Diversity and Simulation

by Ellen Durkin

October 8, 2020

Black hand and white hand doing a handshake

Racism is an ongoing problem in many parts of the world. Recent protests in the United States have prompted many different industries to pause and reflect on how they can work to recognize and eliminate racism and prejudice. The medical field is no different. The Covid-19 pandemic has further brought to attention disparities amongst race, ethnicity, and socioeconomic status, as well as how certain populations are more at-risk for contracting Covid-19 or other serious health issues. Lack of health equity and prejudice and pervasive stigmas within the healthcare system are two issues affecting many people in the United States, and focused improvements to healthcare education could play a significant role towards making things better.

Over the last decade, simulation manikins have become ubiquitous in healthcare training. Simulation manikins are lifelike models made to look and behave like real human patients. They are used in healthcare education to simulate medical scenarios to prepare healthcare providers to care for real, human patients. They are also used to teach providers how to perform tasks such as safely moving patients in a healthcare setting, performing CPR, or administering anesthesia. During the global pandemic, software training applications, including online, app-based, and extended reality (e.g. virtual reality, augmented reality, and mixed reality), have gained more traction to meet the needs for providing remote and hybrid simulations. Simulations, whether makinin-based or software-based, should emulate all patient populations. Thus, it is important that companies create a variety of characteristics and features to represent all groups of people, and to include variations in age, race, and gender in their models and situational simulations.

Simulation labs are often where healthcare providers get their first hands-on experience, before clinicals and their first job in the field. By creating a simulation environment with varied patient characteristics and scenarios, healthcare providers can be introduced to a range of patient populations, and become accustomed to providing care to different types of people. Evidence suggests that simulation is an effective opportunity for cultural competency training. Being able to empathise and treat all patients with the same respect is crucial.

Multicultural education in the healthcare field has become more urgent due to the prediction that by 2050, 50% of the U.S. population will be made up of groups that have been historically oppressed. There is a need for training solutions to meet these educational needs, and innovative methods for educating healthcare providers on cultural competency are necessary. Simulation scenarios and manikins provide a great opportunity to mimic real life situations and implement cultural competency for current and future healthcare providers.

Although manikins are currently offered in multiple skin tones, products with white skin tone are still the ones usually showcased or purchased by schools, in comparison to non-white skin tones. Research on products and manikins at an international simulation conference found that 94% of the body parts shown were white, and only 6% were black. One website even listed their darker skin tone option for their manikin as an “add on and accessory” to the default white manikin, instead of listing the darker skin tone as a standalone product. Because minorities are underrepresented in simulation manikins and scenarios, all learners are missing opportunities to gain critical cultural competencies that may be the difference between life and death. Furthermore, not having multiple skin tones available for simulation training holds the potential to alienate, hurt and marginalize BIPOC students.

Over the last couple of years, companies that specialize in healthcare simulation have made concerted efforts to offer more diverse products in simulation, aside from just offering multiple skin tones, in order to increase realism and diversity in simulator age, race, and gender during simulation scenarios. While this is a step in the right direction for providing more diversity in simulation, outward appearances are only one aspect towards educating for cultural competency and promoting diverse, equitable, and inclusive healthcare environments.

Lumis believes that the products and services offered reflect the culture and values of the company. Thus, Lumis is developing a deeper approach to build diversity, equity, and inclusion into not only the simulation products and solutions offered, but also company policies to foster those same values within the Lumis team.

“We're building our employee handbook and company policies right now, and together as a team, we drafted our own diversity, equity, and inclusion statement, which you can find on our website. That statement, as well as our company values, are being embedded in all of our company policies and permeating into the products that we are building.” - Doug Nelson, Lumis CEO

This is not just a one-time discussion, and Nelson and his team are prepared to revisit the policies and change them when needed. “We understand that policies may need to change moving forward, and we're putting together processes for updating things as needed while including everybody in the company in those discussions,” says Nelson. Incorporating the whole team in policy decisions and conversations, especially as it pertains to diversity, equity, and inclusion, is one way to become more aware of missteps and blindspots the company may have internally, in product development, and in marketing.

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