Exploring Implicit Bias in Medicine

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Department	Interdisciplinary Medicine
Course Number	IDIS 401
Course Title	Exploring Implicit Bias in Medicine
Course Director	Grace E. Henry, EdD
Length (Weeks)	2
When Offered	Available weeks 14-33 except for weeks 22-23 (not available). This course requires pre-approval from the course director.
Prerequisites	All core clerkships
Availability Notes	MS4s preferred. Must have completed third year Implicit Bias session which happens during the surgery rotation.
Contact Name	SMHS Office of Diversity & Inclusion
Contact Phone	202-994-4317
Contact Fax
Contact Email	smhsodi@gwu.edu
Other Contacts
Location	This course will consist of online work and independent research.
Limit	4
Report
Evaluation	Grading: Pass/Fail. Students must complete all assignments. A passing grade requires that students earn >=75.
Description	Purpose and Rationale for the Course: Research suggests that implicit bias may contribute to health care disparities by shaping physician behavior and producing differences in medical treatment along the lines of race, ethnicity, gender or other characteristics. Some research suggests that when motivated individuals are made aware of their biases, they can “mentally correct” initial biases. This 2-week elective course will expose students to implicit bias and bystander intervention literature, introduce examples of how implicit bias may affect the clinical setting, and allow students to apply knowledge learned through the development of an implicit bias intervention presentation. Target Students: MS4s interested in exploring the potential impact physician implicit bias has on clinical care. Course Learning Objectives: By the end of this course, the student should be able to: Recognize self-reflection as a method for understanding one’s own biases and minimizing their clinical impact. Identify strategies to mitigate physician biases in patient care.
Additional Notes	Required Readings and Videos IAT Bias Inventory Project Implicit Social Attitudes (https://implicit.harvard.edu/implicit/) Students are to complete the “Race IAT” and at least one more test (excluding the “Presidents IAT”) Readings Attiah, M. A. (2014). The new diversity in medical education. New England Journal of Medicine, 371(16), 1474-1476. Bailey, Z. et. al. (2017). Structural racism and health inequities in the USA: Evidence and Interventions. The Lancet, 389, 1453-1463. Blair, I. V., Steiner, J. F., & Havranek, E. P. (2011). Unconscious (implicit) bias and health disparities: Where do we go from here?. The Permanente journal, 15(2), 71-78. C. Brooks, K. (2015). A Silent Curriculum. JAMA The Journal of the American Medical Association. 313. 1909-1910. Marmot, M. (2006). Health in an unequal world: social circumstances, biology and disease. The Lancet, 368, 2081-2094. Videos (Available on TedED with embedded reflective questions) “It’s Not Just About Tuskegee: The history of African Americans and Medicine” (Dr. Vanessa Northingham Gamble, 2002) (58min) (https://ed.ted.com/on/U9zNuPGg) “Implicit Bias and Health Care—Where Social Science and Law Meet to Make Medicine Just.” (Dayna Bowen Matthew, 2016) (79mins) (https://ed.ted.com/on/a5btLtil) “How to Be an Anti-Racist” (Dr. Ibram Kendi, 2019) link forthcoming Week 1 Assignment 1: Complete the Implicit Association Test (the “Race IAT” and at least one more test-excluding the “Presidents IAT”) and write a 3-4pp essay that incorporates your reflection on taking the inventory and its relation to your understanding of your personal identity, the potential origins of personal bias and feelings when confronting personal bias and the biases of others. (25 points)** Autobiographical Essay The first step to learning about others is to understand oneself. This paper will help you develop an individual framework for self-exploration into personal biases. In a cogent and well-organized essay, first present your results, and your reaction to the results. Do you agree or disagree? The remainder of the essay should be a personal reflection of personal biases (including those not identified by the IAT). Explore possible origins of bias, and potential impact of bias on your future practice as a physician. Following are questions or prompts which are designed to help you with your essay. Do not write the essay as if you were responding solely to the questions or prompts. Rather, think about these as you compose your essay: What was it like to do the IAT? Were your results what you expected? Regardless of whether you expected them or not, how do you feel about your results? How might your IAT results be related to challenges that you have faced or might face in clinical practice? Reflect on your upbringing and how you define yourself. When did you first notice your most salient social identities (eg. gender, race, ability, and sexual orientation…)? How would you characterize your ability to empathize with others who are “different” from you? If you ever had to advocate for people different from you, reflect on your level of comfort and expertise in doing so. What did you learn about yourself? Have you ever been in situations where you felt like the “other” or experienced bias or discrimination? What did it feel like? What did you learn from being considered an “other”? How did this experience shape your understanding of differences? Think of a time where you observed a situation where bias has played a role. Did you intervene? Why or why not? Do you think personal bias has the ability to impact the quality of clinical encounters? How so? Why does it matter that people understand that they have implicit biases? Assignment 2: Complete assigned readings and videos. Answer interactive questions embedded in assigned videos. (20 points) Week 2 Assignment 3: For the final assignment, students will synthesize information learned from assigned readings and videos. Students will create a PowerPoint presentation and orally present on how to recognize and reduce the effects of implicit bias through the lens of a critical current issue in healthcare. (55 points) Due by the Friday of the final week of enrollment unless an extension is granted. See statement on late work. Critical Issues in Healthcare (Oral Presentation) This assignment is designed to help students move from a theoretical to practical understanding of implicit bias. For this assignment, students are asked to identify a critical current issue in healthcare that is connected to one’s understanding of the impact of implicit bias in the clinical setting (an example may be racial disparities in pain management), formulate strategies and demonstrate “corrective action” towards minimizing the impact. In a 15-20 min in-person presentation (or via web-based modality) students will address the following: Background of current issue What makes this a “critical issue” in healthcare? What challenges does the critical issue pose to the delivery of quality and equitable health care? What implications for the field of medicine are there if left unaddressed? Recommendations for addressing this critical issue Students are expected to utilize articles, videos and other pertinent literature (outside of assigned readings) as support for this assignment.