a Department of Medicine , Albert Einstein College of Medicine/Montefiore Medical Center, Bronx , New York , New York , USA.
Teach Learn Med. 2014;26(1):64-71. doi: 10.1080/10401334.2013.857341.
The varying treatment of different patients by the same physician are referred to as within provider disparities. These differences can contribute to health disparities and are thought to be the result of implicit bias due to unintentional, unconscious assumptions.
The purpose is to describe an educational intervention addressing both health disparities and physician implicit bias and the results of a subsequent survey exploring medical students' attitudes and beliefs toward subconscious bias and health disparities.
A single session within a larger required course was devoted to health disparities and the physician's potential to contribute to health disparities through implicit bias. Following the session the students were anonymously surveyed on their Implicit Association Test (IAT) results, their attitudes and experiences regarding the fairness of the health care system, and the potential impact of their own implicit bias. The students were categorized based on whether they disagreed ("deniers") or agreed ("accepters") with the statement "Unconscious bias might affect some of my clinical decisions or behaviors." Data analysis focused specifically on factors associated with this perspective.
The survey response rate was at least 69%. Of the responders, 22% were "deniers" and 77% were "accepters." Demographics between the two groups were not significantly different. Deniers were significantly more likely than accepters to report IAT results with implicit preferences toward self, to believe the IAT is invalid, and to believe that doctors and the health system provide equal care to all and were less likely to report having directly observed inequitable care.
The recognition of bias cannot be taught in a single session. Our experience supports the value of teaching medical students to recognize their own implicit biases and develop skills to overcome them in each patient encounter, and in making this instruction part of the compulsory, longitudinal undergraduate medical curriculum.
同一医生对不同患者的治疗方式存在差异，这种差异被称为提供者内部差异。这些差异可能导致健康差异，并被认为是由于无意识的、无意识的假设而产生的隐性偏见的结果。
本研究旨在描述一种针对健康差异和医生隐性偏见的教育干预措施，并探讨随后的一项调查，该调查探讨了医学生对潜意识偏见和健康差异的态度和信念。
在一门更大的必修课程中，专门安排了一个单元来讨论健康差异和医生通过隐性偏见导致健康差异的可能性。在课程结束后，学生们匿名接受了关于他们的内隐联想测验（IAT）结果、他们对医疗保健系统公平性的态度和经验以及他们自身隐性偏见潜在影响的调查。学生们根据他们是否不同意（“否认者”）或同意（“接受者”）“无意识偏见可能会影响我的一些临床决策或行为”这一说法进行分类。数据分析专门针对与这种观点相关的因素。
调查的回复率至少为 69%。在回答者中，22%是“否认者”，77%是“接受者”。两组之间的人口统计学特征没有显著差异。与接受者相比，否认者更有可能报告对自己有隐性偏好的 IAT 结果，认为 IAT 无效，并且认为医生和医疗系统为所有人提供平等的护理，而不太可能报告直接观察到不平等的护理。
在一个单一的课程中无法教授偏见的识别。我们的经验支持教授医学生识别自己的隐性偏见并在每次患者接触中发展克服偏见的技能的价值，并将这一指导作为必修的、纵向的本科医学课程的一部分。
