Top 10 tips on starting your EDI journey in simulation training

Maudsley Learning (ML) is part of the South London and Maudsley NHS Foundation Trust, the provider of the most extensive portfolio of mental health services in the UK. ML is the UK’s first mental health simulation training centre, delivering specialised mental health and simulation courses nationally and internationally to both clinical and non-clinical staff. Our simulation team developed the world-first protocol for delivering simulation teaching in a virtual environment and routinely runs actor-facilitated courses. Maudsley Learning has delivered hundreds of programs locally, nationally, and internationally and has a large portfolio of courses that are often interprofessional, interdisciplinary, and focus on the mental-physical interface. Maudsley Learning offers a wide range of courses spanning all ages, from perinatal courses to older adult courses.

Lay the Foundations

By setting the scene from the start and explaining that EDI will be a theme explored throughout the course, participants know what to expect and may feel less uncomfortable when the topic arises. Two possible ways of approaching this are through including it in the outlined learning objectives or through the use of an equality and equity statement shared at the start of the course.

Stay Humble

It is important to acknowledge that it isn’t possible for anyone to know everything about EDI. It is a vast topic and one that will always continue to develop. As simulation educators, it is essential that we are aware of our own limitations so that we can seek advice and further information when needed. Being open to feedback and education from colleagues and course participants allows for further growth in addition to modeling a willingness to develop.

Be Comfortable with Discomfort

Tackling EDI topics can be challenging and is often likely to feel uncomfortable and awkward. It is helpful to acknowledge and accept that this is the case. As facilitators, there are a multitude of unknown factors to consider, often including participants’ cultural backgrounds, past experiences, and where they are on their own EDI journey. Through modeling the acceptance of this discomfort, we can demonstrate that this is a normal and acceptable way to feel.

Learn Your Lingo

Language is often an aspect of discussing EDI that can be anxiety-inducing to the extent that people may be put off becoming involved in a discussion through fear of saying the wrong thing. As a facilitator, it is helpful to think about what language you feel comfortable with using and do your research regarding appropriate terminology.

Data is Key

By arming ourselves and our team with the extensive statistics and facts available, we can enhance not only our own knowledge and understanding but also incorporate these into our practice and debriefs where appropriate. At times, there may be resistance or denial of the effects of discrimination; it can be helpful to have facts and figures available within teaching materials and handouts to bolster discussion. The data available is staggering, and although it can be uncomfortable to read, it is key in raising awareness and appreciation. Please see the resources section below for further information.

Remain Culturally Curious

Genuine curiosity is fundamental in enhancing knowledge on any topic. Through natural human curiosity across different cultures, people, and backgrounds, we can broaden our experience and enrich our knowledge. It is helpful to model this continuous sense of interest in others to instill this within participants. We would encourage moving away from the phrase “culturally competent” as this implies that we can become fully versed in all cultures, which we know is not likely for anyone, regardless of background. Although it is important to be prepared to be surprised and ask questions, it is also important that we do our own research and reading rather than relying only on speaking with individuals from minoritised groups.

Keep it Relevant

EDI topics may be raised within debriefs by participants or by facilitators. It is important, as a facilitator, when opening a conversation about EDI, that it feels relevant and appropriate to either the scenario and its topic or the themes that have been discussed within the debrief. Participants may disengage if teaching feels shoehorned.

Give Time and Space

EDI can be a sensitive topic, and it is important to allow the required time and space for participants to explore it without time pressure. During the course planning stages, this should be considered to ensure that the course is long enough to allow these conversations to grow. When these topics do arise during the course itself, it is important to allow added space for participants to speak before the conversation moves on to the next section.

It can be helpful to consider having a private space or a facilitator available for one-to-one conversations if required, as EDI issues will have varying impacts on different participants, and some discussions may trigger unpleasant memories for learners.

Model Mistakes

EDI is an incredibly complex topic that we are all continuing to navigate. It is inevitable that we will all make mistakes at times. We may act on our unconscious biases, inadvertently overlook others’ feelings or opinions, or use incorrect terminology. This is normal and to be expected. What is important is that when we do make these mistakes during a course, we model how to respond to them. This involves openly acknowledging and apologising for what has happened, asking others about their thoughts or feelings on it, and listening to others’ perspectives. There may also be opportunities during debriefs to share our own previous errors and how we addressed them. This demonstrates to participants the importance of not only transparency surrounding mistakes but also utilising these to develop our understanding and awareness in EDI.

Respect Others’ EDI Journeys

Course participants will all be at different points in their EDI journeys, as will members of the simulation team. It is helpful to acknowledge and accept this. Where it is identified that participants may be at an early stage of their journey, it is helpful to maintain the focus on open dialogue and gentle challenges. This approach serves as a means of encouraging participants to be open to these conversations, and they are thus more likely to explore this further in the future.

Additional Resources:

1. For information on Patient and Carers Race Equalities Framework (PCREF): https://www.england.nhs.uk/mental-health/advancing-mental-health-equalities/
2. Medical Workforce Race Equality Standard (MWRES): https://www.england.nhs.uk/wp-content/uploads/2021/07/MWRES-DIGITAL-2020_FINAL.pdf
3. Workforce Race Equality Standard (WRES): https://www.england.nhs.uk/about/equality/equality-hub/workforce-equality-data-standards/equality-standard/
4. Public Health England, “Health Matters: reducing health inequalities in mental health”: https://www.gov.uk/government/publications/health-matters-reducing-health-inequalities-in-mental-illness/health-matters-reducing-health-inequalities-in-mental-illness
5. Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) – UK perinatal deaths for births from 1 January 2021 to 31 December 2021: https://timms.le.ac.uk/mbrrace-uk-perinatal-mortality/surveillance/#perinatal-mortality-in-the-uk
6. Mind Race Equality Briefing (2020) https://www.mind.org.uk/media/6484/race-equality-briefing-final-oct-2020.pdf
7. Sickle Cell Disease Inquiry : https://www.bmj.com/content/375/bmj.n2782 ​
8. Tides: https://tidesstudy.com/​
9. NHS Race and Health Observatory:https://www.nhsrho.org/
10. Exploring equity, diversity, and inclusion in a simulation program using the SIM-EDI tool: the impact of a reflexive tool for simulation educators,” (Purdy et al., 2023): https://pubmed.ncbi.nlm.nih.gov/37004091/
11. Recommendations and guidelines for the use of simulation to address structural racism and implicit bias” (Vora et al., 2021) https://journals.lww.com/simulationinhealthcare/fulltext/2021/08000/recommendations_and_guidelines_for_the_use_of.8.aspx

This blog was originally published on the UCLPartners London Simulation Network's website in November 2023.