Reducing implicit verbal and nonverbal bias toward Hispanic patients

描述(由申请人提供)：目前的提案寻求支持研究，以记录和减少住院医生在与拉美裔患者互动时表达的隐性语言和非语言偏见。研究表明，虽然刻板印象、偏见和歧视行为可以是有意识和故意的，但医疗保健提供者之间的偏见表达往往是无意的，因为许多人在含蓄或无意识的层面上持有负面态度和刻板印象。因此，内隐语言和非语言偏见可能会渗透到住院医生与拉美裔患者互动的方式中，但培训住院医生控制他们的语言和非语言内隐偏见可以减轻临床期间对患者的负面影响 相遇。虽然之前的研究表明，医疗保健提供者对被污名化的患者持有内隐的负面态度和刻板印象，而且这些偏见会对提供者与少数族裔患者互动的方式以及少数族裔患者在临床接触后报告的满意度产生负面影响，但到目前为止，还没有研究证明内隐偏见和患者满意度之间的关系的中介因素。目前的提案通过开发和测试一种新的内隐语言偏见模型来解决这一空白。内隐林吉斯蒂偏见模型认为，拉美裔患者与对他们及其群体持有内隐偏见的居民之间的互动表现为较低的语言匹配度，较高的要求-撤退语言使用率，以及较高的组间语言偏见。这些隐含的语言偏见的存在，反过来会使患者感到较少参与对话，对提供者缺乏信心和信任，并感觉不太想再次见到提供者。然而，减少临床接触期间隐性语言和非语言偏见的表达，包括隐性语言偏见，可以通过培训住院医生了解隐性偏见的心理学，在临床接触中如何沟通，以及当他们与拉美裔患者互动时如何控制他们的言语和非语言表达的隐性偏见来实现。在五年多的三项大规模研究中，拟议的研究将考察内隐偏见和非言语形式的内隐偏见的存在和减少，包括内隐语言偏见的影响，在住院医师和西班牙裔患者之间的临床接触中。研究一将通过记录和编码住院医师和拉美裔患者之间的互动来开发和检验所提出的内隐语言偏见模型。研究2将开发和测试一种新的混合学习模块的有效性，以培训住院医师内隐偏见的心理学。然后，研究3将检查完成内隐偏见培训模块是否减少了内隐言语和非言语偏见的表达，包括内隐语言偏见的表达，并提高了住院医师与拉美裔患者互动时的患者满意度。

DESCRIPTION (provided by applicant): The current proposal seeks support for research to document and reduce the expression of implicit verbal and nonverbal bias by medical residents when they interact with Hispanic patients. Research shows that while stereotyping, prejudice and acts of discrimination can be conscious and deliberate, the expression of bias among healthcare providers is often unintentional because many hold negative attitudes and stereotypes at an implicit or unconscious level. Thus, implicit verbal and nonverbal biases may leak into the way residents interact with Hispanic patients, but training residents to control thei verbal and nonverbal implicit biases can mitigate the negative effect on patients during a clinical encounter. Whereas previous research shows that healthcare providers hold implicit negative attitudes and stereotypes about stigmatized patients, and that these biases can negatively impact both the way providers interact with minority patients, and the satisfaction that minority patients report after a clinical encounter, no research to date has documented the mediators of the relationship between implicit bias and patient satisfaction. The current proposal addresses this void by developing and testing a new model of Implicit Linguistic Bias. The Implicit Linguisti Bias model proposes that interactions between Hispanic patients and residents, who hold implicit biases toward them and their group are characterized by lower linguistic matching, higher use of demand-withdrawal language, and higher intergroup linguistic bias language. The presence of these implicit linguistic biases, in turn, make the patient feel less involved in the conversation, feel less confidence and trust in the provider, and feel less desire to see the provider again. Reducing the expression of implicit verbal and nonverbal biases, including implicit linguistic biases, during a clinical encounter, however, can be achieved by training residents in the psychology of implicit bias, how it is communicated during a clinical encounter, and how they can control their verbal and nonverbal expressions of implicit bias when they interact with Hispanic patients. In three large-scale studies over five years, the proposed research will examine the presence and reduction of verbal and nonverbal forms of implicit bias, including the effects of implicit linguistic bias, during clinical encounters between medical residents and Hispanic patients. Study 1 will develop and test the proposed model of Implicit Linguistic Bias by recording and coding interactions between medical residents and Hispanic patients. Study 2 will develop and test the effectiveness of a new hybrid-learning module for training medical residents in the psychology of implicit bias. Study 3 will then examine if completing the implicit bias training module reduces the expression of implicit verbal and nonverbal bias, including the expression of implicit linguistic bias, and improves patient satisfaction ratings when medial residents interact with Hispanic patients.