Implicit Bias Research Articles

Précis of Movements of the Mind

In Movements of the Mind (MoM; Wu, 2023a), I give a theory of agency that uncovers its internal psychological structure, revealing how creatures with minds do things. While my focus is on things we do 'in our heads', mental actions, the theory concerns all forms of agency. The book also provides a theory of attention and its essential connection to action. It characterizes intention in action as a type of memory for work, drawing on empirical theories of working memory. Further, it reveals the essential role of bias in action, providing an account of various psychological biases. The theory is then applied to three phenomena prominent in philosophical practice: implicit (better, automatic) bias, reasoning deductively, and introspection of conscious perceptual experience.

Gender Differences in Autonomy Granted to Residents and Fellows During Procedural Training: A Systematic Review and Meta-Analysis.

Supervisors may be prone to implicit (unintentional) bias when granting procedural autonomy to trainees due to the subjectivity of autonomy decisions. The authors aimed to conduct a systematic review and meta-analysis to assess the differences in perceptions of procedural autonomy granted to physician trainees based on gender and/or race. MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were searched (search date: January 5, 2022) for studies reporting quantitative gender- or race-based differences in perceptions of procedural autonomy of physician trainees. Reviewers worked in duplicate for article selection and data abstraction. Primary measures of interest were self-reported and observer-rated procedural autonomy. Meta-analysis pooled differences in perceptions of procedural autonomy based on trainee gender. The search returned 2,714 articles, of which 16 were eligible for inclusion. These reported data for 6,109 trainees (median, 90 per study) and 2,763 supervisors (median, 54 per study). No studies investigated differences in perceptions of autonomy based on race. In meta-analysis of disparities between genders in autonomy ratings (positive number favoring female trainees), pooled standardized mean differences were -0.12 (95% confidence interval [CI], -0.19 to -0.04; P = .003; n = 10 studies) for trainee self-rated autonomy and -0.05 (95% CI, -0.11 to 0.01; P = .07; n = 9 studies) for supervisor ratings of autonomy. Limited evidence suggests that female trainees perceived that they received less procedural autonomy than did males. Further research exploring the degree of gender- and race-based differences in procedural autonomy, and factors that influence these differences is warranted.

“I'm completely off base here on what this child is capable of”: A qualitative analysis of how medical ableism manifests in PICU clinicians' care of children with severe neurological impairment

BackgroundChildren with severe neurological impairment (SNI) are at heightened risk of experiencing medical ableism from clinicians in the pediatric intensive care unit (PICU), where barriers such as time scarcity and heavy workloads limit clinicians’ ability to provide personalized care. ObjectiveTo examine medical ableism and strategies to support PICU clinicians in understanding the lives of children with SNI and their families. MethodsThis US-based, single-center, qualitative study included PICU clinicians identified by the parents/caregivers of a child with SNI. Semi-structured 1:1 60-min interviews about the challenges of caring for children with SNI were conducted virtually. Coded data were extracted, thematically analyzed, and further conceptualized using the Dual Process Theory (DPT) bias reduction framework. ResultsNineteen PICU clinicians participated. Three major themes emerged: 1) assumptions and misconceptions about children with SNI and their families, 2) barriers to providing personalized care, and 3) clinician-suggested strategies to honor the lives of children with SNI. These themes aligned with the DPT framework. As outlined in the DPT, system 1 “fast thinking” errors occur when quick observations inform decisions (e.g., snap judgments about a child's capabilities). Second, barriers (e.g., insufficient time for meaningful interactions) may prevent clinicians from providing unbiased care. Third, system 2 “slow thinking,” where complex decision-making occurs, and can be enhanced through personalization strategies (e.g., viewing visuals of the child at baseline health). ConclusionsIncreasing clinician awareness of their potential implicit biases and utilizing bias reduction strategies to mitigate medical ableism in care are critical areas for future research.

Equity, diversity, and inclusion in Canadian colleges: examining definitions and unveiling perceptions

ABSTRACT Equity, Diversity, and Inclusion (EDI) through strategic policy development has been at the forefront of institutional change, especially within the higher education sector. Canadian colleges have a large equity-seeking student population due to their open admission structure, but despite this, there are implicit biases and actions that impede students’ learning experience. Limited literature exists around how Canadian colleges have approached EDI policy development; thus, this paper initiates the unpacking of the evident policy – practice disconnect by asking: ‘How do colleges understand equity, diversity, and inclusion as articulated in policy documents?’ To address this, the study employs Critical Policy Analysis (CPA) as its main research method to deconstruct the narratives found within purposefully sampled documents including: 1) EDI policies and procedure; 2) institutional multi-year strategic plans; and 3) EDI-based plans and performance reports. Results indicate that colleges tend to be selective in their usage of EDI definitions. There is also a tendency to use ambiguous language around EDI, which makes it difficult to mobilise knowledge effectively and approach equity directly. Policies often fail to address the privileges held by certain positionalities, reinforcing existing power structures rather than challenging them. The significance of this research is in its contribution to enhancing a theoretical understanding of how knowledge supports policy, as well as informing the future development of constructive EDI policies in higher educational institutions.

Retuning Ears & Rewiring Brains for Effective Communication: Foreign-Accent Perception & Sensitivity Training (FAPST)™

Purpose: Communication and psychosocial challenges are associated with processing regional or foreign accents. These challenges result in discrimination, marginalization, and reduced opportunities for culturally, linguistically, or racially diverse people. As a departure from the controversial approaches of training speakers to speak more effectively, this paper presents an innovative and effective methodology to train listeners instead and make the communication environment more “accent friendly”. Built upon two decades of testing and evidence, the Foreign Accent Perception & Sensitivity Training (FAPST)TM is used to develop skills in listening to accents, reducing implicit biases, and increasing appreciation and enjoyment for interacting with accents and cultures. Methodology: 320 undergraduate students from eight sections of a Diversity Issues course were provided the FAPST training online that included 15-20 minutes of gamified experience, over four weeks, in listening and identifying 54 varieties of accent in a structured, multimedia procedure. Assessments included weekly Accent Identification Scores as well as a pre- and post-survey using the CCQ tool to assess listeners’ baseline knowledge, attitudes, stereotypes, preferences, and skills related to processing accents. They also received formative assessments, feedback, and engaged in self-reflections. Results: Paired t-tests showed significant improvement in Accent Identification Scores which increased from 52% in week 1 and reached 75% by week 4, significant at p <0.05 level. The post-training CCQ survey results showed that Factual Knowledge scores improved significantly from 42% to 78%, Stereotypes scores reduced significantly from 89% to 22%, and Competence scores improved significantly from 23% to 76%. Participants reported increased confidence in listening accuracy and improvement in noticing details in accent patterns. Participants reported increased interest and willingness to interact with diversity. Participants also reported increased awareness of discrimination, and willingness to show allyship and advocacy for diverse individuals. Conclusion: This project confirmed that students have preconceived attitudes and biases as well as lower skills and confidence in interacting with diversity and accents which factor in their decisions and preferences to communicate with people with certain accents. It becomes imperative to set students up for success and engagement in a globalized world by training them with skills to navigate diversity. Results show that such a training improves listening accuracy as well as develops increased confidence and interest in engaging with diversity, while reducing implicit biases and stereotypes, along with increased factual knowledge of, and competence with accents.

Codesigning culturally safe oral health care with First Nations Kidney Warriors experiencing kidney disease in South Australia

BackgroundThis paper describes how First Nations Kidney Warriors (Aboriginal and Torres Strait Islander people living with kidney disease), dental hygienists, kidney health care professionals, an Aboriginal hostel accommodation manager and researchers co-designed an approach to improve oral health in South Australia. Kidney Warriors have strong connection to Country, Community and family that underpins health, wellbeing and approaches to research. However, significant colonisation, racism and marginalisation have impacted Kidney Warriors’ social, cultural and financial determinants of health, leading to increased chronic conditions including kidney disease. Access to culturally safe, affordable and responsive oral health care is vital but challenging for First Nations Peoples undergoing dialysis and kidney transplantation; Australian oral health care is generally provided privately, in metropolitan centres, by professionals who may hold unconscious bias about First Nations Peoples and incorrect assumptions regarding equal access to care.MethodsThe AKction – Aboriginal Kidney Care Together Improving Outcomes Now kidney care oral health working group codesigned strategies to address disparities and gaps in care, and co-create more accessible, responsive, culturally safe and sustainable models of care. A decolonising and collaborative participatory action research was informed by Dadirri Deep Listening and Ganma Knowledge Sharing with repeated cycles of Look and Listen, Think and Discuss, Take Action Together. A small pilot evaluation survey of clinical placement in an Aboriginal setting was undertaken.ResultsFour phases of collaboration were undertaken. Community and health professional consultations identified key gaps and priorities. Clinical yarning and cultural safety training and an interprofessional skills day was co-facilitated. Dental hygienist student clinical placement at Kanggawodli Aboriginal Hostel was initiated and evaluated. First Nations Kidney Warriors were positioned as educators and experts of their own lives and health care needs. A new framework for kidney health—oral health cultural safety and clinical education was developed.ConclusionThis codesigned approach involving inter-professional collaboration and joint decision making with community members has significantly informed improvements in oral health care information, services and referral with and for First Nations Peoples with kidney disease. This project provides a working example of how to decolonise health service and education programs from the ground up.Trial registrationNHMRC PAR 2004389.

Nested replicator dynamics, nested logit choice, and similarity-based learning

We consider a model of learning and evolution in games whose action sets are endowed with a partition-based similarity structure intended to capture exogenous similarities between strategies. In this model, revising agents have a higher probability of comparing their current strategy with other strategies that they deem similar, and they switch to the observed strategy with probability proportional to its payoff excess. Because of this implicit bias toward similar strategies, the resulting dynamics – which we call the nested replicator dynamics – do not satisfy any of the standard monotonicity postulates for imitative game dynamics; nonetheless, we show that they retain the main long-run rationality properties of the replicator dynamics, albeit at quantitatively different rates. We also show that the induced dynamics can be viewed as a stimulus-response model in the spirit of Erev and Roth (1998), with choice probabilities given by the nested logit choice rule of Ben-Akiva (1973) and McFadden (1978). This result generalizes an existing relation between the replicator dynamics and the exponential weights algorithm in online learning, and provides an additional layer of interpretation to our analysis and results.

A psychological “how-possibly” model of repression

ABSTRACT In recent philosophical and (neuro)psychological discussions of phenomena such as motivated forgetting, memory inhibition, self-deception, and implicit bias, various authors have suggested that repression might be a useful notion to make sense of these phenomena, or that these phenomena indeed provide evidence for repression. However, surprisingly, these claims usually do not rely on any explicit model of repression. Consequently, it remains unclear whether invoking repression in these discussions is justified. In this paper, I propose a psychological “how-possibly” model that can serve as a basis for scientific research that I call the hybrid model of repression. This model combines the advantages while avoiding the problems of two types of models of repression – the higher-order model and the separation model – that have been discussed and defended by different authors and that both have their origin in Freud. This “how-possibly” model may then set the stage for further empirical research, which can form the basis for a “how-actually” model in the longer run.

Violence Risk or Writing Quality? Predicting Relief Outcomes from Protective Order Narratives.

Civil orders of protection (OPs) are the only victim-initiated legal intervention for intimate partner violence. The OP process is unique because victims write a narrative account of abuse to inform judges' decision-making. Historically, feminist scholars have considered OPs as empowering to victims, as they can signal strength-based change and requesting needed relief. OPs also serve as an important tool for some mothers who need temporary protection related to child custody and visitation. Studies of OP narratives have found that content related to future risk is associated with securing an OP, including allegations of physical and severe violence, suggesting that OPs provide needed protection. At the same time, the OP process is disempowering for some women. The content and quality of survivors' OP narratives vary greatly, and studies have found that well-written accounts are positively associated with securing OPs, uncovering the potential influence of judges' implicit biases. This study used logistic regression to explore how violence risk and writing quality related to the receipt of emergency OPs in a sample of 90 petitions filed by women with minor children in a large Midwest County. As expected, violence severity was positively associated with securing an OP, controlling for the mention of other cases/orders and legal representation. However, the association was no longer significant when writing quality was considered; specifically, greater readability was associated with being granted an OP. Linear structure and appearance of narratives were not related to OP outcomes. Findings underscore the ongoing need to explore how the written narrative requirement of the OP process (dis)empowers survivors and the role implicit biases may play in judicial decision-making in civil OP proceedings.

The Guardians of the Streets: Frontline Law Enforcement Officers

This study explores the intricate realm of frontline law enforcement personnel, the sentinels who patrol the streets and deal with the day-to-day challenges of maintaining community safety. The aim is to investigate the obstacles and prospects they face, with a particular emphasis on mental health, de-escalation strategies, and community involvement. Principal Subjects: The Effects of Prolonged Stress: We will look at how common stress and trauma-related illnesses like depression and PTSD are in front-line law enforcement personnel. De-escalation Techniques and implicit bias the study will examine how well de-escalation training programs reduce the need for force as well as how implicit bias affects officers' judgment when they engage with members of the public. Establishing trust through community Policing. This section will look at ways to help frontline police and the communities they serve build strong bonds, with an emphasis on underserved areas. Principal Arguments Frontline officers' mental health is greatly impacted by ongoing stress. Officers who receive specialized de- escalation training may be better able to settle disputes amicably and use less force. Officers' interactions with the public can be less affected by unconscious stereotypes when they get implicit bias training. Building trust is a key component of effective community policing tactics that can boost public safety and strengthen ties within the community. Significance by looking into these topics, the research hopes to. Develop efficient stress management methods that will improve officer well-being. Implementing evidence-based de-escalation training will improve public safety. improved community-police ties by implementing programs aimed at fostering trust. Target audience: A wide range of people are intended to read this research, including Policymakers and law enforcement leaders who can put the findings into practice by implementing better policies. mental health specialists who are capable of creating focused interventions to enhance the wellbeing of officers. Community organizations trying to bridge the gap between law enforcement and the public. Additionally, the general public is interested in learning more about the opportunities and difficulties that frontline law enforcement officers encounter.

Equity, diversity, and inclusion in oncology pharmacy practice: Everyone's business.

Equity, Diversity, and Inclusion (EDI) is gaining increased attention within all industries healthcare being no exception. The terminology Equity, Diversity, and Inclusion and its abbreviation EDI gained popularity in the early 2000's when varied socio-political factors prompted many organisations to examine EDI concepts and how to operationalise them. The growing diversity of our society requires cross-cultural inclusive approaches to increase equity and access to services. This unique research is community-led research supported by the British Oncology Pharmacy Association, in which the members of the BOPA community are equal partners to inform action on policies that address EDI. This research was a cross-sectional study involving an online survey of financial BOPA members. Demographic data was extracted, and the quotes were analysed for common themes. The majority of respondents were women, and the largest age group was between 34 and 44. The first cause of microaggressions identified by the respondents was of racial and ethnic origin, followed by marital status and religious nature. Participants described the lack of diversity in senior positions and the microaggressions experienced by those who hold leadership positions. Some participants described how some situations at work made them feel excluded or alienated. The impact of discrimination and bullying/microaggressions extended to patients was also reported. Despite strategic directions encompassing this aspect, this research underscores the pressing need for more evidence on the lack of EDI in healthcare institutions. Our findings, located in the pharmacy oncology specialty, have identified the problem and highlighted the potential benefits of addressing it. More needs to be done in training and professional development to address unconscious bias and change behaviours.

Investment, integration, and innovation: Fostering diversity, equity, and inclusion across the HEALthy Brain and Child Development (HBCD) Study consortium

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. From the outset, the HBCD Study integrated diversity, equity, and inclusion (DEI) into its core mission, with key elements like an Associate Director for DEI, a DEI values statement, and establishing a DEI committee to help ensure sustainable progress for the future. The DEI Coordinating Committee supports DEI efforts impacting members of the HBCD consortium, study participants, and the analysis and dissemination of HBCD data. Committee members include representatives from every study site and workgroup which contributes to DEI integration throughout the study. Committee activities include reviewing all measures and protocols, creating accountability metrics, and supporting training opportunities for consortium members. Several successes and lessons have been learned through the Committee’s activities like implementing consortium-wide unconscious bias training and changing the DEI leadership and committee structure. This article presents an overview of HBCD’s DEI components within HBCD and provides examples of collaborative efforts between the DEI Coordinating Committee and other workgroups. The article concludes with plans for future activities and recommendations for other large consortia considering formal DEI structures.

Looking Back to Advance Equity in Psychiatric Nursing: Strategies for the Classroom and for Practice.

With deep historical roots in psychiatry, structural racism persists in psychiatric nursing today. Psychiatric nurses may hold implicit biases and stereotypical beliefs that influence how they perceive, assess, and interact with people from different racial backgrounds, leading to discrimination, poor treatment, and misdiagnosis. To eliminate discrimination in clinical care and diversify the workforce, there is an urgent need to integrate teaching and learning strategies that address influences of racism and racial identity in psychiatric nursing education. This article explores the historical context and proposes antiracist psychiatric nursing teaching and practice interventions to reduce the harms of racism.

THE PERCEPTIONS OF STUDENTS REGARDING GENDER EQUALITY POLICIES IN UNIVERSITIES

The study is about the perceptions of students of the University of Korca regarding the university's commitment to gender equality. Albanian universities have made significant efforts in gender mainstreaming. As part of a higher education institution, we must offer new generations a different path, free from prejudice and stereotypes, embracing people’s freedom and appreciating their individuality and originality. There is a significant commitment from the University of Korca (UNIKO) toward gender equality policies. The paper aims to point out the perceptions of students on gender equality policies followed by UNIKO and the commitment of the university to build an honest and communicative learning and work environment where people are treated equally and there is no discrimination, as well as a community which conveys trust, a sense of belonging and shared goals. A quantitative approach was used for this study. A questionnaire was conducted to measure the perception of students on gender equality policies in the university. The students were recruited in the four faculties of UNIKO. The study focused on students' knowledge of gender mainstreaming; their participation in trainings and activities focused on gender issues; equal representation in the decision-making units and awareness of gender equality and unconscious gender biases. The study showed a high interest of students in the gender policies of the institution, but a more visible involvement of students in informative activities and greater awareness to address gender issues is suggested.

Provider Implicit Racial Bias in Pediatric Sickle Cell Disease.

This study is to (1) assess implicit racial bias among pediatric providers and (2) use virtual patient (VP) vignettes to determine the impact of implicit racial bias on clinical decision-making in pediatric sickle cell disease (SCD) pain care. This cross-sectional study was conducted at a mid-sized, freestanding children's hospital in the northeast. Participants (N = 52) were pediatric SCD providers (87% cisgender female, 90% White, M age = 38.78). Providers completed a demographic questionnaire, the race Implicit Association Test (IAT) with adult and child faces, and a measure of SCD explicit bias (5-point Likert scale). Providers also made clinical decisions for four VP vignettes depicting Black and White youth in the emergency department (ED) with either SCD or cancer pain. Frequency tables were calculated. On the race IAT, providers demonstrated a pro-White implicit bias for both adult (81%) and child (89%) faces. Responses to the explicit bias measure reflected low levels of agreement with negative stereotypes about SCD patients. No significant differences emerged in providers' pain treatment decisions for Black vs. White, or SCD vs. cancer VPs. Findings indicate pediatric providers harbor implicit racial bias similar to the general population. Findings from VP vignettes did not demonstrate that pain treatment decision-making differed based on race or diagnosis. This may be due to standardized protocols and procedures in the pediatric emergency setting. Future research is needed to clarify the role of implicit bias in clinical decision-making and the potential efficacy of treatment protocols in preventing biases from interfering with pediatric SCD pain care.

Gender-based linguistic differences in letters of recommendation for rhinology fellowship over time: A dual-institutional follow-up study using natural language processing and deep learning.

This follow-up dual-institutional and longitudinal study further evaluated for underlying gender biases in LORs for rhinology fellowship. Explicit and implicit linguistic gender bias was found, heavily favoring male applicants.

The Toxic Mix of Multiculturalism and Medicine: The Credentialing and Professional-Entry Experience for Persons of African Descent

This essay is based on a case study of international medical graduates (IMGs) in Canada who migrated from sub-Saharan Africa. The chapter examines how narratives of race are situated and deployed in the field of medicine and can produce some aversive social–psychological landscapes in the credentialing and the professional-entry process as it relates to persons of African descent. It will show that, often without predetermination or intent, professionals of African descent in Canada are highly susceptible to implicit racial associations and implicit racial stereotyping in relation to evaluations of character, credentials, and culture. The article exposes some of the critical intersections of common experience, such as: (a) cultural deficit bias—Whiteness as an institutionalized cultural capital attribute; (b) confirmation bias—reaching a negative conclusion and working backwards to find evidence to support it; (c) repurposed sub-Saharan Blackness stereotypes—binary forms of techno-scamming and fraud; and (d) biased deception judgement—where the accuracy of deception judgements deteriorates when made across cultures. These social psychological phenomena result in significantly disproportionate returns on their foreign education and labour market experience for Black medical professionals that require decisive efforts in changing the narratives.

Exploring the literature on racism and health practitioner regulation: a scoping review protocol

IntroductionRacism in healthcare leads to significant harm to healthcare professionals and the clients, families and communities they serve. Increasingly, health practitioner regulators—responsible for protecting the public and ensuring practitioner competence—are...

Gender Disparities in the Academic Performance of Neurology Residents in Portugal.

Implicit bias has been linked to gender disparities in medical careers, impacting not only access to leadership positions but also early career opportunities. We aimed to evaluate if there were differences in the assessment of Neurology residents according to gender. We collected publicly available grades and rankings of two major evaluations that residents are submitted to, one at the beginning and another at the end of the neurology residency program, the National Board Exam and neurology examination, respectively. The National Board Examination is a multiple-choice gender-blinded evaluation, while the neurology examination is an oral gender-unblinded evaluation. We found that 36.5% of women and 21.6% of men were in the first quartile of the National Board Examination ranking, which reflects a similar representation among top classifications when assessed through a gender-blinded examination. On the other hand, the percentage of men who were in the top classification of NE, a gender-unblinded evaluation, was more than twice as high compared to women (37.8% vs 18.3%, p < 0.05). The findings of the present study may imply that there could be a disparity in women's career progression among neurology residents in Portugal, although the recruitment seems balanced between genders.

Insidious racism and institutional constraints: evidence from national and local case studies in the United States

In recent years, researchers have become increasingly interested in educational and institutional strategies to limit or eradicate contemporary forms of racism in the United States. They have generally accepted that most people in the modern-day United States do not actually want to be racist, but the various legacies of oppression live on through American institutions, promote unconscious biases, and manifest in unintentionally racist behaviors. However, previous research has largely overlooked the interactive relationship specifically between insidious racists, and the institutions meant to limit and punish their intentional behavior. Insidious racists are conscious of their racist beliefs, they engage in intentional acts of racism, and yet, they hold value in not being deemed racist by American society. In this article I develop a framework of the varying institutional constraints associated with addressing insidious racism. I then deploy this framework on national and local case studies to highlight the contribution of this work. The national case study analyzes the institutional constraints that allowed for loan officers to engage in racist actions leading up to the Great Recession. The local case study analyzes institutional constraints that led to the deviant behavior and racist redistricting efforts coordinated by members of the Los Angeles City Council. Taken together, I show that institutional design and administrator ideologies determine the levels of insidious racism prevalent in a given institution.