BIAS: Understanding How it Affects our Patients and our Care of them

Goals Define bias and its significance in the clinical learning environment Consider how it affects health care workers and their patients personally and professionally Explore steps to ameliorate bias by heightened awareness, curricular interventions and institutional priority

Bias General pattern/tendency to think a certain way. It is essentially a quick route our brains can use to make decisions quickly Prejudice in favor of or against one thing, person, or group Cognitive bias: systematic error in thinking that affect decisions/judgments that people make. Heuristics: a mental shortcut so that your brain doesn't have to come up with a new solution every time a new situation arises. Cognitive Biases are logical fallacies that are derived from heuristics. These often can be dangerous because they automate wrong decisions.   

Explicit vs. Implicit Bias “Explicit bias” refers to the attitudes and beliefs we have about a person or group on a conscious level. “Implicit bias” refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.

Awareness of bias is the first step toward solutions Often biases are shaped by life experiences and the social interactions a person has. Implicit bias may actually be exactly opposite to what a person consciously believes It is not possible for humans to be free of bias either explicit or implicit. Building awareness and understanding of our biases is a first step toward making conscious decisions to act fairly.

Awareness of bias is the first step toward solutions

Implicit Attitude Test (IAT) Form small groups (3-5) Discuss your reactions to the IAT. Is this information useful for you? How well do you think it reflects your own implicit bias?

For Discussion What sorts of bias can you identify in your workplace? Are they explicit? Implicit? How does bias affect the learning environment? How does bias affect clinical research and new health advancements? How does bias affect health care delivery and outcomes?

Race/ethnicity Bias Many examples of people receiving differing levels of health care based on racial and ethnic groups. These racial/ethnic related disparities are often intertwined with Social Determinants of Health Race and ethnicity based disparities can be studied in a specialty specific manner. Can you name some health care disparities in OBGYN related to health services access? How might implicit bias contribute to this?

A six step curricular approach to bias Create a safe and nonthreatening learning context Increase knowledge about the science of implicit bias Emphasizing how implicit bias influences behaviors and patient outcomes Increasing self-awareness of existing implicit biases Improving conscious efforts to overcome implicit bias Enhancing awareness of how implicit bias influences others A Framework for Integrating Implicit Bias Recognition Into Health Professions Education J sukhera, C Watling Academic Medicine Jan2018

Group Discussion Since we cannot eliminate bias, how can we ameliorate its effects? naming/acknowledging Counter stereotype examples Targeted exposure to minority groups Practice / feedback / reflection How can we as HCW address unconscious bias? Ask “How is racism operating here?” What exists? / What is lacking? Organize and strategize to act/grassroots/advocacy/politics

Patient bias against physicians What examples have you seen of this Was the interaction reported? To whom? What was the response of the supervising physician? How would you respond to patient bias?

Patient bias against physicians How should faculty/residents deal with this? Assess acuity of patient condition Cultivate a therapeutic alliance Depersonalize reaction Ensure a safe learning environment Consult/review institutional philosophy to promote fairness and ameliorate bias Debrief

What other groups are subject to explicit and implicit bias? LGBTQ Individuals with medical conditions obesity mental illness chronic pain syndromes Addiction Socioeconomic influences including income, insurance status, homelessness Incarcerated individuals Immigrants Disabled individuals Others?

Choose a population from the list (or your experience). Investigate how bias affects them when they interact with health care. Do you interact with patients from this group? With HCWs from this group? What steps could be taken in your institution to move these patients toward health equity?