Zeidan Amy J, Khatri Utsha G, Aysola Jaya, Shofer Frances S, Mamtani Mira, Scott Kevin R, Conlon Lauren W, Lopez Bernard L
Department of Emergency Medicine Hospital of the University of Pennsylvania Philadelphia PA.
Division of General Internal Medicine Department of Medicine Perelman School of Medicine Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.
AEM Educ Train. 2018 Sep 24;3(1):81-85. doi: 10.1002/aet2.10124. eCollection 2019 Jan.
Prior research suggests that health care providers are susceptible to implicit biases, specifically prowhite biases, and that these may contribute to health care disparities by influencing physician behavior. Despite these findings, implicit bias training is not currently embedded into emergency medicine (EM) residency training and few studies exist that evaluate the effectiveness of implicit bias training on awareness during residency conference. We sought to conduct a mixed-methods program evaluation of a formalized educational intervention targeted on the topic of implicit bias.
We used a design thinking framework to develop a curricular intervention. The intervention consisted of taking the Harvard Implicit Association Test (IAT) on race to introduce the concept of implicit bias, followed by a facilitated discussion to explore participant's perceptions on whether implicit bias may lead to variations in care. The facilitated discussion was audio recorded, transcribed, and coded for emerging themes. An online survey assessed participant awareness of these topics before and after the intervention and was analyzed using paired t-tests.
After the intervention, participant's awareness of their individual implicit biases increased by 33.3% (p = 0.003) and their awareness of how their IAT results influences how they deliver care to patients increased by 9.1% (p = 0.03). Emerging themes included skepticism of the implicit bias test results with the desire to have "neutral" results, acknowledgment that pattern recognition may lead to "blind spots" in care, recognition that bias exists on a personal and systemic level, and interest in regular educational interventions to address implicit bias.
This novel educational intervention on implicit bias resulted in improvement in participants' awareness of their implicit biases and how it may affect their patient care. Our intervention can serve as a model for other residency programs to develop and implement an intervention to create awareness of implicit bias and its potential impact on patient care.
先前的研究表明，医疗保健提供者容易受到隐性偏见的影响，特别是亲白人偏见，并且这些偏见可能通过影响医生的行为导致医疗保健差距。尽管有这些发现，但目前隐性偏见培训并未纳入急诊医学（EM）住院医师培训中，而且很少有研究评估隐性偏见培训在住院医师会议期间对意识提升的有效性。我们试图对一项针对隐性偏见主题的正式教育干预措施进行混合方法的项目评估。
我们使用设计思维框架来开发课程干预措施。该干预措施包括进行关于种族的哈佛隐性联想测试（IAT）以引入隐性偏见的概念，随后进行引导式讨论，以探讨参与者对隐性偏见是否可能导致护理差异的看法。引导式讨论进行了录音、转录，并对出现的主题进行编码。一项在线调查评估了干预前后参与者对这些主题的认识，并使用配对t检验进行分析。
干预后，参与者对自身隐性偏见的认识提高了33.3%（p = 0.003），他们对IAT结果如何影响其对患者的护理的认识提高了9.1%（p = 0.03）。出现的主题包括对隐性偏见测试结果的怀疑以及希望得到“中立”结果，承认模式识别可能导致护理中的“盲点”，认识到个人和系统层面都存在偏见，以及对定期教育干预以解决隐性偏见的兴趣。
这项关于隐性偏见的新型教育干预措施提高了参与者对自身隐性偏见及其可能对患者护理产生的影响的认识。我们的干预措施可以作为其他住院医师项目开发和实施干预措施以提高对隐性偏见及其对患者护理潜在影响的认识的典范。
