Coming face to face with implicit bias, microaggressions, and macroaggressions: Understanding the influence of structural racism and misogyny on physician wellness

Richards, Regina; Wohlauer, Max V.

doi:10.1016/j.jvs.2021.04.021

Cited by 10 publications

(6 citation statements)

References 71 publications

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“…(22) Coming face-to-face with implicit bias and microaggressions can disrupt our sense of wellness, and it follows that recognizing our attributes may have a negative impact on the health and well-being of patients could lead to feelings of shame or blame. (23) The IAT results for our diverse women's health department were similar to overall results from the IAT project, in the preponderance of results towards neutral or white over Black people.…”

Section: Discussionsupporting

confidence: 70%

Physician characteristics and implicit bias in disparate rates of primary cesarean delivery in Black vs. non-Black patients

Roloff,

Okekpe,

Stowe

et al. 2024

Preprint

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Background Black patients experience a higher chance of cesarean delivery (5–19% increased incidence over white patients) and reductions in low-risk cesarean deliveries in white patients have surpassed reductions among Black patients. The reasons driving this health care disparity are largely unknown. Here, we assess physician demographic characteristics and a measure of implicit bias in relation to primary cesarean delivery in Black vs. non-Black patients as possible contributing reasons for disparate rates of cesarean delivery by patient race. Methods This is a retrospective study of patients delivered at term at a single safety-net hospital. Demographics of the attending physician responsible for the delivery, including physician gender, race, years in practice, type of training, and physicians' results of an Implicit Association Test were compared to determine associations between provider factors on mode of delivery (cesarean or vaginal) by maternal race (Black vs. non-Black). Multinomial regression analysis was used to model primary cesarean delivery rates in Black compared to non-Black patients. Results In 4,847 singleton, term deliveries without a prior cesarean delivery, we found a significant difference in mode of delivery (cesarean or vaginal delivery) by race in the sample, with higher cesarean delivery rates in Black patients (21.3%) compared to non-Black patients (12.9%) (P < 0.001). Ten of 22 physicians (47.6%) responded to a request to share implicit association test results. Multinomial regression demonstrated higher rate of cesarean delivery in Black vs. non-Black patients that persisted for all physician attributes: gender (aOR 0.53, 0.20–1.38 95% CI), race and ethnicity (aOR 1.01, 0.94–1.09 95% CI), years in practice (aOR 0.71, 0.25-2.00 95% CI), training type (aOR1.05 0.84–1.32 95% CI), and measure of implicit bias (aOR 0.99, 0.82–1.19 95% CI). Conclusion We did not find that higher primary cesarean delivery in Black vs. non-Black patients were related to physician characteristics or implicit association test results.

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Section: Discussionsupporting

confidence: 70%

Physician characteristics and implicit bias in disparate rates of primary cesarean delivery in Black vs. non-Black patients

Roloff,

Okekpe,

Stowe

et al. 2024

Preprint

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“…Sadly, macroaggressions such as blatant acts of homophobia, racism, and misogyny remain a common occurrence in academic medicine. 32,33 . Microaggressions are "subtle snubs, slights, and insults directed towards minorities, as well as to women and other historically stigmatized groups, that implicitly communicate or at least engender hostility" 34 and disproportionately impact students who identify as women, URiM, and LGBTQ+.…”

Section: Microaggressions and Macroaggressionsmentioning

confidence: 99%

Advancing Equity: Understanding, Addressing, and Mitigating Bias in Assessment in Medical Education

Sheffield,

Finta,

Erinc

et al. 2024

Clinical Obstetrics &Amp; Gynecology

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Despite the growing presence of women and historically underrepresented groups in academic medicine, significant disparities remain. This article examines a key aspect of these disparities: biases in assessment and learning environments. Reviewing current literature, including in OBGYN, reveals persistent gender and racial biases in subjective clinical narrative assessments. The paper then outlines a 2-pronged approach for change: first, enhancing the learning environment, and subsequently, providing targeted recommendations for individuals, academic leaders, and healthcare institutions to effectively address these biases.

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“…Tools such as the Implicit Association Test (IAT) can assist faculty in the identification of unconscious bias in addition to opportunities for subsequent learning about bias-reduction techniques. 12,13 Unfortunately, most faculty and people, in general, are unaware of their biases. As such, helping faculty recognize and reckon with these prejudiced thoughts, attitudes, and sentiments may undermine their view of themselves as morally upright.…”

Section: Bias Training and Underrepresented In Medicine Faculty Exper...mentioning

confidence: 99%

“…As such, helping faculty recognize and reckon with these prejudiced thoughts, attitudes, and sentiments may undermine their view of themselves as morally upright. 13 Therefore, it may be challenging for faculty to recognize and acknowledge their biases. When discussing implicit bias, PA educators should consider whether they view the IAT as a tool that can assist in identifying and increasing awareness of their biases, or trigger reflection, particularly regarding intersectionality.…”

Section: Bias Training and Underrepresented In Medicine Faculty Exper...mentioning

confidence: 99%

Addressing the Elephant in the Room: Perceptions and Treatment of Underrepresented in Medicine Physician Assistants/Associate Educators

Drumgold,

Brown,

Frizell

et al. 2023

J Physician Assist Educ

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On Thursday, June 27, 2023, the US Supreme Court struck down race-conscious admission practices in higher education. While other demographic factors, such as the traditional Health Resources and Services Administration-disadvantaged background indicators, can be considered during the holistic admission process, explicit consideration based on race and/or ethnicity is prohibited. As a result, physician assistant/associate (PA) programs are tasked with developing novel ways to address equity, diversity, and inclusion during the admission and hiring processes. As Drumgold et al note, closing the PA workforce diversity gap is necessary to achieve health equity. Despite this, PA programs consistently struggle to attract and retain underrepresented in medicine (URiM) faculty, staff, and students. The latest PA Education Association Student Report indicates that more than 75% of applicants consider faculty and student body diversity when applying to programs. As such, addressing disparities in the recruitment, promotion, evaluation, and retention of URiM faculty is paramount. Here, the authors outline ongoing recruitment and retention challenges for URiM faculty along with institutional recommendations to ensure URiM PA faculty success and engagement.

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Coming face to face with implicit bias, microaggressions, and macroaggressions: Understanding the influence of structural racism and misogyny on physician wellness

Cited by 10 publications

References 71 publications

Physician characteristics and implicit bias in disparate rates of primary cesarean delivery in Black vs. non-Black patients

Physician characteristics and implicit bias in disparate rates of primary cesarean delivery in Black vs. non-Black patients

Advancing Equity: Understanding, Addressing, and Mitigating Bias in Assessment in Medical Education

Addressing the Elephant in the Room: Perceptions and Treatment of Underrepresented in Medicine Physician Assistants/Associate Educators

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