Welcome to a 5th Tuesday feature in Evidence eMended. For new readers, or those who've forgotten, I take the liberty in months containing a 5th Tuesday to break loose from my commentary on AAP Grand Rounds reviews and choose my own topic. This time, I'm hoping readers will accept my New Year's challenge to investigate their own implicit biases and how they might impact patient care.
Van Ryn M, Hardeman R, Phelan SM, et al. Medical school experiences associated with change in implicit racial bias among 3547 students: a medical student CHANGES study report. J Gen Intern Med 2015; 30(12):1748-56. doi: 10.1007/s11606-015-3447-7.
Although most pediatric providers aren't regular readers of the Journal of General Internal Medicine, I find it a great source for studies on medical education and on some of the "biopsychosocial" aspects of medicine. The current study falls into both of those categories. It is a continuation of the medical student "CHANGES" (another forced and painful acronym: Cognitive Habits and Growth Evaluation Study) project. It looked at medical students from 49 schools to determine correlations between student implicit (subconscious) bias towards African Americans and various medical school experiences. The researchers found that increased student implicit racial bias was associated with a) students' having lower self-assessed skills in providing health care to African Americans, b) with having heard negative comments from superiors about African American patients, c) with having unfavorable contact with African American physicians, and d) without completing a Black-White Implicit Association Test during medical school. That last item, part of an online research endeavor from Project Implicit, is the focus of my New Year's challenge to readers.
Note that I'm talking about a different form of bias than what I usually discuss in these pages. This isn't about bias in medical research introduced by poor study design that ultimately challenges credibility of the research conclusions. Rather, it is the unintended, somewhat submerged bias in all of us that can result in disparities in the health care we provide. As suggested by some of the findings in this article, as well as others, sometimes just being aware of our own implicit bias can mitigate its interference in how we provide medical care.
Navigating to the Project Implicit web site allows you to sign on to participate in their online studies, which I did. It doesn't appear that one can choose a particular topic (e.g. the Black-White test), but instead just take whatever testing is offered (maybe it's a random order). So far, I've participated in a happy versus sad face association study, a Gulliver's Travels-like association of nonsense ethnic group names with attitudes, and a study of bias involving disabled versus abled people. It took me less than 5 minutes to register on the web site, and then maybe 10 minutes to complete each test and view the results and discussion. I found them all to be enjoyable and revealing, not only of my own implicit biases but also how these researchers structured their questions. I highly recommend the experience.
So, my New Year's challenge to all of my readers: take the time to register and participate in these tests. I plan to do 1 test per week until I've gone through everything. Although it's a bit of unknown commitment, since I don't know how many tests are in there, I'm certain I'll come away with a new understanding of my implicit biases, to the benefit of my patients.
It looks like the next 5th Tuesday comes around in March, I'll let you know about my progress then. In the meantime, I wish you all a safe and peaceful 2016.