Let’s Talk About it: Facilitating Discussions
with Medical Students on Implicit Bias
Bahij Austin, Lars Osterberg, Pree Basaviah,
Stanford University School of Medicine
Kevin Moynahan, University of Arizona College of Medicine – Tucson
Molly Jackson, University of Washington School of Medicine
Sunny Smith and Lindia Willies-Jacobo, UC San Diego School of Medicine
• Be able to acknowledge that bias is inherent in our
perspectives.
• Describe four educational approaches of teaching
medical students about implicit (unconscious) bias
• Recognize the importance of self-reflection as a
method to understanding and addressing bias.
• Share strategies in developing and leading
discussions on bias at your institution.
Objectives
• Prejudices we all have but are unaware of
• “mental shortcuts” based on social norms and stereotypes
• even if we sincerely believe that we are being fair and objective,
stereotypes may still be influencing our opinions
• The Implicit Association Test (IAT) can also be used to
measure our unconscious biases and can help
individuals gain important self-awareness
https://implicit.harvard.edu/implicit/education.html
• Being aware of one’s own biases can help improve one’s
ability to care for patients from diverse backgrounds
• allows us to be more culturally sensitive
• However, acknowledging and discussing one’s
biases can be uncomfortable and a safe space of the
LCs can help students share sensitive topics
Background- Unconscious Bias
• 90-minute faculty development session for LC faculty
• 20 minute lecture on Unconscious Bias and the
Implicit Association Test (IAT)
• Faculty all took one or more IAT
• Faculty provided and reviewed facilitation guide
adapted from MedEdPortal, Best Intentions
• Faculty divided into two small groups to discuss IAT
results; groups then combined to discuss best practices
for facilitation for the student small group session:
Cultural Competency and Bias
Stanford:
Faculty Development Description
• Students received short lecture on unconscious bias
• Students all took IAT (race, sexuality, or weight)
• Students divided into small groups with LC faculty
for discussion (45 min) with following prompts:
•
•
•
•
•
Did the IAT surprise you? What does this mean to you?
How can the IAT help when interacting with others?
Is it a problem to have biases?
How does it impact your life?
Are you willing to share your biases?
Student Session Description:
Cultural Competency and Bias
Addressing Implicit Bias in Health Care
We address implicit bias in medical training with first year students through
two workshops. The workshops are designed to:
• Integrate the psychology of implicit bias into the curriculum for medical
students and residents (Burgess, et al., 2007; Blair et al, 2011; Stone &
Moskowitz, 2011; Teal et al., 2012)
• Avoid making students defensive and resistant when making them
aware of bias
• Use clinically relevant research examples and scenarios to illustrate
bias
• Translate multiple bias reduction strategies for use as clinical skills
• Use active learning exercises so students can practice the skills and
receive feedback on execution
Addressing Implicit Bias in Health Care
Learning goals for the workshops:
Workshop I: FTF lecture (50 minutes)
• Introduce the Psychology of explicit and implicit intergroup bias
• Demonstrate implicit bias toward obese patients (handclaps)
• Discuss how implicit bias affects judgment and behavior in health care
(clinical research and scenarios)
Workshop II: Active learning exercises (90 minutes)
• Students work in 6 person groups to discuss and practice strategies for
reducing implicit bias when evaluating and interacting with patients
Strategies for Reducing Implicit Bias
Workshop II notes: Emphasize that strategies are skills for controlling the
use of stereotypes in order to provide individualized patient care
I. Be aware of the potential for implicit bias:
• When interacting with stigmatized patients
• When forming impressions of stigmatized patients (e.g., Reviewing a
history/labs or talking with a colleague)
II. Strategies for controlling implicit bias:
• Learn to activate Chronic Egalitarian Goals when interacting with
patients
• Look for a Common Identity or group membership they share with
patient
• Search for Counter-stereotypic Attributes that describe the patient
• Walk in their shoes: Perspective Taking
• Create and rehearse Implementation Intentions: e.g., “When I interact
with a Hispanic patient, then I will (insert strategy)”
• Immersion: Health Imperative - Identity Iceberg,
Community Visits, Health Imperative (human right,
structural factors), What Impacts Health (ecology),
Danger of a Single Story, Talking Across Difference
• Foundations of Clin Med: Cross-Cultural Medicine
• Interrupting Bias (65 min)
• Physicians and Implicit Bias and one IAT (prework for
students + faculty)
• Framing: all humans have bias, bias impacts patient care
• Discussion: IAT findings, tools to interrupt bias, awareness
of triggers, strategies to change an unconscious bias
University of Washington
UW Faculty Development (2014-2017)
• 6/ 2014: Identity, Race, and Social Difference Workshop
• 12/2014: Identity, Race and Social Difference in Medical
Student Education (All College Faculty Meeting)
• 2015-16: Targeted faculty development for new mentors and
“just in time” sessions for new teaching sessions
• 6/2017: Addressing Race and Culture in Teaching and
Mentoring
Remaining challenges
• Huge regional school, 6 campuses, content requires skilled
facilitators, large number of new mentors, maintaining support
into clinical years, addressing ‘hidden curriculum’
University of Washington
Implicit Bias Curriculum
Faculty Workshop(2-hour session)-Session framed around interpersonal
communication skills, empathy and decision-making
Fall 2016
70 Faculty members in attendance (small group facilitators)
Lecture (1 hour)
“Uncovering Our Biases: The Impact of ‘Mindset’ on Interpersonal
Communication, Empathy, and Decision-Making”
Small group activities(40 minutes)
• Interactive Exercise
• Thought Questions
Debrief (20 minutes)
• De-biasing strategies
• Faculty strongly encouraged to take the IAT in a category of their choice
Implicit Bias Curriculum
Incorporated into the Practice of Medicine (POM) Curriculum (Session framed around
interpersonal communication skills, empathy and decision-making)
Student Session: MS1s and MS2s(Separate sessions for each class)
Fall 2016
• 134 MS1s
• 125 MS2s
Lecture(2 hours)
“Uncovering Our Biases: The Impact of ‘Mindset’ on Interpersonal Communication, Empathy, and DecisionMaking”
• Students given 20 minutes to take the IAT in class
• Quick De-Brief of IAT
• De-biasing strategies
Small group activities(2 hours)
• Students are divided into small groups based on Academic Communities
• Discussion centered on IAT results
• More expansive dialogue about implicit bias in a cultural context
Outcomes
Overall, very well received
“enjoyed having space for this
level of dialogue”
“session was very thought
provoking and necessary”
“very important topic; very
well presented”
“would love to have continued
dialogue for longer period of
time”
“create more opportunities
throughout the year for implicit
bias training”
“space given for discourse
during the lecture”
Faculty Feedback
Student Feedback
Implicit Bias Curriculum
• Stanford University School of Medicine
• Bahij Austin, [email protected]
• Pree Basaviah, [email protected]
• Lars Osterberg, [email protected]
• University of Arizona College of Medicine – Tucson
• Kevin Moynahan, [email protected]
• University of Washington School of Medicine
• Molly Jackson, [email protected]
• UC San Diego School of Medicine
• Sunny Smith, [email protected]
• Lindia Willies-Jacobo, [email protected]
Contact Information