Implicit Bias Training in Health Professions Education: A Scoping Review

Mavis, Stephanie C.; Caruso, Catherine; Dyess, Nicolle Fernández; Carr, Cara Beth; Gerberi, Dana; Dadiz, Rita

doi:10.1007/s40670-022-01673-z

Cited by 11 publications

(11 citation statements)

References 78 publications

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“…This study examined patient records at two hospitals in a large city in the Northeast, which may limit generalizability. We also studied EHR notes from one year (2017), which may not represent current documentation practices as secular trends such as the 2020 COVID‐19 pandemic and racial reckoning in the United States resulted in an increase in racism and bias awareness and training in academic and hospital settings (Chandler et al, 2022; Knox et al, 2021; Mavis et al, 2022; Royce et al, 2023). Data were not available on clinician demographics such as race or ethnicity, which may influence the use of stigmatizing language.…”

Section: Discussionmentioning

confidence: 99%

A qualitative analysis of stigmatizing language in birth admission clinical notes

et al. 2023

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The presence of stigmatizing language in the electronic health record (EHR) has been used to measure implicit biases that underlie health inequities. The purpose of this study was to identify the presence of stigmatizing language in the clinical notes of pregnant people during the birth admission. We conducted a qualitative analysis on N = 1117 birth admission EHR notes from two urban hospitals in 2017. We identified stigmatizing language categories, such as Disapproval (39.3%), Questioning patient credibility (37.7%), Difficult patient (21.3%), Stereotyping (1.6%), and Unilateral decisions (1.6%) in 61 notes (5.4%). We also defined a new stigmatizing language category indicating Power/privilege. This was present in 37 notes (3.3%) and signaled approval of social status, upholding a hierarchy of bias. The stigmatizing language was most frequently identified in birth admission triage notes (16%) and least frequently in social work initial assessments (13.7%). We found that clinicians from various disciplines recorded stigmatizing language in the medical records of birthing people. This language was used to question birthing people's credibility and convey disapproval of decision-making abilities for themselves or their newborns.We reported a Power/privilege language bias in the inconsistent documentation of traits considered favorable for patient outcomes (e.g., employment status). Future work on stigmatizing language may inform tailored interventions to improve perinatal outcomes for all birthing people and their families.

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Section: Discussionmentioning

confidence: 99%

A qualitative analysis of stigmatizing language in birth admission clinical notes

et al. 2023

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“…In addition, validated measures were not used to assess learning attitudes regarding implicit bias. While there are assessment tools available, 41 , 42 there is a lack of consensus on the value of some of these assessment tools, such as the Implicit Association Test, 43 for long-term learning, or as a program evaluation tool. The measures used in this study assessed the specific outcomes and objectives of the training that the providers completed.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Virtual Health Equity Training for Mid-Career Primary Healthcare Providers

Roberts,

Omaits

2023

Journal of Medical Education and Curricular Development

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OBJECTIVES Providing cultural competence training is recommended as a way to improve patient-centered care and reduce health disparities. Increasing awareness of implicit biases and understanding internal motivations for overcoming these biases can influence provider decisions and communications with patients. This study aims to provide a health equity and implicit bias training to healthcare providers and assess knowledge and attitude gains. METHODS Mid-career primary healthcare providers (n = 21) with at least 5 years of primary care experience participated in the training as a prerequisite for providing patient care in a telehealth primary care practice that overwhelmingly serves patients of color. RESULTS There was a significant increase in knowledge ( p < .001) as well as attitudes ( p < .001) in healthcare providers from pretest to posttest. Almost none (4.5%) of the providers were distracted during the training, which may be due to the interactive nature of the training that included group-based reflection discussions. CONCLUSION A virtual training for primary healthcare providers on health equity and implicit bias improved knowledge and equitable attitudes and had high satisfaction. Additional research is needed to determine if this type of training can influence providers’ ability to actively address known disparities in care.

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“…Furthermore, incorporating evaluation of learner behavior in clinical settings immediately after curriculum implementation and longitudinally is of paramount importance to ensure the curriculum is impacting behavior and action in the clinical environment (level 4 on Kirkpatrick's model), 45 a metric frequently missing from curricular evaluation strategies. 10 The vast majority of the survey cohort believed that IB affects how NICU team members interact with patients and families; however, fewer respondents believed that IB affects how they interact with patients and families. This discrepancy illustrates an optimism bias, where our respondents perceived their own biases to be less likely to affect their interactions than others, which could decrease individual engagement and self-directed learning on these topics.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Although we did not include any questions regarding the impact of the pandemic in our survey, we believe our results provide a representative description of the current, post-pandemic landscape of IB and HD education within NPM to inform the creation of a national curriculum. Additionally, since IB and HD education has progressively increased within recent years, 10 differences in experiences related to IB and HD education between early, middle, and later career neonatologists may exist and were not assessed in this survey. To create an inclusive curriculum, obtaining perspectives from all members of the NICU multidisciplinary team and NICU families is an important next step.…”

Section: Limitationsmentioning

confidence: 99%

“…Though a promising framework for designing curricula on IB exists, 9 operationalizing this into practical, populationspecific content is infrequently done. 10 Awareness, identification, and incorporation of actionable strategies to address bias and the HD they contribute to are particularly important in the neonatal intensive care unit (NICU), where IB and HD affect both infants and their families. 11 Black birthing persons experience disproportionate rates of premature birth, and their infants have worse outcomes than non-Hispanic white and Hispanic infants.…”

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confidence: 99%

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Implicit Bias and Health Disparities Education in the Neonatal Intensive Care Unit

Dyess,

Carr,

Mavis

et al. 2024

Am J Perinatol

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Objective To characterize implicit bias (IB) and health disparities (HD) education in neonatal-perinatal medicine (NPM), including current educational opportunities, resources, and barriers. Study Design A national web-based survey was sent to NPM fellows, neonatologists, and front-line providers after iterative review by education experts from the National Neonatology Curriculum Committee. Quantitative data were analyzed with chi-square and Fisher exact tests. Qualitative data were evaluated using thematic analysis. Results Of 452 NPM survey respondents, most desired additional IB (76%) and HD (83%) education. A greater proportion of neonatologists than fellows received IB (83% vs. 57%) and HD (87% vs. 74%) education. Only 41% of neonatologists reported that their institution requires IB training. A greater proportion of fellows than neonatologists expressed dissatisfaction with the current approaches for IB (51% vs. 25%, p<0.001) and HD (43% vs. 25%, p=0.015) education. The leading drivers of dissatisfaction included insufficient time spent on the topics, lack of specificity to NPM, inadequate curricular scope or depth, and lack of local educator expertise. A minority of faculty who are tasked to educate others have received specific educator training on IB (21%) and HD (16%). Thematic analysis of survey free-text responses identified three main themes on the facilitators and barriers to successful IB and HD education: individual, environmental, and curricular design variables. Conclusions NPM trainees and neonatologists desire tailored, active, and expert-guided IB and HD education. Identified barriers are important to address in developing an effective IB/HD curriculum for the NPM community.

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Implicit Bias Training in Health Professions Education: A Scoping Review

Cited by 11 publications

References 78 publications

A qualitative analysis of stigmatizing language in birth admission clinical notes

A qualitative analysis of stigmatizing language in birth admission clinical notes

Evaluation of a Virtual Health Equity Training for Mid-Career Primary Healthcare Providers

Implicit Bias and Health Disparities Education in the Neonatal Intensive Care Unit

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