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

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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.