more than these 22 studies to be able to develop a best practice guideline for portraying people of gender diverse identities authentically and respectfully.

Laura Weingartner:

And I think that last point also extends to really any SP case. So we’re focusing on gender diverse identities, but it would also be important to talk about, this is a cisgender woman, this is a cisgender man and making that explicit, if the case is important to have a cisgender person in this hypothetical case, is making sure we’re being consistent about reporting that.

Laura Weingartner:

And then also thinking about historic cases that your program has had, do those really need to be cisgender cases? Could they be portrayed by someone who is trans or non-binary? And that’s another way, that second point of considering your casting limitations. If you were able to recruit people who identify as trans and non-binary into your program, but maybe not enough to run an entire case like a gender affirming care case, could you instead have those SPs be representing their true gender identity in your earache case, in your broken arm case, whatever it is, does it have to be cisgender person or could you address more diversity in that other way, in that other method?

Laura Weingartner:

So I think we keep getting back to being purposeful about who is being cast, who is being portrayed, and what other opportunities are there to include more diverse gender identities in simulation.

Daniele Olveczky:

As I hear this, it’s so inspiring, but I’m going to give you a question that I often get in my role by the way, which is, have you implemented any of your recommendations at your own institution? And if you did, how did it go and what barriers did you face?

Laura Weingartner:

Sure. So as part of our broader research group that’s been working on some of these questions, Carrie Bohnert, who is our Director of the Standardized Patient Clinic here, she has done a lot of work thinking about how to represent diverse gender identities in our standardized patient program. Our program, we only represent trans and non-binary identities with people who also hold those identities because we think that that is the best way to have that authentic representation of identity. Some of the barriers that we’ve experienced though are exactly what we found in many of the articles that we found for the scoping review. It’s the limitations around recruitment and retention. So a lot of people who are in standardized patient work know this, that the SP pools are always in flux.

Laura Weingartner:

I know general diversity of SP pools is often a topic at the simulation meetings and often a challenge for a lot of simulation programs. So we have experienced that barrier. And the case that we ran, the case is actually published now in MedEdPORTAL this year, we had multiple gender identities that were represented, trans men, trans women, genderqueer patients, and then also cis men and cis women. It is tough for us to fill up. We try to aim for about two thirds, three quarters of the rooms being a gender diverse patient. And it is tough to keep those numbers consistent to the point where we had to stop running the case for a couple years because we weren’t able to recruit enough people.

Laura Weingartner:

So I don’t think that some of the recruiting challenges, they can be a true barrier. So I think stepping back and thinking about maybe this doesn’t, as Luca said, doesn’t have to be a one-to-one student and SP standardized patient case or clinical skills assessment. Maybe thinking more creatively about how students can still practice these skills and be able to apply these inclusive skills in a training setting without maybe the traditional one-to-one SP case.

Laura Weingartner:

The other challenge that I think is important to talk about is we have a specific clinical skills training, we have an integrated LGBTQ curriculum that touches over 50 hours of content in our medical school. So we really feel like there’s robust training that goes on here and we still found after even a specific clinical skills training that students weren’t using the skills in SP cases consistently. We were measuring LGBTQ inclusive skills and looking at microaggressions in an unannounced case. So this is where we didn’t want students to perform allyship or to perform inclusion. We want to just see, here’s a new patient. We know we don’t tell you sex assigned at birth. We know we didn’t tell you the gender identity or sexual orientation. How would you actually take this new patient history and what would that look like? And we were actually very surprised that we didn’t see better performance even after the clinical skills training. Students got there, they prescribed hormones in a primary care setting at a much higher rate, but there were still a lot of microaggressions.

Laura Weingartner:

We realized what that if we don’t make it part of our requirements on our checklists, some of these inclusive questions, introducing yourself with your pronouns, getting the patients pronouns, asking a two-part gender identity question. If we don’t include this on the checklist for every patient, students don’t associate that with this is how you take a history. They think to themselves that, oh, these are skills I use with my LGBTQ patients, but how do you know who the patient is unless you’re going through those questions? So I think a big takeaway for us is that we have to teach students these skills certainly, but then we also have to hold them accountable by including it on their assessment.

Luca Petrey:

I will say from the student side of things here, we do have these things on our checklist, at least in my year, required for every patient, to ask about the person’s pronouns, introduce your own pronouns, elicit the person’s gender identity, their sex assigned at birth. Those are things that have been on my checklist as a student, which has been great. I will say that I have seen other students at least take these things into consideration when taking a history from their patient, when presenting their patient. I have seen a lot more awareness of pronouns in these things in the student body. However, one of the barriers to actually performing these skills that we are taught within the simulation lab is the generational gap in knowledge and experience.

Luca Petrey:

I will say some attendings here have done things like the LGBTQ health care affirming program. Some attendings are within the community themselves. There are great examples of people who are really taking these things into account and modifying their practice to be more affirming of people. However, there are many still who do not do those things or don’t know to do those things. So it is difficult in such a hierarchical structure, where the medical student is at the bottom of this huge hierarchy that ends with the attending. It is difficult in that situation to specifically stand up to the attending because it is not seen as appropriate in a lot of settings.

Luca Petrey:

Another thing I will say, coming from a southern state, Kentucky, it is a difficult thing sometimes to go into a room and not say mister or missus their last name because it is a lot of times considered culturally what is the most respectful and there isn’t currently an expectation of saying mx or another gender inclusive honorific. So that is just a cultural barrier from society’s standpoint, from medical culture’s standpoint, there are multiple issues as far as actual implementation within clinical structures.

Daniele Olveczky:

I was just going to jump in on these two points because I actually was going to do a reaction, a clapping reaction to that, what you just said, Luca, because I realized that I didn’t even introduce my pronouns because I come from that generation where we don’t do that naturally. And I was thinking so much, I’ve mentioned the hidden curriculum. Again, we need to role model these behaviors for our students.

Daniele Olveczky:

I was going to ask you if you’ve done any widespread training of faculty because I do believe it’s a complimentary sandwich when we teach our students, we need to teach our faculty so they’re marching lock step with the students. So I should have said my pronouns are she/her/hers. I didn’t mean not to say that, but it just is not something that I really grew up saying. And so I think that’s my one question I was going to ask if there’s been any, how you’ve addressed teaching that with faculty, especially faculty who have been there for a while and this is totally new and don’t really interact that closely with trainees all the time. Those may be the harder ones to talk about why this is anti-oppressive, how this tells the patient I see you, I hear you, and I see and hear all of you. So I was just wondering if you could comment on that.

Laura Weingartner:

Sure. We certainly have a clinical skills manual that has a three-hour CME module that’s available for all of our faculty. We have an LGBT health affirming care series, which is like a certificate series that many faculty have gone to.

Laura Weingartner:

I think one of the limitations of the faculty development, which is experienced by all aspects of faculty development, is the people who probably don’t need the training are the ones that are participating in the training. So they already have awareness of health disparities for LGBTQ populations, especially for trans and non-binary communities. So they are coming, they’re training, they’re learning more, but we’re not really able to reach necessarily the faculty that need it.

Laura Weingartner:

I don’t know that I have a good solution for that other than top down. I think coming from both places, a lot of our curriculum development was from bottom up. Students wanting it, desiring it, needing it, and especially newer classes that are coming in now are expecting to have this content, which is great. But I think top down and having health systems require some of this training or require some of the content and inclusive information and the health histories that we’re talking about is really what’s going to push it over the edge in the way that we’re not seeing now.

Arianne Teherani:

Yeah, I couldn’t agree more. Laura, thank you for that. So as we sort start to think about the work you’ve done and really building out the question that Daniele asked you originally about your findings and your recommendations for practice, as you think about where future work in this area should go, what do you think the implications are of your work for fostering inclusion among learners from diverse gender identities and/or in general?

Laura Weingartner:

So I think these skills aren’t limited to patient care, just as we just talked about introducing yourself and using pronouns. Certainly faculty that are interacting in an educational setting can still include some of this information and some of these skills into their everyday interactions with learners.

Laura Weingartner:

I think too, one of our main takeaways about the lack of non-binary representation in the literature also extends to medical education where a lot of patient cases or case scenarios that faculty are developing for their learners are oftentimes going to be binary or thinking about some of the assumptions that are made, obviously in a written patient case, no one’s portraying it, but it’s still the assumptions that it’ll be a binary person or maybe still representing all binary identities that are also transgender. So faculty thinking about how they can be more purposeful to include more diverse gender representation is one way this affects more broadly than just patient simulation.

Luca Petrey:

On another side of this is, as far as learners who identify within these communities, I can say as a learner who identifies as a non-binary person, I was so encouraged by the University of Louisville’s attempts and continued development of the way that they are portraying LGBTQ people within their general education as well as in the simulation cases. Because while no attempt is going to be perfect, it is so encouraging to see the continuous development, the continuous wanting of feedback from students, from faculty, how to make these things better, more authentic, more respectful. And I think that that is very encouraging as a future medical provider to feel built up in that within my training institution so that I can go forward and, wherever I end up as a resident next year, I can train confidently medical students. As I become a resident, I will train interns, I will train fellows, I will train attendings wherever I end up because this foundation is critical to feel supported and to carry on that culture of support.

Laura Weingartner:

I think too, what’s heartening is that you’ll also be a model for other learners. Even if you’re not specifically training those ideas. What you do in the clinic, other learners and other trainees are going to see you do that and feel comfortable modeling those traits in a way that maybe we’re not seeing now with the gap in practicing clinicians.

Daniele Olveczky:

Just to mention, I think what’s a really important takeaway from this work is the power of community involvement. This is the way I see the magic of academia is how we get to change the future and shape the future. And we really are called upon to bring our communities closer to our academic medical centers. And this is just a really important way because in doing that we really empower our patients and then we empower ourselves to make the change that we need to see.

Daniele Olveczky:

So I was wondering, I think many people feel, how do we get out there? How do we bridge that gap between academia and our communities? And maybe you could share with us some of your reflections of what you think has really worked well, because I’ve heard wonderful talks from faculty at your institution and the amazing work that you’ve done in this space that might be helpful for educators out there.

Laura Weingartner:

Sure. I think the first step is a lot of institutions have an on-campus LGBT center or something similar. I think that is a wonderful first step is, if the school of medicine doesn’t already have a relationship with that program, that’s the best place to start. Most cities also have community groups that they can reach out to. And I think even far in advance of trying to plan a standardized patient case or patient simulation activity, establishing those relationships and getting feedback from community members in those programs can be so helpful for planning the curriculum and thinking about what the needs of the local community are. Because that’s something that I don’t think we’ve talked about either is the recruitment and the community relationships for a city like Louisville are going to be very different than say, New York or another city in different parts of the country, it’s going to be a different situation.

Laura Weingartner:

So we may end up finding that what is a best practice in Louisville may not look like a best practice in New York. And as Luca said, always driving to make things better. And this is a lot of what DEI work is, it’s never checked off. We’re always trying to improve and make better. It might be that programs are going to be at different places in their ability to represent diverse gender identities or their ability to do it in the way that they most want to. I think that has to be taken into consideration too but establishing those relationships with the community is certainly the first step.

Laura Weingartner:

If you are listening and you are a program that hasn’t done a lot of this community engagement yet, one thing to consider is that it is important to compensate community members’ time, because their knowledge, their expertise and time, we are so lucky to have had wonderful community engagement, but it’s important, if you’re bringing people in for patient panels or if you’re bringing them in to facilitate SP training or case development, that these are compensated roles in really valuing that expertise that community members are bringing to medical education.

Laura Weingartner:

Ideally, we will see more representation not only just from trans and non-binary providers, medical students who are then finishing their training programs, but in medical education itself, in simulation programs and administration. I think that’s really what we want to see more of and that will ultimately improve a lot of these efforts.

Toni Gallo:

And Daniele has mentioned in the chat here then not just including them in the education piece, but in the scholarship and research piece that comes out of that. So along that line, in your scoping review, you kind of charted out over time how the scholarship has developed and there has been more scholarship on diverse gender identities more recently. And I wonder if you could talk just a little bit about maybe how the scholarship has developed and then what gaps there are or where you think the research needs to go from here. You touched on this a little bit earlier, but I wonder if you could talk about it more as well.

Laura Weingartner:

Sure. So I think that the biggest gap that we’re finding is this lack of best practices around casting decisions. The decisions that are being made are really not evidence based. And in fact a lot of the decisions on who are being cast are made by primarily cisgender people in medical education. So cisgender faculty or cisgender people in patient simulation. And we know that not only from this study but also some of the previous work we did talking to simulation programs. I think connecting back to that community engagement piece, we really need to go back to trans and non-binary communities and talk about what are their priorities for having these skills training and representation given some of the barriers that programs are experiencing.

Laura Weingartner:

And some of the work that our team has been doing now is we’ve been talking to trans and non-binary health care providers. So these are people who would be most knowledgeable not only about representation of their own identities, but then also simulation. Really what we’re finding is that initial reaction is like, of course trans and non-binary identities should be portrayed by trans and non-binary people. But then as you start to layer on more and more barriers about patient simulation is, well, what if the case can’t run? Should you cancel the case or should you cast cisgender person? It gets a little bit more muddled, then we see more diverse ideas about what would be the appropriate responses. Maybe it is canceled the case or maybe it is have a facilitator there that identifies as trans or non-binary who is really active in that role of training the cisgender patients.

Laura Weingartner:

Those sorts of studies and those sort of conversations with community members can help us understand more about how we can do this effectively and respectfully. Looking at student interactions because ultimately we’re doing all of this work in medical education to train the learners. Looking at feedback that students are getting from trans and non-binary SPs about these skills versus cisgender SPs, we assume that if we train a SP, they can give the same type of feedback if they’re well trained. But we haven’t done those studies, we don’t have the evidence to show that so that’s another component too. I guess also the continuing education. We keep talking about the practicing providers and having that generational gap and being able to fill that, is going to be a huge piece.

Toni Gallo:

So I think we’re just about at the end of our time. I want to give everybody a chance if you have any final thoughts that you want to share, anything you really want listeners to take away from our conversation today.

Laura Weingartner:

Sure. I guess we focus this work on patient simulation and standardized patients, which is a very narrow part of medical education. I think that there are ways to represent diverse gender identities, even if you’re a faculty member who doesn’t work in patient simulation. I’m not a clinician, but I teach the biostatistics course here. And I think a lot about how can I incorporate diverse gender identities into the scenarios that I’m developing. Or if I’m presenting a data set that is binary male/female, pointing that out to the students. I’m still using that data set, but I’m making them think actively about what are the implications of presenting the data this way. So even if you’re a faculty member that’s not involved in patient simulation, there is a way for you to be purposeful about representing diverse gender identities in your work too.

Luca Petrey:

I think my final thoughts on this are, we’ve touched on it quite a bit, but just to reiterate that programs who are seeking to develop these simulation cases, my advice is to just don’t get caught up in the perfection of it because there is not a perfect point of this. There is no single end point, and I don’t want that to be depressing in any way. I think it’s a push forward because there’s always going to be more to learn, there’s always going to be more to teach. Society develops, people develop, and that is why there is no endpoint to this because it’s a continual work. So what’s most important here is the integrity and honesty piece of this. So I would ask yourself, am I doing what I can right now? Wherever you are, whether you’re an educator, whether you are a clinician, anything. Am I doing what I can right now and am I pushing for more at the same time?

Arianne Teherani:

I just had to also resonate with what Laura said because that was very much on my mind as I read this paper. And really as I’ve heard this dialogue is that incorporation of diverse gender identities and the day to day, the ongoing day to day of what we teach and what we assess for is incredibly critical to make sure that fostering inclusion among learners continues to play a significant role in the education that we do.

Daniele Olveczky:

As I reflect on this time that we spent together, what I really think is important to take away is just our intentionality at being anti-oppressive in everything we do. And that really, really needs a genuine, sustained outreach to our community that empowers them, empowers us, and we really have to hold our leadership accountable. And I think that’s what I really take away and that’s been really helpful to have spent this time together and just come out ready to go. As you said, Luca, not scared of the imperfection, but just embracing the better.

Toni Gallo:

I think that’s a great note to end our conversation on today. So I want to thank you all for being on the podcast and I want to encourage our listeners to look for Laura and Luca’s paper, which is available on academicmedicine.org along with the entire RIME supplement. So thanks very much.

Laura Weingartner:

Thanks for having us.

Daniele Olveczky:

Thank you so much for having me.

Toni Gallo:

Be sure to check back in November for the next conversation in this year’s RIME podcast series. We’ll be talking about a study of the different research methodologies that are used in health professions education publications. From the journal’s website, you can access the latest articles as well as our complete archive dating back to 1926. There’s also additional content like free eBooks and article collections. Subscribe to Academic Medicine through the subscription services link under the Journal Info tab or visit shop.lww.com and enter Academic Medicine in the search bar. Be sure to follow us and interact with the journal staff on Twitter @AcadMedjournal and subscribe to this podcast anywhere podcasts are available. Be sure to leave us a rating and a review when you do. Let us know how we’re doing. Thanks so much for listening.