C.M. Gonzalez is professor of medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
S.A. Walker is a medical student, Oregon Health and Sciences University School of Medicine, Portland, Oregon.
Acad Med. 2020 Dec;95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments):S150-S155. doi: 10.1097/ACM.0000000000003697.
Students perceive bias in learning environments. Curricula targeting implicit bias recognition and management increase student awareness and achieve strategy identification, but fall short of actual skill development to address bias. In light of this gap, the authors developed and evaluated a skills-based elective to recognize and manage implicit bias in the learning environment.
Nine 1.5-hour sessions were delivered to 15 first-year medical students from 2017 to 2019. An evidence-based conceptual framework and transformative learning theory informed the instructional design; it incorporated active learning exercises. Skills assessment occurred through direct observation of student performances in role-play exercises. Using thematic analysis, the authors conducted a program evaluation based on focus groups with students and data from notes taken by the investigative team.
Students engaged with all aspects of instruction, including role-plays. Authors identified 3 themes from the program evaluation: (1) Student engagement can be enhanced, (2) Instruction is empowering, and (3) It (addressing bias in one's own and witnessed encounters) can be done! Analysis additionally highlighted opportunities for improvement and lessons learned.
This innovative course achieved skill development and practice for medical students in implicit bias recognition and management as it pertains to 3 facets of clinical care present at every stage of a health professional's career. These include interpersonal encounters, advocating for patients when bias is perceived in witnessed encounters with peers and supervisors, and addressing comments made by others within the learning environment. Outcomes could inform novel, skills-based curricula across the spectrum of health professions training and practice.
学生在学习环境中能够察觉到偏见。针对隐性偏见识别和管理的课程可以提高学生的意识,并帮助学生确定策略,但无法真正培养学生处理偏见的实际技能。鉴于这一差距,作者开发并评估了一门基于技能的选修课程,以帮助学生识别和管理学习环境中的隐性偏见。
从 2017 年到 2019 年,作者向 15 名一年级医学生教授了 9 个 1.5 小时的课程。一个基于证据的概念框架和变革性学习理论为教学设计提供了信息;它结合了主动学习练习。技能评估是通过观察学生在角色扮演练习中的表现来进行的。作者通过学生焦点小组和调查团队记录的数据,采用主题分析方法,对课程进行了评估。
学生参与了教学的各个方面,包括角色扮演。作者从课程评估中确定了 3 个主题:(1)可以提高学生的参与度,(2)教学具有赋权作用,(3)可以做到(在自己和目睹的遭遇中处理偏见)!分析还突出了改进的机会和经验教训。
这门创新性课程实现了医学生隐性偏见识别和管理技能的发展和实践,涵盖了临床护理的 3 个方面,存在于医疗保健专业人员职业生涯的各个阶段。这包括人际互动、在与同事和导师目睹的遭遇中察觉到偏见时为患者辩护、以及在学习环境中处理他人的评论。其结果可以为健康专业培训和实践的各个领域的新型基于技能的课程提供信息。