Sabin Janice, Mick Eric, Eisdorfer Ethan, Yazdani Majid, Garcia Maria M, Hale Janet Fraser, Terrien Jill, Puerto Geraldine, Duodu Vennesa, Zolezzi-Wyndham Valerie, Rumbut Joshua, Calista Joanne, Valdman Olga, Potts Stacy, Allison Jeroan, Pugnaire Michele, Tjia Jennifer
Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA.
Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA.
Adv Med Educ Pract. 2025 Mar 19;16:419-430. doi: 10.2147/AMEP.S492884. eCollection 2025.
Implicit bias education that utilizes the Implicit Association Test (IAT) to raise self-awareness of bias can induce defensiveness.
To describe clinical learners' bias awareness, self-perceptions of bias relative to colleagues (better-than-average), implicit and explicit biases and defensive response to the IATs.
Cross-sectional study.
Internal medicine and family medicine residents, and Doctor of Nursing Practice students at a public medical and nursing school affiliated with a disproportionate share hospital and who completed an implicit bias recognition and mitigation educational program (including didactics, IATs, and communication skills training and practice with standardized patients) in 2018-2019.
We measured implicit and explicit attitudes and stereotypes, reactions to IAT results (defensive or not defensive), better-than-average perceptions, bias awareness and participants' characteristics. We examined associations between defensive responses to the IAT and participant characteristics, self-reported explicit biases, bias awareness within self, society, and healthcare, and IAT scores.
Of N=61 respondents, 57% were female and 59% White. We found moderate implicit bias favoring White people versus Black people, weak bias favoring White people versus Hispanic/Latinx people and moderate bias favoring White people on both race and ethnicity medical compliance stereotype IATs. Participants demonstrated awareness of bias in society and healthcare, but not within self. Eighteen percent were defensive regarding their IAT results. Perceptions of own bias (self) were always of their having less bias than their colleagues, and they were better-than-average. There were no statistically significant associations between IAT scores and participant demographics and no interaction effect between implicit bias, defensiveness and better-than-average scores.
Clinical learners hold moderate implicit biases, believe they have less bias than others, and almost 1-in-5 have a defensive response to IAT feedback. It is important to design implicit bias educational interventions to include reflection on personal bias and provide a safe environment to minimize defensiveness.
利用内隐联想测验（IAT）提高对偏见的自我意识的内隐偏见教育可能会引发防御心理。
描述临床学习者的偏见意识、相对于同事的偏见自我认知（优于平均水平）、内隐和外显偏见以及对IAT的防御反应。
横断面研究。
一所与高比例份额医院相关的公立医学与护理学校的内科和家庭医学住院医师以及护理实践博士学生，他们在2018 - 2019年完成了一项内隐偏见识别与缓解教育项目（包括教学、IAT、沟通技能培训以及与标准化患者的练习）。
我们测量了内隐和外显态度及刻板印象、对IAT结果的反应（防御性或非防御性）、优于平均水平的认知、偏见意识以及参与者特征。我们研究了对IAT的防御反应与参与者特征、自我报告的外显偏见、自我、社会和医疗保健中的偏见意识以及IAT分数之间的关联。
在N = 61名受访者中，57%为女性，59%为白人。我们发现，在种族和族裔医疗依从性刻板印象IAT中，存在适度的有利于白人而非黑人的内隐偏见、有利于白人而非西班牙裔/拉丁裔的微弱偏见以及有利于白人的适度偏见。参与者表现出对社会和医疗保健中偏见的意识，但对自身偏见缺乏意识。18%的人对自己的IAT结果持防御态度。对自身偏见（自我）的认知总是认为自己的偏见比同事少，且他们优于平均水平。IAT分数与参与者人口统计学特征之间无统计学显著关联，内隐偏见、防御性和优于平均水平分数之间也无交互作用。
临床学习者存在适度的内隐偏见，认为自己的偏见比他人少，且近五分之一的人对IAT反馈有防御反应。设计内隐偏见教育干预措施时，纳入对个人偏见的反思并提供一个安全的环境以尽量减少防御心理非常重要。
