Investigating the Relationship between Resident Physician Implicit Bias and Language Use during a Clinical Encounter with Hispanic Patients

Prior research suggests that the implicit biases of physicians are negatively associated with quality of medical care and patient satisfaction among minority patients. However, relatively little is known about how physicians express these subtle forms of bias in patient interactions. This study examined the implicit and explicit anti-Hispanic biases of 53 resident physicians and the relationship between anti-Hispanic bias and language use during outpatient medical appointments with 291 Hispanic patients. Physician implicit bias was positively associated with use of interrogatives and work-related words and negatively associated with the use of prepositions and relativity-related words (e.g., words related to time and the future). These findings contribute to the growing body of evidence suggesting that, in addition to nonverbal and paraverbal behaviors, providers may communicate implicit bias to patients through the words they use during a clinical visit.

The Relationship Between Racial Prejudice and Cardiovascular Disease Mortality Risk at the State and County Level

BACKGROUND

Robust evidence shows that perceived discrimination among stigmatized groups is associated with negative health outcomes. However, little work has examined whether holding prejudiced attitudes toward others is associated with health risks for prejudiced individuals.

PURPOSE

The study is a test of the hypothesis that holding prejudicial attitudes has negative health implications for both the holders and targets of prejudicial attitudes.

METHODS

The project connected data (2003-2015) at the state and county levels on average explicit and implicit prejudice held by White, Black, and Native American respondents from Project Implicit with data on cardiovascular disease (CVD) mortality for White, Black, and Native American individuals from the CDC Wonder database. Separate analyses regressed implicit and explicit prejudice on CVD mortality risk for White, Black, and Native American individuals, respectively.

RESULTS

At the state level, among White individuals, explicit prejudice toward Blacks (β = .431, p =.037) and implicit prejudice toward Native Americans (β = .283, p = .045) were positively associated with greater CVD mortality for Whites. At the county level, White individuals' implicit prejudice toward Blacks (β =.081, p = .015) and Black individuals' implicit prejudice toward Whites (β = -.066, p = .018) were associated with greater CVD mortality for Whites. Also, at the county-level, among Black individuals, higher implicit (β = -.133, p < .001) and explicit (β = -.176, p < .001) prejudice toward Whites predicted CVD mortality for Blacks. Moreover, explicit prejudice held by White individuals was positively associated with Blacks' county-level CVD deaths (β = .074, p = .036).

CONCLUSIONS

This evidence suggests that across racial groups, holding racial prejudice is associated with CVD mortality risk for both the prejudiced and the stigmatized groups. Future research should verify the reliability of this potential public health effect with additional work explicating moderators and mediators to inform surveillance and interventions.

Testing active learning workshops for reducing implicit stereotyping of Hispanics by majority and minority group medical students

The present research tested if having first year medical students complete active learning workshops would reduce their implicit stereotyping of Hispanics as medically noncompliant. The workshops were tested with 78-majority (White) group, 16-target minority (Hispanic, African-American and American-Indian) group, and 42-non-target minority (Asian-American and foreign born students from East Asia and Southeast Asia) group students in the 2018 and 2021 classes in the American Southwest. Prior to the workshops, students completed an implicit association test (IAT), and then participated in two workshops that covered the psychology of intergroup bias, the role of implicit bias in patient care, and activities for learning six strategies for controlling the implicit stereotyping of patients. The results showed that before the workshops, the level of implicit stereotyping of Hispanics was significant for the majority and non-target minority group students, but it was not significant for the target minority group students. After the workshops, target minority students again showed no bias, and implicit stereotyping was significantly lower for the majority group students, but not for the non-target minority students. The results suggest that the workshops may have been effective for majority group and target minority group students, but that more cultural tailoring of the materials and activities may be necessary to address implicit bias among some minority group medical students.

Implicit bias toward cervical cancer: Provider and training differences

OBJECTIVE

Implicit prejudice and stereotyping may exist in health care providers automatically without their awareness. These biases can correlate with outcomes that are consequential for the patient. This study examined gynecologic oncology care providers' implicit prejudice and stereotyping toward cervical cancer.

METHODS

Members of professional gynecologic oncology organizations were asked to complete two Implicit Association Tests to determine if they implicitly associate cervical cancer with feelings of anger (prejudice) and beliefs about culpability for the disease (stereotypes), compared to ovarian cancer. Linear models and Student t-tests examined average levels of implicit bias and moderators of the implicit bias effects.

RESULTS

One-hundred seventy-six (132 female, 43 male, 1 nonresponse; X¯_age = 39.18 years, SD_age = 10.58 years) providers were recruited and the final sample included 151 participants (93 physicians and 58 nurses, X¯_age = 38.93, SD_age = 10.59). Gynecologic oncology providers showed significant levels of implicit prejudice, X¯ = 0.17, SD = 0.47, 95% CI: (0.10, 0.25), toward cervical cancer patients. They also showed significant levels of implicit stereotyping of cervical cancer patients, X¯ = 0.15, SD = 0.42, 95% CI: (0.08, 0.21). Whereas physicians did not demonstrate significant levels of implicit bias, nurses demonstrated greater levels of implicit prejudice and implicit stereotyping. Providers without cultural competency/implicit bias training demonstrated greater bias than those who had completed such training (p < .05).

CONCLUSIONS

This study provides the first evidence that gynecologic oncology providers hold implicit biases related to cervical cancer. Interventions may be designed to target specific groups in gynecologic oncology to improve interactions with patients.

The Role of Conscious Attention in How Weight Serves as an Embodiment of Importance

Inconsistency among findings in the embodied cognition literature suggests a need for theoretical boundary conditions. The current research proposes that conscious attention of a bodily state can moderate its influence on social judgment. Three studies tested this possibility in the case of the demonstrated effect of weight sensations on judgments of an abstract idea's importance. Studies 1 and 2 showed that participants rated a topic as more important when holding a moderately heavy, compared with light, clipboard. However, when the clipboard was very heavy, participants rated the survey topic as less important compared with when the clipboard was moderately heavy. The differences in importance ratings were not caused by derogation of the topic or the activation of a different metaphor. In Study 3, the importance rating difference between light and moderately heavy clipboards was eliminated by explicitly drawing perceiver's attention to the clipboard's weight. Implications and future directions are discussed.

The Evil Animal: A Terror Management Theory Perspective on the Human Tendency to Kill Animals

This research tested whether support for the killing of animals serves a terror management function. In five studies, death primes caused participants to support the killing of animals more than control primes, unless the participants' self-esteem had been elevated (Study 4). This effect was not moderated by gender, preexisting attitudes toward killing animals or animal rights, perceived human-animal similarity, religiosity, political orientation, or by the degree to which the killing was justified. Support for killing animals after subliminal death primes was also associated with an increased sense of power and invulnerability (Study 5). Implications and future directions are discussed.

He Dies, He Scores: Evidence That Reminders of Death Motivate Improved Performance in Basketball

This research applied insights from terror management theory (TMT; Greenberg, Pyszczynski, & Solomon, 1986) to the world of sport. According to TMT, self-esteem buffers against the potential for death anxiety. Because sport allows people to attain self-esteem, reminders of death may improve performance in sport. In Study 1, a mortality salience induction led to improved performance in a "one-on-one" basketball game. In Study 2, a subtle death prime led to higher scores on a basketball shooting task, which was associated with increased task-related self-esteem. These results may promote our understanding of sport and provide a novel potential way to improve athletic performance.

Evidence of negative implicit attitudes toward individuals with a tattoo near the face

Three studies examined if people express negative implicit attitudes toward individuals with a tattoo near the face. In Study 1, participants who completed an Implicit Association Test (IAT) expressed moderately negative implicit attitudes toward individuals with a tribal tattoo on one side of the neck. Study 2 replicated Study 1 when the tattoo was symmetrical, suggesting that negative affect, and not processing fluency, underlies the implicit negative evaluation of individuals with a tribal tattoo near the face. Study 3 showed dissociation between explicit and implicit attitudes toward individuals with a tribal tattoo near the face, and that the negative implicit evaluation was attenuated if the tattoo image was an objectively positive symbol. The implications for displaying a tattoo near the face are discussed.

Examining the Presence, Consequences, and Reduction of Implicit Bias in Health Care: A Narrative Review

Recent evidence suggests that one possible cause of disparities in health outcomes for stigmatized groups is the implicit biases held by health care providers. In response, several health care organizations have called for, and developed, new training in implicit bias for their providers. This review examines current evidence on the role that provider implicit bias may play in health disparities, and whether training in implicit bias can effectively reduce the biases that providers exhibit. Directions for future research on the presence and consequences of provider implicit bias, and best practices for training to reduce such bias, will be discussed.