#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Pre-clinical medical student reflections on implicit bias: Implications for learning and teaching


Autoři: Christine Motzkus aff001;  Racquel J. Wells aff002;  Xingyue Wang aff003;  Sonia Chimienti aff004;  Deborah Plummer aff005;  Janice Sabin aff006;  Jeroan Allison aff007;  Suzanne Cashman aff008
Působiště autorů: Clinical and Population Health Research, University of Massachusetts Medical School, Worcester, MA, United States of America aff001;  Division of Nephrology, Duke University, Durham, NC, United States of America aff002;  Department of Family Medicine, University of Washington Medical School, Seattle, WA, United States of America aff003;  Office of Student Affairs, University of Massachusetts Medical School, Worcester, MA, United States of America aff004;  Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States of America aff005;  Department of Biomedical Informatics and Medical Education, University of Washington, School of Medicine, Seattle, WA, United States of America aff006;  Department of Population and Quantitative Health Sciences University of Massachusetts Medical School, Worcester, MA, United States of America aff007;  Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, United States of America aff008
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0225058

Souhrn

Context

Implicit bias affects health professionals’ clinical decision-making; nevertheless, published reports of medical education curricula exploring this concept have been limited. This research documents a recent approach to teaching implicit bias.

Methods

Medical students matriculating during 2014 and 2015 participated in a determinants of health course including instruction about implicit bias. Each submitted a reflective essay discussing implicit bias, the experience of taking the Implicit Association Test (IAT), and other course content. Using grounded theory methodology, student essays that discussed reactions to the IAT were analyzed for content themes based on specific statements mapping to each theme. Twenty-five percent of essays underwent a second review to calculate agreement between raters regarding identification of statements mapping to themes.

Outcome

Of 250 essays, three-quarters discussed students’ results on the IAT. Theme comments related to: a) experience taking the IAT, b) bias in medicine, and c) prescriptive comments. Most of the comments (84%) related to students’ acknowledging the importance of recognizing implicit bias. More than one-half (60%) noted that bias affects clinical decision-making, and one-fifth (19%) stated that they believe it is the physician’s responsibility to advocate for dismantling bias.

Conclusions

Through taking the IAT and developing an understanding of implicit bias, medical students can gain insight into the effect it may have on clinical decision-making. Having pre-clinical medical students explore implicit bias through the IAT can lay a foundation for discussing this very human tendency.

Klíčová slova:

Decision making – Medical education – Medicine and health sciences – Patient advocacy – Patients – Physicians – Professions – Reflection


Zdroje

1. Banaji MR, Greenwald AG. 2016. Blindspot: Hidden biases of good people. New York (NY): Bantam.

2. Greenwald A, Banaji M. The Implicit Revolution: Reconceiving the Relation Between Conscious and Unconscious. Am Psychol. 2017(72):861–871.

3. Perry SP, Murphy MC, Dovidio JF. 2015. Modern prejudice: Subtle, but unconscious? the role of bias awareness in whites' perceptions of personal and others' biases. J Exp Soc Psychol. 61:64–78.

4. Kirwan Institute for the Study of Race and Ethnicity The Ohio State University. Unconscious Bias in Academic Medicine: How the Prejudices We Don’t Know We Have Affect Medical Education, Medical Careers, and Patient Health. http://kirwaninstitute.osu.edu/. Published 2017. Accessed October 15, 2018.

5. Greenwald AG, Banaji MR. 1995. Implicit Social Cognition: Attitudes, Self-Esteem, and Stereotypes. Psychol Rev. 102(1):4–27. doi: 10.1037/0033-295x.102.1.4 7878162

6. Gonzalez CM, Kim MY, Marantz PR. 2014. Implicit bias and its relation to health disparities: A teaching program and survey of medical students. Teach Learn Med. 26(1):64–71. doi: 10.1080/10401334.2013.857341 24405348

7. Teal CR, Gill AC, Green AR. Crandall S. 2012. Helping medical learners recognize and manage unconscious bias toward certain patient groups. Med Educ. 46(1):80–88. doi: 10.1111/j.1365-2923.2011.04101.x 22150199

8. Sabin JA, Rivara FP, Greenwald AG. 2008. Physician implicit attitudes and stereotypes about race and quality of medical care. Med Care. 46(7):678–685. doi: 10.1097/MLR.0b013e3181653d58 18580386

9. Howell JL, Ratliff KA. 2017. Not your average bigot: The better‐than‐average effect and defensive responding to Implicit Association Test feedback. Br J Soc Psychol. 56(1):125–145. doi: 10.1111/bjso.12168 27709628

10. Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, Iezzoni Li et al. 2007. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J G Intern Med. 22(9):1231–1238.

11. Cooper LA, Roter DL, Carson KA, Beach MC, Sabin JA, Greenwald AG et al. 2012. The associations of clinicians' implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 102(5):979–987. doi: 10.2105/AJPH.2011.300558 22420787

12. Dovidio JF, Fiske ST. 2012. Under the radar: How unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities. Am J Public Health. 102(5):945–952. doi: 10.2105/AJPH.2011.300601 22420809

13. Sabin JA, Greenwald AG. 2012. The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: Pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. Am J Public Health. 102(5):988–995. doi: 10.2105/AJPH.2011.300621 22420817

14. Burgess DJ. 2010. Are providers more likely to contribute to healthcare disparities under high levels of cognitive load? how features of the healthcare setting may lead to biases in medical decision making. Med Decis Making. 30(2):246–257. doi: 10.1177/0272989X09341751 19726783

15. Greenwald A., McGhee D., Schwartz J., 1998. Measuring Individual Differences in Implicit Cognition: The Implicit Association Test. Journal of Personality and Social Psychology. 74(6):1464–1480 doi: 10.1037//0022-3514.74.6.1464 9654756

16. van Ryn M, Saha S. 2011. Exploring unconscious bias in disparities research and medical education. JAMA. 306(9):995–996. doi: 10.1001/jama.2011.1275 21900142

17. Sukhera J, Milne A, Teunissen PW, Lingard L, Watling C. 2018. The actual versus idealized self: Exploring responses to feedback about implicit bias in health professionals. Acad Med. 93(4):623–629. doi: 10.1097/ACM.0000000000002006 29140915

18. Sukhera J, Watling C. 2018. A framework for integrating implicit bias recognition into health professions education. Acad Med. 93(1):35–40. doi: 10.1097/ACM.0000000000001819 28658015

19. Hernandez RA, Haidet P, Gill AC, Teal CR. 2013. Fostering students' reflection about bias in healthcare: Cognitive dissonance and the role of personal and normative standards. Med Teach. 35(4):1082–1089.

20. Sandars J. The use of reflection in medical education: AMEE guide no. 44. 2009. Med Teach. 31(8):685–695. 19811204

21. Mann K, Gordon J, MacLeod A. 2009. Reflection and reflective practice in health professions education: A systematic review. Adv Health Sci Educ. 14(4):595–621.

22. Thompson BM, Teal CR, Rogers JC, Paterniti DA, Haidet P. 2010. Ideals, activities, dissonance, and processing: A conceptual model to guide educators’ efforts to stimulate student reflection. Acad Med. 85(5):902–908. doi: 10.1097/ACM.0b013e3181d7423b 20520048

23. Sukhera J, Wodzinski M, Milne A, Teunissen PW, Lingard L, Watling C. 2019. Implicit Bias and the Feedback Paradox: Exploring How Health Professionals Engage With Feedback While Questioning Its Credibility. Acad Med. 94(8):1204–1210. doi: 10.1097/ACM.0000000000002782 31045605

24. Strauss A, Corbin J. 1994. Grounded theory methodology. Handbook of qualitative research. 17:273–285.

25. Ely J, Graber M, Croskerry P. 2011. Checklists to Reduce Diagnostic Errors. Acad Med. 86(3):307–313. doi: 10.1097/ACM.0b013e31820824cd 21248608

26. University of Massachusetts Medical School. UMMS competencies for medical education. [cited 2018 Nov 20]. Available from: www.umassmed.edu/oume/oume/umms-competencies-for-medical-education1.

27. Bhate T, Loh L. 2015. Building a generation of physician advocates: The case for including mandatory training in advocacy in Canadian medical school curricula. Acad Med. 90(12):1602–1606. doi: 10.1097/ACM.0000000000000841 26200573

28. Kanter SL. 2011. On physician advocacy. Acad Med. 86(9):1059–1060. doi: 10.1097/ACM.0b013e318227744d 21865891

29. Huddle TS. Perspective: 2011. Medical professionalism and medical education should not involve commitments to political advocacy. Acad Med. 86(3):378–383. doi: 10.1097/ACM.0b013e3182086efe 21248605

30. Tsai J, Ucik L, Baldwin N, Hasslinger C, George P. 2016. Race matters? examining and rethinking race portrayal in preclinical medical education. Acad Med. 91(7):916–920. doi: 10.1097/ACM.0000000000001232 27166865

31. Finucane TE, Carrese JA. 1990. Racial bias in presentation of cases. J Gen Intern Med. 5(2):120–121. doi: 10.1007/bf02600511 2313403

32. Martin GC, Kirgis J, Sid E, Sabin JA. 2016. Equitable Imagery in the Preclinical Medical School Curriculum: Findings from One Medical School. Acad Med. 91(7):1002–1006 doi: 10.1097/ACM.0000000000001105 26839941

33. Gaufberg EH, Batalden M, Sands R, Bell SK. 2010. The hidden curriculum: What can we learn from third-year medical student narrative reflections? Acad Med. 85(11):1709–1716. doi: 10.1097/ACM.0b013e3181f57899 20881818

34. Hojat M, Vergare MJ, Maxwell K, et al. 2009. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med. 84(9):1182–1191. doi: 10.1097/ACM.0b013e3181b17e55 19707055

35. Newton BW, Barber L, Clardy J, Cleveland E, O'Sullivan P. 2008. Is there hardening of the heart during medical school? Acad Med. 83(3):244–249. doi: 10.1097/ACM.0b013e3181637837 18316868

36. Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. 2013. Teaching empathy to medical students: An updated, systematic review. Acad Med. 88(8):1171–1177. doi: 10.1097/ACM.0b013e318299f3e3 23807099

37. van Ryn M, Hardeman R, Phelan SM, Burgess DJ, Dovidio JF, Herrin J et al. 2015. Medical school experiences associated with change in implicit racial bias among 3547 students: A medical student CHANGES study report. J Gen Intern Med. 30(12):1748–1756. doi: 10.1007/s11606-015-3447-7 26129779

38. Social determinants of health. [cited 2018 Oct 15]. Available from: https://www.who.int/social_determinants/en/.

39. Arkes HR, Tetlock PE. 2004. Attributions of implicit prejudice, or "would Jesse Jackson 'fail' the implicit association test?" Psychological Inquiry. 15(4):257–278.

40. Greenwald AG, Poehlman TA, Uhlmann EL, Banaji MR. 2009. Understanding and using the implicit association test: III. meta-analysis of predictive validity. J Pers Soc Psychol. 97(1):17–41. doi: 10.1037/a0015575 19586237


Článek vyšel v časopise

PLOS One


2019 Číslo 11
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

KOST
Koncepce osteologické péče pro gynekology a praktické lékaře
nový kurz
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Svět praktické medicíny 5/2023 (znalostní test z časopisu)

Imunopatologie? … a co my s tím???
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#