Actors train Minnesota medical providers to avoid racial bias

Kim Lorence's job was to comfort a father who felt he was watched at the hospital door because he was Black and ignored in his newborn son's room.

"Down there, I feel like I have a target on my back," the father said, his voice rising as he waved with his arms. "While up here, I feel like I'm not being talked to!"

"I really am sorry," Lorence replied. "That is not the experience anybody should have. And so ..."

The clinical education specialist paused, then turned to the group gathered in the makeshift neonatal intensive care unit: "Someone else?"

The exchange on Tuesday was a simulation, but it generated real discomfort — which was the point. Children's Minnesota is one of the first health systems using live actor simulations to train doctors, nurses and others to confront racial bias in medical care.

Live action creates teachable moments that don't happen with training videos, said Dr. Samreen Vora, medical director at the Children's Minnesota Simulation Center in Edina. Biases can be subtle, like perceiving body language as aggressive from a Black patient or parent but the same as non-threatening from a white person, she added.

"The goal is not to surprise somebody and say, 'Hey, you're racist,'" she said. "The goal is to say, 'Hey, let's brainstorm and see if we can uncover some of our biases.' Because we're all human, we all have biases."

The pandemic accentuated the cost of racial and other inequities in health care. A lack of access to, or trust in, medical providers contributed to more unmanaged chronic diseases in Minnesota's minority populations, which led to more severe COVID-19 cases and higher age-adjusted death rates. The number of non-COVID deaths has been higher than expected among minority groups during the pandemic as well.

Worse outcomes for people of color preceded the pandemic. The share of births involving inadequate prenatal care was 7% among white mothers but 21% among Black mothers in Minnesota from 2018 through 2020, according to the March of Dimes. Black mothers consequently had higher rates of preterm births and infant mortality.

Children's started its live training two years ago for all hospital and clinic staff. The pandemic slowed progress, but the effort has drawn attention from leaders of hospitals worldwide, Vora said.

Tuesday's scene was set with actor Michael Terrell Brown sitting next to a baby doll in a bassinette. Brown was instructed on how to play his character, William, a first-time father who was upset that his premature newborn was put on formula instead of breastmilk.

Brown, a familiar actor in local playhouses, said he spent a lot of time thinking about William before participating in the simulations. He figured William was a type A Black man who wanted to get married before having children but ended up with an unexpected pregnancy and a child born prematurely

"I never know where William is going to go" once the scene starts, Brown said, but that baggage would weigh on him if he felt hospital workers were ignoring his advice or treating him like an outcast. "It's important for him to be the rock, and he's not able to be the rock in this situation."

The training by design is heavier on discussion and lighter on instruction by Vora or the other co-leader of the program, Brittany Dahlen. The idea is to get people thinking about how their own biases affect patient care.

In addition to improving patient trust, Vora said the training hopefully has an impact on workplace safety. Hospital worker injuries from assaults by patients and visitors of all races have tripled in Minnesota in recent years. People like William are fairly common — stressed out by being in the hospital and at risk of boiling over if treated unjustly, she said.

"Often, we miss the cues, we miss the microaggressions that William is having to face," she said. "And we don't see it until he is really angry ... This course allows us to talk about those things so that they happen less often."

Lorence, a white woman, was in a group of eight people during Tuesday's training and was one of three to interact with Brown. She felt embarrassed that she "tapped out" of the simulation when she couldn't respond to the character's feelings of mistreatment because of his race.

"What do I do with that?" she said. "Because I want to do something."

A father alone in the NICU isn't uncommon, because parents have work and other children and have to rotate shifts in the hospital, said social worker Tristessa Johnson. Asking about his well-being can help.

"Maybe someone should ask him, 'Are you eating? Are you taking time to yourself?' " she said.

Vora said "you've got to say something," but an uncomfortable worker could step out of the room to think about a response, or ask open-ended questions to keep the conversation going. Dahlen said a conversation like that is unlikely to produce closure, so it should focus on ways to improve care inside the hospital.

"We're not going to get to a point," she said, "where we're going to solve systemic racism with this family."