Abstract
BackgroundRacial bias in medical care is a significant public health issue, with increased focus on microaggressions and the quality of patient-provider interactions. Innovations in training interventions are needed to decrease microaggressions and improve provider communication and rapport with patients of color during medical encounters.MethodsThis paper presents a pilot randomized trial of an innovative clinical workshop that employed a theoretical model from social and contextual behavioral sciences. The intervention specifically aimed to decrease providers’ likelihood of expressing biases and negative stereotypes when interacting with patients of color in racially charged moments, such as when patients discuss past incidents of discrimination. Workshop exercises were informed by research on the importance of mindfulness and interracial contact involving reciprocal exchanges of vulnerability and responsiveness. Twenty-five medical student and recent graduate participants were randomized to a workshop intervention or no intervention. Outcomes were measured via provider self-report and observed changes in targeted provider behaviors. Specifically, two independent, blind teams of coders assessed provider emotional rapport and responsiveness during simulated interracial patient encounters with standardized Black patients who presented specific racial challenges to participants.ResultsGreater improvements in observed emotional rapport and responsiveness (indexing fewer microaggressions), improved self-reported explicit attitudes toward minoritized groups, and improved self-reported working alliance and closeness with the Black standardized patients were observed and reported by intervention participants.ConclusionsMedical providers may be more likely to exhibit bias with patients of color in specific racially charged moments during medical encounters. This small-sample pilot study suggests that interventions that directly intervene to help providers improve responding in these moments by incorporating mindfulness and interracial contact may be beneficial in reducing racial health disparities.
Highlights
Racial bias in medical care is a significant public health issue, with increased focus on microaggressions and the quality of patient-provider interactions
Disparities in medical care and outcomes for Black patients compared to White patients in the US are well documented [1] and have not changed significantly for decades [2]
Kanter et al BMC Medical Education (2020) 20:88 example, White providers who score higher on measures of implicit bias, but not explicit bias, speak faster, dominate conversations, have shorter visits [7, 8], display fewer positive nonverbal cues [9] and less warmth [10], and use more first-person plural pronouns and anxietyrelated words [11, 12] when interacting with Black patients
Summary
Racial bias in medical care is a significant public health issue, with increased focus on microaggressions and the quality of patient-provider interactions. Among the multiple factors responsible for Kanter et al BMC Medical Education (2020) 20:88 example, White providers who score higher on measures of implicit bias, but not explicit bias, speak faster, dominate conversations, have shorter visits [7, 8], display fewer positive nonverbal cues [9] and less warmth [10], and use more first-person plural pronouns and anxietyrelated words [11, 12] when interacting with Black patients. Emotional rapport may be challenging for providers to establish when negative stereotypes and implicit biases are activated by certain normative Black presentations [21] This may be alarmingly common, such as whenever issues of socio-economic status or race are made salient in the encounter [22] or when a patient discloses past incidents of discrimination. In these racially charged moments, a provider’s biased responses may include shifts in attention to focus on the racial features of the other person (e.g. [23]), expressions of automatic, inaccurate, negative stereotypes [21, 22], heightened physiological threat responses [24] and anxiety [25, 26], and avoidance of discussions of race and racism [27]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
