Pre-clinical medical student reflections on implicit bias: Implications for learning and teaching

Abstract

ContextImplicit bias affects health professionals’ clinical decision-making; nevertheless, published reports of medical education curricula exploring this concept have been limited. This research documents a recent approach to teaching implicit bias.MethodsMedical students matriculating during 2014 and 2015 participated in a determinants of health course including instruction about implicit bias. Each submitted a reflective essay discussing implicit bias, the experience of taking the Implicit Association Test (IAT), and other course content. Using grounded theory methodology, student essays that discussed reactions to the IAT were analyzed for content themes based on specific statements mapping to each theme. Twenty-five percent of essays underwent a second review to calculate agreement between raters regarding identification of statements mapping to themes.OutcomeOf 250 essays, three-quarters discussed students’ results on the IAT. Theme comments related to: a) experience taking the IAT, b) bias in medicine, and c) prescriptive comments. Most of the comments (84%) related to students’ acknowledging the importance of recognizing implicit bias. More than one-half (60%) noted that bias affects clinical decision-making, and one-fifth (19%) stated that they believe it is the physician’s responsibility to advocate for dismantling bias.ConclusionsThrough taking the IAT and developing an understanding of implicit bias, medical students can gain insight into the effect it may have on clinical decision-making. Having pre-clinical medical students explore implicit bias through the IAT can lay a foundation for discussing this very human tendency.

The Impact of Implicit Biases in Pharmacy Education

“…19 Studies have also demonstrated that students believe implicit bias education should occur in pre-clinical, didactic years, prior to exposure to patient care arenas. 20 Didactic instruction about bias may be the initial step for a learner in recognizing biases. Colleges can begin by supplementing cultural competency curriculums with implicit bias focuses.…”

“…When given in conjunction with the IAT, students reported newfound insight into unperceived biases, providing them the tools to be more perceptive in the future. 9,20 Prior to initiating reflection, educators must explain the "why" behind reflecting, so students understand the motivation for self-reflection. Educators must be skillfully trained, must cultivate a safe space for students to face these unconscious perceptions and feedback delivery should be considered when assessing.…”

Defeating Unconscious Bias: The Role of a Structured, Reflective, and Interactive Workshop

“…1 Unconscious biases are universal and have adverse consequences for the workplace, health care, and the learning environment. [2][3][4] Studies show that clinicians' negative implicit bias correlated with poorer quality of care, inadequate clinician-patient communication, and health care disparities and inequities. [3][4][5][6][7][8] Unconscious biases adversely affect faculty recruitment and promotion, including the persistent underrepresentation of Black Americans and other minorities in medicine, further exacerbating racial health care disparities.…”

“…11,12 Authors of the IATs have noted that the tool may not reflect actual biases or acts of discrimination related to identified preferences. 4 Subsequently, the objective of this study was to determine: (1) if a brief educational workshop can increase knowledge and perceptions regarding unconscious bias, and (2) show that inaccurate first impressions can be elicited without the IATs.…”

Critical Incident Assessment as a Tool to Reflect on Students' Emotional Responses During International Experiences

“…experience and information that we gather early in life and are made more complex because they intersect with our culture and identity. Critical reflection allows us to identify and acknowledge both explicit and implicit (unknown or hidden) bias, [10] and is an important step in becoming more culturally competent. [2,11] Cultural competence may be especially important for training students in global electronics sustainability due to the global nature of the electronics supply chain and associated waste (ewaste).…”