Future physicians reflect on unconscious attitudes that may affect how they treat patients
Implicit biases are unconscious attitudes that individuals hold about other people based on racial, social and other stereotypes. Implicit bias is important in health care because it can affect how a provider treats a patient. In a study published in PLOS ONE, UMass Medical School students found that trainees value becoming aware of their own implicit biases as they prepare to practice medicine.
“I initiated this project because I wanted to learn more about the medical student experience as it pertains to how they believed their conscious versus unconscious thoughts affected their reasoning,” said Racquel Wells, MD, SOM ’16. “This line of inquiry has made my clinical practice more conscious of patients’ specific experiences, not just the diagnosis, and how that needs to be part of clinical decision-making.”
Dr. Wells co-authored the study with fellow students Xingyue Wang, MD, SOM ’17; and Christine Motzkus, MD, PhD, SOM ’19; along with UMMS faculty members Suzanne Cashman, DSc, professor of family medicine & community health; Jeroan Allison, MD, chair and professor of population & quantitative health sciences; Sonia Chimienti, MD, associate professor of medicine; and Deborah Plummer, PhD, former vice chancellor for diversity and inclusion and professor of psychiatry; and Janice Sabin, PhD, research associate professor of biomedical informatics and medical education at the University of Washington.
“We all have implicit bias because it’s how our brains work. We categorize things. It’s universal, part of being human,” said Dr. Cashman. “It is important for our students to understand that biases like racial stereotyping are fundamental determinants of health.”
The Social Determinants of Health course, required for all first- and second-year School of Medicine students, spurred the study. The course challenges students to think beyond the parameters of the human body to consider the many ways in which the external environment affects and influences health, to understand disparities and inequities that affect people’s health. The Implicit Association Test is a component of the course, which students take to identify their own unconscious biases.
Three-quarters of the 250 students chose to focus on the results on their Implicit Association Tests in their reflective essays. They wrote about their experience taking the IAT, bias in medicine and ways to counteract it. Most (84 percent) of the comments related to students acknowledging the importance of recognizing implicit bias, more than half (60 percent) noted that bias affects clinical decision-making and one in five stated that they believe it is the physician’s responsibility to advocate for dismantling bias.
“The discussion went a long way toward allowing me to approach the subject of racism in a more open fashion and will, I believe, make it easier for me to recognize my own implicit biases,” one student wrote.
“Moving forward I am going to use what I learned about myself as well as about biases in the health care system as a whole in order to monitor my actions and decisions,” wrote another.
The authors conclude that through developing an understanding of implicit bias, medical students can gain insight into the effect it may have on clinical decision-making. Read the full study here.