Implicit bias refers to the systematic error in thinking—outside of conscious awareness or control—that affects decisions and judgements (Hall et al., 2015). Unfortunately, even health care professionals are not immune to implicit biases. According to a systematic review conducted by Hall et al. (2015), implicit racial/ethnic bias among health care professionals against Black, Hispanic/Latino, and dark-skinned people was at low to moderate levels, similar to the general population. Additionally, this implicit bias was found to significantly relate to negative patient–provider interactions and negative health outcomes for patients (Hall et al., 2015). It is imperative that health care professionals become aware of their biases so that they are providing optimal care to patients and do not further contribute to health disparities for people of color (Hall et al., 2015). Health disparities are the differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States (Mio, Barker, & Tumambing, 2012). These disparities are evident by the fact that minorities are disproportionately (a) more likely to be diagnosed with late-stage breast cancer, (b) more likely to die from HIV, (c) more likely to account for new AIDS diagnoses, (d) less likely to receive optimal care for acute myocardial infarctions, (e) more likely to be affected by Type 2 Diabetes, (f) more likely to die from cancer, (g) more likely to be affected by cardiovascular disease, and (h) more likely to face hypertension-related, end-stage kidney disease (Mio et al., 2012). In order to eliminate health disparities, we must work to reduce implicit biases of health professionals that may influence the suboptimal care they provide to minority patients. So, how can we reduce implicit racial/ethnic bias? One way is by incorporating online CME trainings aimed at reducing biases and increasing cultural sensitivity into medical professional training programs. These online CME trainings are perfect for the packed schedules of health care professionals. The trainings are easy to administer and can be taken on any mobile device at a time most convenient for trainees.
One might be wondering, how is implicit bias measured? One way to measure whether one does have implicit biases is by taking the Implicit Association Test (IAT). The IAT measures implicit prejudices by measuring the speed at which test takers assign positive or negative associations to a group of interest (Aronson, Wilson, Akert, & Sommers, 2015). These target groups may be racial or ethnic minorities; lesbian, gay, or transgender individuals; obese or disabled individuals; elderly individuals; or other marginalized groups that are the target of societal discrimination. The IAT is administered online and is fairly easy to take. In the first phase of the IAT, one is shown a series of faces that must be sorted into two categories as quickly as possible. For example, if the target group consists of elderly individuals, one must press the left arrow key when presented with an image of an older face and the right arrow key when presented with an image of a younger face. In the next phase, one is shown a series of positive words (e.g., triumph, joyful, spectacular) and a series of negative words (e.g., hurtful, miserable, devil) that must be sorted into a positive or negative category by clicking the left arrow key for a positive word and the right key for a negative word. This task is also done as quickly as possible. Finally, in the last phase, one is prompted to press the left arrow key for older faces or positive words, and the right arrow key for younger faces or negative words. This last task is also done as quickly as possible (Aronson et al., 2015).
More often than not, people respond more quickly to positive words paired with younger faces and negative words paired with older faces than to positive words paired with older faces and negative words paired with younger faces (Aronson et al., 2015). This suggests that people generally have an implicit bias against elderly individuals because it is harder for them to link older individuals with positive descriptions. Online CME trainings like these can increase awareness of bias, which can ultimately foster better patient–provider interactions, improving the quality of care for patients from marginalized groups.
3 Ways to Provide Better Care Once Aware of Implicit Biases
- Help patients from minority groups take part in treatment decisions to improve patient–provider interactions. When patients feel they have agency and are treated with respect by their providers, this reduces their negative stress reactions to care providers which are linked to hypertension, cardiovascular disease, and mental health diagnoses (Late, 2003).
- Encourage other health care professionals to increase their cultural sensitivity regardless of whether they have already obtained a medical degree (Mio et al., 2012).
- Ensure health services are consistent with patient cultural norms (Edwards & Erwin-Johnson, 2003).
Aronson, E., Wilson, T. D., Akert, R. M., & Sommers, S. R. (2015). Social psychology (9th ed.). London, United Kingdom: Pearson.
Edwards, W. V., & Erwin-Johnson, C. (2003). NAACP to focus on minority health disparities. Crisis, 110(6), 54–56. Retrieved from https://www.thecrisismagazine.com/
Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. P., . . . Coyne-Beasley, T. (2015). Implicit racial/ethnic bias among health care professionals and its influence om health care outcomes: A systematic review. American Journal of Public Health, 105, 60–76. doi:10.2105/AJPH.2015.302903
Late, M. (2003). Many Americans unaware of racial, ethnic, health disparities. The Nation’s Health, 33, 6–12. Retrieved from http://thenationshealth.aphapublications.org/
Mio, J. S., Barker, L. A., & Tumambing, J. S. (2012). Multicultural psychology: Understanding our diverse communities (3rd ed.). Oxford, United Kingdom: Oxford University Press.