OvercomingStudents’PreconceivedNotions
AboutCulturalCompetenceandDiversity:
FramingImplicitBiasasaCognitive
Judgment
Sabrina M. Neeley, PhD, MPH
Director, Population Health Curriculum
Boonshoft School of Medicine, Wright State University
Co‐authors: Paul Hershberger, PhD; Ryan Mast, MD; Mary T. White, PhD
This presenter has no financial relationships with any commercial interests to disclose
LearningObjectives
Upon completion of this session, participants should be able to:
1. Explain how framing implicit bias as a factor in judgment may allow for more open discussion among students
1. Describe how the Implicit Association Test (IAT) may be used to encourage students to identify and discuss bias
PurposeofTeachingActivity
• Having discussion about bias is difficult, but needed
• Students may embrace ego‐defensive (“I’m not racist”) attitudes if they know the class topic is about bias, which may lead to dismissal of the learning opportunity
• Teaching bias as an example of judgment that occurs with fast thinking may increase students’ willingness to internalize the educational experience
• Biases are common
• Biases originate and are socialized through early learning experiences and are reinforced through societal messages
• Individuals should identify inherent biases and learn how to account for biases in life and work situations (metacognition)
RelatedtoCourseObjective:
By the end of this course, students should be able to:
• Identify factors that influence patient perceptions of care and the patient experience including interpersonal communication, the patient‐physician relationship, biases, and the social context of medicine
Methods/TeachingActivity
116 students /Patient, Physician & Society (MS‐1) course “How Doctors Think” (2.5‐hr class session)
Pre‐class reading about cognitive heuristics and errors
30‐minute in‐class didactic clarification of concepts
Each student completed 2 IATs (1 assigned/1 self‐select)
Small group discussion of IAT results (3‐5 students)
Large class discussion Clinical faculty facilitated discussion about how healthcare professionals can account for biases when interacting with patients
• Post‐class written reflection
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EvidenceBase
• Kahneman & Tversky – cognitive heuristics/fast & slow thinking
• Reading: Croskerry P. The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them. Acad Med. 2003;78:775‐780.
• ascertainment bias, attribution error, gender bias, stereotyping, visceral bias, • Implicit Association Test (IAT): https://implicit.harvard.edu/implicit/takeatest.html
• Measures the strength of associations of concepts and attributes
• Common indirect assessment of automatic associations related to race, age, gender, sexual orientation, religion, and other characteristics
Results
• Students initially reluctant to discuss IAT results and acknowledge implicit biases
• Some students argued that IAT was invalid and unreliable
• Some students shared surprise at having biases and how life experiences contributed to biases
• Students were concerned about how to account for biases in interactions with patients
• Course evaluation:
• 3.65/5.0 – “The How Doctors Think” Reflection helped me identify areas where I can focus my professional development”
• 4.05/5.0 – “identify factors that influence patient perceptions of care and patient experience”
• 4.06/5.0 – “explain characteristics of patient‐physician relationship and how relationship affects patient care and outcomes”
SelectedStudentReflections
• “Prior to beginning the IAT, I did not anticipate that I would have any biases. The IAT, however, told me otherwise.” • “I learned that a common societal bias I was aware of, and thought I had overcome, was actually still engrained within me.” • “Having these biases proven to me in a test was difficult to handle.”
• “During the discussion, I was able to reveal to my group that I do have certain biases and I was able to talk to them about those.”
• “I understand that accepting this bias is the first step to counter it when I am a practicing doctor.”
• “In reflecting on the biases I discovered today, I am planning to utilize slow thinking and to reflect on my own thoughts about those around me more often.”
• “Now that I am more aware of my common biases I can adjust my first impression of patients and try to put off making an assumption until I interact with that patient.”
• “I think the single best aspect of this course was learning about our own biases. For a lot of us, this was the first time we really analyzed our own biases.” (final course evaluation)
Conclusion
• Framing implicit bias as a common factor in judgment that occurs with fast thinking allows students to more freely admit and express their own biases, identify the source of the biases, and discuss how to account for biases in clinical work.
• The Implicit Association Test (IAT) is one tool that can easily be used in an educational environment and provides a good prompt for further discussion of bias.