Reducing Racial Bias Among Health Care Providers: Lessons from Social-Cognitive Psychology

Abstract

The paper sets forth a set of evidence-based recommendations for interventions to combat unintentional bias among health care providers, drawing upon theory and research in social cognitive psychology. Our primary aim is to provide a framework that outlines strategies and skills, which can be taught to medical trainees and practicing physicians, to prevent unconscious racial attitudes and stereotypes from negatively influencing the course and outcomes of clinical encounters. These strategies and skills are designed to: 1) enhance internal motivation to reduce bias, while avoiding external pressure; 2) increase understanding about the psychological basis of bias; 3) enhance providers' confidence in their ability to successfully interact with socially dissimilar patients; 4) enhance emotional regulation skills; and 5) improve the ability to build partnerships with patients. We emphasize the need for programs to provide a nonthreatening environment in which to practice new skills and the need to avoid making providers ashamed of having racial, ethnic, or cultural stereotypes. These recommendations are also intended to provide a springboard for research on interventions to reduce unintentional racial bias in health care.

Affective Forecasting: An Unrecognized Challenge in Making Serious Health Decisions

“…However, when patients are upset, physicians sometimes respond in problematic ways, ranging from avoidance, to anger, to using stereotypes as a form of distancing. [68][69][70] And studies show that physicians' specific professional biases may lessen their ability to see patients' situations clearly, for example, when they are overly influenced by the memory of a rare bad outcome. 65,71 Therefore, physicians are likely to better address patients' emotional needs if they incorporate tools for reflective self-awareness into their practices.…”

Implicit Gender Bias and the Use of Cardiovascular Tests Among Cardiologists

“…The first step in minimizing any potential negative effects of implicit bias is increasing awareness. Awareness of unwanted implicit stereotypes and being motivated to counteract them—or creating structures that minimize their effects—may help ensure that implicit bias does not overtly influence behavior 34, 60. Implicit bias is modifiable in experimental settings using counterstereotyping exercises; however, these methods have not been applied in a clinical setting 61.…”

Reducing Implicit Bias Through Curricular Interventions

“…Burgess et al 7 suggested that increasing provider confidence and ability to interact with socially dissimilar patients can increase opportunity to create positive associations to replace automatic negative stereotypes. There is a growing body of research supporting the positive impact of cultural competency training including field experience with community health and perspective taking exercises on intermediate outcomes such as knowledge, attitudes, and skills of health professionals.…”