Implicit Bias Education and Emergency Medicine Training: Step One? Awareness

Abstract

Objective: Prior research suggests that health care providers are susceptible to implicit biases, specifically prowhite biases, and that these may contribute to health care disparities by influencing physician behavior. Despite these findings, implicit bias training is not currently embedded into emergency medicine (EM) residency training and few studies exist that evaluate the effectiveness of implicit bias training on awareness during residency conference. We sought to conduct a mixed-methods program evaluation of a formalized educational intervention targeted on the topic of implicit bias. Methods:We used a design thinking framework to develop a curricular intervention. The intervention consisted of taking the Harvard Implicit Association Test (IAT) on race to introduce the concept of implicit bias, followed by a facilitated discussion to explore participant's perceptions on whether implicit bias may lead to variations in care. The facilitated 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: After the intervention, participant's awareness of their individual implicit biases increased by 33.3%(p = 0.003) and their awareness of how their IAT results influences how they deliver care to patients increased by 9.1% (p = 0.03). Emerging themes included skepticism of the implicit bias test results with the desire to have "neutral" results, acknowledgment that pattern recognition may lead to "blind spots" in care, recognition that bias exists on a personal and systemic level, and interest in regular educational interventions to address implicit bias.Conclusions: This novel educational intervention on implicit bias resulted in improvement in participants' awareness of their implicit biases and how it may affect their patient care. Our intervention can serve as a model for other residency programs to develop and implement an intervention to create awareness of implicit bias and its potential impact on patient care.

Do Racial Stereotypes Contribute to Medical Misdiagnosis of Child Abuse?

“…The fact that we found effects on our participants' information-processing but not decisionmaking is consistent with prior work suggesting that many medical practitioners are already aware of the need to ensure that bias does not contaminate their judgments (Green et al, 2007;Tsai & Michelson, 2017). In fact, bias training and other interventions designed to enhance racial sensitivity appear to be prevalent in hospitals throughout the United States (e.g., Tsai & Michelson, 2017) and evidence suggests they can be effective (e.g., Devine et al, 2012;FitzGerald et al, 2019;Zeidan et al, 2019). Our findings suggest that it might be beneficial to expand existing training to address the potential for racial bias in the context of child abuse cases.…”

Review article: Implicit bias towards Aboriginal and Torres Strait Islander patients within Australian emergency departments

“…These cases were all in regional under‐resourced communities, with Gowa's case being the most significant in terms of remoteness 7–9 . Together with the lack of clinical information this has been shown to result in implicit racial bias 11 . Because of the retrospective nature of these cases, we are unable to make any accurate conclusions about patient perceptions of discrimination; however, it was indicated that Naomi was dissatisfied with her care prior to her death 7 .…”

“…It fails to recognise individual patient characteristics, dynamic interactions and institutional context factors that may lead a clinician to make certain management decisions. The use of clinical vignettes may not accurately reflect the decisions made in the ED where physician fatigue, patient burden, time pressures and lack of clinical information may result in prejudiced patient management 2,11 . Clinical vignettes may also be prone to response bias, where participants provide a more socially desirable response than what they would do in clinical practice 23 .…”

How to Embrace Antiracism as a US Plastic Surgeon: Definitions, Principles, and Practice

“…Emergency medicine and family medicine have seen improvements by implementing the aforementioned action items. 13 , 14 …”

“… 11 , 12 Most plastic surgery training programs’ curricula lack implicit bias and cultural competency training when compared with other specialties (family medicine, emergency medicine, etc.). 13 , 14 Finally, access and equitable care has come into question regarding post mastectomy breast reconstruction rates, cleft lip and palate care, and even body contouring rates regarding black and brown communities. 6 , 8 , 15 Although the etiology of these disparities is complex and multifactorial, systemic and structural racism is a significant factor.…”