The time is now: addressing implicit bias in obstetrics and gynecology education

Royce, Celeste; Morgan, Helen; Baecher-Lind, Laura; Cox, Susan M.; Everett, Elise; FLEMING, Angela; Graziano, Scott; Sims, Shireen Madani; Morosky, Christopher M.; Sutton, Jill M.; Sonn, Tammy

doi:10.1016/j.ajog.2022.12.016

Cited by 14 publications

(6 citation statements)

References 127 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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“…Described racial disparities were attributed to systemic racism and implicit bias. 30,31 In addition to providing education, resources and emotional support, our participants discussed the importance of their role in assisting birthing persons and families by teaching self-advocacy and providing advocacy in the healthcare setting (SEM interpersonal/institutional level). Doulas assist birthing people in navigating their healthcare journeys, processing the healthcare field, overcoming obstacles, and providing valuable information.…”

Section: Discussionmentioning

confidence: 99%

“…Doula responses revealed multiple action steps for implementation (Table 3) including doula certification programs include more on systemic racism and implicit bias education and awareness (e.g., one suggestion for how to begin a foundation for this is Royce et al's Special Report on addressing implicit bias in obstetrics and gynecology education). 31 Regarding need for improved doula-provider communicative relationship, we suggest working toward a "cycle of doula communication," where there is a clearly defined goals and roles for all stakeholders from the beginning to avoid what may have been a historically adversarial relationship. Health communication experts could provide training programs, scripts, and suggestions for events ranging from monthly webinars/meet-and-greets and brown bag lunches between healthcare providers and doulas.…”

Section: Discussionmentioning

confidence: 99%

Florida Doulas’ Perspectives on their Role in Reducing Maternal Morbidity and Health Disparities

Applequist

Wilson

Perkins

et al. 2023

Preprint

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Introduction: Maternal mortality rates continue to rise in the United States. Considerable racial disparities exist, as Black women are 2-3 times more likely to die from pregnancy-related complications than White women. Doulas have been associated with improved maternal outcomes. This study aimed to 1) investigate Florida doulas perspectives on severe maternal morbidity/mortality, related inequities, and their influence on these areas as well as 2) identify opportunities for actionable change. Methods: This qualitative study included seven online, in-depth interviews and seven focus groups with doulas (n = 31) in the state of Florida. Interview and focus group guides aimed to investigate how doulas perceive their role in the context of a) maternal morbidity and b) health disparities/inequities. Results: Doulas associated maternal morbidity and health disparities with Black pregnant people, attributing racism as a major contributor. Doulas identified their role in mitigating this problem as one that involves: providing positive social surveillance and emotional support, equipping clients with access to education and resources, and championing for advocacy in healthcare settings. Actionable steps utilizing the social ecological model and reproductive justice framework are provided. Discussion and Health Equity Implications: Doulas perceived their role as integral to mitigating maternal morbidity and maternal health disparities, particularly in the context of race. Equitable access to doulas for low-income and or minoritized populations may be one key strategy to improve maternal health equity.

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“…[13][14][15] Ways to address racial bias and cognitive biases in obstetrics and gynecology education has been covered in depth recently. 16 Although the eradication of the deleterious effects of racism on heath awaits broader societal engagement, within the health care setting, some of the steps that need to be taken overlap with those required to confront other forms of bias. Thus, a cognitive and racial bias assessment should become a routine part of all performance-improvement reviews.…”

Section: Racial Bias and Cognitive Biasesmentioning

confidence: 99%

“…13–15 Ways to address racial bias and cognitive biases in obstetrics and gynecology education has been covered in depth recently. 16…”

Section: Racial Bias and Cognitive Biasesmentioning

confidence: 99%

Diagnosing Fast and Slow

Atallah,

Gomes,

Minkoff

2023

Obstetrics &Amp; Gynecology

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The time is now: addressing implicit bias in obstetrics and gynecology education

Cited by 14 publications

References 127 publications

A qualitative analysis of stigmatizing language in birth admission clinical notes

A qualitative analysis of stigmatizing language in birth admission clinical notes

Florida Doulas’ Perspectives on their Role in Reducing Maternal Morbidity and Health Disparities

Diagnosing Fast and Slow

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