Acknowledging and assessing implicit bias among healthcare professionals: A randomized controlled trial

Abstract

Implicit bias, defined as the attitudes or stereotypes that affect understanding, actions, and decisions in an unconscious manner, results in substandard health care and propagates health disparities. The extent of implicit bias among healthcare professionals is unknown but could break down the cohesive team dynamic required for providing optimal patient care. and Outcomes: This randomized controlled trial sought to evaluate implicit bias of pharmacists toward other health professionals (HP) and develop a positive framing intervention to reduce implicit bias toward the most biased HP. The primary outcome was the level of implicit bias of pharmacists towards physicians, nurses, and other pharmacists as a group. Secondary outcomes included the change in implicit bias levels from baseline to after the framing intervention. Pharmacist participants recruited from a pharmacy practice listserv completed a baseline Implicit Attitudes Test (IAT) and explicit attitude questionnaire. A positively framed passage was written about the HP with the most negative bias as identified from the baseline IAT. After a 16-week washout, participants were randomized to read the positively framed passage (intervention) or neutral passage (control) and retake the IAT. Comparison of standardized difference in reaction times of the IAT (D-score) between HP groups was done using a linear fixed model. Fifty-seven pharmacists completed the full study. Pharmacists had statistically higher D-scores toward physicians (0.26, SD 0.41, p = 0.002) and nurses (0.2, SD 0.34, p = 0.03) than toward other pharmacists (0.09, SD 0.36). A positive framing passage was written about pharmacists as the HP with the least positive attitudes. Pharmacist implicit attitudes towards other pharmacist grew more positive between the phases in the intervention group compared to other HPs (p = 0.03). Pharmacists’ implicit attitudes toward other pharmacists, physicians, and nurses is more positive than toward the general public, but it is lower towards pharmacist colleagues than physicians or nurses. Positively framed passages can improve subconscious bias among healthcare professionals and contribute to a cohesive interprofessional team dynamic.