EleVATE-Clinicians: a tool to mitigate implicit bias by increasing clinicians' empathy

摘要 集体产前护理是少数几项被证明可以改善黑人女性妊娠结局的干预措施之一，但 其机制尚不清楚。我们建议利用R01资助的随机对330名孕妇进行的试验 到个人产前护理或提高声音，解决抑郁、有毒压力和群体平等 产前护理，称为提升患者。提高患者的关注点是干预是否改善 围产期抑郁与妊娠结局。这里提出的Elevate-临床医生研究，推动了 从病人到他们的临床医生的焦点。促进提升群体的临床医生接受创伤方面的培训- 知情关怀、反压迫原则、消除种族主义和群体动力。我们将衡量是否 患者去看同理心得分较高的临床医生(通过有效的自我和患者报告)的可能性较小。 经历过围产期抑郁、早产、低出生体重(目标1)，以及是否参与提升 GC培训和促进小组产前护理与增加临床医生的同理心有关(目标2)。我们 假设临床医生花20个小时提供团体护理允许他们纵向应用 从反种族主义培训中吸取教训，建立更密切的患者关系，尊重患者的交叉 加强他们为不同社会背景的患者提供高质量护理的能力。我们 假设以这种方式增加同理心可以减轻内隐偏见的影响，并有助于 改善了患者的预后。此R21中的数据将用于规划进一步测试的多站点试验 这一假设，并确定是否参与提升促进了更大的临床医生倡导 改革以消除医疗保健领域的结构性种族主义。

Abstract Group prenatal care is one of few interventions proven to improve pregnancy outcomes for Black women, but the mechanism is unknown. We propose to leverage an R01-funded trial of 330 pregnant patients randomized to individual prenatal care or Elevating Voices, Addressing Depression, Toxic Stress and Equity in Group Prenatal Care, called EleVATE-Patients. The focus of EleVATE-Patients is whether the intervention improves perinatal depression and pregnancy outcomes. The EleVATE-Clinicians study, proposed here, moves the focal point from patients to their clinicians. Clinicians facilitating EleVATE groups receive training in trauma- informed care, anti-oppressive principles, dismantling racism, and group dynamics. We will measure whether patients seeing clinicians with high empathy scores (by validated self- and patient-report) will be less likely to experience perinatal depression, preterm birth, low birthweight (Aim 1), and whether participating in EleVATE GC training and facilitating group prenatal care is associated with increased clinician empathy (Aim 2). We hypothesize that the 20+ hours that clinicians spend providing group care allows them to longitudinally apply lessons learned from anti-racism training, develop closer patient relationships, respect patients' intersectional identities, and strengthens their ability to provide high-quality care for socially dissimilar patients. We hypothesize that increasing empathy in this way mitigates the impact of implicit bias and contributes to improved patient outcomes. The data from this R21 will be used to plan a multi-site trial powered to further test this hypothesis and determine whether participation in EleVATE facilitates greater clinician advocacy for changes to dismantle structural racism in healthcare.