Association for Behavior Analysis International

Medical education has addressed implicit biases associated with burnout, cooperation and equitable patient care in classroom settings, but there is evidence that in some cases, simply teaching about cultural differences may only reinforce some negative stereotypes. Based on the alarming epidemic pertaining to burnout in medical education and practice, and high frequency of medical errors that are products of team dynamic, medical schools are developing curricular elements that increase resiliency, self-compassion, and empathy towards diverse patients to combat these effects. Acceptance and Commitment Training (ACT) has received the attention of medical educators and professionals as an effective approach for management of burnout and implicit biases inhibiting cooperation and patient care. Research has demonstrated ACT has positive outcomes in a wide variety of settings with a wide variety of populations including: mental health and innovation, stigma, stress, burnout, sick leave, physical and psychological well-being, absenteeism, college performance, and worksite distress. This symposium will provide an overview of applied research pertaining to implicit behavioral assessment and ACT with the focus on medical education.

Audience members should have a basic understanding of behavioral systems analysis and implicit behavioral assessment.

The practice of medicine is inherently stressful and social. To be truly effective as a healthcare provider, one must not only know how to healthfully manage the psychological stressors of the current U.S. healthcare system - which has been noted as being a breeding ground for burnout - but one must also be able to continuously and humbly adapt to the ever evolving cultural climate the healthcare system is a part. Ideally, in a way that ensures each patient is treated with dignity, respect, and equity. In order to ensure healthcare providers are equipped with the repertoires required to sustain healthy and culturally humble repertoires in medicine, medical educators should continuously and systematically examine the impact their curricula have on healthcare student performance. In 2016, our research group began to systematically introduce a series of Acceptance and Commitment Training (ACT) sessions as a mandatory component of students’ medical curriculum. The current study explored one wing of this research, by exploring the relationship between measures of implicit bias, psychological flexibility, and clinical engagement during a standardized patient encounter with third-year medical students. Preliminary results and implications for future research will be discussed.

As part of our longstanding interdisciplinary collaboration with the University of Nevada, Reno School of Medicine (UNR Med), we have focused on longitudinal measurement in a variety of domains of implicit biases identified as important by medical school administrators. Implicit bias has been a means of assessing change over time in domains related to student wellness and diversity issues. Additionally, we introduced an Acceptance and Commitment Training (ACT) curriculum to promote student well-being, psychological flexibility, and resilience to well-known stressors of medical training. This presentation examines a particular slice of the overarching interdisciplinary work with a focus on longitudinal implicit measures of burnout and cooperation, which is viewed as a crucial component in naturalistic medical settings (e.g., a doctor’s willingness and ability to delegate to and depend on other members of the healthcare team). These longitudinal assessments are considered in the context of corresponding assessments of psychological flexibility (i.e., Acceptance and Action Questionnaire-II [AAQ-II]) before and after implementations of ACT, stratified by students identified as “at-risk” by the AAQ-II and a comparison of healthy controls, in order to understand the complex relationships among these variables and the impact of the ACT curriculum over time

Cultural humility was originally introduced by healthcare providers as an alternative to cultural competence. While cultural competence was conceptualized as an outcome, cultural humility was considered a lifelong ongoing process. Cultural humility refers to a psychological posture in which self-reflection, self-critique, taking the role of a life-long learner, identifying, and intervening on power imbalances, and non-paternalistic partnerships with clients are embraced. Medical practitioners work with patients from a wide variety of cultural backgrounds and work in highly stressful environments. It is important practitioners have the tools to best treat their patients, mitigate their own biases, and acquire the skills to establish a healthy rapport with patients from different backgrounds. As such, an online Acceptance and Commitment Training (ACT) based cultural humility training module was developed for medical students enrolled in a medical Spanish elective in order to aid in the establishment of such a repertoire. A recently developed Cultural Humility Multidimensional Scale was identified as the primary dependent variable to assess participants’ cultural humility repertoires before, after and several weeks following the training. The preliminary data including the aggregated pre and post scores of the Cultural Humility Multidimensional Scale demonstrate the positive impact of ACT on participants’ target skills.

Behavior analytic literature has highlighted the importance of social validity as a source of consumer feedback pertaining to the goals, procedures, and effects of behavioral interventions. This study examined the utility of social validity in the development of an Acceptance and Commitment Training (ACT) curriculum in medical education. While ACT has been shown to be efficacious in higher education settings, there is still a need to ensure those receiving ACT find it socially valid. Medical students are a unique population given their heightened and chronic levels of stress. Therefore, medical students’ buy-in and engagement with ACT is critical to its experiential impact as related to their stress management, psychological flexibility, and patient care skills over time. Given the complexity of the medical training systems and stressful nature of medical students’ experiences throughout their education, their feedback pertaining to the quality, duration, and timing of ACT is critical to its success as a training program. This study’s primary goal was to determine the social validity of an ongoing ACT-based wellness curriculum for first year medical students at a Western U.S. medical school and will provide insight on the aspects of the ACT curriculum students perceived as most beneficial.