How Clinicians and Educators Can Mitigate Implicit Bias in Patient Care and Candidate Selection in Medical Education

Abstract

In an attempt to help us navigate a complex world, our unconscious minds make certain group associations on the basis of our experiences. Physicians are not immune to these implicit associations or biases, which can lead physicians to unknowingly associate certain demographic groups with negative concepts, like danger, noncompliance, and lower competence. These biases can influence clinical decision making in ways that potentially harm patients and may unfairly influence the medical school, residency, and fellowship application processes for candidates in certain underrepresented groups. To minimize the potential negative impact of implicit biases on patient care and diversity in the medical profession, physician-leaders have a responsibility to understand biases and how to consciously override them. This article discusses the potential impact of implicit bias in health care and student/trainee selection and reviews research-proven tools to reduce implicit bias in one-on-one interactions.

Case Report: Defining Applicant Attributes to Be Prioritized in the Selection of Child and Adolescent Psychiatry Subspecialty Residents at the University of Toronto

“…This event occurs annually and is attended by faculty and learners from the Division as an opportunity to reflect on and celebrate the previous academic year and plan for the year ahead. Educational theories, emerging concepts in medical education and evidence related to established best practices in selection processes were summarized for participants (2)(3)(4)(7)(8)(9). Following these didactic sessions, participants gathered in small groups to discuss the initial list of priority attributes and brainstorm further ideas.…”

“…Renewal of the CAP subspecialty selection process was seen to be an integral component of defining and establishing the UT CAP brand identity, thus, differentiating the UT CAP training program from others across the country (6) and fostering applicant's self-selection of the program. By defining key attributes and then incorporating them into the admissions process, we also sought to mitigate some sources of bias in the admissions process (7). Further, the identified priority attributes for resident selection would guide future CAP residency curriculum renewal to bring alignment across UT CAP selection and curriculum practices and ultimately the vision and mission for the DCYMH.…”

A Policy Statement of the Society of General Internal Medicine on Tackling Racism in Medical Education: Reflections on the Past and a Call to Action for the Future

“…Some important work has been done with respect to interpersonal manifestations of racism, like supporting trainees in the face of microaggressions and mistreatment 45, 46 and acknowledging implicit bias. 47 Indeed, though curricula that focus on individual-level factors (implicit bias and microaggressions) may increase awareness of the negative experiences of URiM trainees and physicians, this "consciousness raising" 48 can create a false perception of change if the increased dialogue about interpersonal bias is not accompanied by efforts to identify and correct the systemic racist structures present within our institutions. In addition, URiM faculty and trainees are often asked or expected to conduct these trainings without adequate compensation.…”

Just in TIME: Trauma-Informed Medical Education

“…Individuals and institutions should understand their role in adhering to the principles of TIME (Table 1). TIME's formalized curriculum may include a historical review of discrimination in medical education, a review of the current literature related to bias in medicine and medical education, strategies to identify bias, and mechanisms to reduce bias at the individual and institutional level [47]. TIME adds another component to implicit bias mitigation by prioritizing a reduction in the traumatic impact of bias and discrimination on its targets.…”