Gonzalez Cristina M, Noah Yuliana S, Correa Nereida, Archer-Dyer Heather, Weingarten-Arams Jacqueline, Sukhera Javeed
Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.
Department of Pediatrics, Jacobi Medical Center, Bronx, NY, USA.
Med Educ. 2021 Jun;55(6):741-748. doi: 10.1111/medu.14468. Epub 2021 Feb 24.
Health professions educators use the Implicit Association Test (IAT) to raise awareness of implicit bias in learners, often engendering strong emotional reactions. Once an emotional reaction ensues, the gap between learner reaction and strategy identification remains relatively underexplored. To better understand how learners may identify bias mitigation strategies, the authors explored perspectives of medical students during the clinical portion of their training to the experience of taking the IAT, and the resulting feedback.
Medical students in Bronx, NY, USA, participated in one 90-minute session on implicit bias. The focus of analysis for this study is the post-session narrative assignment inviting them to take the race-based IAT and describe both their reaction to and the implications of their IAT results on their future work as physicians. The authors analysed 180 randomly selected de-identified essays completed from 2013 to 2019 using an approach informed by constructivist grounded theory methodology.
Medical students with clinical experience respond to the IAT through a continuum that includes their reactions to the IAT, acceptance of bias along with a struggle for strategy identification, and identification of a range of strategies to mitigate the impact of bias on clinical care. Results from the IAT invoked deep emotional reactions in students, and facilitated a questioning of previous assumptions, leading to paradigm shifts. An unexpected contrast to these deep and meaningful reflections was that students rarely chose to identify a strategy, and those that did provided strategies that were less nuanced.
Despite accepting implicit bias in themselves and desiring to provide unbiased care, students struggled to identify bias mitigation strategies, a crucial prerequisite to skill development. Educators should endeavour to expand instruction to bridge the chasm between students' acceptance of bias and skill development in management of bias to improve the outcomes of their clinical encounters.
健康职业教育工作者使用内隐联想测验（IAT）来提高学习者对隐性偏见的认识，这往往会引发强烈的情绪反应。一旦产生情绪反应，学习者反应与策略识别之间的差距仍相对未得到充分探索。为了更好地理解学习者如何识别偏见缓解策略，作者探讨了医学生在临床培训期间对参加IAT的体验以及由此产生的反馈。
美国纽约布朗克斯区的医学生参加了一次为期90分钟的关于隐性偏见的课程。本研究的分析重点是课后叙述作业，邀请他们参加基于种族的IAT，并描述他们对IAT结果的反应及其对未来医生工作的影响。作者采用建构主义扎根理论方法，对2013年至2019年随机抽取的180篇匿名完成的文章进行了分析。
有临床经验的医学生通过一个连续体对IAT做出反应，这个连续体包括他们对IAT的反应、对偏见的接受以及为策略识别而进行的挣扎，以及识别一系列减轻偏见对临床护理影响的策略。IAT的结果在学生中引发了深刻的情绪反应，并促使他们对以前的假设提出质疑，从而导致范式转变。与这些深刻而有意义的反思形成意外对比的是，学生很少选择识别一种策略，而那些选择识别策略的学生提供的策略缺乏细微差别。
尽管学生们承认自己存在隐性偏见，并希望提供无偏见的护理，但他们难以识别偏见缓解策略，而这是技能发展的关键前提。教育工作者应努力扩大教学内容，弥合学生对偏见的接受与偏见管理技能发展之间的差距，以改善他们临床接触的结果。
