Article
Implicit and explicit biases are among many factors that contribute to disparities in health and health care.1 Explicit biases, attitudes, and assumptions that we recognize as part of our personal belief systems can be assessed directly through self-report . Explicit, openly racist, sexist and homophobic attitudes often underpin discriminatory actions. Implicit biases, on the other hand, are attitudes and beliefs about race, ethnicity, age, ability, gender, or other characteristics that operate outside of our consciousness and can only be measured indirectly. See the article : Sophisticated Settings — Lifestyle — July 01, 2022. Implicit biases surreptitiously influence judgment and may unintentionally contribute to discriminatory behavior.2 A person may have explicit egalitarian beliefs while harboring implicit attitudes and stereotypes that contradict their conscious beliefs.
In addition, our individual prejudices operate within larger social, cultural, and economic structures, whose biased policies and practices perpetuate systemic racism, sexism, and other forms of discrimination. In medicine, discriminatory practices and policies driven by prejudice not only negatively affect patient care and the medical education environment, but also limit the diversity of the health workforce, leading to an unequal distribution of health care funding. research and can hinder professional advancement.
A review of studies with physicians, nurses, and other medical professionals found that the implicit racial bias of health care providers is associated with diagnostic uncertainty and, for black patients, negative assessments of their less-focused clinical interactions. in the patient, poor communication with the provider, insufficient treatment. pain, opinions of black patients as less medically adherent than white patients, and other harmful effects.1 These biases are learned from cultural exposure and internalized over time: in one study, 48.7% of students U.S. medical respondents reported having been exposed to negative situations. comments on black patients from attending or resident physicians, and these students demonstrated a significantly greater implicit racial bias in year 4 than in year 1.3
A review of the literature on implicit bias reduction, which examined the evidence on many approaches and strategies, revealed that methods such as exposure to counter-stereotypical examples, recognition and understanding of others ’perspectives and appeals. equations to egalitarian values have not resulted in the reduction of implicit biases. 2 In fact, no intervention to reduce implicit biases has been shown to have lasting effects. It therefore makes sense for healthcare organizations to refrain from bias reduction interventions and focus on eliminating discriminatory behavior and other harm caused by implicit bias.
Although widespread, the implicit bias is hidden and difficult to recognize, especially in oneself. It can be assumed that we all have implicit biases, but both individual and organizational actions can combat the damage caused by these attitudes and beliefs. Bias awareness is a step towards behavior change. There are several ways to increase our awareness of personal prejudice, such as testing the Harvard Implicit Association, paying close attention to our own misconceptions, and reflecting critically on the biased behavior we participate in or experience. . González and colleagues offer 12 tips for teaching the recognition and management of implicit bias; these include the creation of a safe environment, the presentation of the science of implicit bias, and evidence of its influence on clinical care, the use of critical reflection exercises, and student participation in exercises and activities. of skill development in which they must accept their discomfort.4
Education about implicit bias and ways to manage its damage should be part of the efforts of the entire healthcare system to standardize knowledge in this area and to recognize and manage bias. Research from the Center for Health Workforce Studies at the University of Washington (UW) School of Medicine (where I work) assessed whether a short online course on bias implicit in the clinical and learning environment would raise awareness of bias in a national sample of universities. doctors. It was found that the course significantly increased bias awareness in clinicians, regardless of their personal or practical characteristics or the strength of their implicit racial and gender biass.5 The lasting effects of the course on patient awareness are being evaluated. clinicians on bias and their reports of subsequent behavioral changes.
Beyond awareness, examples of actions that physicians can take immediately to manage the effects of implicit bias include the practice of a model of conscious, positive, formal, and informal behavior; train active spectators to learn how to deal with or interrupt microaggressions and other harmful incidents; and conducting training aimed at eliminating negative patient descriptions and stigmatizing words in history notes and direct communications with the patient. Faculty of academic medical centers can develop curricular materials that contain inclusive and diverse images and examples and can strive to use inclusive language in all oral and written communications.
At the organizational level, the cornerstone of institutional bias management initiatives should be a comprehensive and ongoing program of interactive education and skills development in diversity, equity and inclusion (IED) that incorporates the recognition and management of implicit bias for all employees and learners. throughout the healthcare system. Organizations need to collect data to monitor equity. Organizations can also implement best practices to increase workforce diversity (https://diversity.nih.gov/); to recognize the participation in the education and the antibiotic practices like necessary and meritorious criteria in its policy of professionalism; and create recruitment, review, and promotion policies that recognize and accredit candidates for their DEI activities. Many health care organizations in the United States have codified these practices, but not all have.
Some healthcare organizations have developed bias information systems. For example, UW School of Medicine and UW Medicine have implemented an online tool that allows the target or observer of a biased incident to report their concerns (https://depts.washington.edu/hcequity/bias- reporting-tool /). These incidents are then assessed by a qualified incident response team that gathers more information and directs the concern to an existing system, such as the human resources department, or refers the incident for further investigation and a proper monitoring. Because transparency is key, UW Medicine issues a quarterly report on the number of bias incidents that have occurred, the groups (faculty, patients, caregivers, staff, students, students, visitors, or any combination) that go see affected by incidents, reported groups that have perpetrated them, locations of reported incidents, and topics or types of reported incidents. An initial assessment of the data collected by the reporting tool identified four high-priority areas for immediate institutional intervention: bias affecting pain management, response to microaggressions and implicit biases, biased comments, or patient actions. towards members of the medical team and opportunities to make our institution more inclusive. These elements are now priorities in our action plan for bias management.
Innovative research is being conducted on strategies to disrupt the effects of implicit bias on health care. Researchers at Indiana University are developing objective blood biomarkers of pain severity to open the door to accurate pain management (https://pubmed.ncbi.nlm.nih.gov/30755720/). These objective measures are promising to reduce the subjectivity and intrusion of bias implicit in pain assessment. Harvard researchers have proposed methods to minimize biases that are inadvertently incorporated into artificial intelligence algorithms that lead to health inequalities (https://www.hsph.harvard.edu/ecpe/how-to -prevent-algorithmic-bias-in-health-). cure /). Researchers at UW (biomedical computing and medical education) and the University of California, San Diego (computer science) are collaboratively developing technology to help address the implicit bias in clinical care; the developing tool will automatically detect nonverbal social signals that transmit physicians ’implicit bias in real-time interactions with patients and provide accurate feedback to the physician or physician in training so that an individualized program can be designed to develop communication skills ( https: //www.unbiased.health/).
U.S. health care organizations vary widely in that they have accepted the need to address the effects of implicit bias. The steps outlined here can help healthcare systems and physicians begin or continue the process of reducing and ultimately eliminating the damage caused by the bias implicit in healthcare.
Funding and Disclosures
Disclosure forms provided by the author are available at NEJM. Read also : UConn Health Specialty Pharmacy: 2 years of success and still growing – UConn Today.org.
This article was published on July 9, 2022 on NEJM.org.
Author Affiliations
From the Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle.
Supplementary Material
References (5)
1. FitzGerald C, Hurst S. Implicit Bias in Healthcare Professionals: A Systematic Review. To see also : Oregon health officials postpone meeting because ‘Emergency is a value of white supremacy’. BMC Med Ethics 2017; 18: 19-19.
2. Greenwald AG, Dasgupta N, Dovidio JF, Kang J, Moss-Racusin CA, Teachman BA. Implicit Bias Remedies: Treating discriminatory bias as a public health problem. Psychol Sci Public Interest 2022; 23: 7-40.
3. van Ryn M, Hardeman R, Phelan SM, et al. Medical school experiences associated with change in implicit racial bias among 3547 students: a CHANGES medical student study report. J Gen Intern Med 2015; 30: 1748-1756.
4. Gonzalez CM, Lypson ML, Sukhera J. Twelve tips for teaching the recognition and management of implicit bias. Med Teach 2021; 43: 1368-1373.
5. Sabin J, Guenther G, Ornelas IJ, et al. A brief education about implicit online bias raises awareness of bias among clinical teaching faculty. Med Educ Online 2022; 27: 2025307-2025307.
What is the most popular bias?
1. Confirmation bias. One of the most common cognitive biases is confirmation bias. Confirmation bias is when a person searches for and interprets information (whether news, statistics, or other people’s opinions) that supports a hypothesis or theory they already have.
What are the 5 biases? 5 biases that affect decision making
- Similarity bias. The bias of resemblance means that we often prefer things that are like us to things that are different from us. …
- Expedition bias. …
- Experience Bias. …
- Bias away. …
- Security bias.
What are the 3 biases?
Three types of bias can be distinguished: information bias, selection bias, and confusion bias. These three types of bias and their possible solutions are discussed with several examples.
What five strategies can be used to reduce the impact of implicit bias?
Challenge the implicit biases by identifying your own, teaching them to classmates, watching teachers close gaps, stopping “tone vigilance,” and tuning those biases into your school.
What can educators do to overcome the impact of implicit bias? Once you have increased awareness, there are things you can do to limit and combat your biases. Talk about it, anticipate it, create systems to reduce it, and take responsibility. Be aware, reflect and question your decisions. Work to increase empathy and empathic communication.
How do you identify implicit bias?
Explore and identify your own implicit biases by doing implicit association testing or by other means. Practice ways to reduce stress and increase awareness, such as meditation, yoga, or concentrated breathing. Consider the experiences from the point of view of the stereotyped person.
What are the 3 types of implicit bias? Types of Implicit Bias Among the various implicit biases that predominate throughout society are some, such as racial and ethnic bias, age bias, gender bias, LGBTQIA community bias, and gender bias. skills.
What is implicit bias?
We have a bias when, instead of being neutral, we have a preference (or aversion to) a person or group of people. Therefore, we use the term “implicit bias” to describe when we have attitudes toward people or associate stereotypes with them without our conscious knowledge.
