Journal of General Internal Medicine

, Volume 25, Supplement 2, pp 115–118 | Cite as

When Best Intentions Aren’t Enough: Helping Medical Students Develop Strategies for Managing Bias about Patients

  • Cayla R. Teal
  • Rachel E. Shada
  • Anne C. Gill
  • Britta M. Thompson
  • Ernest Frugé
  • Graciela B. Villarreal
  • Paul Haidet
Innovations in Education



Implicit bias can impact physician–patient interactions, alter treatment recommendations, and perpetuate health disparities. Medical educators need methods for raising student awareness about the impact of bias on medical care.


Seventy-two third-year medical student volunteers participated in facilitated small group discussions about bias.

Program Description

We tested an educational intervention to promote group-based reflection among medical students about implicit bias.

Program Evaluation

We assessed how the reflective discussion influenced students’ identification of strategies for identifying and managing their potential biases regarding patients. 67% of the students (n = 48) identified alternate strategies at post-session. A chi-square analysis demonstrated that the distribution of these strategies changed significantly from pre-session to post-session \( \left( {{X^2}\left( {11} \right) = 27.93,\,p < 0.01} \right) \), including reductions in the use of internal feedback and humanism and corresponding increases in the use of reflection, debriefing and other strategies.


Group-based reflection sessions, with a provocative trigger to foster engagement, may be effective educational tools for fostering shifts in student reflection about bias in encounters and willingness to discuss potential biases with colleagues, with implications for reducing health disparities.

Key words

bias physician–patient interactions medical students 



This work was supported in part by the Houston VA HSR&D Center of Excellence (HFP90-020, from the Office of Research and Development, U.S. Department of Veterans Affairs. This work was also supported by K07-HL85622 from the National Heart, Lung, and Blood Institute, and K07 HL082629-01 from the National Institutes of Health Office of Behavioral and Social Sciences Research. The funders had no role in writing or the decision to submit this report for publication. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Conflict of Interest

The authors report no conflicts of interest. Dr. Haidet has been a consultant for Merck Inc. during the last 3 years.


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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Cayla R. Teal
    • 1
    • 2
  • Rachel E. Shada
    • 1
    • 2
  • Anne C. Gill
    • 3
    • 4
  • Britta M. Thompson
    • 5
    • 6
  • Ernest Frugé
    • 4
  • Graciela B. Villarreal
    • 4
  • Paul Haidet
    • 7
    • 8
  1. 1.Houston VA HSR&D Center of ExcellenceMichael E. DeBakey VA Medical CenterHoustonUSA
  2. 2.Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonUSA
  3. 3.Office of Undergraduate Medical EducationBaylor College of MedicineHoustonUSA
  4. 4.Department of PediatricsBaylor College of MedicineHoustonUSA
  5. 5.Office of Educational Development and SupportThe University of Oklahoma College of MedicineOklahoma CityUSA
  6. 6.Department of PediatricsThe University of Oklahoma College of MedicineOklahoma CityUSA
  7. 7.The Office of Medical EducationThe Pennsylvania State University College of MedicineHersheyUSA
  8. 8.Department of MedicineThe Pennsylvania State University College of MedicineHersheyUSA

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