Implicit Bias Education and Emergency Medicine Training: Step One? Awareness
Implicit Bias Education and Emergency Medicine Training: Step One? Awareness
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DOI：
10.1002/aet2.10124
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发表时间：
2019-01-01
影响因子：
1.8
通讯作者：
Lopez, Bernard L.
中科院分区：
文献类型：
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作者：
Zeidan, Amy J.;Khatri, Utsha G.;Lopez, Bernard L.
目的：先前的研究表明，医疗保健提供者容易受到隐性偏见的影响，特别是支持白人的偏见，而这些偏见可能会影响医生的行为，从而导致医疗保健不平等。尽管有这些发现，隐性偏见培训目前尚未嵌入急诊医学 (EM) 住院医师培训中，而且很少有研究评估隐性偏见培训对住院医师会议期间意识的有效性。我们试图对针对隐性偏见主题的正式教育干预进行混合方法计划评估。方法：我们使用设计思维框架来开发课程干预。干预措施包括参加关于种族的哈佛内隐联想测试（IAT），以引入内隐偏见的概念，然后进行便利的讨论，以探讨参与者对内隐偏见是否可能导致护理差异的看法。促进的讨论是针对新出现的主题进行音频录制、转录和编码的。一项在线调查评估了参与者在干预前后对这些主题的认识，并使用配对 t 检验进行了分析。结果：干预后，参与者对其个人隐性偏见的认识增加了 33.3% (p = 0.003)，他们对 IAT 结果如何影响他们向患者提供护理的方式的认识增加了 9.1% (p = 0.03)。新出现的主题包括对隐性偏见测试结果的怀疑并希望获得“中性”结果，承认模式识别可能会导致护理中的“盲点”，认识到个人和系统层面上存在偏见，以及对解决隐性偏见的定期教育干预感兴趣。结论：这种针对隐性偏见的新颖教育干预提高了参与者对其隐性偏见及其如何影响患者护理的认识。我们的干预措施可以作为其他住院医师项目的模型，以制定和实施干预措施，以提高人们对隐性偏见及其对患者护理的潜在影响的认识。
Objective: Prior research suggests that health care providers are susceptible to implicit biases, specifically prowhite biases, and that these may contribute to health care disparities by influencing physician behavior. Despite these findings, implicit bias training is not currently embedded into emergency medicine (EM) residency training and few studies exist that evaluate the effectiveness of implicit bias training on awareness during residency conference. We sought to conduct a mixed-methods program evaluation of a formalized educational intervention targeted on the topic of implicit bias.Methods: We used a design thinking framework to develop a curricular intervention. The intervention consisted of taking the Harvard Implicit Association Test (IAT) on race to introduce the concept of implicit bias, followed by a facilitated discussion to explore participant's perceptions on whether implicit bias may lead to variations in care. The facilitated discussion was audio recorded, transcribed, and coded for emerging themes. An online survey assessed participant awareness of these topics before and after the intervention and was analyzed using paired t-tests.Results: After the intervention, participant's awareness of their individual implicit biases increased by 33.3% (p = 0.003) and their awareness of how their IAT results influences how they deliver care to patients increased by 9.1% (p = 0.03). Emerging themes included skepticism of the implicit bias test results with the desire to have "neutral" results, acknowledgment that pattern recognition may lead to "blind spots" in care, recognition that bias exists on a personal and systemic level, and interest in regular educational interventions to address implicit bias.Conclusions: This novel educational intervention on implicit bias resulted in improvement in participants' awareness of their implicit biases and how it may affect their patient care. Our intervention can serve as a model for other residency programs to develop and implement an intervention to create awareness of implicit bias and its potential impact on patient care.