The Effect of Implicit Bias and Role Misidentification in the Learning Environment.
Ontology highlight
ABSTRACT: Background
Little is known about the impact of implicit bias our trainees experience in the form of role misidentification in the clinical learning environment.Activity
We surveyed 540 residents and clinical medical students to determine the frequency and impact of role misidentification.Results and discussion
Most respondents (85%, n = 162) experienced role misidentification, directly resulting in heightened emotions that led to guarded behavior. An additional indirect impact for trainees is transmitted through frequent non-promotional role misidentification and personalizing the incidents. Women and trainees with marginalized identities had significant impacts. These findings present an opportunity to improve our understanding of the trainee experience.Supplementary information
The online version contains supplementary material available at 10.1007/s40670-021-01475-9.
SUBMITTER: Wilcox AR
PROVIDER: S-EPMC8814075 | biostudies-literature | 2022 Feb
REPOSITORIES: biostudies-literature
Publications
The Effect of Implicit Bias and Role Misidentification in the Learning Environment.
Wilcox Allison R AR Foster-Johnson Lynn L Pinto-Powell Roshini R
Medical science educator 20211201 1
<h4>Background</h4>Little is known about the impact of implicit bias our trainees experience in the form of role misidentification in the clinical learning environment.<h4>Activity</h4>We surveyed 540 residents and clinical medical students to determine the frequency and impact of role misidentification.<h4>Results and discussion</h4>Most respondents (85%, <i>n</i> = 162) experienced role misidentification, <i>directly</i> resulting in heightened emotions that led to guarded behavior. An additio ...[more]
Similar Datasets
Project description:ImportanceRacial implicit bias can contribute to health disparities through its negative influence on physician communication with Black patients. Interventions for physicians to address racial implicit bias in their clinical encounters are limited by a lack of high-fidelity (realistic) simulations to provide opportunities for skill development and practice.ObjectiveTo describe the development and initial evaluation of a high-fidelity simulation of conditions under which physicians might be influenced by implicit racial bias.Design, setting, and participantsThis cross-sectional study, performed on an online platform from March 1 to September 30, 2022, recruited a convenience sample of physician volunteers to pilot an educational simulation.ExposuresIn the simulation exercise, physicians saw a 52-year-old male standardized patient (SP) (presenting as Black or White) seeking urgent care for epigastric pain, nausea, and vomiting. The case included cognitive stressors common to clinical environments, including clinical ambiguity, stress, time constraints, and interruptions. Physicians explained their diagnosis and treatment plan to the SP, wrote an assessment and management plan, completed surveys, and took the Race Implicit Association Test (IAT) and Race Medical Cooperativeness IAT. The SPs, blinded to the purpose of the study, assessed each physician's communication using skills checklists and global rating scales.Main outcomes and measuresAssociation between physicians' IAT scores and SP race with SP ratings of communication skills.ResultsIn 60 physicians (23 [38.3%] Asian, 4 [6.7%] Black, 23 [38.3%] White, and 10 [16.7%] other, including Latina/o/x, Middle Eastern, and multiracial; 31 [51.7%] female, 27 [45.0%] male, and 2 [3.3%] other), the interaction of physicians' Race IAT score and SP race was significant for overall communication (mean [SD] β = -1.29 [0.41]), all subdomains of communication (mean [SD] β = -1.17 [0.52] to -1.43 [0.59]), and overall global ratings (mean [SD] β = -1.09 [0.39]). Black SPs rated physicians lower on communication skills for a given pro-White Race IAT score than White SPs; White SP ratings increased as physicians' pro-White bias increased.Conclusions and relevanceIn this cross-sectional study, a high-fidelity simulation calibrated with cognitive stressors common to clinical environments elicited the expected influence of racial implicit bias on physicians' communication skills. The outlined process and preliminary results can inform the development and evaluation of interventions that seek to address racial implicit bias in clinical encounters and improve physician communication with Black patients.
| S-EPMC10955368 | biostudies-literature
Project description:IntroductionStudents desire instruction in skill development to address both their own implicit biases and bias perceived in the learning environment. Curricula to date achieve strategy identification through reflection and discussion but do not provide opportunity for personally relevant skill development and practice in implicit bias recognition and management. To address this gap, we developed and evaluated a skills-based elective in implicit bias recognition and management focused on learners' own interpersonal interactions, including patient encounters, and perceived bias in the learning environment.MethodFifteen first-year medical students completed the nine-session elective over three annual offerings. Each session lasted 1.5 hours. Curriculum development was informed by published frameworks and transformative learning theory. Direct observation of student performances in role-plays and other active learning exercises constituted the formative assessment. Program evaluation focused on the impact of instruction through pre- and posttests, along with analysis of notes taken by the investigative team, including notes on formative assessments.ResultsStudents engaged with all aspects of instruction, including role-plays. Pretest/posttest results demonstrated increased self-reported knowledge and comfort in addressing perceived bias. Formative assessment demonstrated students' skill development in safely and respectfully addressing perceived bias in the learning environment without endangering their relationships with supervisors.DiscussionSkills developed-addressing bias in interpersonal encounters and perceived bias in clinical and teaching encounters-are relevant to learners throughout their careers. This course is relevant to medical students and trainees at various experience levels and could serve as a template for novel, skills-based curricula across health professions.
| S-EPMC8275619 | biostudies-literature
Project description:SignificancePublic databases are an important resource for machine learning research, but their growing availability sometimes leads to "off-label" usage, where data published for one task are used for another. This work reveals that such off-label usage could lead to biased, overly optimistic results of machine-learning algorithms. The underlying cause is that public data are processed with hidden processing pipelines that alter the data features. Here we study three well-known algorithms developed for image reconstruction from magnetic resonance imaging measurements and show they could produce biased results with up to 48% artificial improvement when applied to public databases. We relate to the publication of such results as implicit "data crimes" to raise community awareness of this growing big data problem.
| S-EPMC9060447 | biostudies-literature
Project description:Background Medical students from racially minoritized backgrounds receive negative evaluations more frequently, possibly from implicit bias. Objective To determine if a preference for White applicants over Asian and Black applicants exists among resident and attending reviewers of obstetrics and gynecology (OB/GYN) residency applications. Methods In 2021, we sampled academic OB/GYN physicians from 6 academic institutions to randomly receive questionnaire form A or B, each containing 4 contrived Electronic Residency Application Service profiles stratified by United States Medical Licensing Examination scores; institutions attended; and strength of recommendation letters into top-, mid-, and low-tiers. Form A applicants were White top-tier, White mid-tier without resilience, Asian mid-tier with resilience, and White low-tier. Form B applicants were Black top-tier, Asian mid-tier without resilience, White mid-tier with resilience, and White low-tier applicants. Both questionnaires' profiles were identical except for applicants' names and races. The primary outcome was participants' rankings of applicants from most to least desirable. Baseline characteristics of participants were compared with chi-square tests. Rankings were compared using generalized estimating equations to calculate the odds ratio (significance P<.05). Results One hundred and ninety-one were invited to participate; 109 participants started the questionnaire, and 103 ranked applicants (response rate 54%). Fifty-three participants completed form A, and 56 completed form B. No significant differences were found in participants' demographics. Participants frequently ranked White applicants significantly more highly than Black applicants (-3.3, 95% CI -3.5, -3.1) and Asian applicants (-3.3, 95% CI -3.5, -3.1). Conclusions Despite identical qualifications, a stronger preference for White applicants over Black or Asian applicants was found.
| S-EPMC11475431 | biostudies-literature
Project description:IntroductionSimulation is a valuable and novel tool in the expanding approach to racism and bias education for medical practitioners. We present a simulation case focused on identifying and addressing the implicit bias of a consultant to teach bias mitigation skills and limit harm to patients and families.MethodsLearners were presented with a case of a classic toddler's fracture in an African American child. The learners interacted with an orthopedic resident who insisted on child welfare involvement, with nonspecific and increasingly biased concerns about the child/family. The learners were expected to identify that this case was not concerning for nonaccidental trauma and that the orthopedic resident was demonstrating bias. They were expected to communicate with both the resident and the parent effectively to defuse the situation and prevent harm from reaching the family. A debrief and an anonymous survey followed the case.ResultsSeventy-five learners participated, including pediatric and emergency medicine residents, fellows, attendings, and medical students. After the case, the majority of learners expressed confidence that they could recognize racial bias in the care of a patient (90%), ensure patient care was not influenced by racial bias (88%), and utilize a tool to frame a concern about bias (79%).DiscussionParticipants felt that this simulation was relevant and effective and overall left the experience feeling confident in their abilities to identify and manage racially biased patient care. This anti-racist simulation offers an important skill-building opportunity that has been well received by learners.
| S-EPMC10507144 | biostudies-literature
Project description:Knowledge without awareness, or implicit knowledge, influences a variety of behaviors. It is unknown however, whether implicit knowledge of statistical structure informs visual perceptual decisions or whether explicit knowledge of statistical probabilities is required. Here, we measured visual decision-making performance using a novel task in which humans reported the orientation of two differently colored translational Glass patterns; each color associated with different orientation probabilities. The task design allowed us to assess participants' ability to learn and use a general orientation prior as well as a color specific feature prior. Classifying decision-makers based on a questionnaire revealed that both implicit and explicit learners implemented a general orientation bias by adjusting the starting point of evidence accumulation in the drift diffusion model framework. Explicit learners additionally adjusted the drift rate offset. When subjects implemented a stimulus specific bias, they did so by adjusting primarily the drift rate offset. We conclude that humans can learn priors implicitly for perceptual decision-making and depending on awareness implement the priors using different mechanisms.
| S-EPMC8379185 | biostudies-literature
Project description:BackgroundImplicit negative attitudes towards other races are important in certain kinds of prejudicial social behaviour. Emotional mechanisms are thought to be involved in mediating implicit "outgroup" bias but there is little evidence concerning the underlying neurobiology. The aim of the present study was to examine the role of noradrenergic mechanisms in the generation of implicit racial attitudes.MethodsHealthy volunteers (n = 36) of white ethnic origin, received a single oral dose of the β-adrenoceptor antagonist, propranolol (40 mg), in a randomised, double-blind, parallel group, placebo-controlled, design. Participants completed an explicit measure of prejudice and the racial implicit association test (IAT), 1-2 h after propranolol administration.ResultsRelative to placebo, propranolol significantly lowered heart rate and abolished implicit racial bias, without affecting the measure of explicit racial prejudice. Propranolol did not affect subjective mood.ConclusionsOur results indicate that β-adrenoceptors play a role in the expression of implicit racial attitudes suggesting that noradrenaline-related emotional mechanisms may mediate negative racial bias. Our findings may also have practical importance given that propranolol is a widely used drug. However, further studies will be needed to examine whether a similar effect can be demonstrated in the course of clinical treatment.
| S-EPMC3395337 | biostudies-literature
Project description:The aim of the study was to explore the nature of the gender-congruency effect, characterized by a facilitation on the processing of congruent words in grammatical gender. Moreover, we explored whether resemblances between gender identities and gender attitudes with grammatical gender modulated lexical processing. We designed a gender-priming paradigm in Spanish, in which participants decided the gender of a masculine or feminine pronoun preceded by three different primes: biological gender nouns (mapping biological sex), stereotypical nouns (mapping biological and stereotypical information), and epicene nouns (arbitrary gender assignment). We found faster processing of gender congruent pronouns independently of the type of prime, showing that the grammatical gender feature is active even when processing bare nouns that are not conceptually related to gender. This indicates that the gender-congruency effect is driven by the activation of the gender information at the lexical level, which is transferred to the semantic level. Interestingly, the results showed an asymmetry for epicene primes: the gender-congruency effect was smaller for epicene primes when preceding the feminine pronoun, probably driven by the grammatical rule of the masculine being the generic gender. Furthermore, we found that masculine oriented attitudes can bias language processing diminishing the activation of feminine gender, which ultimately could overshadow the female figure.
| S-EPMC10242114 | biostudies-literature
Project description:Although a greater degree of personal obesity is associated with weaker negativity toward overweight people on both explicit (i.e., self-report) and implicit (i.e., indirect behavioral) measures, overweight people still prefer thin people on average. We investigated whether the national and cultural context - particularly the national prevalence of obesity - predicts attitudes toward overweight people independent of personal identity and weight status. Data were collected from a total sample of 338,121 citizens from 71 nations in 22 different languages on the Project Implicit website (https://implicit.harvard.edu/) between May 2006 and October 2010. We investigated the relationship of the explicit and implicit weight bias with the obesity both at the individual (i.e., across individuals) and national (i.e., across nations) level. Explicit weight bias was assessed with self-reported preference between overweight and thin people; implicit weight bias was measured with the Implicit Association Test (IAT). The national estimates of explicit and implicit weight bias were obtained by averaging the individual scores for each nation. Obesity at the individual level was defined as Body Mass Index (BMI) scores, whereas obesity at the national level was defined as three national weight indicators (national BMI, national percentage of overweight and underweight people) obtained from publicly available databases. Across individuals, greater degree of obesity was associated with weaker implicit negativity toward overweight people compared to thin people. Across nations, in contrast, a greater degree of national obesity was associated with stronger implicit negativity toward overweight people compared to thin people. This result indicates a different relationship between obesity and implicit weight bias at the individual and national levels.
| S-EPMC3866190 | biostudies-literature
Project description:Implicit racial bias remains widespread, even among individuals who explicitly reject prejudice. One reason for the persistence of implicit bias may be that it is maintained through structural and historical inequalities that change slowly. We investigated the historical persistence of implicit bias by comparing modern implicit bias with the proportion of the population enslaved in those counties in 1860. Counties and states more dependent on slavery before the Civil War displayed higher levels of pro-White implicit bias today among White residents and less pro-White bias among Black residents. These associations remained significant after controlling for explicit bias. The association between slave populations and implicit bias was partially explained by measures of structural inequalities. Our results support an interpretation of implicit bias as the cognitive residue of past and present structural inequalities.
| S-EPMC6575576 | biostudies-literature