Cristina M Gonzalez1, Mimi Y Kim, Paul R Marantz. 1. a Department of Medicine , Albert Einstein College of Medicine/Montefiore Medical Center, Bronx , New York , New York , USA.
Abstract
BACKGROUND: The varying treatment of different patients by the same physician are referred to as within provider disparities. These differences can contribute to health disparities and are thought to be the result of implicit bias due to unintentional, unconscious assumptions. PURPOSES: The purpose is to describe an educational intervention addressing both health disparities and physician implicit bias and the results of a subsequent survey exploring medical students' attitudes and beliefs toward subconscious bias and health disparities. METHODS: A single session within a larger required course was devoted to health disparities and the physician's potential to contribute to health disparities through implicit bias. Following the session the students were anonymously surveyed on their Implicit Association Test (IAT) results, their attitudes and experiences regarding the fairness of the health care system, and the potential impact of their own implicit bias. The students were categorized based on whether they disagreed ("deniers") or agreed ("accepters") with the statement "Unconscious bias might affect some of my clinical decisions or behaviors." Data analysis focused specifically on factors associated with this perspective. RESULTS: The survey response rate was at least 69%. Of the responders, 22% were "deniers" and 77% were "accepters." Demographics between the two groups were not significantly different. Deniers were significantly more likely than accepters to report IAT results with implicit preferences toward self, to believe the IAT is invalid, and to believe that doctors and the health system provide equal care to all and were less likely to report having directly observed inequitable care. CONCLUSIONS: The recognition of bias cannot be taught in a single session. Our experience supports the value of teaching medical students to recognize their own implicit biases and develop skills to overcome them in each patient encounter, and in making this instruction part of the compulsory, longitudinal undergraduate medical curriculum.
BACKGROUND: The varying treatment of different patients by the same physician are referred to as within provider disparities. These differences can contribute to health disparities and are thought to be the result of implicit bias due to unintentional, unconscious assumptions. PURPOSES: The purpose is to describe an educational intervention addressing both health disparities and physician implicit bias and the results of a subsequent survey exploring medical students' attitudes and beliefs toward subconscious bias and health disparities. METHODS: A single session within a larger required course was devoted to health disparities and the physician's potential to contribute to health disparities through implicit bias. Following the session the students were anonymously surveyed on their Implicit Association Test (IAT) results, their attitudes and experiences regarding the fairness of the health care system, and the potential impact of their own implicit bias. The students were categorized based on whether they disagreed ("deniers") or agreed ("accepters") with the statement "Unconscious bias might affect some of my clinical decisions or behaviors." Data analysis focused specifically on factors associated with this perspective. RESULTS: The survey response rate was at least 69%. Of the responders, 22% were "deniers" and 77% were "accepters." Demographics between the two groups were not significantly different. Deniers were significantly more likely than accepters to report IAT results with implicit preferences toward self, to believe the IAT is invalid, and to believe that doctors and the health system provide equal care to all and were less likely to report having directly observed inequitable care. CONCLUSIONS: The recognition of bias cannot be taught in a single session. Our experience supports the value of teaching medical students to recognize their own implicit biases and develop skills to overcome them in each patient encounter, and in making this instruction part of the compulsory, longitudinal undergraduate medical curriculum.
Authors: Enrico G Castillo; Jessica Isom; Katrina L DeBonis; Ayana Jordan; Joel T Braslow; Robert Rohrbaugh Journal: Acad Med Date: 2020-12 Impact factor: 6.893
Authors: Ashti Doobay-Persaud; Mark D Adler; Tami R Bartell; Natalie E Sheneman; Mayra D Martinez; Karen A Mangold; Patricia Smith; Karen M Sheehan Journal: J Gen Intern Med Date: 2019-05 Impact factor: 5.128
Authors: William J Hall; Mimi V Chapman; Kent M Lee; Yesenia M Merino; Tainayah W Thomas; B Keith Payne; Eugenia Eng; Steven H Day; Tamera Coyne-Beasley Journal: Am J Public Health Date: 2015-10-15 Impact factor: 9.308
Authors: Cristina M Gonzalez; Maria L Deno; Emily Kintzer; Paul R Marantz; Monica L Lypson; Melissa D McKee Journal: J Gen Intern Med Date: 2019-05 Impact factor: 5.128
Authors: Cristina M Gonzalez; Ramya J Garba; Alyssa Liguori; Paul R Marantz; M Diane McKee; Monica L Lypson Journal: Acad Med Date: 2018-11 Impact factor: 6.893