The effects of an instructional intervention on racial attitude formation in occupational therapy students

The nature and validity of implicit bias training for health care providers and trainees: A systematic review

The number of health care educational institutions/organizations adopting implicit bias training is growing. Our systematic review of 77 studies (published 1 January 2003 through 21 September 2022) investigated how implicit bias training in health care is designed/delivered and whether gaps in knowledge translation compromised the reliability and validity of the training. The primary training target was race/ethnicity (49.3%); trainings commonly lack specificity on addressing implicit prejudice or stereotyping (67.5%). They involved a combination of hands-on and didactic approaches, lasting an average of 343.15 min, often delivered in a single day (53.2%). Trainings also exhibit translational gaps, diverging from current literature (10 to 67.5%), and lack internal (99.9%), face (93.5%), and external (100%) validity. Implicit bias trainings in health care are characterized by bias in methodological quality and translational gaps, potentially compromising their impacts.

Implicit Bias Training in Health Professions Education: A Scoping Review

There is a recurrent call for effective implicit bias (IB) education within health professions education (HPE). We aimed to explore the state of IB education within HPE for clinical learners and IB educators using the Arksey and O'Malley scoping review framework. Thirty publications variable in curricular design met inclusion criteria. No studies assessed learner outcomes at the level of Miller's "shows" or "does" nor reported program evaluation outcomes at the level of Kirkpatrick's "behavior" or "results." Rigorous, theory-guided studies assessing behavioral change, patient care delivery, and patient outcomes are needed to move the field of IB education forward within HPE.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01673-z.

Educational strategies used to improve the knowledge, skills, and attitudes of health care students and providers regarding implicit bias: An integrative review of the literature

Background

The thoughts, feelings, and attitudes health care professionals unconsciously have about patients can negatively impact patients' health outcomes. Systematic reviews related to implicit bias in health care providers have uncovered negative implicit bias towards older adults, people of color, people with disabilities, psychiatric patients, patients who are obese, people of low socioeconomic status, and women. Implicit bias impacts the quality, safety, and competence of care delivered; interactions between patients and providers; and patient approval of treatment recommendations. Health care professions students and health care providers need to participate in evidence-based educational strategies to manage and diminish bias.

Objective

To review the evidence regarding educational strategies used with health care professions students and providers to improve their knowledge of implicit bias, reduce bias, and improve attitudes about bias.

Design

Integrative review.

Methods

The literature review was completed in July 2020 with two updates performed in February 2021 and June 2021 using nine databases including Academic Search Complete™, Embase®, ERIC®, Ovid, PubMed®, Scopus®, and Web of Science™. Key terms used related to education, health care professions' students, health care providers, implicit, bias, incivility, microaggression, and microassult. Publications dates from 2011 to 2021 were included. Covidence software was used for the initial screening and for full-text analysis.

Results

Thirty-nine articles were analysed for this review. The most commonly used educational strategies to instruct about principles of implicit bias include discussion groups, simulation and case-based learning, pre-tests for awareness, use of expert facilitators, commitment to action/change, and debriefing. Common components of successful strategies include thoughtful program planning, careful selection of program facilitators (who are content experts), support of participants, and a system-level investment.

Conclusions

Diverse educational strategies successfully addressed implicit bias across studies. Recommendations for future studies includes addressing limitations in sampling strategies and data collection to clarify relationships between educational strategies and participant outcomes. Educational opportunities are warranted that challenge health care professionals to explore their implicit bias towards others in an effort to provide care that considers diversity, equity, and inclusion and also limits personal implicit bias.

The Concept of Oppression and Occupational Therapy: A Critical Interpretive Synthesis

Background. Occupational therapy and occupational science literature include growing attention to issues of justice, marginalization, and rights. In contrast, the concept of oppression has scarcely been employed. Purpose. This paper investigates how adding the concept of oppression may enhance occupational therapy approaches to injustice, prioritizing a focus on structural causes, and facilitating conscientious action. Method. A critical interpretive synthesis explored insights from authors who name oppressions in occupational therapy and occupational science literature. In total, a sample of 28 papers addressing oppression, ableism, ageism, classism, colonialism, heterosexism, racism, and/or sexism was selected for inclusion. Findings. Four themes were identified: oppression and everyday doing; effects of structures and power; responding and resisting; and oppression within occupational therapy. Implications. Incorporating oppression within the plurality of social discourse may help occupational therapists to avoid individualistic explanations, attend to relationships between social structures and constrained occupations, frame intersectional analysis, and engage in praxis.

Validity evidence for a novel instrument assessing medical student attitudes toward instruction in implicit bias recognition and management

BACKGROUND

Implicit bias instruction is becoming more prevalent in health professions education, with calls for skills-based curricula moving from awareness and recognition to management of implicit bias. Evidence suggests that health professionals and students learning about implicit bias ("learners") have varying attitudes about instruction in implicit bias, including the concept of implicit bias itself. Assessing learner attitudes could inform curriculum development and enable instructional designs that optimize learner engagement. To date, there are no instruments with evidence for construct validity that assess learner attitudes about implicit bias instruction and its relevance to clinical care.

METHODS

The authors developed a novel instrument, the Attitude Towards Implicit Bias Instrument (ATIBI) and gathered evidence for three types of construct validity- content, internal consistency, and relationship to other variables.

RESULTS

Authors utilized a modified Delphi technique with an interprofessional team of experts, as well as cognitive interviews with medical students leading to item refinement to improve content validity. Seven cohorts of medical students, N = 1072 completed the ATIBI. Psychometric analysis demonstrated high internal consistency (α = 0.90). Exploratory factor analysis resulted in five factors. Analysis of a subset of 100 medical students demonstrated a moderate correlation with similar instruments, the Integrative Medicine Attitude Questionnaire (r = 0.63, 95% CI: [0.59, 0.66]) and the Internal Motivation to Respond Without Prejudice Scale (r = 0.36, 95% CI: [0.32, 0.40]), providing evidence for convergent validity. Scores on our instrument had low correlation to the External Motivation to Respond Without Prejudice Scale (r = 0.15, 95% CI: [0.09, 0.19]) and the Groningen Reflection Ability Scale (r = 0.12, 95% CI: [0.06, 0.17]) providing evidence for discriminant validity. Analysis resulted in eighteen items in the final instrument; it is easy to administer, both on paper form and online.

CONCLUSION

The Attitudes Toward Implicit Bias Instrument is a novel instrument that produces reliable and valid scores and may be used to measure medical student attitudes related to implicit bias recognition and management, including attitudes toward acceptance of bias in oneself, implicit bias instruction, and its relevance to clinical care.

Dona Ivone Lara e terapia ocupacional: devir-negro da história da profissão

Resumo Este ensaio apresenta uma análise das contribuições de memórias negras que perpassam a terapia ocupacional – colocando em tela a história de Yvonne Lara. Yvonne Lara foi enfermeira, assistente social e especialista em terapia ocupacional. A partir dos anos 1940, realizou práticas voltadas para o cuidado de pessoas com transtornos mentais, utilizando a música como atividade terapêutica e o trabalho de articulação com a família e comunidade, na busca de processos de desinstitucionalização dos sujeitos. O texto aponta a inovação dessas práticas de cuidado, tendo em vista a hegemonia da corrente organicista e asilar que marcava a psiquiatria na época. Defende-se que o resgate de histórias como de Yvonne seja central para a reconstituição histórica da profissão, rompendo com o epistemicídio racista das contribuições do conhecimento dos povos negros. Busca-se visibilizar figuras marginalizadas pelas narrativas oficiais e construir uma diversidade epistêmica no campo, o que denominamos como o devir-negro da terapia ocupacional.

Current Landscape of Teaching Diversity in Occupational Therapy Education: A Scoping Review

IMPORTANCE

Critical research in health professions education makes clear the role of educational institutions in perpetuating problematic discourses related to diversity, as well as their potential role in dismantling and rebuilding those discourses to reflect the realities of power relations that create systemic injustice.

OBJECTIVE

To provide a comprehensive overview of current pedagogical practices and educational paradigms used by occupational therapy educators to teach concepts of, and skills for, equity and diversity.

DATA SOURCES

Seven education and health care databases were searched for articles published between 2007 and 2018.

STUDY SELECTION AND DATA COLLECTION

Consensually developed criteria were refined until an agreement rate of >80% was achieved among the authors. Inclusion criteria focused on entry-level occupational therapy education across the world and explicitly examined approaches to teaching diversity. All articles meeting the criteria were kept for full-text review (N = 87).

FINDINGS

Diversity in professional occupational therapy education programs is taught within five main underlying educational paradigms and theories: competency-based (44%), social justice (29%), critical (11%), social accountability (10%), and constructivism (6%). Within these paradigms, 14 key pedagogical practices were applied, with community service learning (37%), international service learning (25%), and didactic or course-based practices (23%) making up the majority of pedagogical practices.

CONCLUSIONS AND RELEVANCE

Although current occupational therapy research demonstrates a trend toward critical paradigms and practices, problematic cultural competency theories and uncritical international service learning practices continue to dominate occupational therapy education for diversity. Educators should implement pedagogies and approaches within critical educational paradigms.

WHAT THIS ARTICLE ADDS

This article highlights the importance to occupational therapy education of attending to coherence across educational ethics, paradigms, and learning outcomes in teaching for diversity and health equity.

Genetic counselors' implicit racial attitudes and their relationship to communication

OBJECTIVE

Implicit racial attitudes are thought to shape interpersonal interactions and may contribute to health-care disparities. This study explored the relationship between genetic counselors' implicit racial attitudes and their communication during simulated genetic counseling sessions.

METHOD

A nationally representative sample of genetic counselors completed a web-based survey that included the Race Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998; Cooper et al., 2012). A subset of these counselors (n = 67) had participated in an earlier study in which they were video recorded counseling Black, Hispanic, and non-Hispanic White SCs about their prenatal or cancer risks. The counselors' IAT scores were related to their session communications through robust regression modeling.

RESULTS

Genetic counselors showed a moderate to strong pro-White bias on the Race IAT (M = 0.41, SD = 0.35). Counselors with stronger pro-White bias were rated as displaying lower levels of positive affect (p < .05) and tended to use less emotionally responsive communication (p < .10) when counseling minority SCs. When counseling White SCs, pro-White bias was associated with lower levels of verbal dominance during sessions (p < .10). Stronger pro-White bias was also associated with more positive ratings of counselors' nonverbal effectiveness by White SCs.

CONCLUSION

Implicit racial bias is associated with negative markers of communication in minority client sessions and may contribute to racial disparities in processes of care related to genetic services.