Abstract
This article was migrated. The article was not marked as recommended. Objective: Mounting evidence reveals that health care disparities stem from a combined effect of structural bias within our health system and the unconscious bias of well-intentioned health care professionals. The authors designed and evaluated a novel educational intervention to introduce the concept of unconscious bias to front-line providers. Methods: The authors designed and implemented an educational curricula for providers from three different programs at a single large, urban, tertiary-care academic institution. The intervention consisted of participants taking the implicit attitudes test (IAT), which was followed by a facilitated discussion. The discussion was audio recorded, transcribed, and coded for emerging themes. An online survey assessed participant awareness of these topics before and after the intervention and was analyzed using paired t-tests. Results: The authors analyzed the results by focus group. There were 19 participants in Focus Group 1 (FG1), 6 in Focus Group 2 (FG2), and 42 in Focus Group 3 (FG3). The majority of participants were white, between the ages of 26 to 35 and female. When analyzed in aggregate, authors found a statistically significant improvement in self-reported domains on whether the intervention changed participant understanding of healthcare disparities and implicit bias. While the authors' qualitative results indicated varying acceptance of the implicit attitude test, most participants acknowledged that implicit bias exists. Conclusion: Our educational intervention was successful at engaging front-line clinicians on the role of implicit bias on the development of health care disparities. However, prior to scaling our intervention to other institutions, many improvements should be considered including session structure, choice of facilitator and introduction of strategies to mitigate biases in clinical practice.
Highlights
Mounting evidence reveals that health care disparities stem from a combined effect of structural bias within our health system and the unconscious bias of well-intentioned health care professionals (Smedley et al, 2003)(Hall et al, 2015)
One study demonstrates that dedicated implicit bias curricula for undergraduate, medical, and physician assistant (PA) students raised learners’ awareness of their implicit biases (Archambault et al, 2008)
Intervention Development and Design The study team consisted of two Emergency Medicine residents, one Internal Medicine resident, one Radiation Oncology resident, two Advanced Practice Providers (APPs), and three senior advisors, all of whom were members of the University of Pennsylvania Graduate Medical Education Housestaff and advanced practice providers (APPs) (HAP) Quality Council, an organizing body of residents and APPs focused on patient safety and quality
Summary
Mounting evidence reveals that health care disparities stem from a combined effect of structural bias within our health system and the unconscious bias of well-intentioned health care professionals (Smedley et al, 2003)(Hall et al, 2015). A study by Green et al found that among internal medicine and emergency medicine residents, significant pro-White bias exists despite no explicitly reported preference for Whites over Blacks (Green et al, 2007). Another study by Sabin et al examined data from Harvard’s Project Implicit website and found that the 2,535 website participants reporting an MD degree demonstrated significant pro-White bias (Sabin, Rivara, and Greenwald, 2008). Social scientists assert that such unconscious attitudes and stereotypes acquired through socialization can be unlearned, or inhibited, by countervailing influences (Dovidio et al, 2008). There are limited studies to date that evaluate the use of countervailing influences in medical education. To date there lacks formal training in implicit bias in graduate medical education (GME) and training for residents, fellows, and advanced practice providers (APPs). We are unaware of prior assessments of residents’ or APPs’ perceptions on whether implicit bias affects their own patient care
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