A survey of implicit bias training in physician assistant and nurse practitioner postgraduate fellowship/residency programs

Abstract

Background There has been renewed focus on advancing inclusivity within organized medicine to reduce health disparities and achieve health equity by addressing the deleterious effects of implicit bias in healthcare and clinical outcomes. It is well documented that negative implicit attitudes and stereotypes perpetuate inequity in healthcare. The aim of this study is to investigate implicit bias training in postgraduate physician assistant (PA) and nurse practitioner (NP) education; describe delivery of content to trainees; and detail program directors’ attitudes toward this type of training. Although there is research examining implicit bias training in physician residency education, there are no published studies on implicit bias training in postgraduate PA and NP postgraduate residency/fellowship programs. Method A non-experimental, descriptive study was designed to obtain information via survey from members of the Association of Postgraduate Physician Assistant Programs (APPAP). Results The response rate was 41%. The majority of respondents (76%) felt that PA and NP postgraduate programs should include implicit bias instruction. Educational strategies used by PA and joint PA/NP postgraduate programs or their sponsoring institution to deliver implicit bias content to trainees include: implicit bias training modules (50%), facilitated group discussions (36%), invited speaker on implicit bias (33%), case studies on implicit bias (16%), and implicit association test (10%); however, 30% of postgraduate programs do not provide implicit bias training to PA and/or NP trainees. Barriers to implementing implicit bias training expressed by some postgraduate programs include: uncertainty in how to incorporate implicit bias training (16%); lack of strategic alignment with training program or sponsoring institution (13%); time constraints (10%); financial constraints (6%); lack of access to content experts (6%); and unfamiliarity with evidence supporting implicit bias training (6%). Conclusion The present study sheds some light on the current state of implicit bias training in PA and joint PA/NP postgraduate residency/fellowship programs. While the majority of programs offer some sort of implicit bias training, there is a need to standardize this training in PA and joint PA/NP postgraduate education curricula using an actionable framework.

Job satisfaction and moral distress of nurses working as physician assistants: focusing on moderating role of moral distress in effects of professional identity and work environment on job satisfaction

“…The high moral distress in this study might be attributed to limited decision authority of nurses working as PA and their poor work environment. Unlike other countries where PA is officially recognized as a job and produced through an accredited program [ 1 , 43 ], many nurses are performing PA duties as needed by healthcare institutions without any accredited training [ 8 ]. Thus, many nurses working as PAs have experienced high moral distress, which can lead to job dissatisfaction.…”

Racial Implicit Bias and Communication Among Physicians in a Simulated Environment

“…Given the negative influence of racial implicit bias on physician communication with Black patients 1 , 2 , 3 , 4 and the contributions of implicit bias in general to health care disparities, 8 addressing implicit bias has become a focus of medical education. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 Addressing implicit bias is mandated by accreditation bodies for undergraduate and graduate medical education. 23 , 24 Training in addressing implicit bias has been suggested for all practicing physicians.…”

Exploring Motivations and Barriers To Accreditation Adoption Among Physician Assistant and Nurse Practitioner Emergency Medicine and Orthopedic Surgery Residency and Fellowship Programs

“…Joint accreditation is important since approximately half of postgraduate programs accept both PAs and NPs [ 8 ]. Some benefits of joint accreditation include decreased administrative burdens and costs for postgraduate programs during the initial application and renewal process, having one set of standards for an all-inclusive specialty training experience, and meeting the unique needs of the healthcare institutions, such as enhancing multifaceted, diverse learning experiences [ 9 , 10 ].…”