Implicit bias in healthcare professionals: a systematic review Blind yourself from the individual. How marketeers make you like their products. What Is the Contact Hypothesis in Psychology?, VeryWellMind, How Does Implicit Bias Influence Behavior?, Vox, Companies Like Starbucks Love Anti-Bias Training. But what about the children? We provide a few examples of these strategies that you can use to reduce implicit bias . Learning to identify and overcome them is an important step toward overcoming prejudice and social and racial stereotypes. I think youre right, it is surprising. Gaining exposure to other groups and ways of thinking can mitigate both of these types of bias. The physician treating Alex in the introduction could use this technique by slowing down and reassessing his medical care. From that perspective, it can seem nearly impossible to change our implicit biases. But the fact is we all have biases. Among dedicated health care professionals, it can be especially difficult to contemplate the possibility of harboring unconscious attitudes or stereotypes. PDF Combating implicit bias and stereotypes - HHS.gov To help prevent unintended discrimination, the leaders of organizations need to decide to track data to see where disparities are occurring. Such dissociations fostered the idea that implicit bias is highly resistant to change and dependent on automatic processes that do not take our conscious beliefs into account. Freedom from resentment and pain can follow the decision to let go. Positive interaction with other groups members decreases the likelihood that biases will be applied. Education, exposure, and a systematic approach to understanding implicit bias may bring us closer to our aspirational goal to care for all our patients in the best possible way and move us toward a path of achieving health equity throughout the communities we serve. Receive information about the benefits of our programs, the courses you'll take, and what you need to apply. Devine and colleagues offer six strategies to reduce implicit bias: Similarly, in Seeing Patients: Unconscious Bias in Health Care, Dr. Augustus White offers these practical tips to combat implicit bias in health care: For an extensive bibliography and other helpful resources, please consult IHIs Achieving Health Equity: A Guide for Health Care Organizations white paper. For instance, many of us may be surprised to learn after taking an implicit association test that we follow the typical bias of associating males with science an awareness that may explain why the patient in our first case example addressed questions to the male medical student instead of the female attending. So far, brain training has failed to live up to its promises. Easier done than undone: Asymmetry in the malleability of implicit preferences. In one study, individuals who listened to a 10-minute meditative audiotape that focused them and made them more aware of their sensations and thoughts in a nonjudgmental way caused them to rely less on instinct and show less implicit bias against black people and the aged.10. He reports worsening lower extremity pain and is frustrated that, despite his bringing this up repeatedly to different clinicians, no one has addressed it. Studies show that health care professionals have the same level of implicit bias as the general population and that higher levels are associated with lower quality care.5 Providers with higher levels of bias are more likely to demonstrate unequal treatment recommendations, disparities in pain management, and even lack of empathy toward minority patients.6 In addition, stressful, time-pressured, and overloaded clinical practices can actually exacerbate unconscious negative attitudes. Implicit bias, also known as unconscious bias, is the bias in judgment and/or behavior that results from subtle cognitive processes (e.g., implicit attitudes and implicit stereotypes) that often operate at a level below conscious awareness and without intentional control. In a 2015 systematic review by Hall and colleagues, researchers found that implicit bias is significantly related to patient-provider interactions, treatment decisions, treatment adherence, and patient health outcomes. The Learning and Implicit Processes Lab at Ghent University examines when and how people learn and evaluate. For example, when a nurse practitioner asks a female-presenting woman if she has a boyfriend when discussing her sexual history, implicit bias is at play. So there may have been no evolutionary pressure for the human brain to develop a method of unlearning the associations. The first step toward overcoming your implicit biases is to identify them. When I first tried that reversed form, my response time was about a third of a second slower compared to the first version. See permissionsforcopyrightquestions and/or permission requests. Here are a few examples that demonstrate how it can occur in just about any situation in which people make decisions that affect other people. In the classic Institute of Medicine report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, the authors concluded that bias, stereotyping, and clinical uncertainty on the part of health care providers may contribute to racial and ethnic disparities in health care often despite providers' best intentions.1 For example, studies show that discrimination and bias at both the individual and institutional levels contribute to shocking disparities for African-American patients in terms of receiving certain procedures less often or experiencing much higher infant mortality rates when compared with non-Hispanic whites.2,3 As racial and ethnic diversity increases across our nation, it is imperative that we as physicians intentionally confront and find ways to mitigate our biases. But It Doesnt Work and May Backfire. Learn more about our online degree programs. Defamatory And another strategy is making people aware that they have implicit biases or that implicit biases are pervasive in the population. Pages (2009, August). Consistent and conscious use of these strategies can help you create a habit of nonbiased thinking. 1. NYPD Study: Implicit Bias Training's Effect On Policing Unclear : NPR (2019). Take two: Resisting implicit bias is lifelong work. What degree program are you most interested in. Create environments to encourage intergroup contact. The mechanisms by which our brains form associations and acquire them from the cultural environment evolved over long periods of time, during which people lived in an environment that was consistent. | Copyright 2023 American Academy of Family Physicians. / Carnes, M., et al. This blog is not intended to provide medical, financial, or legal advice. This content was adapted from the following sources: Carnes, M., et al. Create an open culture where individuals can acknowledge their biases and can respond to others biases. Yet, more recent research challenged this view, showing that strong and immediate change in implicit bias is possible and depends on changes in beliefs and rational reasoning. For instance, implicit anti-fat bias tends to correlate more with an explicit anti-fat bias than racial bias, where explicit and implicit attitudes often diverge significantly. Theyre bound to find things that theyd rather not see. Left: To achieve health equity, health care organizations have a responsibility to mitigate the effect of implicit bias in all interactions and at all points of contact with patients. They incorporate the biases of past decision-makers. Most police departments keep data on what we know as profiling, though they dont like to call it that. Starbucks responded by holding companywide training to address implicit bias, promote conscious inclusion, and prevent discrimination.. Understand and respect the tremendous power of unconscious bias. Tackling Implicit Bias in Health Care. Betsy Mason, Knowable Magazine. We must also acknowledge implicit bias and address it. Practice cultural humility, a lifelong process of critical self-reflection to readdress the power imbalances of the clinician-patient relationship. by Francesca Gino and Katherine. And once you know whats happening, the next step is what I call discretion elimination. As positive exemplars become more salient in your mind, they become cognitively accessible and challenge your stereotypic biases. Psychology Today 2023 Sussex Publishers, LLC, More from The Learning and Implicit Processes Lab. Retrieved fromhttps://www.aamc.org/download/102364/data/aibvol9no2.pdf, Google (2016). Some of Jamie's patients assume the male member of the team is the attending physician. A study showed that when people feel especially vulnerable to infectious disease, their negative attitudes toward older adults may be heightened. Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. Practice ways to reduce stress and increase mindfulness, such as meditation, yoga, or focused breathing. How does implicit bias by physicians affect patients' health care? Implicit Bias | Teaching + Learning Lab - Massachusetts Institute of In the office:Hiring managers were less likely to invite an obese applicant for an interview, people see older workers as less valuable and bias against Arab-Muslim men influenced hiring decisions in Sweden. While individual action is helpful, organizations and institutions must also work to eliminate systemic problems. Here are some strategies: (1) Simplify.. A vast body of research shows that the hiring process is biased and unfair. Implicit bias, also known as unconscious bias, is "the bias in judgment and/or behavior that results from subtle cognitive processes (e.g., implicit attitudes and implicit stereotypes) that often operate at a level below conscious awareness and without intentional control." Get the help you need from a therapist near youa FREE service from Psychology Today. For example, studies have found that after meditating, people are less likely to have automatic negative associations or stereotypes based on race, age, and social status. They were not actually likely to acquire something that they would later have to unlearn, because the environment wasnt going to change. Implicit or unconscious. His last A1C was 7.8. This can show up in class discussions, where our biases can lead us to (unintentionally) respond differently to student comments or call on certain students more than others. Eliminating implicit bias: First step, admit you have it An implicit bias may counter a person's conscious beliefs without them realizing it. Floyd, an unarmed black man, died in Minneapolis last month after a white police officer pressed his knee into Floyds neck for nearly nine minutes. (2009, August). For one, check your media bias: Do you find that the blogs you follow, the shows you stream, or the social media accounts you like are all produced by people quite similar to you? Combating Implicit Bias in the Courts: Understanding Risk Factors The following conditions increase the likelihood that implicit bias may influence one's thoughts and actions. Understanding implicit bias is critical because both positive and negative unconscious beliefs can lead to structural and systemic inequalities. They'll probably be just fine. Though more research is needed . Because of that, many of the strategies to reduce implicit bias revolve around inner work. Age bias occurs when people make assumptions about others based on their age, such as when a hiring manager looking for a social media-savvy applicant rejects a resume because the graduation date tips off that the applicant is middle-aged, unconsciously assuming that the candidate wouldnt be adept at social media management. Set criteria to assess job skills needed for successful job performance. Those tests have revealed just how pervasive implicit bias is. These eight tactics, which spell out "IMPLICIT," can help you mitigate your own implicit biases: I ntrospection: Explore and identify your own prejudices by taking implicit association. How to Identify and Overcome Your Implicit Bias, BuiltIn, 16 Unconscious Bias Examples and How to Avoid Them in the Workplace, , Unconscious Bias: How It Affects Us More Than We Know, ONGIG, 10 Examples of Awesome Inclusion Statements, PLOS ONE, What Is Creating the Height Premium? PDF Implicit Bias - University of Michigan (2009, August). See everyone as the unique, individual soul they are, with their own opinions and emotions, and consider them on a personal level. Blog Can We Change Our Implicit Bias? | Psychology Today Accept the responsibility to identify and understand your implicit biases The table below presents the next steps you can take to confront your implicit biases and reduce stereotypic thinking. This content is owned by the AAFP. I would have described myself at that point as someone who is lacking in biases or prejudices of a racial nature. The idea is to develop algorithms that identify promising applicants by matching their qualities to those of past applicants who turned out to be successful employees. Learn more about Friends of the NewsHour. Although such cognitive processes help us efficiently sort and filter our perceptions, these reflexive biases also promote inconsistent decision making and, at worst, systematic errors in judgment. 1 Explicit biases, the attitudes and . But that wouldnt happen in viewing a white person do exactly the same action. You might then consider how the biased response could be avoided in the future and replace it with an unbiased response. When Parents Hurt Their Children's Self-Esteem. Gender bias occurs when people assume one gender is better suited for a particular job such as welding or babysitting regardless of an applicants experience level. But can they also learn? Implicit Bias (Unconscious Bias): Definition & Examples - Simply Psychology Three-quarters of friends with benefits either dissolve or change form in the span of one year. And these hidden attitudes known as implicit bias influence the way we act toward each other, often with unintended discriminatory consequences. If you have a different interpretation of an event, share your view as an alternative, not as a challenge to anothers perspective. Someone shares an experience that is unfamiliar or counters your own observations. One study found that a substantial number of medical students and residents held false beliefs about biological differences between white and black individuals (such as believing that black skin is tougher than white skin), and found that these beliefs predict racial bias in pain treatment recommendations. Alex has been on gabapentin 100 mg before bed for 18 months without change, and his physicians haven't increased or changed his medication to help with pain relief. Implicit bias occurs because of automatic thinking. Experience bias can lead us to overestimate how much others see things the same way we do, to believe that we are less vulnerable to bias than others, and to assume that our intentions are clear and obvious to others. Psychological Science, 30, 1362-1370. https://doi.org/10.1177/0956797619865183, Van Dessel, P., Ye, Y., & De Houwer, J. "This kind of research is essential in making . For example, the next time you interact with someone in a stereotyped group or observe societal stereotyping, such as through the media, recognize what responses are based on stereotypes, label those responses as stereotypical, and reflect on why the responses occurred. Break out of your usual routine: Join a club sports team or library book group; volunteer with a nonprofit in a different neighborhood; take part in different cultural celebrations (e.g., National Puerto Rican Day, Juneteenth, or Nowruz, the Iranian New Year). Addressing implicit bias is never easy. But it is worth a deeper dive because of its implications for patient treatment on both a personal and a health-care level, she says. And while these biases arent always negative, theyre shaped by a survival instinct that causes people to associate with people they perceive to be similar to them, because theyre deemed to be safe.. You could also survey your institution to make sure it is embracing multicultural (and not colorblind) messaging. This has had a major impact on the rate at which women have become instrumentalists in major symphony orchestras. Learn to slow down: Before interacting with people from certain groups, pause and reflect to reduce reflexive actions. As the writer Anais Nin is often credited with saying, We don't see things as they are, we see them as we are. To shed light on your potential blind spots and unconscious sorting protocols, we encourage you to take one or more implicit association tests. This article is the eighth in a series exploring the effects that unconscious racial biases have on the criminal justice system in the United States. Maintaining a powerful safety program is essential to the long-term health of your department, organization, or health care system and to ensuring that your patients receive the safe and reliable care they deserve. Corrice, A. Unconscious bias in faculty and leadership recruitment: A literature review. "The first step is awareness," says German Gomez, assistant general counsel of . This text told the alleged story that Gandhi prevented doctors from giving medication to his wife because of religious reasons and, as a result, his wife died. Four Ways Teachers Can Reduce Implicit Bias We're all subject to bias. Conscious, deliberative thinking minimizes and potentially disrupts the link between implicit biases and overt actions. How Meditation May Help Reduce Implicit Bias and Prejudice - Insider Adam Fingerhut and Nora A. Murphy, Department of Psychology, Loyola Marymount University 2017. Discovering a moderate to strong bias in favor of or against certain social identities can help you begin this critical step in self exploration and understanding.8 You can also complete this activity with your clinic staff and fellow physicians to uncover implicit biases as a group and set the stage for addressing them. But employers and others rarely forgo the opportunity to know the identity of the person theyre evaluating. / What we know comes from the rare occasions in which the effects of discretion elimination have been recorded and reported. Implicit Bias in Policies, Structures, and Norms. For instance, we might want to build arguments for why out-group members are trustworthy and repeatedly act in-line with this belief when seeing out-group members foster generalization. All these may seem reasonable, but theres no empirical demonstration that they work. The results, published in the journal Academic Emergency Medicine Education and Training, demonstrate how education can effectively change awareness and self-identification of bias, which could lead to reducing health disparities. Reflect on your biases and be proactive in identifying the negative stereotypes you have about others. Implicit bias is the unconscious collection of stereotypes and attitudes that we develop toward certain groups of people, which can affect our patient relationships and care decisions. In medical practice, these unconscious beliefs and stereotypes influence medical decision-making. The implications of conscious judgment being shaped in this way by an automatic, implicit process of which the perceiver is unaware can assume great importance in outcomes of interactions with police. Patient Safety Executive Development Program, Improvement Advisor Professional Development Programme, Stereotype replacement Recognizing that a response is based on stereotype and consciously adjusting the response, Counter-stereotypic imaging Imagining the individual as the opposite of the stereotype, Individuation Seeing the person as an individual rather than a stereotype (e.g., learning about their personal history and the context that brought them to the doctors office or health center), Perspective taking Putting yourself in the other persons shoes, Increasing opportunities for contact with individuals from different groups Expanding ones network of friends and colleagues or attending events where people of other racial and ethnic groups, gender identities, sexual orientation, and other groups may be present, Partnership building Reframing the interaction with the patient as one between collaborating equals, rather than between a high-status person and a low-status person. How to Reduce Implicit Bias - Institute for Healthcare Improvement An open-dialogue environment encourages communication. Research continues to reveal more about the nature and impacts of implicit bias something hidden from our direct awareness that causes tangible damage in many spheres of life, even for the very young.