Abstract:Introduction
Health professions educators use the Implicit Association Test (IAT) to raise awareness of implicit bias in learners, often engendering strong emotional reactions. Once an emotional reaction ensues, the gap between learner reaction and strategy identification remains relatively underexplored. To better understand how learners may identify bias mitigation strategies, the authors explored perspectives of medical students during the clinical portion of their training to the experience of taking the I… Show more
“…To understand the experiences of students in this program, we used qualitative analysis on students’ written reflections. Reflection is widely applied in qualitative studies [ 23 , 24 ]. The academic literature on reflection has revealed that it can help us understand participants' internal dialogues and analyze their thought processes.…”
Background
Reflection is a key element in learning from observation and experience of future profession’s roles and responsibilities in clinical encounters. Moreover, reflection helps students cope with the challenges, complexities, and uncertainties of professional development. Students’ written reflections on clinical exposure offer valuable information, and their analysis provides instructors with invaluable insight into students' experiences. This study evaluated Operating Room students’ written reflections on their first clinical exposure experiences towards their future profession through the shadowing program.
Methods
This study was a qualitative analysis on Operating Room freshmen’s reflections in the undergraduate program of Zahedan and Zabol University of Medical Sciences in Iran. After the shadowing program, all participants were asked to write an unstructured written reflection, and these fifty written reflections were de-identified and independently analyzed using the thematic analysis approach.
Results
Qualitative analysis extracted 10 subthemes and four main themes including (i) Moving towards the guiding realities of future profession, (ii) Discovering milestones of realizing professional identity, (iii) Managing the emotions affecting the perception of future profession’s desirability, and (iv) Excellence in professional growth and development.
Conclusion
Reflecting on the experience of the shadowing program, the participants described being in the OR environment as a stimulating and valuable learning opportunity. Moreover, this experience helped improve their perception of future profession’s realities, as well as initiate realization of professional identity and planning for professional developments.
“…To understand the experiences of students in this program, we used qualitative analysis on students’ written reflections. Reflection is widely applied in qualitative studies [ 23 , 24 ]. The academic literature on reflection has revealed that it can help us understand participants' internal dialogues and analyze their thought processes.…”
Background
Reflection is a key element in learning from observation and experience of future profession’s roles and responsibilities in clinical encounters. Moreover, reflection helps students cope with the challenges, complexities, and uncertainties of professional development. Students’ written reflections on clinical exposure offer valuable information, and their analysis provides instructors with invaluable insight into students' experiences. This study evaluated Operating Room students’ written reflections on their first clinical exposure experiences towards their future profession through the shadowing program.
Methods
This study was a qualitative analysis on Operating Room freshmen’s reflections in the undergraduate program of Zahedan and Zabol University of Medical Sciences in Iran. After the shadowing program, all participants were asked to write an unstructured written reflection, and these fifty written reflections were de-identified and independently analyzed using the thematic analysis approach.
Results
Qualitative analysis extracted 10 subthemes and four main themes including (i) Moving towards the guiding realities of future profession, (ii) Discovering milestones of realizing professional identity, (iii) Managing the emotions affecting the perception of future profession’s desirability, and (iv) Excellence in professional growth and development.
Conclusion
Reflecting on the experience of the shadowing program, the participants described being in the OR environment as a stimulating and valuable learning opportunity. Moreover, this experience helped improve their perception of future profession’s realities, as well as initiate realization of professional identity and planning for professional developments.
“…Despite having had at least two instructional sessions on implicit bias, being not only aware but accepting of their implicit biases, they could not identify strategies to manage the potential impact of their implicit biases. 54 Given these limitations, we propose sustainable longitudinal skill development that harnesses the good intentions of most physicians. Interventions targeting implicit bias must go beyond awareness to providing instruction on strategies for bias management and opportunities for skill development and practice.…”
Section: Limitations Of Common Approaches To Teaching About Implicit ...mentioning
“…The IAT and other measures ( 32 ) of implicit bias, stigma, and attitudes toward groups of persons were used among subjects to ( a ) demonstrate the existence of participant implicit biases, ( b ) act as a springboard to create cognitive dissonance for oral and/or written reflection and to practice bias management skills, and ( c ) evaluate interventions. Gonzalez et al ( 37 ) found that using the IAT without priming on its results and without a follow-up debriefing led some subjects (22%) to question the validity of the measure and the existence of implicit biases, and therefore advised judicious use of the IAT and trained facilitators. Subjects who accepted the results of the IAT were not able to develop management strategies for those biases without dedicated instruction.…”
Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers’ work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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