Confronting implicit bias toward patients: a scoping review of post-graduate physician curricula

Abstract

Background Physicians’ behavior may unknowingly be impacted by prejudice and thereby contribute to healthcare inequities. Despite increasingly robust data demonstrating physician implicit bias (The Office of Minority Health. Minority Population Profiles, 2021; COVID-19 Shines Light on Health Disparities, National Conference of State Legislatures 2021), the evidence behind how to change this with training programs remains unclear. This scoping review therefore reports on the implementation, outcomes, and characteristics of post-graduate physician implicit bias curricula. Methods The authors conducted a literature review using scoping review methodology. They searched 7 databases in February and November 2020 for English-language academic and gray literature on implicit bias curricula for physicians at all levels of post-graduate training. Ten reviewers screened studies for eligibility independently, then extracted data from these studies and compiled it into a chart and analytical summary. Results Of the 4,599 articles screened, this review identified 90 articles on implicit bias interventions for post-graduate physicians. Inductive data analysis revealed a spectrum of educational approaches, which were categorized int o 4 educational models called Competence, Skills-Based, Social Contact, and Critical Models. The most commonly reported strength was the interactive nature of the curricula (26%), and the most frequently identified challenges were related to time and resources available (53%). Half of the interventions discussed facilitator preparation, and the majority (62%) evaluated outcomes using pre and post self-assessments. Conclusions This review provides a comprehensive synthesis of the literature on physician implicit bias curricula. It is our goal that this supports medical educators in applying and improving aspects of these interventions in their own programs.

Implementation of Formal Curriculum on Health Care Disparities in Military Family Medicine Residency

“…To our knowledge, this is the first formal curriculum on HCD to incorporate the AAFP implicit bias training in GME. 19 Following curriculum implementation, responses to all survey questions demonstrated statistically significant improvement except for question 7, which asked whether the respondent understood what implicit bias means. Residents and faculty likely already had a good understanding of the definition of implicit bias prior to curriculum implementation (precurriculum mean=2.25; postcurriculum mean=1.56; P=.077).…”

Recommendations for Faculty Development in Addressing Implicit Bias in Clinical Encounters and Clinical Learning Environments

“…Faculty with exposure to bias instruction often lacked opportunity to develop and practice skills to address implicit bias: Few published skills-based interventions exist for faculty to provide instruction on implicit bias or to address it in their clinical encounters. [23][24][25] In contrast, medical students or residents (collectively referred to as learners) are targeted with implicit bias interventions. [23][24][25] This almost exclusive focus on them is insufficient to improve patient outcomes.…”

“…[23][24][25] In contrast, medical students or residents (collectively referred to as learners) are targeted with implicit bias interventions. [23][24][25] This almost exclusive focus on them is insufficient to improve patient outcomes. Implicit bias training in the formal curriculum leads to gains in knowledge and attitudes, but can be undone by negative faculty role-modeling in the hidden (informal) curriculum, 14,26 that is, the socialization process in the clinical learning environment and the attitudes and behaviors role modeled.…”

“…To achieve equitable patient outcomes and enhance clinical learning, health professions educators have developed interventions addressing implicit bias. [23][24][25] Some raise awareness and use a change in implicit bias from pre-to post-intervention as their outcome, most commonly by having participants take an IAT. This awareness approach is unlikely to improve behaviors in addressing implicit bias, given evidence demonstrating that even when measured implicit bias moves closer to neutral, behaviors do not change.…”

Using an Animated Film to Foster Understanding of and Engagement in Addressing Implicit Bias Through Empathy Across the Health Care Continuum

“…Purpose: Despite increasing recognition of the adverse impact of implicit bias in clinical care and the need for enhancing empathy within increasingly complex health care (and learning) environments, we found no published curricula for health professionals and students to reflect on empathy as a tool for mitigating the negative effects of implicit bias. [1][2][3] To address this gap, we developed and delivered an innovative curriculum built around a high-quality animated film ("The Elephant in the Waiting Room"). We report participants' self-reported outcomes and perceived impact of the sessions as a preliminary program evaluation.…”