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Incorporating Bias Checks Into Inpatient Rounding

April 17, 2023

Editor’s Note: Elizabeth Zeichner is a former high school teacher and fourth-year medical student at Emory University School of Medicine. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

We all bring our own backgrounds and biases to each patient interaction. As medical students learn to care for patients, their own attitudes and implicit biases, as well as those of their residents and attendings, can have a significant impact on learning and patient care.

This week, Pediatrics is early releasing an article, “Explicitly Addressing Implicit Bias on Inpatient Rounds: Student and Faculty Reflections,” by Rebecca G. Carter, MD, and Sarah Lake, MD, from the University of Maryland and Brown University (10.1542/peds.2023-061585). This article shares perspectives from both Dr. Carter, as an attending physician who incorporates implicit bias reflections into inpatient rounds, and Dr. Lake, as she reflects upon her time as a medical student who participated in these rounds.

When Dr. Carter leads inpatient rounds, she incorporates de-biasing strategies that allow team members to recognize biases, at both an individual and system level. She has introduced quick “bias checks” on morning rounds for each patient. She leads by example, sharing some of her own biases, and asks team members to identify how these biases would affect decisions about treatment plans. Learners are encouraged to question their own assumptions, whether they be about a patient’s family, social situation, or understanding of illness. Dr. Carter noted that this process in rounds has generated much discussion and sometimes changes in management plans. Additionally and importantly, these bias checks have helped the team “proceed with caution, more mindful of the risk of bias but in agreement” that their decision best serves the patient and their family.

In Dr. Lake’s reflection on her time as a medical student who participated in these bias checks, she notes that while she was initially apprehensive to share her potential biases out of fear they would affect how she was perceived and evaluated, she appreciated how this exercise was normalized and emphasized as a necessary action.

While it can be uncomfortable for us all to acknowledge our own biases, the authors write that acknowledging our biases, and normalizing and prioritizing this process of bias checks, can “increase accountability and improve patient care.” After reading this article, I feel empowered to incorporate some brief bias reflections as I continue through my fourth-year rotations and beyond in residency. I hope to see these implemented in more structured ways throughout my training. I encourage you to read this article to see how bias checks can be implemented into your daily patient care.

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