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Implicit bias instruction across disciplines related to the social determinants of health: a scoping review

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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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Acknowledgement

None

Funding

Dr. Gonzalez is supported by NIH/National Institute for Minority Health and Health Disparities grant number K23MD014178 and was previously supported while conducting this scoping review by the Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation grant number 70639, and by the Macy Faculty Scholars Program of the Josiah Macy Jr. Foundation.

Author information

Authors and Affiliations

  1. Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA

    Cristina M. Gonzalez

  2. Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Chavon M. Onumah

  3. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA

    Sydney A. Walker

  4. Department of Pediatrics, North Central Bronx Hospital, Bronx, NY, USA

    Elisa Karp

  5. Albert Einstein College of Medicine, Bronx, NY, USA

    Rachel Schwartz

  6. Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA

    Monica L. Lypson

Authors
  1. Cristina M. Gonzalez
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  2. Chavon M. Onumah
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  3. Sydney A. Walker
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  4. Elisa Karp
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  5. Rachel Schwartz
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  6. Monica L. Lypson
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Correspondence to Cristina M. Gonzalez.

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Appendices

Appendix 1

Complete search strategy for all databases

PubMed

(((((("Curriculum"[Mesh]) OR "Education"[Mesh]) OR "Teaching"[Mesh])) OR (((educat*[Text Word] OR instruct*[Text Word] OR curricul*[Text Word] OR teach*[Text Word] OR train*[Text Word])) OR (educat*[Title/Abstract] OR instruct*[Title/Abstract] OR curricul*[Title/Abstract] OR teach*[Title/Abstract] OR train*[Title/Abstract])))) AND (((((("implicit bias"[Text Word] OR "conscious bias"[Text Word] OR "unconscious bias"[Text Word] OR "nonconscious bias"[Text Word] OR "subconscious bias"[Text Word])) OR ("implicit bias"[Title/Abstract] OR "conscious bias"[Title/Abstract] OR "unconscious bias"[Title/Abstract] OR "nonconscious bias"[Title/Abstract] OR "subconscious bias"[Title/Abstract]))) OR (((subconscious bias[MeSH Major Topic]) OR non conscious bias[MeSH Major Topic]) OR unconscious bias[MeSH Major Topic]) OR conscious bias[MeSH Major Topic]) OR implicit bias[MeSH Major Topic]).

EMBASE

'implicit bias':ti,ab OR 'conscious bias':ti,ab OR 'unconscious bias':ti,ab OR 'nonconscious bias':ti,ab OR 'subconscious bias':ti,ab OR (implicit NEAR/3 bias):ti,ab OR (conscious NEAR/3 bias):ti,ab OR (nonconscious NEAR/3 bias):ti,ab OR (unconscious NEAR/3 bias):ti,ab OR (subconscious NEAR/3 bias):ti,ab AND (educat*:ti,ab OR instruct*:ti,ab OR curricul*:ti,ab OR teach*:ti,ab OR train*:ti,ab).

ERIC

1. implicit bias.mp

2. conscious bias.mp

3. conscious bias.mp

4. unconscious bias.mp

5. nonconscious bias.mp

6. subconscious bias.mp

7. 1 or 2 or 3 or 4 or 5 or 6

8. instruct*.mp

9. curricul*.mp

10. teach*.mp

11. train*.mp

12. 8 or 9 or 10 or 11

13. exp Higher Education/ or exp Teaching Methods/ or instruct*.mp

14. exp Curriculum Development/ or exp College Curriculum/ or exp National Surveys/ or curricul*.mp. or exp Professional Education/ or exp Higher Education/

15. exp Curriculum Development/ or exp Teaching Methods/ or exp Higher Education/ or teach*.mp. or exp Science Instruction/

16. exp Teacher Education/ or exp Program Development/ or exp Instructional Effectiveness/ or exp Competency Based Education/ or exp Models/ or exp Higher Education/ or train*.mp. or exp Curriculum Development/

17. 7 and 12

18. 13 or 14 or 15 or 16

19. 7 and 18

20. 8 or 9 or 10 or 11 or 13 or 14 or 15 or 16

21. 7 and 20

22. 21 not 17

JSTOR

(("implicit bias" or "conscious bias" or "unconscious bias" or "nonconscious bias" or "subconscious bias") AND ((educat* or instruct* or curricul* or teach* or train*)).

Lexis-Nexis*

title(implicit bias OR conscious bias OR unconscious bias OR nonconscious bias OR subconscious bias AND educat! OR instruct! OR curricul! OR teach! OR train!) OR hlead(implicit bias OR conscious bias OR unconscious bias OR nonconscious bias OR subconscious bias AND educat! OR instruct! OR curricul! OR teach! OR train!).

*Due to subscription changes, this search engine was not included after April 2019.

PsycINFO

( " implicit bias" OR " conscious bias" or " unconscious bias" or " nonconscious bias" or " subconscious bias")) OR ( Title: ( " implicit bias" OR " conscious bias" or " unconscious bias" or " nonconscious bias" or " subconscious bias")) OR ( Abstract: ( " implicit bias" OR " conscious bias" or " unconscious bias" or " nonconscious bias" or " subconscious bias"))) AND ( ( ( Index Terms: ( " Curriculum") OR Index Terms: ( " Education") OR Index Terms: ( " Teaching") OR Index Terms: ( " Training"))) OR ( ( Subject: ( " Curricul*") OR Subject: ( " Educat*") OR Subject: ( " Teach*") OR Subject: ( " Train*") OR Subject: ( " Instruct*"))) OR ( ( Title: ( " Curricul*") OR Title: ( " Educat*") OR Title: ( " Teach*") OR Title: ( " Train*") OR Title: ( " Instruct*"))) OR ( ( Abstract: ( " Curricul*") OR Abstract: ( " Educat*") OR Abstract: ( " Teach*") OR Abstract: ( " Train*") OR Abstract: ( " Instruct*")))).

Web of Science

TS = ((educat* or instruct* or curricul* or teach* or train*)) AND TS = (implicit NEAR/5 bias or conscious NEAR/5 bias or unconscious NEAR/5 bias or nonconscious NEAR/5 bias or subconscious NEAR/5 bias).

CINAHL

Title (" implicit bias" OR " conscious bias" OR " unconscious bias" OR " non-conscious bias" OR " subconscious bias") AND ( educat* OR instruct* OR curricul* OR teach* OR train*) OR Abstract ("implicit bias" OR " conscious bias" OR " unconscious bias" OR " non-conscious bias" OR " subconscious bias") AND ( educat* OR instruct* OR curricul* OR teach* OR train*).

MededPORTAL

“Implicit bias” in search function.

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Gonzalez, C.M., Onumah, C.M., Walker, S.A. et al. Implicit bias instruction across disciplines related to the social determinants of health: a scoping review. Adv in Health Sci Educ 28, 541–587 (2023). https://doi.org/10.1007/s10459-022-10168-w

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