Implicit Bias Research Articles

Unintended consequences – Risk for bias in competency-based assessment

As nursing education transitions to competency-based education, careful attention to the assessment methodology must be considered. As nursing education contends with structural implicit bias and supports social justice, any transition to the education delivery model must consider the underserved and marginalized. Multilingual and marginalized students have long had inequitable experiences when taking standardized assessments influenced by the perspectives and values of the dominant culture. Resourced and under-resourced nurse educators must be empowered to access information to inform the competency-based assessment design. This perspective article aims to uncover the risk of bias in competency-based assessment when not properly implemented and to present strategies to reduce bias in competency-based assessment. Considerations for schools/colleges of nursing as they implement competency-based assessment are explored.

Perceived Discrimination Among Food Pantry Clients in Massachusetts.

Food insecurity is defined as inconsistent access to enough food to meet nutritional needs. Discrimination is associated with food insecurity and poor health, especially among racial and ethnic minoritized and sexual or gender minoritized groups. We examined the demographic associations of perceived everyday discrimination and food pantry discrimination in Massachusetts. From December 2021 through February 2022, The Greater Boston Food Bank conducted a cross-sectional, statewide survey of Massachusetts adults. Of the 3,085 respondents, 702 were food pantry clients for whom complete data on food security were available; we analyzed data from this subset of respondents. We used the validated 10-item Everyday Discrimination Scale to measure perceived everyday discrimination and a 10-item modified version of the Everyday Discrimination Scale to measure perceived discrimination at food pantries. Logistic regression adjusted for race and ethnicity, age, gender identity, sexual orientation, having children in the household, annual household income, and household size assessed demographic associations of perceived everyday discrimination and discrimination at food pantries. Food pantry clients identifying as LGBTQ+ were more likely than those identifying as non-LGBTQ+ to report perceived everyday discrimination (adjusted odds ratio [AOR] = 2.44; 95% CI, 1.24-4.79). Clients identifying as Hispanic (AOR = 1.83, 95% CI, 1.13-2.96) were more likely than clients identifying as non-Hispanic White to report perceived discrimination at food pantries. To equitably reach and serve households with food insecurity, food banks and pantries need to understand experiences of discrimination and unconscious bias to develop programs, policies, and practices to address discrimination and create more inclusive interventions for food assistance.

The Effects of the 2020 BLM Protests on Racial Bias in the United States.

The 2020 Black Lives Matter (BLM) protests in response to the murder of George Floyd highlighted the lingering structural inequalities faced by Black people in the United States. In the present research, we investigated whether these protests led to reduced implicit and explicit racial bias among White U.S. Americans. Combining data from Project Implicit, Armed Conflict Location Event Data Project (ACLED), Google Trends, and the American Community survey, we observed rapid drops in implicit and explicit measures of racial bias after the onset of the protests. However, both types of racial bias slowly increased again over time as (attention to) BLM faded. We use directed acyclic graphs to show under which assumptions causal inferences are warranted. We discuss our results in light of situational models of bias, their implications for protest movements, and raise questions about when and how social norms play a role in large-scale attitude change.

Familiarity Effect in the Perception of Handwriting: Evaluating in-group/out-group effect among readers of the Latin script

There is much evidence that familiarity can affect perception of stimuli, with items that are familiar to the individual being preferred and better remembered. Previous research has also shown that familiarity with a typeface increases preference for it, but no studies have evaluated the impact of familiarity in relation to the affect towards handwritten text. For the present study, a two-part experiment (N = 422) was designed to measure how contemporary users of the Latin script perceive handwritten text. The first section was designed to collect specimens of the participants’ handwriting. The second, which was adapted to each participant’s handwriting style, measured implicit judgments of certain familiar letter shapes against unfamiliar ones. Results show that familiarity positively influences the extent to which one judges the friendliness and trustworthiness of handwritten text. Furthermore, the greater the similarity to how one writes a letterform, the greater the observed effect in terms of perceived friendliness. These findings suggest that people have an implicit bias towards handwriting that looks like their own.

Inpatient Management of Pain Episodes in Children with Sickle Cell Disease: A Review.

Sickle cell disease (SCD) is the most common hemoglobinopathy in the world. Sickle cell vaso-occlusive episodes (VOEs) are very painful acute events and the most common complication as well as reason for hospitalization. SCD pain is best evaluated holistically with a pain functional assessment to aid in focusing pain management on reducing pain in addition to improving function. Patients with SCD have long endured structural racism and negative implicit bias surrounding the management of pain. Thus, it is important to approach the management of inpatient pain systematically with the use of multi-modal medications and nonpharmacologic treatments. Furthermore, equitable pain management care can be better achieved with standardized pain plans for an entire system and individualized pain plans for patients who fall outside the scope of the standardized pain plans. In this article, we discuss the best practices to manage SCD VOEs during an inpatient hospitalization.

As our population changes, so must we: how race and ethnicity data merging has evolved over time in the Wisconsin Administrative Data Core

The Institute for Research on Poverty (IRP), centered at the University of Wisconsin-Madison in Wisconsin, USA, began collaboration with various Wisconsin state agencies in 1985 to link data between disparate state agencies. These initial efforts have since evolved into the Wisconsin Administrative Data Core (WADC) which is an individual-level population dataset connecting extensive administrative data spanning decades of Wisconsin social services program history. Since its purpose is to facilitate evidence-driven policymaking and support program evaluation, it is essential that our data linking efforts accurately represent our Wisconsin population. Since its inception, the WADC has adapted to changes in how race and ethnicity are collected and reported. While Wisconsin has a racial makeup that is generally less diverse than the national population, the number of non-white and multi-racial identifying residents has increased over time. Furthermore, varying state agency demographic collection and reporting methods have fueled the need for our linking methods to change, too. IRP initially implemented standard data linkage methods using a mixture of probabilistic and deterministic matching of personal identifying information. But as the racial composition of Wisconsin residents changed over time, our linking assumptions induced implicit biases. In response, we updated our matching algorithm to account for the cultural nuances in how personally identifying information is assigned and reported within various racial and ethnic subgroups. Furthermore, we prioritized values from data sources that were self-reported rather than assigned from a third-party. These methodological modifications have improved the WADC’s reliability and representativeness of the population.

Design and evaluation of Enthralled: A higher education conversation game based on Euripides’ Bacchae

This article presents the design, goals, and evaluation of Enthralled following the 2022 playtesting in three undergraduate Liberal Arts core courses. Enthralled draws on ancient Greek myths and the classical tragedy Bacchae by Euripides. As an immersive pedagogical intervention, Enthralled promotes group collaboration and rewards consideration of diverse viewpoints and cultural values. Participants vote on the motivations of dramatic characters, which allows for a deeper understanding of their preconceptions and implicit biases and offers the opportunity for self-reflection and dialogue. The game toolkit includes an original deck of cards, a role-playing script, a character sheet, ballots, a hints-and-clues deck, instructions for players and moderators, and scoring materials. The third version of Enthralled exceeded our entertainment efficacy, playability, and usability goals and contributed positively to the learning outcomes of the courses. Minor game improvements and a course-tailored implementation toolkit are the next steps for scaling this project.

The Supervisory Relationship and Contextual Stressors

The effectiveness of supervision throughout the student writing process depends on several key factors: regular academic meetings, transparent expectations, progress documentation, and the cultivation of an inclusive research environment. To effectively address unconscious biases and inequities within the supervisory relationship, a gender-responsive approach is crucial. Implementing gender-sensitive supervision strategies is essential for mitigating the negative effects of gender-based interaction patterns on supervisees, which, in turn, enhances the overall quality of research. By fostering a more equitable supervisory environment, these strategies contribute to improved outcomes and a more supportive research process.

Language and the use of law are predictive of judge gender and seniority

There are examples of how unconscious bias can influence actions of people. In the judiciary, however, despite some examples there is no general theory on whether different demographic attributes such as gender, seniority or ethnicity affect case sentencing. We aim to gain insight into this issue by analyzing over 100k decisions of three different areas of law with the goal of understanding whether judge identity or judge attributes such as gender and seniority can be inferred from decision documents. We find that stylistic features of decisions are predictive of judge identities, their gender and their seniority, a finding that is aligned with results from analysis of written texts outside the judiciary. Surprisingly, we find that features based on legislation cited are also predictive of judge identities and attributes. While own content reuse by judges can explain our ability to predict judge identities, no specific reduced set of features can explain the differences we find in the legislation cited of decisions when we group judges by gender or seniority. Our findings open the door for further research on how these differences translate into how judges apply the law and, ultimately, to promote a more transparent and fair judiciary system.

Racial differences in cardiothoracic surgery letters of recommendation

ObjectiveCardiothoracic surgery lacks racial diversity. Attracting the best candidates requires valuing diversity and advancing a recruitment process that minimizes racial bias. Implicit bias in recommendation letters has been identified as an influential mechanism for lack of diversity in cardiothoracic surgery. We aim to investigate how applicant race impacts language used in cardiothoracic surgery fellowship recommendation letters. MethodsWe examined applications to an accredited cardiothoracic surgery fellowship program between 2017 and 2021. Recommendation letter authors were categorized as cardiothoracic and noncardiothoracic surgeons. Applicant self-reported race was dichotomized as White and non-White. Applicant characteristics were described using standard descriptive statistics and compared between applicant race. Recommendation letters were examined with linguistic analysis software and higher-level analysis to assess language associations between applicant race and author specialty. ResultsA total of 597 recommendation letters were analyzed from 158 individual applications. Cardiothoracic surgeons composed 334 (55.9%) recommendation letters. A total of 95 applicants (60.1%) were categorized as White. White applicants were described as more driven (P = .03), whereas letters for non-White applicants were more authentic (P = .02) and highlighted past experiences (P = .05). Cardiothoracic surgeons wrote longer letters (P = .04) with standout adjectives (P = .03) more frequently for White applicants and emphasized perceptiveness (P = .02) more often when writing for non-White applicants. ConclusionsWe demonstrate that authors' recommendation letters are influenced by applicant race. Letters written for White candidates are significantly longer and more descriptive of drive and outstanding characteristics than letters written for non-White candidates, particularly when written by cardiothoracic surgeons. Addressing this bias is crucial for recruiting the best candidates for cardiothoracic surgery.

Übersichtsarbeiten / Review Articles. Voreingenommenheiten und Wahrnehmungsverzerrungen (Bias) in der psychiatrisch-psychotherapeutischen Versorgung von Kindern und Jugendlichen mit intellektueller Beeinträchtigung

Bias in Mental Health Care of Children and Adolescents with Intellectual Disabilities Implicit and explicit bias and distortions of perception are partly responsible for the unequal and significantly deficient psychotherapeutic and psychiatric care situation for children and adolescents with intellectual disabilities and additional behavioral problems. The extent to which these biases influence misdiagnoses and treatment errors, refusals and exclusions from professional care, and grossly hostile rejections of people with disabilities requires empirical evidence (Bartig et al., 2021). The fact that all forms occur - probably to a considerable extent - contradicts the ethical principles of the medical and psychotherapeutic profession. In order to avoid misdiagnosis and treatment as a result of bias, this must be openly addressed. Selfawareness, supervision and second views, the concept of working diagnosis and, above all, the full application of child and adolescent psychiatric standards help to reduce bias.

Lessons for Flying Astronauts with Disabilities Drawn from Experience in Aviation.

INTRODUCTION: Accessible spaceflight may seem a distant concept. As part of a diverse European Space Agency funded Topical Team, we are working on the physiological feasibility of space missions being undertaken by people with physical disabilities. Here, the first activity of this team is presented in the form of key lessons learned from aviation to inform new work on space missions.DISCUSSION: The first lesson is agreeing on realistic expectations about impairments, their severity, and the possibility of flying independently. This is important in terms of astronaut recruitment and societal expectations. The second lesson relates to training and adjustments for people with disabilities. Flexibility is important while maintaining safety for everyone involved. The third lesson is about managing unconscious bias from the different stakeholders. We conclude by arguing that engagement with people from different backgrounds is essential for the success of the first space mission with people with physical disabilities.Miller-Smith MJ, Tucker N, Anderton R, Caplin N, Harridge SDR, Hodkinson P, Narici MV, Pollock RD, Possnig C, Rittweger J, Smith TG, Di Giulio I. Lessons for flying astronauts with disabilities drawn from experience in aviation. Aerosp Med Hum Perform. 2024; 95(9):716-719.

The Roots of Leadership

This article describes an author’s journey from a childhood marked by empathy and familial responsibilities to becoming a notable scientist and leader. The author reflects on her academic struggles and successes, highlighting pivotal moments such as her decision to transfer to Goucher College and her transformative experience at MIT. Her career trajectory includes significant roles in academia, administration, and the biotech industry, where she navigated challenges and leveraged her skills to achieve notable accomplishments. The article emphasizes the importance of persistence, the impact of mentors, and the value of diversity in STEM fields. It concludes with the author’s current focus on addressing unconscious biases in scientific communities and her commitment to fostering diversity and inclusion.

Surgical stabilization of rib fractures—Does race matter?

BackgroundAdvances in medical technology have widened the gaps and exposed disparities in medical treatments. The prevalence of surgical stabilization for rib fractures is rising despite its controversial indications for this treatment modality. In situations of equipoise, surgeons may find themselves choosing patients for surgery, revealing potential implicit biases. We hypothesize that there exists an inequity in surgical stabilization for rib fractures performed based on race. MethodsData were obtained from the American College of Surgeons 2013–2021 Trauma Quality Improvement Program database. Study participants were divided into race groups according to Trauma Quality Improvement Program data registry. To assess the association between race and surgical stabilization for rib fractures, a Poisson regression model was used. Potential confounding adjusted include race, age, sex, highest abbreviated injury severity score in each region, flail chest, sternum fracture, pneumothorax, hemothorax, pulmonary contusion, and comorbidities. ResultBlack patients were more often treated at a level 1 trauma center (74%) (P < .001). Flail chest was most common in White (3.2%) and American Indian (3.4%) patients compared with other races (P = .012). After adjusting for potential confounding in the Poisson regression analyses, Black patients were 26% less likely to undergo surgical stabilization for rib fractures (adjusted incident rate ratio [95% confidence interval]: 0.74 [0.64–0.85], P < .001) and Asian were 40% less likely to undergo surgical stabilization for rib fractures (adjusted incident rate ratio [95% confidence interval]: 0.60 [0.43–0.81], P = .001) than White patients. ConclusionThere is a disparity in the delivery of surgical stabilization for rib fractures in patients with rib fractures. Black and Asian patients undergo surgical stabilization for rib fractures at a significantly lower rate than their White counterparts. This discrepancy in the delivery of care is concerning and requires further study.

Is access to leadership roles contributing to the gender pay gap in the pharmaceutical sciences?

Gender disparity in the pharmaceutical sciences contributes to the overall gender pay gap. The gender pay inequity is worse at later career stages. Salary data for pharmaceutical scientists has been reviewed from both the American Association of Pharmaceutical Sciences (AAPS) Salary Survey and the American Association of Colleges of Pharmacy (AACP) Pharmacy Faculty Demographics and Salaries report. We share some potential causes of the pay inequity, including implicit bias, pipeline issues, family responsibilities, and others. We suggest how organizations can put processes in place to help narrow the gender pay gap. Additionally, we share suggestions for how women must take a proactive role to ensure they reach their full potential and pay equity.

A critical view: Examining disparities regarding timely cholecystectomy

BackgroundImplicit bias may prevent patients with abdominal pain from receiving optimal workup and treatment. We hypothesized that patients from socially disadvantaged backgrounds would be more likely to experience delays in receiving operative treatment for cholecystitis. To study this question, we examined factors related to having a prior emergency department presentation for abdominal pain (prior emergency department visit) within 3 months of urgent cholecystectomy. MethodsWe performed a retrospective analysis of consecutive patients who received an urgent cholecystectomy at an urban safety net public hospital between July 2019 and December 2022. The main outcome of interest was prior emergency department visit within 3 months of index cholecystectomy. We examined patient age, sex, race, ethnicity, preferred language, insurance, and employment status. Bivariate comparisons and logistic regression were used to determine the relationship between patient factors and prior emergency department visit. ResultsOf 508 cholecystectomy patients, 138 (27.2%) had a prior emergency department visit in the 3 months preceding their surgery. In bivariate analysis, younger age, Black race, Hispanic ethnicity, non-English preferred language, and type of insurance (P < .05) were associated with prior emergency department visit. In regression, younger age, Black race, Hispanic ethnicity, and having Medicare or being uninsured were associated with higher odds of having a prior emergency department visit. ConclusionMore than 1 in 4 patients had an evaluation for abdominal pain within 3 months of having an urgent cholecystectomy, and these patients were more likely to be from socially disadvantaged backgrounds. Standardized evaluation pathways for abdominal pain are needed to reduce disparities from institutional or implicit bias.

Perceptions of bias and credibility of male and female clinical psychologist and psychiatrist expert witnesses presenting clinical information in the courtroom

Expert witness credentials and gender have independently been shown to influence jurors' perceptions of expert witness credibility and legal decision-making. This study examined how manipulations of expert witness gender (Male/Female) and profession (Consultant Clinical Psychologist/Consultant Psychiatrist) together affected mock jurors' perceptions of expert witness credibility, judgements, and decision-making. Mock jurors (N = 182; 80.9 % were White) were recruited from England and Wales and were randomly assigned to watch a video-recorded mock expert witness testimony. Participants rated the expert witness using the Witness Credibility Scale and reported the likelihood of assigning the defendant to a guilty verdict. Results showed significant interaction effects of expert witness gender and profession on jurors' perceptions of their likeability, trustworthiness, knowledge, and total credibility. Male psychiatrists, followed by female clinical psychologists, received the highest scores in most credibility variables. Varied main effects of expert witness gender and profession on credibility were also found. Overall, jurors' ratings of expert witness credibility, when controlled by the expert's gender and profession, predicted jurors' determination of guilt. This study provides evidence of a potential interaction effect between profession and gender in expert witness credibility and supports existing research linking credibility with ultimate decision-making. More research is needed to understand jurors' unconscious biases and cognitive processes in making legal decisions.

Evaluation of simulation-based intervention for implicit bias mitigation: A response to systemic racism

BackgroundTraining health care professionals to mitigate implicit biases can reduce health inequities caused by racism. Implicit bias mitigation strategies (IBMS) have been shown to reduce biased behaviors. This study aimed to determine the impact of IBMS practice simulation on learners’ behaviors and family experience in one hospital unit. MethodsThis study used a quasi-experimental design in a large pediatric hospital. In total, 195 participants completed a simulation-based education intervention. Learners practiced IBMS with Simulated Participants. Participant perceptions were measured at four time points, and translational outcomes were collected using survey results and other outcomes. ResultsSituational judgment test results improved postintervention and at follow-up. Participants reported using IBMS skills at time points three and four. Internal and External Motivation Scale and family satisfaction scores remained unchanged. Family experience measures improved, showing decreases in security dispatch calls for perceived family escalation and in deny entries and behavioral contracts stratified by race. ConclusionsSimulation can shift perspectives and behaviors. More research is needed on the impact of simulation-based interventions on IBMS skill development and translational outcomes.

Race norming and biases in surgical oncology care.

Disparities in surgical oncology care may be due to race/ethnicity. Race norming, defined as the adjustment of medical assessments based on an individual's race/ethnicity, and implicit bias are specifically explored in this focused systematic review. We aim to examine how race norming and bias impact oncologic care and postsurgical outcomes, particularly in Black patient populations, while providing potential strategies to improve equitable and inclusive care.

A replication of “unconscious bias in citizens' evaluations of public sector performance”

AbstractIn recent years, the phenomenon of anti‐public sector bias (APSB) has garnered significant attention among public administration scholars. It is of especial interest given its possible effects on how citizens evaluate public sector performance. Despite the prominence of APSB in academic discourse, conclusive evidence requires further empirical testing. Our study addresses this gap by conducting a replication of Marvel (2016) using a different study population (citizens from China, N = 1410). The results reaffirm the negative influence of APSB on citizens' assessments of public sector performance. Notably, our research indicates the potential for altering citizens' APSB in the context of a pro‐public sector culture. This study contributes to public administration research and the discourse on APSB by confirming the effects presented by Marvel (2016) and suggesting strategies for mitigating the negative effects of APSB.