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Diversity and inclusion in simulation: addressing ethical and psychological safety concerns when working with simulated participants
  1. Leanne Picketts1,
  2. Marika Dawn Warren2,
  3. Carrie Bohnert3
  1. 1 Centre for Collaborative Clinical Learning and Research, Dalhousie University, Halifax, Nova Scotia, Canada
  2. 2 Department of Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada
  3. 3 School of Medicine, University of Louisville, Louisville, Kentucky, USA
  1. Correspondence to Leanne Picketts, Centre for Collaborative Clinical Learning and Research, Dalhousie University, Halifax, Canada; Leanne.Picketts{at}dal.ca

Abstract

Healthcare learners can gain necessary experience working with diverse and priority communities through human simulation. In this context, simulated participants (SPs) may be recruited for specific roles because of their appearance, lived experience or identity. Although one of the benefits of simulation is providing learners with practice where the risk of causing harm to patients in the clinical setting is reduced, simulation shifts the potential harm from real patients to SPs. Negative effects of tokenism, misrepresentation, stereotyping or microaggressions may be amplified when SPs are recruited for personal characteristics or lived experience. Educators have an ethical obligation to promote diversity and inclusion; however, we are also obliged to mitigate harm to SPs.

The goals of simulation (fulfilling learning objectives safely, authentically and effectively) and curricular obligations to address diverse and priority communities can be in tension with one another; valuing educational benefits might cause educators to deprioritise safety concerns. We explore this tension using a framework of diversity practices, ethics and values and simulation standards of best practice. Through the lens of healthcare ethics, we draw on the ways clinical research can provide a model for how ethical concerns can be approached in simulation, and suggest strategies to uphold authenticity and safety while representing diverse and priority communities. Our objective is not to provide a conclusive statement about how values should be weighed relative to each other, but to offer a framework to guide the complex process of weighing potential risks and benefits when working with diverse and priority communities.

  • health professions education
  • safety
  • simulated patient
  • simulation
  • education
  • curriculum

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Footnotes

  • Contributors All authors contributed in writing and editing the manuscript at all stages of development. LP contributed to the conception of the topic, initial draft, writing and editing of the work. MDW contributed to the conception of the healthcare ethics and values framework, writing and editing of the work. CB contributed to the writing and editing of the work. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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