• 180 likes • 189 Views
Explore the significance of bias in healthcare settings, its effects on both providers and patients, and steps to address bias through awareness and interventions.
E N D
BIAS: Understanding How it Affects our Patients and our Care of them
Goals • Define bias and its significance in the clinical learning environment • Consider how it affects health care workers and their patients personally and professionally • Explore steps to ameliorate bias by heightened awareness, curricular interventions and institutional priority
Bias • General pattern/tendency to think a certain way. It is essentially a quick route our brains can use to make decisions quickly • Prejudice in favor of or against one thing, person, or group • Cognitive bias: systematic error in thinking that affect decisions/judgments that people make. • Heuristics: a mental shortcut so that your brain doesn't have to come up with a new solution every time a new situation arises. Cognitive Biases are logical fallacies that are derived from heuristics. These often can be dangerous because they automate wrong decisions.
Explicit vs. Implicit Bias • “Explicit bias” refers to the attitudes and beliefs we have about a person or group on a conscious level. • “Implicit bias” refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.
Awareness of bias is the first step toward solutions • Often biases are shaped by life experiences and the social interactions a person has. • Implicit bias may actually be exactly opposite to what a person consciously believes • It is not possible for humans to be free of bias either explicit or implicit. • Building awareness and understanding of our biases is a first step toward making conscious decisions to act fairly.
Implicit Attitude Test (IAT) • Form small groups (3-5) • Discuss your reactions to the IAT. • Is this information useful for you? • How well do you think it reflects your own implicit bias?
For Discussion • What sorts of bias can you identify in your workplace? • Are they explicit? Implicit? • How does bias affect the learning environment? • How does bias affect clinical research and new health advancements? • How does bias affect health care delivery and outcomes?
Race/ethnicity Bias • Many examples of people receiving differing levels of health care based on racial and ethnic groups. • These racial/ethnic related disparities are often intertwined with Social Determinants of Health • Race and ethnicity based disparities can be studied in a specialty specific manner. • Can you name some health care disparities in OBGYN related to health services access? How might implicit bias contribute to this?
A six step curricular approach to bias • Create a safe and nonthreatening learning context • Increase knowledge about the science of implicit bias • Emphasizing how implicit bias influences behaviors and patient outcomes • Increasing self-awareness of existing implicit biases • Improving conscious efforts to overcome implicit bias • Enhancing awareness of how implicit bias influences others A Framework for Integrating Implicit Bias Recognition Into Health Professions Education J sukhera, C Watling Academic Medicine Jan2018
Group Discussion • Since we cannot eliminate bias, how can we ameliorate its effects? • naming/acknowledging • Counter stereotype examples • Targeted exposure to minority groups • Practice / feedback / reflection • How can we as HCW address unconscious bias? • Ask • “How is racism operating here?” • What exists? / What is lacking? • Organize and strategize to act/grassroots/advocacy/politics
Patient bias against physicians • What examples have you seen of this • Was the interaction reported? To whom? • What was the response of the supervising physician? • How would you respond to patient bias?
Patient bias against physicians • How should faculty/residents deal with this? • Assess acuity of patient condition • Cultivate a therapeutic alliance • Depersonalize reaction • Ensure a safe learning environment • Consult/review institutional philosophy to promote fairness and ameliorate bias • Debrief
What other groups are subject to explicit and implicit bias? • LGBTQ • Individuals with medical conditions • obesity • mental illness • chronic pain syndromes • Addiction • Socioeconomic influences including income, insurance status, homelessness • Incarcerated individuals • Immigrants • Disabled individuals • Others?
Choose a population from the list (or your experience). • Investigate how bias affects them when they interact with health care. • Do you interact with patients from this group? With HCWs from this group? • What steps could be taken in your institution to move these patients toward health equity?