Amber Barnato is an expert in simulation studies. A health services researcher and palliative care physician, Amber lauds the ability of simulation studies to isolate one variable in a study. For example, we spend the first half talking about a RCT simulation study of clinician verbal and non-verbal communication with a seriously ill patient with cancer. In one room the physician under study interacts with a white patient-actor, and in another room interacts with a Black patient-actor. They found no differences in verbal communication, but clear differences in non-verbal rapport building communication: physicians stood farther away, crossed their arms, didn’t touch the Black patient as frequently. Amber tells the moving story of how these findings led a clinical colleague, her chief, to question and change his behavior. Of note, we talked about implicit bias in depth in this podcast with Kimberely Courseen.

As we’ve written about on GeriPal when we were a blog (a decade ago!) these simulation studies can be used to study language, such as patient or surrogate choices when we use the terms “allow natural death” vs “do-not-resuscitate.” This change in framing is a nudge, more evidence that the choices we make to use one phrase or another, or the order in which we present options, are all nudges that influence patient choice - listen to our podcast on the ethics of nudging with Jenny Blumenthal-Barby and Scott Halpern for more.

Additional links to simulation studies:

https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201411-495OC

https://journals.lww.com/ccmjournal/Abstract/2011/07000/A_randomized_trial_of_the_effect_of_patient_race.9.aspx

https://www.liebertpub.com/doi/full/10.1089/jpm.2015.0089

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687021/

https://journals.sagepub.com/doi/pdf/10.1177/0272989X14522099

Theoretical underpinnings:
https://home.csulb.edu/~cwallis/382/readings/482/nisbett%20saying%20more.pdf

What can we learn from simulations? Amber Barnato

GeriPal - A Geriatrics and Palliative Medicine Podcast