Developing an Implicit Bias Curriculum: Six point Framework
John Gilboy, MS4 Tufts Maine Track.
Implicit bias has been shown to impact clinical decision-making and patient outcomes.1 In addition to clinical outcomes, bias among health care professionals has been linked to the gender gap within health care leadership and specialties. 2 While exploring health care disparities has been a focus in all levels of medical education, few educational interventions have adequately addressed recognition bias. Below is a six-point framework described by Sukhera et al to implement an implicit-bias-informed educational curriculum for health care provider.
Six Point Framework3
- Creating a safe and nonthreatening learning context
Addressing bias in an educational setting is both risky and challenging for learners and educators. Often instructors and learners can be reluctant to recognize and disclose biases. However, by emphasizing and reinforcing that bias is pervasive in society and that only through explicit recognition is removal possible, learners will be more willing to reflect on personal practices and potential biases. When designing interventions, optimize learner and instructor characteristics to encourage safe and constructive discussion. Instructors should be approachable, nonthreatening, knowledgeable, and supportive of a safe nonjudgmental learning environment.
- Increasing knowledge about the science of implicit bias
When addressing implicit bias recognition, include descriptions of the psychological and neurobiological components of bias and the cognitive science at the root of implicit biases. Discussing the scientific foundation of implicit bias will contextualize the pervasiveness of bias among both caregivers and patients. It also allows for discussion of the different types of biases.
- Emphasizing how implicit bias influences behavior and patient outcomes
Emphasizing how implicit bias impacts clinical decisions and patient care is integral to this framework because it enables the instructor to align the educational intervention with health dipartites. It also facilitates discussion on the visible and invisible sociocultural forces that affect our interactions with colleagues, patient, and healthcare outcomes. When discussing with clinical learners, instructors are encouraged to compare bias to heuristic principles in clinical decision making to further highlight the effect on patient care.
- Increasing self-awareness of existing bias
Implicit association test (IAT) is a computer based exercise that aims to assess a person’s automatic associations between words and pictures. Through utilization implicit association tests, instructors hope to spark discussion and self-inventory among learners. Additional techniques to increase awareness of biases work by enhancing reflective capability. Such techniques include an identity exercises in which a learner discusses the dominant and non-dominant cultures to which they belong.
- Improve conscious efforts to overcome bias
Once identified, instructors show learners how to apply conscious effort in order to negate implicit bias in their decision-making and behaviors. Strategies discussed with learners include metacognitive strategies, which incorporate self-regulation, self-monitoring, and mindfulness training. Learners should be encouraged to set goals and longitudinal checkpoints over time to facilitate self-monitoring and reflection.
- Enhance awareness of how implicit bias influences others
In conjunction with encouraging self-reflection, instructors illustrate the role that implicit bias plays in communication, rapport building, and empathy. Research has demonstrated that awareness of cognitive and affective components of empathy protects against the implicit bias formation and negative care effects. While social-contact-based interventions may be powerful, they can be difficult to manage in a group setting, particularly in groups with hierarchical power dynamics, and require an experienced instructor.
Figure 1 . Framework to integrate implicit bias recognition and management into health professions curricula, as proposed by the authors. The framework includes six key features: creating a safe and nonthreatening learning context, increasing knowledge about the science of implicit bias, emphasizing how implicit bias influences behaviors and patient outcomes, increasing self-awareness of existing implicit biases, improving conscious efforts to overcome implicit bias, and enhancing awareness of how implicit bias influences others. Under each key feature are a few examples of elements or strategies that should be incorporated into each category; for example, another strategy for increasing self-awareness of existing implicit biases is the use of facilitated discussions on how bias impacts care. Abbreviation: IAT indicates implicit association test.3
For more detailed explanation of framework: Framework article
To take implicit association test: https://implicit.harvard.edu/implicit/takeatest.html
1) Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28:1504–1510.
2) Girod S, Fassiotto M, Grewal D, et al. Reducing Implicit Gender Leadership Bias in Academic Medicine With an Educational Intervention. Academic medicine: journal of the Association of American Medical Colleges. 2016;91(8):1143–1150
3) Sukhera, Javeed, and Chris Watling. “A Framework for Integrating Implicit Bias Recognition Into Health Professions Education.” Academic Medicine, vol. 93, no. 1, 2018, pp. 35–40., doi:10.1097/acm.0000000000001819.