TY - JOUR
T1 - Implicit Bias and Its Relation to Health Disparities
T2 - A Teaching Program and Survey of Medical Students
AU - Gonzalez, Cristina M.
AU - Kim, Mimi Y.
AU - Marantz, Paul R.
N1 - Funding Information:
This study was partially supported by a grant from the National Institutes of Health (Office of Behavioral and Social Science Research), K07HD051528.
Funding Information:
Faculty were asked to reserve the last 10 minutes of class to allow students time to complete a voluntary survey. The survey was a 15-question anonymous survey focusing on their self-reported results on the IAT, student’s attitudes toward the validity of the results, and their attitudes and experiences regarding the fairness of the health care system, and their own potential implicit bias. The questions used a 4-point Likert scale, providing statements that students could respond to over a range from 1 (strongly agree) to 4 (strongly disagree) (with no “neutral” or “uncertain” choice available). Demographic data including, ethnicity, race, gender, sexual orientation and years between college and medical school were collected. Students were informed that these surveys were for research purposes and that completing the survey was completely voluntary; there were no identifiers on the forms used for data entry. The study was conducted as part of a larger educational grant from the National Institutes of Health (K07HD051528), and was classified as “exempt” (research conducted in educational settings) by the Albert Einstein College of Medicine Institutional Review Board.
PY - 2014/1
Y1 - 2014/1
N2 - 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.
AB - 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.
KW - attitude assessment
KW - health disparities
KW - implicit bias
KW - student survey
UR - http://www.scopus.com/inward/record.url?scp=84893040436&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84893040436&partnerID=8YFLogxK
U2 - 10.1080/10401334.2013.857341
DO - 10.1080/10401334.2013.857341
M3 - Article
C2 - 24405348
AN - SCOPUS:84893040436
SN - 1040-1334
VL - 26
SP - 64
EP - 71
JO - Teaching and Learning in Medicine
JF - Teaching and Learning in Medicine
IS - 1
ER -