PROJECT SUMMARY Cardiovascular disease (CVD) is a leading contributor to racial disparities in life expectancy and uncontrolled hypertension is a critical risk factor underlying this disparity. Despite interventions to overcome barriers to hypertension control, accumulating evidence demonstrates that well-meaning, egalitarian providers can harbor implicit biases that affect patient interactions, clinical decision-making, and the effectiveness of interventions to mitigate cross-cultural differences. We propose a program called COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP), a theory-based, multi-component, training intervention that targets medical residents and nurse practitioner students. CONSULT-BP will adapt and test a theory-based, `awareness, exposure and skill-building' intervention, applied in the safety of a simulation-based learning center, to improve providers' interaction skills with minority and poor patients. We will use our established platform of community-based participatory research to implement CONSULT-BP in an academic medical center with a large, safety-net health system that serves a minority and poor population. The CONSULT-BP project will: 1. recruit and hire Community Advisors (CA) representing diverse underserved populations who will participate in the adaptation of evidence-based hypertension communication tools and the design, development, and implementation of the training curriculum; 2. use online self-assessments of clinicians' implicit bias for race and patient compliance to raise bias self-awareness and to examine the effect of bias on knowledge and skill development; and 3. hire Community SPs to (a) conduct face-to-face, simulated clinical encounters with medical trainees and NP students, and (b) provide evaluation and feedback about communication skills along with trained CA observers and faculty facilitators. The educational intervention is a program of two, 90-minute, sessions, spaced 5 weeks apart that combine online learning with in-person skill practice. To understand how much training exposure is required to `move the needle' of clinical skills and patient outcomes, we will assess the effect of CONSULT-BP by conducting two, sequential, randomized trials. Trial 1 will evaluate the effectiveness of one-time CONSULT training on outcomes, and Trial 2 will evaluate the effect of repeat, booster training on outcomes. To support training feasibility in Trial 1, CONSULT-BP will train cohorts of IM, FM, and NP trainees over a 3-year period, and will target advanced (2nd or 3rd-year) trainees within a given academic year for one-time exposure to the training intervention. Within each academic year, we will randomize training times to 1 of 5 start dates using a stepped wedge design to accommodate pre-existing training schedules and to mitigate the effect of temporal trends in clinical skill proficiency. Trial 2 will randomly assign continuing trainee participants from Trial 1 to a secon...