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

摘要 小组产前护理是少数被证明可以改善黑人妇女妊娠结局的干预措施之一， 其机制尚不清楚。我们建议利用R01资助的330名孕妇随机 个人产前护理或提高声音，解决抑郁症，有毒压力和群体公平 产前护理，称为Elevate-Patients。Elevate-Patients的重点是干预是否改善 围产期抑郁症和妊娠结局。Elevate-Clinicians研究，在这里提出，移动 从患者到临床医生。协助Elevate小组的临床医生接受创伤培训- 知情护理，反压迫原则，消除种族主义和群体动力学。我们将衡量 患者看到临床医生与高同情分数（通过验证自我和患者报告）将不太可能 经历围产期抑郁、早产、低出生体重（目标1），以及是否参加Elevate GC培训和促进小组产前护理与增加临床医生同情心（目标2）。我们 假设临床医生花费20多个小时提供团体护理，使他们能够纵向应用 从反种族主义培训中吸取的教训，发展更密切的患者关系，尊重患者的交叉 他们的目标是提高患者的身份，并加强他们为社会上不同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减轻了内隐偏见的影响，并有助于 改善患者的预后。来自该R21的数据将用于计划多中心试验，以进一步测试 这一假设，并确定参与Elevate是否有助于更大的临床医生倡导， 消除医疗保健领域结构性种族主义的变革。

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.