Healthcare simulation is a valuable tool for training healthcare professionals, the improvement of patient safety, and quality of care enhancement. However, the language used in healthcare simulation case writing and development can sometimes inadvertently perpetuate stigmas and biases. These biases can negatively impact the learning experience and reinforce harmful stereotypes. Healthcare simulation professionals have a responsibility to be mindful of the language they use to create a more inclusive and equitable learning environment. This article by Rémy Roe, Phd, Simulation Technology Specialist of Educational Programs and Services at the Center for Immersive and Simulation-based Learning at the Stanford School of Medicine, explores the concept of de-stigmatizing language in healthcare simulation and offers strategies for the implementation of change.
De-stigmatizing Language in Healthcare Simulation Scenarios
De-stigmatizing language is the practice of using neutral, person-first language that avoids stereotypes, biases, and judgmental terminology. The use of de-stigmatizing language involves mindfulness of the words and phrases used in the descriptions of patients, their conditions, and their behaviors. Stigmatizing language can be found in various aspects of healthcare simulation, like case scenarios, patient histories, and debrief discussions.
Examples of stigmatizing language include:
- Labels such as “drug abuser” or “addict” instead of “person with substance use disorder”.
- A patient described as “non-compliant” instead of “having difficulty adhering to treatment”.
- Terms like “crazy” in the description of a patient with a mental health condition.
De-stigmatizing language enables a team to create a more respectful and compassionate learning environment that promotes compassion and empathy. This approach aligns with the principles of diversity, equity, and inclusion (DEI), which are essential for the provision of high-quality, patient-centered care.
How to implement de-stigmatizing language in healthcare simulation
There are several opportunities to address stigmatizing language and promote a more inclusive learning environment throughout the healthcare simulation process. Throughout healthcare simulation case development, be mindful of the language used to describe patients, their conditions, and their behaviors. Here are a few helpful examples:
| Principle | Instead of… | Try… |
|---|---|---|
| Use person-first language | Diabetic, schizophrenic, etc. | Patient with… |
| Eliminate pejorative terms | Track marks | Injection related wounds |
| Avoid labels | noncompliant | Not taking medications regularly |
| Do not weaponize quotations | …has “stress at home” | …has multiple stressors, including… |
| Avoid unintentional blame | Failed outpatient treatmentRefuses admission | Oral antibiotics did not workDeclines admission |
| Avoids verbs that undermine patients | Patient claims to be in severe pain | Patient is in severe pain |
| Deficit vs. Strength-based language | Patient is suffering from… | Patient is recovering from/living with… |
Another actionable step before an event occurs is to establish a peer-review process for healthcare simulation cases to identify and address any instances of stigmatizing language. Encourage open dialogue among simulation team members to discuss the potential impact of language choices and explore alternatives. This process can also help ensure consistency in the use of de-stigmatizing language across all simulation activities.
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Be aware of the language used by facilitators, actors, and participants during a simulation. Encourage the use of de-stigmatizing language and provide gentle corrections when necessary. This not only promotes a more inclusive environment for learning, but also models best practices for patient interactions in real-world clinical settings. Debriefing sessions can be utilized as an opportunity to discuss the impact of language on patient care and provider attitudes.
Encourage participants to reflect on their own language choices and consider how they might adopt more inclusive and respectful communication strategies. Facilitators should also be prepared to address any instances of stigmatizing language that may have occurred during the simulation and guide participants towards more appropriate alternatives. An excellent resource that can be used from case development, through execution and debriefing, is Dr. Eve Purdy’s “SIM EDI Tool” (2023). This tool is already in use at healthcare simulation centers across the globe, like the Center for Immersive and Simulation-based Learning (CISL) at Stanford University.
Any Healthcare Simulation Role Can Make an Impact
Healthcare Simulation professionals contribute further to this diversity. They come from numerous clinical and technology backgrounds, with some being former or current EMT’s, nurses, or physicians. The background or credentials of a healthcare simulation professional may impact their role in the development, preparation, and execution of a healthcare simulation course or event. However, regardless of background or credentials, all members of a healthcare simulation team take part in the development, preparation, and execution of a course or event.
For instance, a Simulation Technology Specialist can review case materials for stigmatizing language throughout the technical preparation process, while an educator can model inclusive language in a debriefing session. Therefore, every member of every healthcare simulation team has the opportunity and responsibility to make an impact in the effort to de-stigmatize case language and promote diversity, equity, and inclusion in the field.
Strategies to Assist Implementation of De-stigmatizing Language
While the benefits of using de-stigmatizing language in healthcare simulation are clear, the implementation of this approach can come with challenges such as resistance to change. Healthcare simulation professionals, particularly those who have been in the field for many years, may be accustomed to the use of certain terminology and may be hesitant to adopt new language practices. Additionally, some individuals may not fully understand the impact of stigmatizing language on learners and patients, which can lead to a lack of awareness and motivation to change.
Education and training on the importance of de-stigmatizing language can aid to overcome resistance to change. This can include workshops, seminars, or online courses that highlight the benefits of inclusive language practices and provide concrete examples of how to implement them in healthcare simulation. Encouragement of open dialogue and the creation of a safe space for individuals to ask questions and express concerns can also help address resistance and promote a culture of continuous improvement.
Another potential barrier is the lack of standardized guidelines or resources for de-stigmatizing language in healthcare simulation. While some organizations have developed their own guidelines, there is no universally accepted framework to ensure consistency across different institutions and programs. This creates a challenge for healthcare simulation professionals to know where to start or how to ensure the use of appropriate language. To address this challenge, healthcare simulation organizations and professional associations can collaborate to develop and disseminate standardized guidelines and resources for de-stigmatizing language. These resources could include templates for case scenarios, best practices for debriefs, and examples of inclusive language alternatives.
Language Can Change Clinical Education and Care Outcomes
Using de-stigmatizing language in healthcare simulation can help address systemic biases and disparities in healthcare. When learners are exposed to case scenarios that challenge stereotypes and promote inclusive attitudes, they are better equipped to recognize and address biases in real-world clinical settings. This, in turn, can lead to more equitable care and improved health outcomes for marginalized communities. When DEI principles are incorporated into healthcare simulation learners from diverse backgrounds also benefit. When learners see themselves and their experiences reflected in case scenarios and discussions, they feel more included and engaged in the learning process. This can lead to increased motivation, better retention of information, and ultimately, more effective learning outcomes. Prioritizing DEI in healthcare simulation through the use of de-stigmatizing language is not only a matter of creating a more respectful learning environment but also a critical step towards the promotion of health equity and improvement of patient outcomes.
Word Choice Matters: Reception of Simulation-Based Learning is Impacted by Framing
References
- Purdy, E., Symon, B., Marks, R. E., Speirs, C., & Brazil, V. (2023). Exploring equity, diversity, and inclusion in a simulation program using the SIM-EDI tool: the impact of a reflexive tool for simulation educators. Advances in simulation (London, England), 8(1), 11. https://doi.org/10.1186/s41077-023-00250-7
