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Abstract
How often a researcher is cited usually plays a decisive role in that person's career advancement, because academic institutions often use citation metrics, either explicitly or implicitly, to estimate research impact and productivity. Research has shown, however, that citation patterns and practices are affected by various biases, including the prestige of the authors being cited and their gender, race, and nationality, whether self-attested or perceived. Some commentators have proposed that researchers can address biases related to social identity or position by including a Citation Diversity Statement in a manuscript submitted for publication. A Citation Diversity Statement is a paragraph placed before the reference section of a manuscript in which the authors address the diversity and equitability of their references in terms of gender, race, ethnicity, or other factors and affirm a commitment to promoting equity and diversity in sources and references. The present commentary considers arguments in favor of Citation Diversity Statements, and some practical and ethical issues that these statements raise.
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Affiliation(s)
- Keisha S Ray
- McGovern Center For Humanities & Ethics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Perry Zurn
- Department of Philosophy and Religion, American University, Washington, Washington DC, USA
| | - Jordan D Dworkin
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Dani S Bassett
- Departments of Bioengineering, Electrical & Systems Engineering, Physics and Astronomy, Neurology, and Psychiatry, University of Pennsylvania; and the Santa Fe Institute, Philadelphia, Philadelphia, USA
| | - David B Resnik
- National Institutes of Health, National Institute of Environmental Health Sciences, New York, New York, USA
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Kreynin A, Meurer T, Pictor L, Laboe AA, Gavuji M, Fleege S, Bowden E, Schaumberg K. The Body Advocacy Movement-Health: a pilot randomized trial of a novel intervention targeting weight stigma among health professional students. J Eat Disord 2024; 12:156. [PMID: 39375802 DOI: 10.1186/s40337-024-01114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 09/17/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Weight stigma among healthcare professionals is associated with negative health impacts on patients, yet there are few effective strategies to combat weight stigma among health professional learners. The Body Advocacy Movement-Health (BAM-Health) is a novel group-based, peer-led stigma reduction intervention for health professional students that targets weight stigma across intrapersonal, interpersonal, and structural levels. The present study (1) assesses short-term impacts of BAM-Health participation on intrapersonal and interpersonal weight bias compared to an informational brochure control condition and (2) explores the feasibility and acceptability of BAM-Health among a sample of health professional students. METHODS Sixty-seven health professional students participated in BAM-Health (n = 34) or received an informational brochure about weight stigma (n = 33). Participants completed validated self-report surveys assessing internalized weight/ appearance concerns and interpersonal weight stigma prior to their assigned intervention (baseline), immediately following intervention (post-intervention), and four weeks after intervention (follow-up). Baseline to post-intervention and baseline to follow-up effect sizes on each measure were calculated. At post-intervention, participants completed feedback surveys for thematic assessment. RESULTS BAM-Health participation had a large baseline to post-intervention effect on internalized weight/ appearance concerns that diminished slightly at follow-up (Cohen's d = -0.88; d = -0.62). Receipt of the informational brochure had a small effect on internalized weight/ appearance concerns (d = -0.27); however, these changes were not sustained at follow-up (d = 0.04). BAM-Health participation resulted in reductions in interpersonal obesity stigma and anti-fatness with small effect sizes (d = -0.32; d = -0.31). The effect on obesity stigma was slightly amplified at follow-up (d = -0.43); however, decreases in anti-fatness were not sustained (d = -0.13). The brochure condition failed to demonstrate effects on anti-fatness (d = 0.13, d = 0.14) or obesity stigma (d = -0.12; d = -0.12) at either time point. Between-session attrition rates of 4.5%, favorable quantitative ratings on post-session acceptability surveys, and free responses demonstrating appreciation of the virtual group environment and session activities reflect feasibility and acceptability of BAM-Health. CONCLUSIONS BAM-Health is a novel peer-led intervention that aims to reduce weight stigma among health professional students. BAM-Health met feasibility benchmarks and received positive feedback from participants, demonstrating acceptability and indicating interest among health professional students in analyzing and reducing weight stigma in their personal lives and careers. The intervention led to promising decreases in internalized and interpersonal weight stigma at post-intervention, some of which were sustained at follow-up. However, lack of effect on internalized weight/ appearance concerns measures may indicate that BAM-Health participants are more likely to reject weight stigma directed toward others following intervention, while maintaining thin ideals for themselves. Further investigation of BAM-Health with a larger sample and continued program development is warranted.
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Affiliation(s)
- Anna Kreynin
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA
| | - Tessa Meurer
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA
| | - Lauren Pictor
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI, 53719, USA
| | - Agatha A Laboe
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI, 53719, USA
| | - Mahathi Gavuji
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI, 53719, USA
| | - Sabrina Fleege
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA
| | - Erin Bowden
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA
| | - Katherine Schaumberg
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI, 53719, USA.
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Wang VHC, Cuevas AG, Osokpo OH, Chang JE, Zhang D, Hu A, Yun J, Lee A, Du S, Williams DR, Pagán JA. Discrimination in Medical Settings across Populations: Evidence From the All of Us Research Program. Am J Prev Med 2024; 67:568-580. [PMID: 38844146 DOI: 10.1016/j.amepre.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 07/01/2024]
Abstract
INTRODUCTION Discrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations. METHODS Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021-2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a healthcare provider within the past 12 months. Statistical analysis was performed in 2023-2024. RESULTS About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05. CONCLUSIONS The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the healthcare system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing healthcare disparities.
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Affiliation(s)
- Vivian Hsing-Chun Wang
- Department of Foundations of Medicine, Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine, New York, New York
| | - Adolfo G Cuevas
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York; Center for Anti-Racism, Social Justice and Public Health, New York University School of Global Public Health, New York, New York
| | - Onome Henry Osokpo
- Department of Population Health Nursing Science, University of Illinois College of Nursing, Chicago, Illinois
| | - Ji Eun Chang
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, New York
| | - Donglan Zhang
- Department of Foundations of Medicine, Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine, New York, New York; Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Anqing Hu
- Department of Civil and Engineering, Urban Systems Doctoral Program, New York University Tandon School of Engineering, Brooklyn, New York
| | - Jeongwook Yun
- Department of Biomedical Engineering, University of Texas at Austin Cockrell School of Engineering, Austin, Texas
| | - Adaora Lee
- Center for Anti-Racism, Social Justice and Public Health, New York University School of Global Public Health, New York, New York
| | - Shilei Du
- Department of Biostatistics, New York University School of Global Public Health, New York, New York
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of African and African American Studies, Harvard University, Cambridge, Massachusetts
| | - José A Pagán
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, New York.
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Abbas M, Chua IS, Tabata-Kelly M, Bulger AL, Gershanik E, Sheu C, Kerr E, Ruan M, Dey T, Lakin JR, Bernacki RE. Racial and Ethnic Disparities in Serious Illness Conversation Quality during the COVID-19 Pandemic. J Pain Symptom Manage 2024; 68:205-213.e6. [PMID: 38782305 DOI: 10.1016/j.jpainsymman.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/03/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
CONTEXT The COVID-19 pandemic disproportionately impacted non-Hispanic Black and Hispanic patients. However, little is known about the quality of serious illness communication in these communities during this time. OBJECTIVE We aimed to determine whether racial and ethnic disparities manifested in serious illness conversations during the pandemic. METHODS This was a retrospective, observational, cohort study of adult patients with a documented serious illness conversation from March 2020 to April 2021. Serious illness conversation documentation quality was assessed by counting the median number (IQR) of conversation domains and their elements included in the documentation. Domains included (1) values and goals, (2) prognosis and illness understanding, (3) end-of-life care planning, and (4) life-sustaining treatment preferences. A multivariable ordinal logistic regression analysis was conducted to assess associations between differences in serious illness documentation quality with patient race and ethnicity. RESULTS Among 291 patients, 149 (51.2%) were non-Hispanic White; 81 (27.8%) were non-Hispanic Black; and 61 (21.0%) were Hispanic patients. Non-Hispanic Black patients were associated with fewer domains (OR 0.46 [95% CI 0.25, 0.84]; P=.01) included in their serious illness conversation documentation compared to non-Hispanic White patients. Both non-Hispanic Black (OR 0.35 [95% CI 0.20, 0.62]; P<.001) and Hispanic patients (OR 0.29 [95% CI 0.14, 0.58]; P<.001) were associated with fewer elements in the values and goals domain compared to non-Hispanic White patients in their serious illness documentation. CONCLUSION During the COVID-19 pandemic, serious illness conversation documentation among non-Hispanic Black and Hispanic patients was less comprehensive compared to non-Hispanic White patients.
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Affiliation(s)
- Muhammad Abbas
- Department of General Surgery(M.A.), Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - Isaac S Chua
- Division of General Internal Medicine and Primary Care(I.S.C., E.G.), Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care(I.S.C., J.R.L., R.E.B.), Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School(I.S.C., J.L.R., R.E.B.), Boston, MA, USA.
| | - Masami Tabata-Kelly
- The Center for Surgery and Public Health(M.T.K., E.K., M.R., T.D., C.S.), Brigham and Women's Hospital, Boston, MA, USA; The Center for Geriatric Surgery(M.T.K., A.L.B., C.S., R.E.B.), Brigham and Women's Hospital, Boston, MA, USA; The Heller School for Social Policy and Management(M.T.K.), Waltham, MA, USA
| | - Amy L Bulger
- The Center for Geriatric Surgery(M.T.K., A.L.B., C.S., R.E.B.), Brigham and Women's Hospital, Boston, MA, USA; Department of Care Continuum Management(A.L.B.), Brigham and Women's Hospital, Boston, MA, USA
| | - Esteban Gershanik
- Division of General Internal Medicine and Primary Care(I.S.C., E.G.), Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School(I.S.C., J.L.R., R.E.B.), Boston, MA, USA
| | - Christina Sheu
- The Center for Surgery and Public Health(M.T.K., E.K., M.R., T.D., C.S.), Brigham and Women's Hospital, Boston, MA, USA; The Center for Geriatric Surgery(M.T.K., A.L.B., C.S., R.E.B.), Brigham and Women's Hospital, Boston, MA, USA
| | - Emma Kerr
- The Center for Surgery and Public Health(M.T.K., E.K., M.R., T.D., C.S.), Brigham and Women's Hospital, Boston, MA, USA
| | - Mengyuan Ruan
- The Center for Surgery and Public Health(M.T.K., E.K., M.R., T.D., C.S.), Brigham and Women's Hospital, Boston, MA, USA
| | - Tanujit Dey
- The Center for Surgery and Public Health(M.T.K., E.K., M.R., T.D., C.S.), Brigham and Women's Hospital, Boston, MA, USA
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care(I.S.C., J.R.L., R.E.B.), Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School(I.S.C., J.L.R., R.E.B.), Boston, MA, USA; Division of Palliative Medicine (J.R.L., R.E.B.), Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rachelle E Bernacki
- Department of Psychosocial Oncology and Palliative Care(I.S.C., J.R.L., R.E.B.), Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School(I.S.C., J.L.R., R.E.B.), Boston, MA, USA; The Center for Geriatric Surgery(M.T.K., A.L.B., C.S., R.E.B.), Brigham and Women's Hospital, Boston, MA, USA; Division of Palliative Medicine (J.R.L., R.E.B.), Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Wehbe LH, Duncan S, Banas K, Papies EK. To stand out or to conform: Stereotypes and meta-stereotypes as barriers in the transition to sustainable diets. Appetite 2024; 200:107506. [PMID: 38782094 DOI: 10.1016/j.appet.2024.107506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
What factors hinder the reduction of meat and/or dairy intake? In this study, we explored the perceived barriers that meat and/or dairy reducers experienced when shifting their diets. We particularly focused on how meat and/or dairy reducers were affected by their beliefs about how omnivores stereotype vegans (i.e., meta-stereotypes), as meta-stereotypes have not been previously explored in this context. Through open-ended questions in an online survey, we explored the experiences and perceived barriers among female meat and/or dairy reducers (n = 272), as well as their perceptions of vegans (i.e., stereotypes and meta-stereotypes), and how these perceptions affected their lived experiences. We analysed the data using reflexive thematic analysis and generated six themes. We highlighted perceptions of cost (Theme 1) and perceptions of health concerns (Theme 2) as the most dominant barriers to the reduction of meat and/or dairy intake. Regarding (meta) stereotypes, participants' perceptions of vegans were shaped by personal experiences and encounters with vegans (Theme 3), and how participants related to vegans was sometimes reflected in the language they used to describe vegans (Theme 4). Participants felt that they, or reducers more generally, were occasionally judged as vegans (Theme 5), which might influence participants' choices and conformity to eating norms (Theme 6). Meta-stereotypes may play a role in polarised dietary group perceptions, and we discuss how they are shaped by social identity processes as well as by aspects of Western food systems.
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Affiliation(s)
- Lara H Wehbe
- School of Psychology and Neuroscience, University of Glasgow, United Kingdom.
| | - Sophie Duncan
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Well-being, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, United Kingdom.
| | - Kasia Banas
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom.
| | - Esther K Papies
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Well-being, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, United Kingdom.
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Deshpande SR, Lepore G, Wieland L, Kogan JR. Racial and Ethnic Bias in Letters of Recommendation in Academic Medicine: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:1032-1037. [PMID: 38466619 DOI: 10.1097/acm.0000000000005688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
PURPOSE Letters of recommendations (LORs) are key components of academic medicine applications. Given that bias against students and trainees underrepresented in medicine (UIM) has been demonstrated across assessment, achievement, and advancement domains, the authors reviewed studies on LORs to assess racial, ethnic, and UIM differences in LORs. Standardized LORs (SLORs), an increasingly common form of LORs, were also assessed for racial and ethnic differences. METHOD A systematic review was conducted for English-language studies that assessed racial or ethnic differences in LORs in academic medicine published from database inception to July 16, 2023. Studies evaluating SLORs underwent data abstraction to evaluate their impact on the given race or ethnicity comparison and outcome variables. RESULTS Twenty-three studies describing 19,012 applicants and 41,925 LORs were included. Nineteen studies (82.6%) assessed LORs for residency, 4 (17.4%) assessed LORs for fellowship, and none evaluated employment or promotion. Fifteen of 17 studies (88.2%) assessing linguistic differences reported a significant difference in a particular race or ethnicity comparison. Of the 7 studies assessing agentic language (e.g., "strong," "confident"), 1 study found fewer agentic terms used for Black and Latinx applicants, and 1 study reported higher agency scores for Asian applicants and applicants of races other than White. There were mixed results for the use of communal and grindstone language in UIM and non-UIM comparisons. Among 6 studies, 4 (66.7%) reported that standout language (e.g., "exceptional," "outstanding") was less likely to be ascribed to UIM applicants. Doubt-raising language was more frequently used for UIM trainees. When SLORs and unstructured LORs were compared, fewer linguistic differences were found in SLORs. CONCLUSIONS There is a moderate bias against UIM candidates in the domains of linguistic differences, doubt-raising language, and topics discussed in LORs, which has implications for perceptions of competence and ability in the high-stakes residency and fellowship application process.
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Gonzalez CM, Greene RE, Cooper LA, Lypson ML. Recommendations for Faculty Development in Addressing Implicit Bias in Clinical Encounters and Clinical Learning Environments. J Gen Intern Med 2024; 39:2326-2332. [PMID: 38831249 PMCID: PMC11347534 DOI: 10.1007/s11606-024-08832-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Richard E Greene
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Office of Diversity Affairs, NYU Grossman School of Medicine, New York, NY, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine and Johns Hopkins Center for Health Equity, Baltimore, MD, USA
| | - Monica L Lypson
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Golubickis M, Persson LM, Falbén JK, Seow SH, Jalalian P, Sharma Y, Ivanova M, Macrae CN. Facial misfits accelerate stereotype-based associative learning. Sci Rep 2024; 14:19320. [PMID: 39164271 PMCID: PMC11336254 DOI: 10.1038/s41598-024-67770-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/15/2024] [Indexed: 08/22/2024] Open
Abstract
Counterstereotypes challenge the deleterious effects that gender-typed beliefs exert on people's occupational aspirations and lifestyle choices. Surprisingly, however, the critical issue of how readily unexpected person-related knowledge can be acquired remains poorly understood. Accordingly, in two experiments in which the facial appearance of targets was varied to manipulate goodness-of-stereotype-fit (i.e., high vs. low femininity/masculinity), here we used a probabilistic selection task to probe the rate at which counter-stereotypic and stereotypic individuals can be learned. Whether occupational (Expt. 1) or trait-related (Expt. 2) gender stereotypes were explored, a computational analysis yielded consistent results. Underscoring the potency of surprising information (i.e., facial misfits), knowledge acquisition was accelerated for unexpected compared to expected persons, both in counter-stereotypic and stereotypic learning contexts. These findings affirm predictive accounts of social perception and speak to the optimal characteristics of interventions designed to reduce stereotyping outside the laboratory.
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Affiliation(s)
- Marius Golubickis
- School of Psychology, University of Aberdeen, King's College, Aberdeen, AB24 3FX, Scotland, UK.
| | - Linn M Persson
- School of Psychology, University of Aberdeen, King's College, Aberdeen, AB24 3FX, Scotland, UK
| | - Johanna K Falbén
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Siew Hwee Seow
- School of Psychology, University of Aberdeen, King's College, Aberdeen, AB24 3FX, Scotland, UK
| | - Parnian Jalalian
- School of Psychology, University of Aberdeen, King's College, Aberdeen, AB24 3FX, Scotland, UK
| | - Yadvi Sharma
- School of Psychology, University of Aberdeen, King's College, Aberdeen, AB24 3FX, Scotland, UK
| | - Margarita Ivanova
- School of Psychology, University of Aberdeen, King's College, Aberdeen, AB24 3FX, Scotland, UK
| | - C Neil Macrae
- School of Psychology, University of Aberdeen, King's College, Aberdeen, AB24 3FX, Scotland, UK
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Hagiwara N, Duffy C, Cyrus J, Harika N, Watson GS, Green TL. The nature and validity of implicit bias training for health care providers and trainees: A systematic review. SCIENCE ADVANCES 2024; 10:eado5957. [PMID: 39141723 PMCID: PMC11323883 DOI: 10.1126/sciadv.ado5957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 07/09/2024] [Indexed: 08/16/2024]
Abstract
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.
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Affiliation(s)
- Nao Hagiwara
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA
| | - Conor Duffy
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - John Cyrus
- Research and Education Department, Health Sciences Library, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Nadia Harika
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Ginger S. Watson
- Virginia Modeling Analysis & Simulation Center, Old Dominion University, Suffolk, VA 23435, USA
| | - Tiffany L. Green
- Departments of Population Health Sciences and Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI 53726, USA
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Wainstein T, Yeung D, Jennings L, Elliott AM. Adolescents' implicit and explicit attitudes toward their peers with genetic conditions. J Adolesc 2024; 96:1249-1262. [PMID: 38711256 DOI: 10.1002/jad.12335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Previous research has demonstrated that children lacking knowledge about genetic disorders may have harmful attitudes toward people with disabilities, but disability awareness can successfully modify these attitudes. We explored adolescents' implicit and explicit attitudes toward peers with genetic conditions to determine whether improved genetics/genomics literacy can mitigate the impact of ableism in this population. METHODS English-speaking adolescents (10-18 years) from British Columbia were invited to complete a Disability Attitudes Implicit Association Test (DA-IAT) and participate in a semi-structured focus group centering on a fictionalized vignette about an adolescent with Down syndrome. We used pragmatism as an analytical paradigm. Descriptive and inferential statistics were used to analyze DA-IAT and sociodemographic data; phronetic iterative analysis with constant comparison as a coding strategy for transcripts; and interpretive description to develop a conceptual model. RESULTS Twenty-two adolescents completed the DA-IAT and participated in one of four focus groups. Participants had a statistically significant implicit preference for non-disabled people (D-score = 0.72, SD = 0.44; t = 7.18, p < .00001). They demonstrated greater diversity in their explicit attitudes during the focus groups. Although participants articulated a positive attitude toward improved genetics education, results demonstrate their belief that social and personal interactions with disabled peers would be essential to address negative perceptions. CONCLUSIONS This study lays important groundwork to understand, explain, and influence the negative attitudes of adolescents toward individuals with disabilities. Findings will be used to inform the design of interventions that address biased perceptions of people with genetic disorders, with the goal of reducing prejudices and improving social interactions.
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Affiliation(s)
- Tasha Wainstein
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - David Yeung
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren Jennings
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- BC Women's Hospital Research Institute, Vancouver, British Columbia, Canada
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Wilson SM, Johnson KS, Svetkey LP. Achieving Equity in Hypertension Control: Could Addressing Clinician Implicit Bias Play a Role? JACC. ADVANCES 2024; 3:100951. [PMID: 39129989 PMCID: PMC11312355 DOI: 10.1016/j.jacadv.2024.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Affiliation(s)
- Sarah M. Wilson
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Mental and Behavioral Health Service, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Kimberly S. Johnson
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura P. Svetkey
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Naar S, Pettus C, Anderson N, Pooler-Burgess M, Ralston P, Flynn H, Combs T, Baquet C, Schatschneider C, Luke D. Study protocol for transforming health equity research in integrated primary care: Antiracism as a disruptive innovation. PLoS One 2024; 19:e0306185. [PMID: 38935743 PMCID: PMC11210870 DOI: 10.1371/journal.pone.0306185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/11/2024] [Indexed: 06/29/2024] Open
Abstract
Among the consequences of systemic racism in health care are significant health disparities among Black/African American individuals with comorbid physical and mental health conditions. Despite decades of studies acknowledging health disparities based on race, significant change has not occurred. There are shockingly few evidence-based antiracism interventions. New paradigms are needed to intervene on, and not just document, racism in health care systems. We are developing a transformative paradigm for new antiracism interventions for primary care settings that integrate mental and physical health care. The paradigm is the first of its kind to integrate community-based participatory research and systems science, within an established model of early phase translation to rigorously define new antiracism interventions. This protocol will use a novel application of systems sciences by combining the qualitative systems sciences methods (group model building; GMB) with quantitative methods (simulation modeling) to develop a comprehensive and community-engaged view of both the drivers of racism and the potential impact of antiracism interventions. Community participants from two integrated primary health care systems will engage in group GMB workshops with researchers to 1) Describe and map the complex dynamic systems driving racism in health care practices, 2) Identify leverage points for disruptive antiracism interventions, policies and practices, and 3) Review and prioritize a list of possible intervention strategies. Advisory committees will provide feedback on the design of GMB procedures, screen potential intervention components for impact, feasibility, and acceptability, and identify gaps for further exploration. Simulation models will be generated based on contextual factors and provider/patient characteristics. Using Item Response Theory, we will initiate the process of developing core measures for assessing the effectiveness of interventions at the organizational-systems and provider levels to be tested under a variety of conditions. While we focus on Black/African Americans, we hope that the resulting transformative paradigm can be applied to improve health equity among other marginalized groups.
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Affiliation(s)
- Sylvie Naar
- Center for Translational Behavioral Science, Florida State University, Tallahassee, FL, United States of America
| | - Carrie Pettus
- Wellbeing & Equity Innovations, Tallahassee, FL, United States of America
| | - Norman Anderson
- Office of Vice President for Research and College of Social Work, Florida State University, Tallahassee, FL, United States of America
| | - Meardith Pooler-Burgess
- Center for Translational Behavioral Science, Florida State University, Tallahassee, FL, United States of America
| | - Penny Ralston
- Center on Better Health and Life for Underserved Populations, Florida State University, Tallahassee, FL, United States of America
| | - Heather Flynn
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, United States of America
| | - Todd Combs
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Claudia Baquet
- Hope Institute, LLC and UM School of Pharmacy, Baltimore, Maryland, United States of America
| | | | - Douglas Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
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Pollak KI, Davenport CA, Duck V, Falls A, Pepka S, Parente V, Jackson LR, Johnson KS. Discriminatory and valuing communication behaviors in cardiology encounters. PATIENT EDUCATION AND COUNSELING 2024; 123:108224. [PMID: 38395022 PMCID: PMC10997491 DOI: 10.1016/j.pec.2024.108224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Many have found racial differences in clinician-patient communication using validated codebooks that represent effective communication. No codebooks used for examining racial differences, however, have included patient input. In this paper, we describe creating codebook with Black patient advocates to determine if we could reliably code discriminatory/valuing communication and assess racial differences in these behaviors. METHODS We created a codebook for discriminatory/valuing communication behaviors with the input of Black patient advocates. We used the codebook to analyze data from 101 audio recorded encounters between White cardiologists and Black and White patients. We examined the differences in the prevalence of behaviors in cardiology encounters. RESULTS In comparison to White patients, cardiologists made fewer tailoring statements to their Black patients (68% vs. 49%, p = 0.07). Coders found 4 instances of stereotyping behaviors and only Black patients (p = 0.12). We found no significant associations between any of the other outcomes and patient race. Black patients had a lower incidence of tailoring statements (p = 0.13), lower incidence of interrupting statements (p = 0.16), and higher rushed global score (p = 0.14). CONCLUSION AND PRACTICE IMPLICATIONS We found that coders can reliably identify discriminatory/valuing behaviors in cardiology encounters. Future work should apply these codes to other datasets to assess their validity and generalizability.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | | | - Veronica Duck
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC, USA
| | - Allison Falls
- Department of Psychology, Duke University, Durham, NC, USA
| | - Sara Pepka
- Department of Psychology, Duke University, Durham, NC, USA
| | - Victoria Parente
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Kimberly S Johnson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Medical Center, Durham, NC, USA
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Friedman C, VanPuymbrouck L, Gordon Z. 'Not seeing people as capable': Disability professionals' mis/understandings of ableism. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13218. [PMID: 38403303 DOI: 10.1111/jar.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Knowledge about how disability professionals understand ableism may provide insight into the production of inequalities. The aim of this study was to examine how disability professionals understand ableism. METHODS We asked 347 disability professionals, all of whom worked with people with intellectual and developmental disabilities, among other populations, to define ableism and then analysed those definitions using content analysis. RESULTS The themes about how participants understood ableism were: discrimination; differential treatment; individualization; norms and othering; ableist language; microaggressions; and systems and environments. It was also not uncommon for participants to say ableist things, and express misconceptions in their definitions. This included these themes: avoiding disability; using ableist language; framing disability as in/ability; centring people without disabilities; ignoring invisible disabilities; believing only people without disabilities have bias; and believing ableism does not exist. CONCLUSIONS Knowing disability professionals' understandings of ableism is necessary to intervene biased attitudes and reduce ableism.
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Affiliation(s)
- Carli Friedman
- The Council on Quality and Leadership (CQL), Towson, Maryland, USA
| | | | - Zach Gordon
- American Association on Intellectual and Developmental Disabilities (AAIDD), Silver Spring, Maryland, USA
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15
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Alzahrani F, Waite N, Beazely M, Cooke M. Estimating implicit and explicit racial and ethnic bias among community pharmacists in Canada. Saudi Pharm J 2024; 32:102024. [PMID: 38525267 PMCID: PMC10960120 DOI: 10.1016/j.jsps.2024.102024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/09/2024] [Indexed: 03/26/2024] Open
Abstract
Background Bias, whether implicit (unconscious) or explicit (conscious), can lead to preferential treatment of specific social groups and antipathy towards others. When healthcare professionals (HCPs), including pharmacists, act on these biases, patient care and health outcomes can be adversely affected. This study aims to estimate implicit and explicit racial/ethnic bias towards Black and Arab people among community pharmacists in Ontario, Canada. Methods Community pharmacists participated in a secure, web-based survey using a cross-sectional design that included Harvard's Race and Arab Implicit Association Tests (IATs) to examine bias towards Black and Arab people. Explicit (stated) preferences were measured by self-report. Data were analyzed using descriptive and inferential statistics. Results The study surveyed 407 community pharmacists, 56.1 % of whom were women with an average age of 46.9. Implicit Association Test (IAT) results showed a statistically significant moderate preference for white people over both Black (mean IAT = 0.41) and Arab people (mean IAT = 0.35). However, most pharmacists explicitly stated that they had no racial/ethnic preference, with 75.7 % expressing a neutral preference between Black and white and 66.6 % neutral between Arab and white. However, a slight preference for white individuals was observed. Demographic factors such as age, place of birth, race/ethnicity, and experience significantly impacted IAT scores. For example, older, Canadian-born, white pharmacists with more experience displayed higher implicit bias scores. A mild correlation was found between implicit and explicit bias, indicating as implicit bias increases, explicit bias tends to become more negative. Conclusions This study is the first to explore the issue of pharmacist bias in Canada and concentrate on anti-Arab bias. Our findings reveal that Ontario community pharmacists tend to have an unconscious inclination towards white people, which calls for further understanding of this matter. Additionally, we discovered a moderate degree of anti-Arab bias, indicating that studies on other HCPs should consider bias against this social group. Educational interventions are needed to address the implicit biases among community pharmacists in Ontario, Canada. These findings should aim to raise self-awareness of biases, educate about the potential implications of these biases on patient care, and provide strategies to reduce bias.
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Affiliation(s)
- Fahad Alzahrani
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Nancy Waite
- School of Pharmacy, University of Waterloo, Kitchener, Canada
| | - Michael Beazely
- School of Pharmacy, University of Waterloo, Kitchener, Canada
| | - Martin Cooke
- Department of Sociology and Legal Studies & School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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16
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Bascom E, Casanova-Perez R, Tobar K, Bedmutha MS, Ramaswamy H, Pratt W, Sabin J, Wood B, Weibel N, Hartzler A. Designing Communication Feedback Systems To Reduce Healthcare Providers' Implicit Biases In Patient Encounters. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2024; 2024:452. [PMID: 38933286 PMCID: PMC11204363 DOI: 10.1145/3613904.3642756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Healthcare providers' implicit bias, based on patients' physical characteristics and perceived identities, negatively impacts healthcare access, care quality, and outcomes. Feedback tools are needed to help providers identify and learn from their biases. To incorporate providers' perspectives on the most effective ways to present such feedback, we conducted semi-structured design critique sessions with 24 primary care providers. We found that providers seek feedback designed with transparent metrics indicating the quality of their communication with a patient and trends in communication patterns across visits. Based on these metrics and trends, providers want this feedback presented in a dashboard paired with actionable, personalized tips about how to improve their communication behaviors. Our study provides new insights for interactive systems to help mitigate the impact of implicit biases in patient-provider communication. New systems that build upon these insights could support providers in making healthcare more equitable, particularly for patients from marginalized communities.
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Affiliation(s)
- Emily Bascom
- Information School, University of Washington, Seattle, Washington, USA
| | - Reggie Casanova-Perez
- Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Kelly Tobar
- University of California, San Diego, San Diego, California, USA
| | | | | | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
| | - Janice Sabin
- Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Brian Wood
- University of Washington, Seattle, Washington, USA
| | - Nadir Weibel
- Computer Science and Engineering & Design Lab, University of California, San Diego, San Diego, California, USA
| | - Andrea Hartzler
- Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
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Ashana DC, Welsh W, Preiss D, Sperling J, You H, Tu K, Carson SS, Hough C, White DB, Kerlin M, Docherty S, Johnson KS, Cox CE. Racial Differences in Shared Decision-Making About Critical Illness. JAMA Intern Med 2024; 184:424-432. [PMID: 38407845 PMCID: PMC10897823 DOI: 10.1001/jamainternmed.2023.8433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 02/27/2024]
Abstract
Importance Shared decision-making is the preferred method for evaluating complex tradeoffs in the care of patients with critical illness. However, it remains unknown whether critical care clinicians engage diverse patients and caregivers equitably in shared decision-making. Objective To compare critical care clinicians' approaches to shared decision-making in recorded conversations with Black and White caregivers of patients with critical illness. Design, Setting, and Participants This thematic analysis consisted of unstructured clinician-caregiver meetings audio-recorded during a randomized clinical trial of a decision aid about prolonged mechanical ventilation at 13 intensive care units in the US. Participants in meetings included critical care clinicians and Black or White caregivers of patients who underwent mechanical ventilation. The codebook included components of shared decision-making and known mechanisms of racial disparities in clinical communication. Analysts were blinded to caregiver race during coding. Patterns within and across racial groups were evaluated to identify themes. Data analysis was conducted between August 2021 and April 2023. Main Outcomes and Measures The main outcomes were themes describing clinician behaviors varying by self-reported race of the caregivers. Results The overall sample comprised 20 Black and 19 White caregivers for a total of 39 audio-recorded meetings with clinicians. The duration of meetings was similar for both Black and White caregivers (mean [SD], 23.9 [13.7] minutes vs 22.1 [11.2] minutes, respectively). Both Black and White caregivers were generally middle-aged (mean [SD] age, 47.6 [9.9] years vs 51.9 [8.8] years, respectively), female (15 [75.0%] vs 14 [73.7%], respectively), and possessed a high level of self-assessed health literacy, which was scored from 3 to 15 with lower scores indicating increasing health literacy (mean [SD], 5.8 [2.3] vs 5.3 [2.0], respectively). Clinicians conducting meetings with Black and White caregivers were generally young (mean [SD] age, 38.8 [6.6] years vs 37.9 [8.2] years, respectively), male (13 [72.2%] vs 12 [70.6%], respectively), and White (14 [77.8%] vs 17 [100%], respectively). Four variations in clinicians' shared decision-making behaviors by caregiver race were identified: (1) providing limited emotional support for Black caregivers, (2) failing to acknowledge trust and gratitude expressed by Black caregivers, (3) sharing limited medical information with Black caregivers, and (4) challenging Black caregivers' preferences for restorative care. These themes encompass both relational and informational aspects of shared decision-making. Conclusions and Relevance The results of this thematic analysis showed that critical care clinicians missed opportunities to acknowledge emotions and value the knowledge of Black caregivers compared with White caregivers. These findings may inform future clinician-level interventions aimed at promoting equitable shared decision-making.
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Affiliation(s)
- Deepshikha C. Ashana
- Department of Medicine, Duke University, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Whitney Welsh
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Doreet Preiss
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Jessica Sperling
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - HyunBin You
- School of Nursing, Duke University, Durham, North Carolina
| | - Karissa Tu
- School of Medicine, University of Washington, Seattle
| | | | - Catherine Hough
- Department of Medicine, Oregon Health and Science University, Portland
| | - Douglas B. White
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Meeta Kerlin
- Department of Medicine, University of Pennsylvania, Philadelphia
| | | | - Kimberly S. Johnson
- Department of Medicine, Duke University, Durham, North Carolina
- Geriatrics Research Education and Clinical Center (GRECC), Durham Veterans Affairs Healthcare System, Durham, North Carolina
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Altin SE, Kwong M, Hamburg NM, Creager MA, Banerjee S, Oladini L, Schneider MD, Ruddy JM. Addressing Barriers to Entry and Retention of Women in Interventional Vascular Specialties With Proposed Solutions: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e986-e995. [PMID: 38375663 DOI: 10.1161/cir.0000000000001210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Representation of women in interventional vascular fields (interventional cardiology, interventional radiology, and vascular surgery) lags behind that in other specialties. With women representing half of all medical school graduates, encouraging parity of women in these fields needs to start in medical school. Barriers to pursuing careers in vascular intervention include insufficient exposure during core clerkships, early mentorship, visibility of women in the field, length of training, lifestyle considerations, work culture and environment, and concerns about radiation exposure. This scientific statement highlights potential solutions for both the real and perceived barriers that women may face in pursuing careers in vascular intervention, including streamlining of training (as both interventional radiology and vascular surgery have done with a resultant increase in percentage of women trainees), standardization of institutional promotion of women in leadership, and professional and industry partnerships for the retention and advancement of women.
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McIntosh T, Pendo E, Walsh HA, Baldwin KA, King P, Anderson EE, Caldicott CV, Carter JD, Johnson SH, Mathews K, Norcross WA, Shaffer DC, DuBois JM. What Can State Medical Boards Do to Effectively Address Serious Ethical Violations? THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2024; 51:941-953. [PMID: 38477290 PMCID: PMC10937163 DOI: 10.1017/jme.2024.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
State Medical Boards (SMBs) can take severe disciplinary actions (e.g., license revocation or suspension) against physicians who commit egregious wrongdoing in order to protect the public. However, there is noteworthy variability in the extent to which SMBs impose severe disciplinary action. In this manuscript, we present and synthesize a subset of 11 recommendations based on findings from our team's larger consensus-building project that identified a list of 56 policies and legal provisions SMBs can use to better protect patients from egregious wrongdoing by physicians.
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Affiliation(s)
- Tristan McIntosh
- BIOETHICS RESEARCH CENTER, WASHINGTON UNIVERSITY SCHOOL OF MEDICINE, ST. LOUIS, MO, USA
| | - Elizabeth Pendo
- CENTER FOR HEALTH LAW STUDIES, SAINT LOUIS UNIVERSITY SCHOOL OF LAW, SAINT LOUIS, MO, USA
| | - Heidi A Walsh
- BIOETHICS RESEARCH CENTER, WASHINGTON UNIVERSITY SCHOOL OF MEDICINE, ST. LOUIS, MO, USA
| | - Kari A Baldwin
- BIOETHICS RESEARCH CENTER, WASHINGTON UNIVERSITY SCHOOL OF MEDICINE, ST. LOUIS, MO, USA
| | - Patricia King
- LARNER COLLEGE OF MEDICINE, UNIVERSITY OF VERMONT, BURLINGTON, VT, USA
| | - Emily E Anderson
- LOYOLA UNIVERSITY CHICAGO STRITCH SCHOOL OF MEDICINE, MAYWOOD, IL, USA
| | | | - Jeffrey D Carter
- MISSOURI BOARD OF REGISTRATION FOR THE HEALING ARTS, JEFFERSON CITY, MO, USA
| | - Sandra H Johnson
- CENTER FOR HEALTH LAW STUDIES, SAINT LOUIS UNIVERSITY SCHOOL OF LAW, SAINT LOUIS, MO, USA
| | - Katherine Mathews
- DEPARTMENT OF OBSTETRICS, GYNECOLOGY, AND WOMEN'S HEALTH, SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE, ST. LOUIS, MO, USA
| | - William A Norcross
- DIVISION OF FAMILY MEDICINE, UC SAN DIEGO SCHOOL OF MEDICINE, LA JOLLA, CA
| | - Dana C Shaffer
- UNIVERSITY OF PIKEVILLE KENTUCKY COLLEGE OF OSTEOPATHIC MEDICINE
- KENTUCKY BOARD OF MEDICAL LICENSURE, LOUISVILLE, KY, USA
| | - James M DuBois
- BIOETHICS RESEARCH CENTER, WASHINGTON UNIVERSITY SCHOOL OF MEDICINE, ST. LOUIS, MO, USA
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Gonzalez CM, Ark TK, Fisher MR, Marantz PR, Burgess DJ, Milan F, Samuel MT, Lypson ML, Rodriguez CJ, Kalet AL. Racial Implicit Bias and Communication Among Physicians in a Simulated Environment. JAMA Netw Open 2024; 7:e242181. [PMID: 38506811 PMCID: PMC10955368 DOI: 10.1001/jamanetworkopen.2024.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/31/2023] [Indexed: 03/21/2024] Open
Abstract
Importance Racial implicit bias can contribute to health disparities through its negative influence on physician communication with Black patients. Interventions for physicians to address racial implicit bias in their clinical encounters are limited by a lack of high-fidelity (realistic) simulations to provide opportunities for skill development and practice. Objective To describe the development and initial evaluation of a high-fidelity simulation of conditions under which physicians might be influenced by implicit racial bias. Design, Setting, and Participants This cross-sectional study, performed on an online platform from March 1 to September 30, 2022, recruited a convenience sample of physician volunteers to pilot an educational simulation. Exposures In the simulation exercise, physicians saw a 52-year-old male standardized patient (SP) (presenting as Black or White) seeking urgent care for epigastric pain, nausea, and vomiting. The case included cognitive stressors common to clinical environments, including clinical ambiguity, stress, time constraints, and interruptions. Physicians explained their diagnosis and treatment plan to the SP, wrote an assessment and management plan, completed surveys, and took the Race Implicit Association Test (IAT) and Race Medical Cooperativeness IAT. The SPs, blinded to the purpose of the study, assessed each physician's communication using skills checklists and global rating scales. Main Outcomes and Measures Association between physicians' IAT scores and SP race with SP ratings of communication skills. Results In 60 physicians (23 [38.3%] Asian, 4 [6.7%] Black, 23 [38.3%] White, and 10 [16.7%] other, including Latina/o/x, Middle Eastern, and multiracial; 31 [51.7%] female, 27 [45.0%] male, and 2 [3.3%] other), the interaction of physicians' Race IAT score and SP race was significant for overall communication (mean [SD] β = -1.29 [0.41]), all subdomains of communication (mean [SD] β = -1.17 [0.52] to -1.43 [0.59]), and overall global ratings (mean [SD] β = -1.09 [0.39]). Black SPs rated physicians lower on communication skills for a given pro-White Race IAT score than White SPs; White SP ratings increased as physicians' pro-White bias increased. Conclusions and Relevance In this cross-sectional study, a high-fidelity simulation calibrated with cognitive stressors common to clinical environments elicited the expected influence of racial implicit bias on physicians' communication skills. The outlined process and preliminary results can inform the development and evaluation of interventions that seek to address racial implicit bias in clinical encounters and improve physician communication with Black patients.
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Affiliation(s)
- Cristina M. Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York
- Department of Medicine, New York University Grossman School of Medicine, New York
- Department of Population Health, New York University Grossman School of Medicine, New York
| | | | - Marla R. Fisher
- Department of Psychiatry, Mount Sinai Morningside-West, New York, New York
| | - Paul R. Marantz
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Diana J. Burgess
- Department of Medicine, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research in the Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Felise Milan
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | | | - Monica L. Lypson
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Carlos J. Rodriguez
- Department of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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Bagnis A, Colonnello V, Russo PM, Mattarozzi K. Facial trustworthiness dampens own-gender bias in emotion recognition. PSYCHOLOGICAL RESEARCH 2024; 88:458-465. [PMID: 37558932 PMCID: PMC10858080 DOI: 10.1007/s00426-023-01864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 07/30/2023] [Indexed: 08/11/2023]
Abstract
Previous research suggests that emotion recognition is influenced by social categories derived by invariant facial features such as gender and inferences of trustworthiness from facial appearance. The current study sought to replicate and extend these findings by examining the intersection of these social categories on recognition of emotional facial expressions. We used a dynamic emotion recognition task to assess accuracy and response times in the happiness and anger categorization displayed by female and male faces that differed in the degree of facial trustworthiness (i.e., trustworthy- vs. untrustworthy-looking faces). We found that facial trustworthiness was able to modulate the own-gender bias on emotion recognition, as responses to untrustworthy-looking faces revealed a bias towards ingroup members. Conversely, when faces look trustworthy, no differences on emotion recognition between female and male faces were found. In addition, positive inferences of trustworthiness lead to faster recognition of happiness in females and anger in males, showing that facial appearance was able to influence also the intersection between social categories and specific emotional expressions. Together, these results suggest that facial appearance, probably due to the activation of approach or avoidance motivational systems, is able to modulate the own-gender bias on emotion recognition.
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Affiliation(s)
- Arianna Bagnis
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Hospital, Pad. 21, Bologna, Italy.
| | - Valentina Colonnello
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Hospital, Pad. 21, Bologna, Italy
| | - Paolo Maria Russo
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Hospital, Pad. 21, Bologna, Italy
| | - Katia Mattarozzi
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Hospital, Pad. 21, Bologna, Italy
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Sagalowsky ST, Woodward H, Agnant J, Bailey B, Duncan E, Grad J, Kessler DO. Structural Competency in Simulation-Based Health Professions Education: A Call to Action and Pragmatic Guide. Simul Healthc 2024:01266021-990000000-00097. [PMID: 38197665 DOI: 10.1097/sih.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
SUMMARY STATEMENT Simulation-based health professions educators can advance diversity, equity, and inclusion by cultivating structural competency, which is the trained ability to discern inequity not only at an individual level, but also at organizational, community, and societal levels. This commentary introduces Metzl and Hansen's Five-Step Model for structural competency and discusses its unique applicability to the metacognitive underpinnings of simulation-based health professions education. We offer a pragmatic guide for simulation-based health professions educators to collaboratively design learning objectives, simulation cases, character sketches, and debriefs in which structural competency is a simulation performance domain, alongside patient management, resource usage, leadership, situational awareness, teamwork, and/or communication. Our overall goal is to promote a paradigm shift in which educators are empowered to partner with patients, colleagues, and communities to recognize, learn about, and challenge the factors driving health inequities; a skill that may be applied to a broad range of health professions education within and outside of simulation.
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Affiliation(s)
- Selin T Sagalowsky
- From the New York University Grossman School of Medicine (S.T.S., J.A., E.D., J.G.), New York, NY; NewYork-Presbyterian Morgan Stanley Children's Hospital (H.W.), New York, NY; Family Advisory Council (B.B.), NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY; and Columbia University College of Physicians & Surgeons (D.O.K.), New York, NY
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Gandhi TK, Schulson LB, Thomas AD. Bringing the Equity Lens to Patient Safety Event Reporting. Jt Comm J Qual Patient Saf 2024; 50:87-89. [PMID: 37821324 DOI: 10.1016/j.jcjq.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023]
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Ginther J, McNally G. CE: Reducing Bias Against People with Substance Use Disorders. Am J Nurs 2024; 124:28-37. [PMID: 38055841 DOI: 10.1097/01.naj.0000998224.71157.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
ABSTRACT Addiction is a highly misunderstood and stigmatized chronic illness frequently encountered by health care providers during routine medical care. People with substance use disorders, in particular, face extraordinary stigma and bias when interacting with health care providers, including nurses. Stigma associated with addiction contributes to health inequities and is recognized as a significant barrier to people seeking and receiving necessary health care. Since patients often spend the most time with nurses in the clinical setting, nurses are ideally positioned to address addiction stigma. However, many nurses lack knowledge about addiction, stigma, and the impact of the words they use, whether in conversation or in clinical documentation. This article reviews the consequences of addiction stigma (labeling, stereotyping, or discrimination) and the steps nurses can take to reduce biases related to substance use. A case scenario based on our experience will be used to guide a discussion of opportunities for nurses to intervene and improve care.
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Affiliation(s)
- Jane Ginther
- Jane Ginther is an NP on the trauma team in the Department of Orthopedic Surgery, The Ohio State University Wexner Medical Center, Columbus. Gretchen McNally is an NP at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH. The authors acknowledge Carlton Brown, PhD, RN, AOCN, nurse research consultant at Zenith Health Care Solutions, for editorial assistance. Contact author: Jane Ginther, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Durrheim K. Conversational Silencing of Racism in Psychological Science: Toward Decolonization in Practice. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2024; 19:244-257. [PMID: 37470498 PMCID: PMC10790512 DOI: 10.1177/17456916231182922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
This article addresses a paradox between self-perceptions of psychology as a liberal, progressive, antiracist discipline and profession and the persistent criticisms of racism and calls for decolonization. It builds on the criticisms of epistemic exclusion and White centering, arguing that White supremacy is maintained by "conversational silencing" in which the focus on doing good psychology systematically draws attention away from the realities of racism and the operation of power. The process is illustrated by investigations of disciplinary discourse around non-Western, educated, industrialized, rich, and democratic psychology and on stereotyping, racism, and prejudice reduction, which constitute the vanguard of liberal scholarship in the discipline. This progressive scholarship nurtures "White ignorance," an absence of belief about systemic racism that psychology plays a part in upholding.
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Afulani PA, Oboke EN, Ogolla BA, Getahun M, Kinyua J, Oluoch I, Odour J, Ongeri L. Caring for providers to improve patient experience (CPIPE): intervention development process. Glob Health Action 2023; 16:2147289. [PMID: 36507905 PMCID: PMC9754039 DOI: 10.1080/16549716.2022.2147289] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/10/2022] [Indexed: 12/15/2022] Open
Abstract
A growing body of research has documented disrespectful, abusive, and neglectful treatment of women in facilities during childbirth, as well as the drivers of such mistreatment. Yet, little research exists on effective interventions to improve Person-Centred Maternal Care (PCMC)-care that is respectful and responsive to individual women's preferences, needs, and values. We sought to extend knowledge on interventions to improve PCMC, with a focus on two factors - provider stress and implicit bias - that are driving poor PCMC and contributing to disparities in PCMC. In this paper we describe the process towards the development of the intervention. The intervention design was an iterative process informed by existing literature, behaviour change theory, formative research, and continuous feedback in consultation with key stakeholders. The intervention strategies were informed by the Social Cognitive Theory, Trauma Informed System framework, and the Ecological Perspective. This process resulted in the 'Caring for Providers to Improve Patient Experience (CPIPE)' intervention, which has 5 components: provider training, peer support, mentorship, embedded champions, and leadership engagement. The training includes didactic and interactive content on PCMC, stress, burnout, dealing with difficult situations, and bias, with some content integrated into emergency obstetric and neonatal care (EmONC) simulations to enable providers apply concepts in the context of managing an emergency. The other components create an enabling environment for ongoing individual behavior and facility culture change. The pilot study is being implemented in Migori County, Kenya. The CPIPE intervention is an innovative theory and evidence-based intervention that addresses key drivers of poor PCMC and centers the unique needs of vulnerable women as well as that of providers. This intervention will advance the evidence base for interventions to improve PCMC and has great potential to improve equity in PCMC and maternal and neonatal health.
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Affiliation(s)
- Patience A. Afulani
- Epidemiology and Biostatistics Department, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco CA, USA
| | - Edwina N. Oboke
- Research Department, Global Programs for Research and Training, Nairobi, Kenya
| | - Beryl A. Ogolla
- Research Department, Global Programs for Research and Training, Nairobi, Kenya
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco CA, USA
| | - Joyceline Kinyua
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - James Odour
- Migori County Referral Hospital, Migori, Kenya
| | - Linnet Ongeri
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
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Norotsky RL, Dahl KL, Cocroft S, Sauder C, Tracy LF, Stepp CE. Does Implicit Racial Bias Affect Auditory-Perceptual Evaluations of Dysphonic Voices? J Voice 2023:S0892-1997(23)00383-1. [PMID: 38065808 PMCID: PMC11156794 DOI: 10.1016/j.jvoice.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE The purpose of this study was to understand the role of implicit racial bias in auditory-perceptual evaluations of dysphonic voices by determining if a biasing effect exists for novice listeners in their auditory-perceptual ratings of Black and White speakers. METHOD Thirty speech-language pathology graduate students at Boston University listened to audio files of 20 Black speakers and 20 White speakers of General American English with voice disorders. Listeners rated the overall severity of dysphonia of each voice heard using a 100-unit visual analog scale and completed the Harvard Implicit Association Test (IAT) to measure their implicit racial bias. RESULTS Both Black and White speakers were rated as less severely dysphonic when their race was labeled as Black. No significant relationship was found between Harvard IAT scores and differences in severity ratings by race labeling condition. CONCLUSIONS These findings suggest a minimizing bias in the evaluation of dysphonia for Black patients with voice disorders. These results contribute to the understanding of how a patient's race may impact their visit with a clinician. Further research is needed to determine the most effective interventions for implicit bias retraining and the additional ways that implicit racial bias impacts comprehensive voice evaluations.
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Affiliation(s)
- Rachel L Norotsky
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts.
| | - Kimberly L Dahl
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts
| | - Sarah Cocroft
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts
| | - Cara Sauder
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington
| | - Lauren F Tracy
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts; Department of Otolaryngology - Head and Neck Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts; Department of Otolaryngology - Head and Neck Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; Department of Biomedical Engineering, Boston University, Boston, Massachusetts
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Santoro CM, Farmer MC, Lobato G, James M, Herring SJ. Antiracism Training for Nutrition Professionals in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): a Promising Strategy to Improve Attitudes, Awareness, and Actions. J Racial Ethn Health Disparities 2023; 10:2882-2889. [PMID: 36472807 PMCID: PMC9734826 DOI: 10.1007/s40615-022-01465-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/12/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Women, Infants and Children (WIC) nutrition professionals serve as frontline providers for Black families who disproportionately experience poor perinatal outcomes. With racism driving inequities, we developed an antiracism training tailored to WIC. This report describes the training framework, design, components, and evaluation. METHODS In 2019, with feedback from WIC providers, we created a 3-h antiracism training for Philadelphia WIC nutrition professionals that included an identity reflection, key concept definitions, workplace scenario and debrief, a model for repair and disruption, and an action tool. We implemented this training in August 2019 and surveyed WIC staff trainees' awareness of racism and skills to address bias before, immediately after, and 6 months post-training, comparing responses at each time point. RESULTS Among 42 WIC staff trainees, mean age was 30 years, 56% were white, 91% female, and 74% had no prior antiracism training. Before the training, 48% felt quite a bit or extremely aware of the role of racism in the healthcare system; this increased to 91% immediately after and was 75% 6 months later. Similar increases in confidence identifying and addressing interactions that perpetuate racism were achieved immediately after training, although the magnitude decreased by 6 months. One-third felt quite a bit or extremely confident the training improved participant interactions at the 6-month timepoint. Qualitative feedback reinforced findings. DISCUSSION Results suggest antiracism training may improve WIC nutrition professionals' attitudes, awareness, and actions and could be valuable in efforts to advance health equity. More work is needed to examine how changes translate into improvements for WIC participants.
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Affiliation(s)
- Christine M Santoro
- Program for Maternal Health Equity, Center for Urban Bioethics, Department of Urban Health and Population Science, Lewis Katz School of Medicine at Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, USA.
| | - Mari-Carmen Farmer
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gloria Lobato
- Program for Maternal Health Equity, Center for Urban Bioethics, Department of Urban Health and Population Science, Lewis Katz School of Medicine at Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, USA
- NORTH, Inc., Managers of the Philadelphia WIC Program, Philadelphia, PA, USA
| | - Monica James
- NORTH, Inc., Managers of the Philadelphia WIC Program, Philadelphia, PA, USA
| | - Sharon J Herring
- Program for Maternal Health Equity, Center for Urban Bioethics, Department of Urban Health and Population Science, Lewis Katz School of Medicine at Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, USA
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Cunningham R, Imlach F, Every-Palmer S, Haitana T, Peterson D. Dealing With Discrimination in Physical Health Care Services: Strategies of People With Mental Health and Substance Use Conditions. J Patient Exp 2023; 10:23743735231211778. [PMID: 37928962 PMCID: PMC10623936 DOI: 10.1177/23743735231211778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Discrimination against people with mental health and substance use conditions (MHSUC) by health professionals contributes to the poor physical health outcomes this group experiences. We surveyed people with MHSUC in Aotearoa New Zealand to explore how they experienced and responded to discrimination from physical health services. Participants identified 6 strategies used to avoid or minimize the impact of discrimination. Avoidance strategies included not seeking help, not disclosing MHSUC diagnoses and changing or seeking out health professionals who did not behave in discriminatory ways. Minimizing strategies were being a "model patient," taking a support person to consultations or advocating for what they needed, even in the face of discrimination. Physical health services must focus on providing non-discriminatory care to reduce the need for compensatory strategies and improve care of physical illness for people with MHSUC.
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Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Fiona Imlach
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Tracy Haitana
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Debbie Peterson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Cunningham R, Imlach F, Haitana T, Every-Palmer S, Lacey C, Lockett H, Peterson D. It's not in my head: a qualitative analysis of experiences of discrimination in people with mental health and substance use conditions seeking physical healthcare. Front Psychiatry 2023; 14:1285431. [PMID: 37908598 PMCID: PMC10613695 DOI: 10.3389/fpsyt.2023.1285431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Clinician bias contributes to lower quality healthcare and poorer health outcomes in people with mental health and substance use conditions (MHSUC). Discrimination can lead to physical conditions being overlooked (diagnostic overshadowing) or substandard treatment being offered to people with MHSUC. This research aimed to utilise experiences of people with MHSUC to identify discrimination by clinicians, including the role of clinician's beliefs and assumptions in physical health service provision. Methods We surveyed people with MHSUC who accessed physical healthcare services. Of 354 eligible participants, 253 responded to open-ended questions about experiences of those services. Thematic descriptive analysis of survey responses was completed using existing stigma frameworks and inductive coding. Results One dominant theme from survey responses was that diagnostic overshadowing by clinicians was driven by clinician mistrust. Another theme was that clinicians assumed respondent's physical symptoms, including pain, were caused by MHSUC. This influenced decisions not to initiate investigations or treatment. Respondents perceived that clinicians focused on mental health over physical health, contributing to suboptimal care. Discussion Discrimination based on MHSUC leads to poor quality care. Health systems and clinicians need to focus quality improvement processes on access to and delivery of equitable physical healthcare to people with MHSUC, address stereotypes about people with MHSUC and improve integration of mental and physical healthcare.
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Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Fiona Imlach
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Tracy Haitana
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Helen Lockett
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Debbie Peterson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Daya S, Illangasekare T, Tahir P, Bochatay N, Essakow J, Ju M, van Schaik S. Using Simulation to Teach Learners in Health Care Behavioral Skills Related to Diversity, Equity, and Inclusion: A Scoping Review. Simul Healthc 2023; 18:312-320. [PMID: 36194859 DOI: 10.1097/sih.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SUMMARY STATEMENT Bias is commonplace in the health care environment and can negatively impact patients and their health outcomes. Simulation has long been shown to be an effective teaching tool for communication skills in health care, but it has rarely been used to deliver concrete behavioral skills that address issues of diversity, equity, and inclusion (DEI). This scoping review examines 23 published articles surrounding the use of simulation in health care education to impart behavioral skills that reduce bias and promote DEI. Included articles described various behavioral skills including communication, history-taking, and system/community-level advocacy. The most commonly used simulation modality to teach these skills included the use of simulated participants (16 articles, 70%). The main DEI topics addressed in the trainings included sexual orientation/gender identity, language, and culture/ethnicity. Based on findings from this review, the authors suggest recommendations for educators who are considering teaching DEI-related skills through simulation.
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Affiliation(s)
- Sneha Daya
- From the Department of Internal Medicine and Pediatrics (S.D.), Department of Obstetrics & Gynecology (T.I.), Department of Pediatrics (J.E. M.J., S.v.S.), University of California San Francisco (P.T., N.B.), San Francisco, CA
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Friedman C. Explicit and implicit: Ableism of disability professionals. Disabil Health J 2023; 16:101482. [PMID: 37271640 DOI: 10.1016/j.dhjo.2023.101482] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND People who work with disabled people or whose work is about disability - disability professionals - often have direct power over disabled people and can impact their lives immensely; they also have a role in creating and institutionalizing knowledge about disability. OBJECTIVE The aim of this study was to examine the explicit (conscious) and implicit (unconscious) disability attitudes of disability professionals. METHODS Between October 2021 and February 2023, disability professionals (n = 417) completed the Symbolic Ableism Scale (SAS) and the Disability Attitudes Implicit Association Test (DA-IAT). We had the following research questions: (1.) What are disability professionals' explicit attitudes towards disability? (2.) What are disability professionals' implicit attitudes towards disability? (3.) What is the relationship between disability professionals' explicit and implicit disability attitudes? and (4.) What sociodemographic factors correlate with disability professionals' explicit and implicit disability attitudes? We examined these questions using descriptive statistics, t-tests, a two-dimensional model of prejudice, and linear regression models. RESULTS In our sample, 77.24% of disability professionals preferred nondisabled people explicitly and 82.03% implicitly. Most commonly, disability professionals were symbolic ableists (37.8%). Race, political orientation, and job type correlated with disability professionals' explicit attitudes, while disability, gender, and job type correlated with their implicit attitudes. CONCLUSIONS Ableism cannot be eradicated until disability professionals look inward and rid themselves of negative attitudes; until that occurs, disability professionals will continue to do a disservice to the very people they have dedicated their careers to - disabled people.
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Affiliation(s)
- Carli Friedman
- CQL | the Council on Quality and Leadership, 100 West Road, Suite 300, Towson, MD 21204, USA.
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Garrett SB, Jones L, Montague A, Fa-Yusuf H, Harris-Taylor J, Powell B, Chan E, Zamarripa S, Hooper S, Chambers Butcher BD. Challenges and Opportunities for Clinician Implicit Bias Training: Insights from Perinatal Care Stakeholders. Health Equity 2023; 7:506-519. [PMID: 37731787 PMCID: PMC10507933 DOI: 10.1089/heq.2023.0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction In an attempt to address health inequities, many U.S. states have considered or enacted legislation requiring antibias or implicit bias training (IBT) for health care providers. California's "Dignity in Pregnancy and Childbirth Act" requires that hospitals and alternative birthing centers provide IBT to perinatal clinicians with the goal of improving clinical outcomes for Black women and birthing people. However, there is as yet insufficient evidence to identify what IBT approaches, if any, achieve this goal. Engaging the experiences and insights of IBT stakeholders is a foundational step in informing nascent IBT policy, curricula, and implementation. Methods We conducted a multimethod community-based participatory research study with key stakeholders of California's IBT policy to identify key challenges and recommendations for effective clinician IBT. We used focus groups, in-depth interviews, combined inductive/deductive thematic analysis, and multiple techniques to promote rigor and validity. Participants were San Francisco Bay Area-based individuals who identified as Black or African American women with a recent hospital birth (n=20), and hospital-based perinatal clinicians (n=20). Results We identified numerous actionable challenges and recommendations regarding aspects of (1) state law; (2) IBT content and format; (3) health care facility IBT implementation; (4) health care facility environment; and (5) provider commitment and behaviors. Patient and clinician insights overlapped substantially. Many respondents felt IBT would improve outcomes only in combination with other antiracism interventions. Health Equity Implications These stakeholder insights offer policy-makers, health system leaders, and curriculum developers crucial guidance for the future development and implementation of clinician antibias interventions.
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Affiliation(s)
- Sarah B. Garrett
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Linda Jones
- California Preterm Birth Initiative, University of California, San Francisco, California, USA
| | - Alexandra Montague
- UCSF-UC Law Consortium on Law, Science & Health Policy, University of California College of the Law, San Francisco, California, USA
| | - Haleemat Fa-Yusuf
- Independent Researcher and Community Advisor, San Francisco, California, USA
| | - Julie Harris-Taylor
- California Preterm Birth Initiative, University of California, San Francisco, California, USA
| | - Breezy Powell
- California Preterm Birth Initiative, University of California, San Francisco, California, USA
| | - Erica Chan
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stephen Zamarripa
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Sarah Hooper
- UCSF-UC Law Consortium on Law, Science & Health Policy, University of California College of the Law, San Francisco, California, USA
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Lateef H, Adams L, Bernard D, Jellesma F, Frempong MRK, Boahen-Boaten BB, Leach BCB, Borgstrom E, Nartey PB. Mental Health Treatment-Seeking Appraisal, Afrocentric Cultural Norms, and Mental Health Functioning: Buffering Factors of Young Black Men's Externalizing Behavior. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01771-7. [PMID: 37624539 PMCID: PMC10894312 DOI: 10.1007/s40615-023-01771-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Depression rates are disproportionately high among Black American Men. This disparity--compounded by low mental healthcare seeking rates and high incorrect diagnosis rates in men--could be related to masculine norms, including self-reliance, restrictive emotionality, and stoicism. Furthermore, men are more likely to engage in externalized behavior, such as aggression, to cope with mental health challenges; this pattern is influenced by cultural and environmental factors. Contrary to these detrimental factors, social relationships, belief in social networks, and collectivism have been associated with positive mental health in these populations. Similarly, an Afrocentric worldview (including concepts like Ubuntu and African self-consciousness) has been hypothesized to promote positive mental health outcomes among Black American men. However, little research exists on harnessing these factors as a means of increasing health-seeking behaviors in young Black males. AIM To elucidate the effect of region, depression, African humanism, collectivism, and help-seeking values and needs concerning aggression in young Black males. METHOD This study included Black or African American participants (n = 428) identifying as male, aged 18-25 years, who responded to a Qualtrics survey with questions on region, aggression, depression, African humanism, collectivism, and help-seeking value and need. RESULTS Hierarchical linear regression revealed that collectivism, humanness, value, and the need for seeking treatment were inversely associated with aggression (p < 0.001). DISCUSSION/CONCLUSION Highlighting the effect of cultural norms and help-seeking behaviors and the aggravating effect of depression on aggression in young Black males can help to develop aggression-mitigating interventions rooted in Afrocentric Norms.
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Affiliation(s)
- Husain Lateef
- Washington University in St. Louis, St. Louis, MO, USA.
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Kehne A, Bernstein SJ, Thomas J, Bicket MC, Bohnert ASB, Madden EF, Powell VD, Lagisetty P. Improving Access to Care for Patients Taking Opioids for Chronic Pain: Recommendations from a Modified Delphi Panel in Michigan. J Pain Res 2023; 16:2321-2330. [PMID: 37456356 PMCID: PMC10348368 DOI: 10.2147/jpr.s406034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose About 5-8 million US patients take long-term opioid therapy for chronic pain. In the context of policies and guidelines instituted to reduce inappropriate opioid prescribing, abrupt discontinuations in opioid prescriptions have increased and many primary care clinics will not prescribe opioids for new patients, reducing access to care. This may result in uncontrolled pain and other negative outcomes, such as transition to illicit opioids. The objective of this study was to generate policy, intervention, and research recommendations to improve access to care for these patients. Participants and Methods We conducted a RAND/UCLA Modified Delphi, consisting of workshops, background videos and reading materials, and moderated web-based panel discussions held September 2020-January 2021. The panel consisted of 24 individuals from across Michigan, identified via expert nomination and snowball recruitment, including clinical providers, health science researchers, state-level policymakers and regulators, care coordination experts, patient advocates, payor representatives, and community and public health experts. The panel proposed intervention, policy, and research recommendations, scored the feasibility, impact, and importance of each on a 9-point scale, and ranked all recommendations by implementation priority. Results The panel produced 11 final recommendations across three themes: reimbursement reform, provider education, and reducing racial inequities in care. The 3 reimbursement-focused recommendations were highest ranked (theme average = 4.2/11), including the two top-ranked recommendations: increasing reimbursement for time needed to treat complex chronic pain (ranked #1/11) and bundling payment for multimodal pain care (#2/11). Four provider education recommendations ranked slightly lower (theme average = 6.2/11) and included clarifying the spectrum of opioid dependence and training providers on multimodal treatments. Four recommendations addressed racial inequities (theme average = 7.2/11), such as standardizing pain management protocols to reduce treatment disparities. Conclusion Panelists indicated reimbursement should incentivize traditionally lower-paying evidence-based pain care, but multiple strategies may be needed to meaningfully expand access.
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Affiliation(s)
- Adrianne Kehne
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Steven J Bernstein
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Thomas
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark C Bicket
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Erin Fanning Madden
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Victoria D Powell
- Palliative Care Program, Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Geriatrics Research, Education, and Clinical Center, LTC Charles S. Kettles VA Medical Center, Ann Arbor, MI, USA
| | - Pooja Lagisetty
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Barradell AC, Robertson N, Houchen-Wolloff L, Singh SJ. Exploring the Presence of Implicit Bias Amongst Healthcare Professionals Who Refer Individuals Living with COPD to Pulmonary Rehabilitation with a Specific Focus Upon Smoking and Exercise. Int J Chron Obstruct Pulmon Dis 2023; 18:1287-1299. [PMID: 37366431 PMCID: PMC10290857 DOI: 10.2147/copd.s389379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 04/30/2023] [Indexed: 06/28/2023] Open
Abstract
Background We are developing a shared decision-making intervention for individuals with COPD who are deciding between Pulmonary Rehabilitation (PR) programme options. Previously, we identified Healthcare Professional (HCP) beliefs about the characteristics of COPD individuals as a barrier to PR conversations. Beliefs can lead to implicit biases which influence behaviour. To inform our shared decision-making intervention, we aimed to measure the presence of implicit bias amongst HCPs who refer individuals with COPD to PR. Methods We utilised the Implicit Association Test to measure HCPs response times when categorising words related to smoking or exercise (eg stub, run) to matching concepts or evaluations of concepts (eg "smoking, unpleasant" or "exercise, pleasant") and unmatching concepts or evaluations of concepts (eg "smoking, pleasant" or "exercise, unpleasant"). We approached HCPs across the UK. Following consent, we collected demographic data and then administered the test. The primary outcome was the standardised mean difference in response times from the matching and unmatching categorisations (D4-score), measured using a one-sample Wilcoxon Signed Rank Test. We explored the relationship between HCP demographics and their D4-scores using Spearman Rho correlation analysis and logistic regression. Results Of 124 HCPs screened, 104 (83.9%) consented. Demographic data were available for 88 (84.6%). About 68.2% were female and most (28.4%) were in the 45-54 years age category. Test data were available for 69 (66.3%) participants. D4-scores ranged from 0.99 to 2.64 indicating implicit favouring of matching categorisation (MD-score = 1.69, SDD-score = 0.38, 95% CID-score 1.60-1.78, p < 0.05). This was significantly different from zero, z = -7.20, p < 0.05, with a large effect size (r = 0.61, (28)). No demographic predictors of implicit bias were identifiable. Conclusion HCPs demonstrated negative bias towards smoking and positive bias towards exercising. Since implicit bias impacts behaviour, we plan to develop intervention components (eg decision coaching training) to enable HCPs to fully and impartially support shared decision-making for a menu of PR options.
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Affiliation(s)
- Amy C Barradell
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
- Multiple Long Term Conditions, National Institute for Health Research (NIHR) Applied Research Collaboration (East Midlands), Leicester, UK
| | - Noelle Robertson
- Department of Neuroscience, University of Leicester, Leicester, UK
| | - Linzy Houchen-Wolloff
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
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Abdel-Razig S, Ibrahim H. Outsider bias: how your name influences the peer review process. Postgrad Med J 2023; 99:514-515. [PMID: 37319145 DOI: 10.1136/pmj-2022-142046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/06/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Sawsan Abdel-Razig
- Office of Academics, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
- Department of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Halah Ibrahim
- Khalifa University College of Medicine And Health Sciences, Abu Dhabi, UAE
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Batool S, Burks CA, Bergmark RW. Healthcare Disparities in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023; 11:1-14. [PMID: 37362031 PMCID: PMC10247342 DOI: 10.1007/s40136-023-00459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review The purpose of this review is to summarize some of the recent research studies on healthcare disparities across various subspecialties within otolaryngology. This review also highlights the impact of COVID-19 pandemic on disparities and proposes potential interventions to mitigate disparities. Recent Findings Significant healthcare disparities in care and treatment outcomes have been reported across all areas of otolaryngology. Notable differences in survival, disease recurrence, and overall mortality have been noted based on race, ethnicity, socioeconomic status (SES), insurance status, etc. This is most well-researched in head and neck cancer (HNC) within otolaryngology. Summary Healthcare disparities have been identified by numerous research studies within otolaryngology for many vulnerable groups that include racial and ethnic minority groups, low-income populations, and individuals from rural areas among many others. These populations continue to experience suboptimal access to timely, quality otolaryngologic care that exacerbate disparities in health outcomes.
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Affiliation(s)
- Sana Batool
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ciersten A. Burks
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
| | - Regan W. Bergmark
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women’s Hospital and Dana Farber Cancer Institute, 45 Francis Street, Boston, MA 02115 USA
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O'Sullivan L, Kagabo W, Prasad N, Laporte D, Aiyer A. Racial and Ethnic Bias in Medical School Clinical Grading: A Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:806-816. [PMID: 37019709 DOI: 10.1016/j.jsurg.2023.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/26/2023] [Accepted: 03/17/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Improving diversity in healthcare is a widely recognized national goal. The diversity of medical student matriculants has increased, yet this trend is not seen in the composition of competitive residency programs. In this review, we examine racial and ethnic disparities in medical student grading during clinical years and explore the consequences of how this may exclude minority students from accessing competitive residency positions. DESIGN Following PRISMA guidelines, we searched PubMed, Embase, Scopus, and ERIC databases using variations of the terms "race," "ethnicity," "clerkship," "rotation," "grade," "evaluation", or "shelf exam." Of 391 references found using the criteria, 29 were related to clinical grading and race/ethnicity and included in the review. The GRADE criteria were used to determine the quality of evidence. SETTING Johns Hopkins School of Medicine, Baltimore MD. RESULTS Five studies examining a total of 107,687 students from up to 113 different schools found racial minority students receive significantly fewer Honors grades in core clerkships compared to White students. Three studies examining 94,814 medical student evaluations from up to 130 different schools found significant disparities in the wording of written clerkship evaluations based on race and/or ethnicity. CONCLUSIONS A large body of evidence suggests the presence of racial bias in subjective clinical grading and written clerkship evaluations of medical students. Grading disparities can disadvantage minority students when applying to competitive residency programs and may contribute to a lack of diversity in these fields. As low minority representation has a negative impact on patient care and research advancement, strategies to resolve this issue must be further explored.
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Affiliation(s)
- Lucy O'Sullivan
- Johns Hopkins Orthopedics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Whitney Kagabo
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Niyathi Prasad
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Dawn Laporte
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Amiethab Aiyer
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
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Ovid D, Abrams L, Carlson T, Dieter M, Flores P, Frischer D, Goolish J, Bernt MLF, Lancaster A, Lipski C, Luna JV, Luong LMC, Mullin M, Newman MJ, Quintero C, Reis J, Robinson F, Ross AJ, Simon H, Souza G, Taylor J, Ward KE, White YL, Witkop E, Yang C, Zenilman A, Zhang E, Schinske JN, Tanner KD. Scientist Spotlights in Secondary Schools: Student Shifts in Multiple Measures Related to Science Identity after Receiving Written Assignments. CBE LIFE SCIENCES EDUCATION 2023; 22:ar22. [PMID: 36951935 PMCID: PMC10228265 DOI: 10.1187/cbe.22-07-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/02/2022] [Accepted: 02/13/2023] [Indexed: 06/02/2023]
Abstract
Based on theoretical frameworks of scientist stereotypes, possible selves, and science identity, written assignments were developed to teach science content through biographies and research of counter-stereotypical scientists-Scientist Spotlights (www.scientistspotlights.org). Previous studies on Scientist Spotlight assignments showed significant shifts in how college-level biology students relate to and describe scientists and in their performance in biology courses. However, the outcomes of Scientist Spotlight assignments in secondary schools were yet to be explored. In collaboration with 18 science teachers from 12 schools, this study assessed the impacts of Scientist Spotlight assignments for secondary school students. We used published assessment tools: Relatability prompt; Stereotypes prompt; and Performance/Competence, Interest, and Recognition (PCIR) instrument. Statistical analyses compared students' responses before and after receiving at least three Scientist Spotlight assignments. We observed significant shifts in students' relatability to and descriptions of scientists as well as other science identity measures. Importantly, disaggregating classes by implementation strategies revealed that students' relatability shifts were significant for teachers reporting in-class discussions and not significant for teachers reporting no discussions. Our findings raise questions about contextual and pedagogical influences shaping student outcomes with Scientist Spotlight assignments, like how noncontent Instructor Talk might foster student shifts in aspects of science identity.
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Affiliation(s)
- Dax Ovid
- Department of Physiology and Pharmacology, University of Georgia, Athens 30602
| | - L’vannah Abrams
- San Mateo High School–San Mateo Union High School District, San Mateo, CA 94401
| | - Tess Carlson
- Wallenberg High School–San Francisco Unified School District, San Francisco, CA 94115
| | - Mark Dieter
- Encinal Junior Senior High School–Alameda Unified School District, Alameda, CA 94501
| | - Paulos Flores
- Department of Biology, Foothill College, Los Altos Hills, CA 94022
| | - David Frischer
- Abraham Lincoln High School–San Francisco Unified School District, San Francisco, CA 94116
| | - Jolie Goolish
- Department of Biology, Foothill College, Los Altos Hills, CA 94022
- Saint Mary's University of Minnesota, Minneapolis, MN 55404
| | | | - Amber Lancaster
- Wallenberg High School–San Francisco Unified School District, San Francisco, CA 94115
| | - Christopher Lipski
- Hillsdale High School–San Mateo Union High School District, San Mateo, CA 94403
| | - Joshua Vargas Luna
- Department of Biology, San Francisco State University, San Francisco, CA 94132
| | - Lucy M. C. Luong
- Department of Biology, San Francisco State University, San Francisco, CA 94132
| | - Marlene Mullin
- Eastside College Preparatory School–Ravenswood School District, Palo Alto, CA 94303
| | - Mia Janelle Newman
- K. International School Tokyo–Tokyo Metropolitan, Koto City, Tokyo 135-0021, Japan
| | - Carolina Quintero
- Department of Biology, San Francisco State University, San Francisco, CA 94132
| | - Julie Reis
- Abraham Lincoln High School–San Francisco Unified School District, San Francisco, CA 94116
| | - Freja Robinson
- Lowell High School–San Francisco Unified School District, San Francisco, CA 94132
| | - Allison James Ross
- Hillsdale High School–San Mateo Union High School District, San Mateo, CA 94403
| | - Hilary Simon
- Department of Biology, Foothill College, Los Altos Hills, CA 94022
| | - Gianne Souza
- Abraham Lincoln High School–San Francisco Unified School District, San Francisco, CA 94116
| | - Jess Taylor
- Department of Biology, Foothill College, Los Altos Hills, CA 94022
- Cornell University, Ithaca, NY 14850
| | - Katherine E. Ward
- Aragon High School–San Mateo Union High School District, San Mateo, CA 94402
| | | | - Emily Witkop
- Hillsdale High School–San Mateo Union High School District, San Mateo, CA 94403
| | - Christine Yang
- Chaffey High School–Chaffey Joint Union High School District, Ontario, CA 91762
| | - Aliza Zenilman
- San Mateo High School–San Mateo Union High School District, San Mateo, CA 94401
| | - Eddie Zhang
- Department of Biology, Foothill College, Los Altos Hills, CA 94022
| | | | - Kimberly D. Tanner
- Department of Biology, San Francisco State University, San Francisco, CA 94132
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Duncan C, Tölch U, Walter H, Dziobek I. Ethnic discrimination unlearned: experience in the repeated Trust Game reduces trust bias. Front Psychol 2023; 14:1139128. [PMID: 37303892 PMCID: PMC10249959 DOI: 10.3389/fpsyg.2023.1139128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/19/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Discrimination toward ethnic minorities is a persistent societal problem. One reason behind this is a bias in trust: people tend to trust their ingroup and comparatively distrust outgroups. Methods In this study, we investigated whether and how people change their explicit trust bias with respect to ethnicity based on behavioral interactions with in- and outgroup members in a modified Trust Game. Results Subjects' initial explicit trust bias disappeared after the game. The change was largest for ingroup members who behaved unfairly, and the reduction of trust bias generalized to a small sample of new in- and outgroup members. Reinforcement learning models showed subjects' learning was best explained by a model with only one learning rate, indicating that subjects learned from trial outcomes and partner types equally during investment. Discussion We conclude that subjects can reduce bias through simple learning, in particular by learning that ingroup members can behave unfairly.
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Affiliation(s)
- Caitlin Duncan
- School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Institute for Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulf Tölch
- Berlin Institute of Health (BIH) at Charité, BIH Quest Center for Responsible Research, Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Henrik Walter
- School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Isabel Dziobek
- School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Institute for Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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Hanson ER, Quist HE, Mintert JS, Arshad M, Friedman BL, Pleasant A, Monico-Cristales NS, Tillman R, Mehelis M, Karnik A, Sonder A, Mardian AS. Program Evaluation: exploring health disparities that impact chronic pain referrals within a VA Health Care System. FRONTIERS IN PAIN RESEARCH 2023; 4:1110554. [PMID: 37228808 PMCID: PMC10204586 DOI: 10.3389/fpain.2023.1110554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction The present Program Evaluation study examines sociodemographic characteristics of Veterans in the Phoenix VA Health Care System who have back pain, and specifically the likelihood of those characteristics being associated with a referral to the Chronic Pain Wellness Center (CPWC) in the year 2021. We examined the following characteristics: Race/ethnicity, gender, age, mental health diagnosis, substance use disorder diagnosis, and service-connected diagnosis. Methods Our study used cross sectional data from the Corporate Data Warehouse for 2021. 13624 records had complete data for the variables of interest. Univariate and multivariate logistic regression was used to determine the likelihood of patients' being referred to the Chronic Pain Wellness Center. Results The multivariate model found under-referral to be significant for younger adults and for patients who identified as Hispanic/Latinx, Black/African American, or Native American/Alaskan. Those with depressive disorders and opioid use disorders, on the other hand, were found to be more likely to be referred to the pain clinic. Other sociodemographic characteristics were not found to be significant. Discussion Study limitations include the use of cross-sectional data, which cannot determine causality, and the inclusion of patients only if the ICD-10 codes of interest were recorded for an encounter in 2021 (i.e., a prior history of a particular diagnosis was not captured). In future efforts, we plan to examine, implement, and track the impact of interventions designed to mitigate these identified disparities in access to chronic pain specialty care.
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Affiliation(s)
- Eric R. Hanson
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
- Department of Psychiatry, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, United States
| | - Heidi E. Quist
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Jeffrey S. Mintert
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Mahreen Arshad
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Brittany L. Friedman
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Alexandra Pleasant
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | | | - Rhonda Tillman
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Mark Mehelis
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Anita Karnik
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Anais Sonder
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Aram S. Mardian
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
- Department of Family, Community and Preventive Medicine, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, United States
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Burke E, Heron EA, Hennessy M. Gender bias in academic medicine: a resumé study. BMC MEDICAL EDUCATION 2023; 23:291. [PMID: 37127591 PMCID: PMC10152728 DOI: 10.1186/s12909-023-04192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/23/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Minimising the effects of unconscious bias in selection for clinical academic training is essential to ensure that allocation of training posts is based on merit. We looked at the effect of anonymising applications to a training programme for junior doctors on the scores of the applications and on gender balance; and whether female candidates were more likely to seek gender-concordant mentors. METHODS Applications to the training programme were reviewed and scored independently by reviewers who received either an anonymised or named copy. Scores were compared using a paired t-test, and differences in scores compared by gender. The gender of named supervisors for male and female candidates was compared. RESULTS Scores of 101 applications were reviewed. When their identity was known, male candidates scored 1.72% higher and female candidates scored 0.74% higher, but these findings were not statistically significant (p value = 0.279 and 0.579). Following introduction of anonymisation, the proportion of successful female candidates increased from 27 to 46%. Female candidates were more likely to name a female supervisor compared to male (41% vs. 25% of supervisors). CONCLUSIONS Anonymising applications did not significantly change scores, although gender balance improved. Gender-concordant mentoring initiatives should consider effects on mentors as well as mentees.
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Affiliation(s)
- Elaine Burke
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
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Gonzalez CM, Onumah CM, Walker SA, Karp E, Schwartz R, Lypson ML. Implicit bias instruction across disciplines related to the social determinants of health: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:541-587. [PMID: 36534295 DOI: 10.1007/s10459-022-10168-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
One criticism of published curricula addressing implicit bias is that few achieve skill development in implicit bias recognition and management (IBRM). To inform the development of skills-based curricula addressing IBRM, we conducted a scoping review of the literature inquiring, "What interventions exist focused on IBRM in professions related to social determinants of health: education, law, social work, and the health professions inclusive of nursing, allied health professions, and medicine?"Authors searched eight databases for articles published from 2000 to 2020. Included studies: (1) described interventions related to implicit bias; and (2) addressed knowledge, attitude and/or skills as outcomes. Excluded were interventions solely focused on reducing/neutralizing implicit bias. Article review for inclusion and data charting occurred independently and in duplicate. Investigators compared characteristics across studies; data charting focused on educational and assessment strategies. Fifty-one full-text articles for data charting and synthesis, with more than 6568 learners, were selected. Educational strategies included provocative/engagement triggers, the Implicit Association Test, reflection and discussion, and various active learning strategies. Most assessments were self-report, with fewer objective measures. Eighteen funded studies utilized federal, foundation, institutional, and private sources. This review adds to the literature by providing tangible examples of curricula to complement existing frameworks, and identifying opportunities for further research in innovative skills-based instruction, learner assessment, and development and validation of outcome metrics. Continued research addressing IBRM would enable learners to develop and practice skills to recognize and manage their implicit biases during clinical encounters, thereby advancing the goal of improved, equitable patient outcomes.
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Affiliation(s)
- Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
| | - Chavon M Onumah
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sydney A Walker
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elisa Karp
- Department of Pediatrics, North Central Bronx Hospital, Bronx, NY, USA
| | | | - Monica L Lypson
- Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
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Cox WTL. Developing scientifically validated bias and diversity trainings that work: empowering agents of change to reduce bias, create inclusion, and promote equity. MANAGEMENT DECISION 2023; 61:1038-1061. [PMID: 37090785 PMCID: PMC10120861 DOI: 10.1108/md-06-2021-0839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Purpose – Research consistently shows that non-scientific bias, equity, and diversity trainings do not work, and often make bias and diversity problems worse. Despite these widespread failures, there is considerable reason for hope that effective, meaningful DEI efforts can be developed. One approach in particular, the bias habit-breaking training, has 15 years of experimental evidence demonstrating its widespread effectiveness and efficacy. Design/methodology/approach – This article discusses bias, diversity, equity, and inclusion (DEI) efforts from the author's perspective as a scientist-practitioner - the author draws primarily on the scientific literature, but also integrates insights from practical experiences working in DEI. The author provides a roadmap for adapting effective, evidence-based approaches from other disciplines (e.g. cognitive-behavioral therapy) into the DEI context and reviews evidence related to the bias habit-breaking training as one prominent demonstration of a scientifically-validated approach that effects lasting, meaningful improvements on DEI issues within both individuals and institutions. Findings – DEI trainings fail due to widespread adoption of the information deficit model, which is well-known as a highly ineffective approach. Empowerment-based approaches, in contrast, are highly promising for making meaningful, lasting changes in the DEI realm. Evidence indicates that the bias habit-breaking training is effective at empowering individuals as agents of change to reduce bias, create inclusion, and promote equity, both within themselves and the social contexts they inhabit. Originality/value – In contrast to the considerable despair and pessimism around DEI efforts, the present analysis provides hope and optimism, and an empirically-validated path forward, to develop and test DEI approaches that empower individuals as agents of change.
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Affiliation(s)
- William Taylor Laimaka Cox
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Inequity Agents of Change, Madison, Wisconsin, USA
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Niles PM, Augé L, Gilles SA. The value of including reproductive justice into nursing curricula. NURSE EDUCATION TODAY 2023; 123:105742. [PMID: 36791671 DOI: 10.1016/j.nedt.2023.105742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/02/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Affiliation(s)
- P Mimi Niles
- New York University, Rory Meyers College of Nursing, 433 First Ave, New York, NY 10010, United States of America.
| | - Lyndsey Augé
- Mt Sinai Medical Center, 1176 5th Ave, KP6, New York, NY 10029, United States of America.
| | - Selena A Gilles
- Affiliate Faculty, Hartford Institute for Geriatric Nursing, New York University, Rory Meyers College of Nursing, 433 First Ave, Room 420, New York, NY 10010, United States of America.
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Martín-Carbonell M, Espejo B, Castro-Melo GP, Sequeira-Daza D, Checa I. Psychometric Properties of and Measurement Invariance in the Questionnaire of Stereotypes Toward Older Adulthood in Health Care College Students and Health Professionals of Colombia: Psychometric Study. J Med Internet Res 2023; 25:e42340. [PMID: 36892936 PMCID: PMC10037170 DOI: 10.2196/42340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND In health professionals, negative stereotypes toward older adulthood have been associated with the difficulty in recognizing pathological processes and the refusal to care for older patients because of assuming that communication with them will be uncomfortable and frustrating. For these reasons, research on stereotypes in these groups has acquired growing importance. The usual strategy to identify and evaluate agist stereotypes is to use scales and questionnaires. Although multiple scales are currently used, in Latin America, the Questionnaire for the Evaluation of Negative Stereotypes Toward Older Adulthood (Cuestionario de Estereotipos Negativos sobre la Vejez [CENVE]), developed in Spain, is widely used but without evidence of construct validity in our context. In addition, although in the original version, a factorial structure of 3 factors was found, in later studies, a unifactorial structure was obtained. OBJECTIVE The objective is to study the construct validity of the CENVE in a sample of Colombian health personnel to clarify its factorial structure and concurrent validity. Likewise, the measurement invariance according to gender and age was studied. METHODS A nonprobabilistic sample of 877 Colombian health professionals and intern health students was obtained. The data were collected online using the LimeSurvey tool. To study the factor structure of the CENVE, 2 confirmatory factor analysis (CFA) models were carried out, one to test a single factor and the other to test the 3-related-factor structure. The factor measurement reliability was evaluated with the composite reliability index (CRI) and the average variance extracted (AVE). The measurement invariance was studied according to gender (men and women) and age (emerging adults, 18-29 years old, and adults, 30 years old or older). Using a structural equation model, the relationship between age and the latent CENVE total score was studied to obtain evidence of concurrent validity, since studies indicate that the younger the age, the greater the number of stereotypes. RESULTS The 1-factor structure was confirmed. The reliability results indicated that both indices show adequate values. Likewise, the existence of a strong invariance in measurement by gender and age group was verified. After contrasting the means of the groups, the results showed that men show more negative stereotypes toward old age than women. Likewise, emerging adults also showed more stereotypes than adults. We also verified that age is inversely related to the latent score of the questionnaire, such that the younger the age, the greater the stereotype. These results are in agreement with those obtained by other authors. CONCLUSIONS The CENVE shows good construct and concurrent validity, as well as good reliability, and it can be used to assess stereotypes toward older adulthood in Colombian health professionals and health sciences college students. This will allow us to better understand the effect of stereotypes on agism.
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Lyubykh Z, Barclay LJ, Fortin M, Bashshur MR, Khakhar M. Reprint of: Why, how, and when divergent perceptions become dysfunctional in organizations: A motivated cognition perspective. RESEARCH IN ORGANIZATIONAL BEHAVIOR 2023. [DOI: 10.1016/j.riob.2023.100183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Combatting ageism through virtual embodiment? Using explicit and implicit measures. Int Psychogeriatr 2023; 35:157-163. [PMID: 36093860 DOI: 10.1017/s1041610222000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Ageism is defined as stereotypes, prejudice, and discrimination towards people because of their age. Although ageism can be directed towards people of any age group, most research has focused on ageism towards older people. Ageism towards older people is known to have a significant impact on their health and wellbeing and to even result in higher healthcare costs. The present study evaluated the use of virtual embodiment (VE) to reduce self- and other-directed ageism. DESIGN, SETTING, AND PARTICIPANTS We randomized 80 individuals between the ages of 18 and 35 years to one of two conditions: VE as an older or a younger avatar. RESULTS No differences were found on explicit measures of ageism. Once multiple comparisons were accounted for, a nonsignificant reduction in implicit age bias following exposure to the older avatar (Cohen's d = .75, p = .02) also was found. CONCLUSIONS Past research has established the effectiveness of VE in relation to implicit measures. However, once both explicit and implicit measures are included and multiple comparisons are accounted for, neither explicit nor implicit measures of ageism show a significant effect. Given the multidimensional nature of ageism, further research is needed to establish the effectiveness of VE once multiple measures of ageism are considered.
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Sullivan-Bissett E. Virtually imagining our biases. PHILOSOPHICAL PSYCHOLOGY 2023. [DOI: 10.1080/09515089.2023.2184334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Affiliation(s)
- Ema Sullivan-Bissett
- School of Philosophy, Theology and Religion, University of Birmingham, Birmingham, England
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