Optimizing Psychological Safety: Using a Focus Group to Acquire Perspectives from Standardized Patients Who Identify as LGBTQ+

Abstract

Introduction: Gender and sexual minority (lesbian, gay, bisexual, transgender, questioning; LGBTQ+) patients report poor health care experiences, partly because health care providers are not trained to meet their needs. Simulation can help learners practice competencies related to diversity, equity, and inclusion, but there are psychological safety considerations when recruiting standardized patients (SPs). Our objective was to incorporate the expertise of members of the LGBTQ+ community in our SP pool as we developed related curriculum. Methods: All SPs were invited to participate in a focus group if they identified as LGBTQ+ and wanted to contribute. Content experts developed a focus group guide and facilitated the meeting. Additional members of the research team took de-identified notes. After notes were reviewed for agreement, a thematic analysis was performed. An anonymous survey was sent to SP participants after the focus group meeting. Results: Six SPs verbally participated in a 90-minute focus group, and 4 completed an anonymous follow-up survey. SPs acknowledged psychological safety risks but universally supported the developing curriculum. Most were willing to assume personal risk for the greater good. They emphasized the importance of lived experience to authentic portrayal, but they were open to eventual broader casting with coaching and proposed SP peer support and learner preparation as possible protective measures. Discussion: SPs appreciated the recognition of content expertise and opportunity to influence curricular design. They shared concerns about LGBTQ+ SP self-portrayal in simulation and offered creative suggestions to promote psychological safety. Conclusion: SPs with lived experience can share nuanced feedback and be a resource to co-create curriculum related to diversity, equity, and inclusion.