An Evaluation of Implicit Bias Training in Graduate Medical Education

Abstract

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 selfreported 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.

The impact of racism on emergency health care workers

“…In light of EHCWs' concerns about the impact of systemic racism on patient health, more purposeful standardized education on systemic racism, including the impact of clinicians' implicit bias, may be beneficial. [28][29][30][31][32][33][34] During 2020, EHCWs cared for protest participants who suffered serious injuries, including from "less-lethal" weapons used by police for crowd control (such as chemical irritants and projectiles). 17 Given EHCWs' collective experience in caring for patients with injuries related to police use of force, emergency physicians have a Medicine released a statement condemning racial violence 35 and the American College of Emergency Physicians 2020 resolutions included one to ban choke holds and rubber bullets.…”

Racism and Cardiology: A Global Call to Action

“…These discussions should be led by an experienced bias mitigation workshop leader. While data are lacking that cardiovascular outcomes are improved by bias mitigation training of healthcare teams 63,66,67 , there is evidence that to educate clinicians and healthcare workers in strategies to override racial and other biases may enhance the atmosphere of inclusion perceived by patients and colleagues alike, and enhance patient trust 79 .…”

Using Simulation-Based Learning with Standardized Patients (SP) in an Implicit Bias Mitigation Clinician Training Program

“…1,3 In response, the Centers for Disease Control and Prevention has declared that "becoming aware of one's own biases may be a potentially lifesaving step for clinicians to undertake." 4 Trainings for clinicians in bias recognition, management, and mitigation have emerged at academic medical centers [5][6][7][8] and professional organizations. 9 Such programs target medical students, 5,6,10 residents, 7 practicing nurses, 11 and practicing physicians.…”

“…Trainings for clinicians in bias recognition, management, and mitigation have emerged at academic medical centers 5 – 8 and professional organizations. 9 Such programs target medical students, 5 , 6 , 10 residents, 7 practicing nurses, 11 and practicing physicians.…”

“… 9 Common components include didactic presentations, Implicit Association Tests (IATs), group discussions, reflections, self-assessments, and strategy development to address implicit bias in practice. 5 , 7 – 9 Training delivery modalities predominantly include self-paced, online programs. Few explicitly describe inclusion of case studies 9 and, to our knowledge, none involve simulation experiences for communication and skill practice with standardized patients (SPs) or direct interaction with persons from marginalized communities.…”