Addressing Implicit Bias in First-Year Medical Students: a Longitudinal, Multidisciplinary Training Program

Abstract

Background

Studies show that implicit bias among healthcare providers contributes to health disparities. Despite this knowledge, most medical school curricula lack formal methods for assessing and reducing implicit bias among medical students.

Purpose

The purpose of this study was to create a longitudinal, multidisciplinary training program for first-year medical students to reduce implicit bias toward skin tone, to increase awareness of personal bias, and to measure changes in bias after a targeted intervention.

Methods

First-year medical students participated in a three-part implicit bias training program that included visits to an art museum, a lecture on medical anthropology, and an interactive sociological discussion about bias in medical research. A control group did not participate in the training. All participants took the Harvard Implicit Association Test for Skin Tone and completed a questionnaire assessing awareness of implicit bias before and after the study activities were administered.

Results

All participants indicated a bias toward light skin tone. In addition, a stronger bias score in the pre-test correlated with a stronger belief that the scores were inaccurate. Neither the experimental group nor the control group demonstrated a significant change in implicit bias, but the experimental group trended toward a decrease in bias. Power analysis suggested that significant results may have been obtained with a larger sample size. All participants indicated an awareness that implicit biases affect the provision of healthcare. When prompted to reflect on these biases, the experimental group provided richer, more detailed personal accounts of implicit bias in the healthcare environment after participating in the study.

Conclusions

First-year medical students who participated in this study were aware that implicit bias affects the provision of healthcare and therefore plays a role in perpetuating health disparities. However, they were less able to recognize bias in themselves. Providing opportunities for medical students to recognize and confront their own implicit biases is an important goal. This study suggests that a longitudinal, multidisciplinary curricular approach to building awareness and reducing implicit bias can produce promising results in medical students. We anticipate that further development and refinement of curricular activities may lead to significant results.

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Notes

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    Power analysis conducted at power of 0.8 and alpha level of 0.05.

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Acknowledgments

The authors would like to thank Ruha Benjamin, PhD; Liesel Copeland, PhD; Alfredo Franco MS; Peter Guarnaccia, PhD; Donna Gustafson, PhD; Robert Lebeau, EdD; Hanin Rashid, PhD; Victoria Wagner, MLS; and the Rutgers University Zimmerli Art Museum for making this project possible.

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Correspondence to Norma S. Saks.

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Ruben, M., Saks, N.S. Addressing Implicit Bias in First-Year Medical Students: a Longitudinal, Multidisciplinary Training Program. Med.Sci.Educ. 30, 1419–1426 (2020). https://doi.org/10.1007/s40670-020-01047-3

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Keywords

  • Pre-clinical medical education
  • Art and medicine
  • Implicit bias
  • Healthcare disparities