FacultyFocus 1 | 2020
Ten tips on how to combat your unconscious bias
The term unconscious bias (UB) refers to the feelings and attitudes we have—but are not aware off—toward certain people or groups. While UB is not intentional and is not the result of malicious intent, it can lead us to judge, show prejudice, or stereotype people without realizing it. When UB, also called implicit bias, is uncontrolled, it can negatively influence behavior of an individual toward patients and/or learners.
A systematic review of 42 articles published in BMC Medical Ethics in 2017 indicates that health care professionals exhibit the same levels of implicit bias as the wider population (FitzGerald, C. and Hurst, S., 2017).
Research suggests that realizing one’s own implicit biases is more effective than explicit bias training when it comes to combating one’s own implicit biases. With that in mind, the ODII working group shares the following strategies:
1Learn about UB; everyone has it.Some video suggestions to get you startedwith your reflection process. Association of American Medical Colleges:Exploring Unconscious Bias in Academic MedicineAssociation of American Medical Colleges (Washington, DC): AAMC Chief Diversity Officer Marc A Nivet Ed D. interviews Howard Ross, Founder & Chief Learning Officer of Cook Ross and author of Reinventing Diversity: Transforming Organizational Community to Strengthen People, Purpose and Performance. Institute for Healthcare Improvement: How Can Providers Reduce Unconscious Bias?David R Williams, Professor of Public Health at the Harvard T.H. Chan School of Public Health, has been researching health inequities in the United States for two decades. In this video, he sits down with Don Berwick, MD, President Emeritus and Senior Fellow at IHI, to describe three promising strategies to reduce implicit bias.
• Promote diversity, inclusion, and equity at both the individual• and organizational level.• Assessment tools provide impetus to recognize and reveal• deficiencies to implement change.
3Be honest to yourself and acknowledge your UBs • Ask for candid feedback.• Examine your own possible biases to understand the• roots of stereotypes and prejudice.• Practice self-monitoring and self-regulation.• Interrupt biased thinking to generate non-discriminatory• behavior.
4Interact with your patients/learners, considering them as an individual rather than (stereotyped) members of a group• Stereotypes may be harmful to your patients’ health.• Strengthen counter-stereotype associations as a strategy to• reduce and overcome stereotyping
• Consider where biases may influence your thoughts and• behavior.• Examples of UB leading to health disparities include:iii. White male physicians are less likely to prescribe painiii. medication to black patients than to white patients.iii. Doctors assume their black or low-income patients are less intelligent, more likely toiii. engage in risky behaviors, and less likely to adhere to medical advice.iii. Pregnant women face discrimination from health care providers on the basis of theiriv. Women presenting with cardiac heart disease (CHD) symptoms are significantly lessiv. likely than men to receive diagnosis, referral and treatment, due to misdiagnosis of
6Expand your comfort zone• Be curious and make a conscious effort to interact with• individuals and/or groups unfamiliar to you.• Get to know people on an individual level; biases are usually• derived stereotypes and generalizations.
7Be humble, recognize and apologize if you messed up• Acknowledge and apologize for mistakes.• Use mistakes as an opportunity to do things differently• next time.• This process can strengthen your relationships with• others.
8Don’t be a silent bystander when observing UB in the workplace• Identify when bias is emerging and take a decision to address • the situation, to act while continuing the conversation.• Use questions to invite a discussion.• State your unease using ‘I’ statements.
9Talk about UB• Encourage conversations around biases.• Model ideal behaviors.• Discuss the importance of UB with your learners and teams.
• It’s chairperson (not chairmen).• Use neutral pronouns if possible; and use female (not just• male pronouns)• Use the word folks instead of guys.