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.

Metrics

Metrics Loading ...

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

Section

Original Article

Categories

Most read articles by the same author(s)