Introduction

It’s widely recognized that there is a growing need for solutions to address microaggressions (Figure 1) and discrimination in healthcare environments, with approaches being developed at both undergraduate [1] and postgraduate [2] levels. Active Bystander Training (ABT) has been used successfully across military, higher education and government workplaces but despite this remains an under-utilized resource for tackling workplace microaggressions and discrimination in the NHS [3].

Figure 1:

Microaggression definition.

Whilst some approaches to training remain in the realms of didactic sessions and facilitated discussions [1], we are starting to see simulation-based medical education (SBME) incorporate microaggressions into clinical scenarios [2]. This is a positive step forward; however, additional consideration must be given to the psychological safety of participants and faculty when scenario content may prove emotionally distressing or harmful. Successful reports of incorporating microaggressions into blinded immersive simulation scenarios are caveated with reports of faculty feeling emotionally uncomfortable [4], and mitigating the psychological threat to simulated patients from diverse communities is a challenge [5].

We believe that incorporating incidents of microaggressions into blinded immersive simulation carries a risk to psychological safety to all involved, and particularly so to participants (including faculty and actors) with protected characteristics.

Innovation

Locally, common feedback from staff following the existing ABT was that confidence to actively intervene in situations was affected by difficulties in word-choice and phraseology preferences. We have, therefore, designed an innovative ‘Beyond Bystander’ workshop to follow on from knowledge-based training to enable open exploration and, crucially, rehearsal of bystander interventions in a psychologically safe environment.

Our approach uses a helical structure, stacking simulation pedagogies with each phase building on the previous (Figure 2) alongside consistent reference to Active Bystander techniques. Trained simulation facilitators – themselves with protected characteristics and lived experiences – guide participants through the workshop.

Figure 2:

The Beyond Bystander Workshop helical design.

Evaluation and Outcomes

The workshop was evaluated using a combination of pre- and post-session feedback questionnaires and a group interview immediately after the workshop was completed. The questionnaire gathered data on participants’ knowledge of bystander interventions and their confidence in both knowing what to say and actively intervening if they witnessed a microaggression. The post-session questionnaire and group interview also specifically asked about psychological safety, as well as session mechanics and structure.

Four participants attended a proof-of-concept workshop. Evaluation data demonstrated that the workshop increased participants’ knowledge of bystander interventions and their confidence in the words they would use when acting as a bystander. All participants strongly agreed that their psychological safety was protected during the workshop, and they felt comfortable sharing their experiences of microaggressions.

What’s next?

Based on our preliminary feedback, we aim to study our workshop design more comprehensively with larger participant groups from a diverse set of professional roles. Additional longitudinal research will be conducted to explore participants’ experiences of utilising bystander techniques and reflections on whether the workshop encouraged or facilitated these.

We believe our helical design of stacking simulation pedagogy to preserve psychological safety when addressing difficult subjects is transferrable to similar themes. We already plan to adopt the design to address incivility interventions, and there are potential uses for exploring male allyship as part of an approach to tackling sexual misconduct in the workplace.