Let’s Talk about Bias in Healthcare: Experiences from an Interactive Interprofessional Student Seminar

Authors

  • Mckenzie P. Rowe Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA
  • Nancy B. Tahmo Dalla Lana School of Public Health, University of Toronto, ON, CA
  • Opeoluwa O. Oyewole California Council on Science and Technology, Sacramento, CA
  • Keyonna M. King College of Public Health, University of Nebraska Medical Center, Omaha, NE
  • Teresa M. Cochran Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Kearney, NE
  • Yun Saksena College of Dentistry, University of Nebraska Medical Center, Lincoln, NE
  • Carolyn T. Williamson Community Leader, Omaha, NE
  • Rev. Portia A. Cavitt Pastor, Clair Memorial United Methodist Church, Omaha, NE
  • Sherrita A. Strong 9 College of Medicine, University of Nebraska Medical Center, Omaha, NE
  • Michael D. Griffin College of Public Health, University of Nebraska Medical Center, Omaha, NE
  • Timothy C. Guetterman Department of Family Medicine, University of Michigan, Ann Arbor, MI https://orcid.org/0000-0002-0093-858X
  • Jasmine R. Marcelin Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE

Keywords:

interprofessional education, implicit bias education, Bias in medicine, structural competency, racial bias, health professions education, undergraduate health education

Abstract

Background: Education to increase awareness of the impact of bias in healthcare should be included in all health professions training programs. This report describes the implementation and outcomes of an interactive, interprofessional pilot seminar on racial bias in healthcare for health professions students.

Methods: Forty students across the University of Nebraska Medical Center’s six health profession colleges participated in a 3-part, 1-hour seminar, including a video vignette depicting examples of bias in the hospital, facilitated interprofessional small group discussions, and interaction with a health equity expert panel. We analyzed the results of participants’ Ethnic Perspective-Taking (EP) and Implicit Bias Knowledge scale (IBKS) scores before and after the seminar.

Results: There was a statistically significant increase (p<0.001) in the average post-seminar EP scores (30.6 post-seminar vs 27.8 pre-seminar). For the adapted IBKS, there were significant improvements in participant knowledge, skills to identify, and ability to explain the impact of implicit biases (p<0.05). Participants highlighted the importance of including education about bias in healthcare training, and some suggested mandatory education. All facilitators agreed that learners gained a deeper appreciation for the effect of bias and racism on health outcomes and participants understood how bias and racism affect patient care and clinician experience after the seminar.

Conclusion: Health professions training often lacks integrated interprofessional and health equity education. This seminar addresses both, engaging community voices without heavy resources. Despite low participation, results show the benefits of interactive sessions on health equity, helping students grasp their role in equitable care and influencing future practice.

References

Blair IV, Steiner JF, Havranek EP. Unconscious (Implicit) Bias and Health Disparities: Where Do We Go from Here? TPJ. 2011 Jun;15(2):71–8.

Marcelin JR, Siraj DS, Victor R, Kotadia S, Maldonado YA. The Impact of Unconscious Bias in Healthcare: How to Recognize and Mitigate It. The Journal of Infectious Diseases. 2019 Aug 20;220(Supplement_2):S62–73.

Sabin JA, Rivara FP, Greenwald AG. Physician Implicit Attitudes and Stereotypes About Race and Quality of Medical Care. Medical Care. 2008 Jul;46(7):678–85.

Moskowitz GB, Stone J, Childs A. Implicit Stereotyping and Medical Decisions: Unconscious Stereotype Activation in Practitioners’ Thoughts About African Americans. Am J Public Health. 2012 May;102(5):996–1001.

Power-Hays A, McGann PT. When Actions Speak Louder Than Words — Racism and Sickle Cell Disease. N Engl J Med. 2020 Nov 12;383(20):1902–3.

Oliver MN, Wells KM, Joy-Gaba JA, Hawkins CB, Nosek BA. Do Physicians’ Implicit Views of African Americans Affect Clinical Decision Making? The Journal of the American Board of Family Medicine. 2014 Mar 1;27(2):177–88.

Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, Iezzoni LI, et al. Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients. J GEN INTERN MED. 2007 Sep;22(9):1231–8.

Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci USA. 2016 Apr 19;113(16):4296–301.

Standards, Publications, & Notification Forms - LCME [Internet]. [cited 2023 Aug 23]. Available from: https://lcme.org/publications/

Merritt R, Rougas S. Multidisciplinary approach to structural competency teaching. Med Educ. 2018 Nov;52(11):1191–2.

Benoit LJ, Travis C, Swan Sein A, Quiah SC, Amiel J, Gowda D. Toward a Bias-Free and Inclusive Medical Curriculum: Development and Implementation of Student-Initiated Guidelines and Monitoring Mechanisms at One Institution. Academic Medicine. 2020 Dec;95(12S):S145–9.

Khazanchi R, Keeler H, Strong S, Lyden ER, Davis P, Grant BK, et al. Building structural competency through community engagement. Clin Teach. 2021 Oct;18(5):535–41.

Perdomo J, Tolliver D, Hsu H, He Y, Nash KA, Donatelli S, et al. Health Equity Rounds: An Interdisciplinary Case Conference to Address Implicit Bias and Structural Racism for Faculty and Trainees. MedEdPORTAL. 2019 Nov 25;10858.

Hardeman RR, Burgess D, Murphy K, Satin DJ, Nielsen J, Potter TM, et al. Developing a Medical School Curriculum on Racism: Multidisciplinary, Multiracial Conversations Informed by Public Health Critical Race Praxis (PHCRP ). Ethn Dis. 2018 Aug 8;28(Supp 1):271.

Sabato E, Owens J, Mauro AM, Findley P, Lamba S, Fenesy K. Integrating Social Determinants of Health into Dental Curricula: An Interprofessional Approach. Journal of Dental Education. 2018 Mar;82(3):237–45.

Neff J, Holmes SM, Knight KR, Strong S, Thompson-Lastad A, McGuinness C, et al. Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities. MedEdPORTAL. 16:10888.

Core Competencies for Interprofessional Collaborative Practice: 2016 Update. 2016;

Racial Bias (captioned) [Internet]. 2022 [cited 2023 Aug 23]. Available from: https://vimeo.com/691129770/6410d11479

Galinsky AD, Ku G, Wang CS. Perspective-Taking and Self-Other Overlap: Fostering Social Bonds and Facilitating Social Coordination. Group Processes & Intergroup Relations. 2005 Apr;8(2):109–24.

Todd AR, Galinsky AD. Perspective-Taking as a Strategy for Improving Intergroup Relations: Evidence, Mechanisms, and Qualifications: Perspective-Taking and Intergroup Relations. Social and Personality Psychology Compass. 2014 Jul;8(7):374–87.

Liu FF, Coifman J, McRee E, Stone J, Law A, Gaias L, et al. A Brief Online Implicit Bias Intervention for School Mental Health Clinicians. International Journal of Environmental Research and Public Health. 2022 Jan;19(2):679.

Todd AR, Bodenhausen GV, Richeson JA, Galinsky AD. Perspective taking combats automatic expressions of racial bias. Journal of Personality and Social Psychology. 2011 Jun;100(6):1027–42.

Stone J, Moskowitz GB. Non-conscious bias in medical decision making: what can be done to reduce it?: Non-conscious bias in medical decision making. Medical Education. 2011 Aug;45(8):768–76.

Wang YW, Davidson MM, Yakushko OF, Savoy HB, Tan JA, Bleier JK. The Scale of Ethnocultural Empathy: Development, validation, and reliability. Journal of Counseling Psychology. 2003 Apr;50(2):221–34.

Fix RL. Justice Is Not Blind: A Preliminary Evaluation of an Implicit Bias Training for Justice Professionals. Race Soc Probl. 2020 Dec;12(4):362–74.

Braun V, Clarke V. Thematic analysis. In: Cooper H, Camic PM, Long DL, Panter AT, Rindskopf D, Sher KJ, editors. APA handbook of research methods in psychology, Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological [Internet]. Washington: American Psychological Association; 2012 [cited 2023 Aug 23]. p. 57–71. Available from: http://content.apa.org/books/13620-004

Sun M, Oliwa T, Peek ME, Tung EL. Negative Patient Descriptors: Documenting Racial Bias In The Electronic Health Record. Health Aff (Millwood). 2022 Feb;41(2):203–11.

Park J, Saha S, Chee B, Taylor J, Beach MC. Physician Use of Stigmatizing Language in Patient Medical Records. JAMA Netw Open. 2021 Jul 1;4(7):e2117052.

Qin E, Seeds A, Wallingford A, Copley M, Humbert A, Junn C, et al. Transmission of Bias in the Medical Record Among Physical Medicine and Rehabilitation Trainees. Am J Phys Med Rehabil. 2023 Aug 1;102(8):e106–11.

P. Goddu A, O’Conor KJ, Lanzkron S, Saheed MO, Saha S, Peek ME, et al. Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record. J GEN INTERN MED. 2018 May;33(5):685–91.

Academic Affairs [Internet]. [cited 2023 Aug 23]. Interprofessional Education. Available from: https://www.unmc.edu/academicaffairs/educational/ipe/index.html

Stumbar S, Lage O, Whisenant EB, Brown DR. Developing the Community Engaged Physician: Medical Students Reflect on a Household Visit Curriculum. Cureus. 12(11):e11593.

Julian Z, Mengesha B, McLemore MR, Steinauer J. Community-Engaged Curriculum Development in Sexual and Reproductive Health Equity: Structures and Self. Obstet Gynecol. 2021 Apr 1;137(4):723–7.

Bromage B, Encandela JA, Cranford M, Diaz E, Williamson B, Spell VT, et al. Understanding Health Disparities Through the Eyes of Community Members: a Structural Competency Education Intervention. Acad Psychiatry. 2019 Apr;43(2):244–7.

Meleis AI. Interprofessional Education: A Summary of Reports and Barriers to Recommendations: Interprofessional Education. Journal of Nursing Scholarship. 2016 Jan;48(1):106–12.

Khazanchi R, Keeler H, Marcelin JR. Out of the Ivory Tower: Successes From a Community-Engaged Structural Competency Curriculum. Academic Medicine. 2021 Apr;96(4):482–482.

Downloads

Published

2024-11-18

How to Cite

Rowe, M. P., Tahmo, N. B., Oyewole, O. O., King, K. M., Cochran, T. M., Saksena, Y., Williamson, C. T., Cavitt, R. P. A., Strong, S. A., Griffin, M. D., Guetterman, T. C., & Marcelin, J. R. (2024). Let’s Talk about Bias in Healthcare: Experiences from an Interactive Interprofessional Student Seminar. International Journal of Medical Students. Retrieved from https://ijms.info/IJMS/article/view/2457

Issue

Forthcoming

Section

Original Article

Categories

License

Copyright (c) 2024 Mckenzie P. Rowe, Nancy B. Tahmo, Opeoluwa O. Oyewole, Keyonna M. King, Teresa M. Cochran, Yun Saksena, Carolyn T. Williamson, Rev. Portia A. Cavitt, Sherrita A. Strong, Michael D. Griffin, Timothy C. Guetterman, Jasmine R. Marcelin

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

  1. The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
  2. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
  3. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
    1. Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
    2. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
    3. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
    4. Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
    5. The Author represents and warrants that:
      1. the Work is the Author’s original work;
      2. the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
      3. the Work is not pending review or under consideration by another publisher;
      4. the Work has not previously been published;
      5. the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
      6. the Work contains no libel, invasion of privacy, or other unlawful matter.
    6. The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.

Enforcement of copyright

The IJMS takes the protection of copyright very seriously.

If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.

If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org

 

Infringing material

If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org

Most read articles by the same author(s)