Unconscious Bias among Health Professionals: A Scoping Review

2019

More than 15 years after two pivotal reports from the Institute of Medicine (now the National Academy of Medicine) focused their attention on unequal access to healthcare and established health equity as a pillar of quality care, healthcare disparities persist. Some of this can be traced to overt discrimination against certain groups, but this chapter shines a light on a subtler form of prejudice: unconscious bias. The by-product of a normal—and often useful—human tendency to make associations and split-second judgements, unconscious bias, affects even people who believe strongly in equality and equal care. Left unaddressed, unconscious bias can influence relationships between providers and patients and among providers and their colleagues, affecting clinical interactions, workplace diversity, and even patient outcomes. Providers can mitigate unconscious biases by becoming more aware of them and resolving to overcome them through proven strategies for improving health equity and rev...

The New England Journal of Medicine, 2022

Medical Education, 2011

CONTEXT Non-conscious stereotyping and prejudice contribute to racial and ethnic disparities in health care. Contemporary training in cultural competence is insufficient to reduce these problems because even educated, culturally sensitive, egalitarian individuals can activate and use their biases without being aware they are doing so. However, these problems can be reduced by workshops and learning modules that focus on the psychology of non-conscious bias.

BMC Medical Ethics, 2017

Background: Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients.

IMC Journal of Medical Science, 2019

Background and objectives: Health disparities are a growing concern in health care. Research provides ample evidence of bias in patient care and mistrust between patient and providers in ways that could perpetuate health care disparities. This study aimed to review existing literature on implicit bias (or unconscious bias) in healthcare settings and determine studies that have considered adverse effects of bias of more than one domain of social identity (e.g., race and gender bias) in health care. Methods: This is a systematic review of articles using databases such as EBSCO, Embase, CINAHL, COCHRANE, Google Scholar, PsychINFO, Pub Med, and Web of Science. Search terms included implicit bias, unconscious bias, healthcare, and public health. The inclusion criteria included studies that assessed implicit bias in a healthcare setting, written in English, and published from 1997-2018. Results: Thirty-five articles met the selection criteria – 15 of which examined race implicit bias, ten...

The Lancet, 2020

Advances in health sciences education : theory and practice, 2015

There appears to be a fundamental inconsistency between research which shows that some minority groups consistently receive lower quality healthcare and the literature indicating that healthcare workers appear to hold equality as a core personal value. Recent evidence using Implicit Association Tests suggests that these disparities in outcome may in part be due to social biases that are primarily unconscious. In some individuals the activation of these biases may be also facilitated by the high levels of cognitive load associated with clinical practice. However, a range of measures, such as counter-stereotypical stimuli and targeted experience with minority groups, have been identified as possible solutions in other fields and may be adapted for use within healthcare settings. We suggest that social bias should not be seen exclusively as a problem of conscious attitudes which need to be addressed through increased awareness. Instead the delivery of bias free healthcare should become...

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2015

BMJ Open

IntroductionDespite efforts to improve population health and reduce health inequalities, higher morbidity and mortality rates for people with lower socioeconomic status (SES) persist. People with lower SES are said to receive worse care and have worse outcomes compared with those with higher SES, in part due to bias and prejudice. Implicit biases adversely affect professional patient relationships and influence healthcare-related decision-making. A better understanding of the relationship between SES and healthcare-related decision-making is therefore essential to address socioeconomic inequalities in health.AimTo scope the reported impact of health professionals bias about SES on clinical decision-making and its effect on the care of adults with lower SES in wider literature.MethodsThis scoping review will use Joanna Briggs Institute methods and will report its findings in line with Preferred Items for Systematic Reviews and Meta-Analyses for Protocols and Scoping Reviews guideline...

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2017

Disparities in diagnosis and treatment of racial minorities exist in the emergency department (ED). A better understanding of how physician implicit (unconscious) bias contributes to these disparities may help identify ways to eliminate such racial disparities. The objective of this systematic review was to examine and summarize the evidence on the association between physician implicit racial bias and clinical decision making. Based on PRISMA guidelines, a structured electronic literature search of PubMed, CINAHL, Scopus, and PsycINFO databases was conducted. Eligible studies were those that: 1) Included physicians; 2) Included the Implicit Association Test as a measure of implicit bias; 3) Included an assessment of physician clinical decision making; and 4) Were published in peer reviewed journals between 1998 and 2016. Articles were reviewed for inclusion by two independent investigators. Data extraction was performed by one investigator and checked for accuracy by a second inves...