Background: To reduce cognitive dissonance about one's beliefs or behavior, individuals may compare their behavior to personal and/or normative standards. The details of this reflection process are unclear. Aims: We examined how medical students compare their behavior or beliefs to standards in discussions about implicit bias, and explored if and how different reflective pathways ( preserving vs. reconciling) are associated with each standard. Methods: Third-year students engaged in a small-group discussion about bias. Some students and group facilitators also participated in a debriefing about the experience. Using qualitative methods, the transcripts from these 11 sessions were analyzed for evidence of student comparison to a standard and of reflection pathways. Results: Of 557 text units, 75.8% could be coded with a standard and/or a path of reflection. Students referenced personal and normative standards about equally, and preserved or reconciled existing beliefs about equally. Uses of normative standards were associated with preservation-type reflection, and uses of personal standards with reconciliation-type reflection. Conclusions: Normative expectations of physicians are sometimes used to provoke students' consideration of implicit biases about patients. To encourage critical reflection and reconciliation of biased beliefs or behavior, educators should frame reflective activities as a personal exercise rather than as a requirement.
As information about the public health risks surrounding COVID-19 continues to shift over time, families communicate to navigate this ongoing uncertainty. For example, families must interpret inconsistent media and public health messages about COVID-19, which may in turn have implications for health risk behavior. Adding to this complexity, household structures and routines are adapting in response to COVID-19. Adult family members in some families may suddenly experience extreme physical proximity, while others must coordinate to make decisions about their health and prevention behaviors while maintaining physical distance. Furthermore, members of these families must balance relational maintenance while communicating to assess and avoid health risks. The ongoing ambiguity of information about COVID-19 means that these relational processes must be managed in the midst of chronic uncertainty. The current study uses semistructured interviews and interpretive analysis to understand how adult children (aged 23-51 years) manage chronic uncertainty about COVID-19 in communication with their parents. Findings explore themes of navigating information about COVID-19 risks and protections, managing uncertainty management about media and political messages, and accepting time-related uncertainties.
Communication privacy management (CPM) theory posits that culturally specific understandings of privacy guide how people manage private information in everyday conversations. We use the context of miscarriage to demonstrate how societal-level expectations about (in)appropriate topics of talk converge with micro-level decisions about privacy rules and privacy boundary management. More specifically, we explore how people’s perceptions of broad social rules about the topic of miscarriage influence their disclosure decisions. Based on interviews with 20 couples who have experienced pregnancy loss, we examined how couples described miscarriage as a topic that is bound by societal-level expectations about whether and how this subject should be discussed in interpersonal conversations. Participants reflected on their perceptions of societal-level privacy rules for protecting information about their miscarriage experiences and described how these rules affected their own privacy management decisions. We discuss these findings in terms of CPM’s theoretical tools for linking macro-level discourses to everyday talk.
Recommendations are provided for medical educators to improve activities intended to encourage reflection on implicit bias. These recommendations include reframing educational activities as endeavors in "personal" development and uncovering and transforming those normative structures that encourage resistance to implicit bias.
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