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Implicit Bias Mitigation in Healthcare Professional Education: Implications for Life-Long Learning

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 23945

Special Issue Editors

1. Department of Biochemistry, Midwestern University, Downers Grove, IL 60515, USA
2. Department of Medical Humanities, Rocky Vista University, 8401 S. Chambers Road, Parker, CO 80134, USA
Interests: developmental origins of health and disease; environmentally-induced epigenetic modifications and human health; cultural diversity and bias mitigation; relationship-centered teaching and care; interprofessional education and public health
Special Issues, Collections and Topics in MDPI journals
Psychology Department, Edith Cowan University, Perth, Australia
Interests: health and well-being; interpersonal communication; reflective practice
Department of Medical Humanities, Rocky Vista University, 8401 S. Chambers Road, Parker, CO 80134, USA
Interests: bias mitigation; cultural diversity; interprofessional education; public health; immune responses in host defense; autoimmunity

Special Issue Information

Dear Colleagues,

Implicit bias remains a nearly intractable problem in the US and elsewhere. Healthcare professionals hold negative attitudes toward many categories of people (often unconsciously), including those of color and different ethnicities, and discriminate against them. Such biases adversely affect the treatment of patients and their adherence to treatment plans leading to poorer outcomes of their care. Methods to foster implicit bias mitigation and compassionate behavior could, however, be used to train all healthcare professional students. This andragogy would improve public health in general and the health of those against whom we discriminate in particular. To do so, however, requires cultural changes in healthcare professional education. Efforts to mitigate implicit bias through reflection on behavior, such as service to the community, both within and outside of their practices, should continue throughout providers’ careers.

Many tools, such as implicit association tests, can be used to help students and practitioners mitigate unconscious biases not only against people of color and different ethnicities, but also toward other groups experiencing discrimination for their gender, body weight, and sexual orientation. This list can be expanded further to include children, older people, homeless people, those of lower socioeconomic status, and even other healthcare professionals. Thus, the groups of people against whom there is prejudice, and a need to mitigate such bias, expand depending on the circumstances of healthcare delivery. Our goal is to motivate healthcare professionals to mitigate conscious and unconscious biases against patients and other healthcare professions throughout their careers. This mitigation should occur daily through mindfulness, self-examination, critical reflection, and compassionate behavior.

Papers addressing these and related issues are invited for this Special Issue, including those presenting new findings as well as ones reviewing the field more broadly. Works to mitigate unconscious bias in healthcare professions are especially encouraged. Specific themes include but are not limited to the following:

  • Fostering compassionate behavior in healthcare profession education
  • Determining how healthcare professionals can mitigate their unconscious biases against patients and other healthcare professions
  • Use of healthcare practitioners’ reflective capacity and critical reflection to foster empathy and prevent burnout throughout their careers
  • Work in interprofessional teams to provide relationship-centered teaching and care
  • Examining whether humanities help us mitigate our implicit biases

Prof. Lon Jeffrey Van Winkle
Dr. Shane L. Rogers
Dr. Nicole M. Michels
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Compassion
  • empathy
  • Healthcare professions education
  • Implicit bias
  • Life-long learning
  • Medical education
  • Critical reflection

Published Papers (5 papers)

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Research

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19 pages, 1413 KiB  
Article
A Brief Online Implicit Bias Intervention for School Mental Health Clinicians
by Freda F. Liu, Jessica Coifman, Erin McRee, Jeff Stone, Amy Law, Larissa Gaias, Rosemary Reyes, Calvin K. Lai, Irene V. Blair, Chia-li Yu, Heather Cook and Aaron R. Lyon
Int. J. Environ. Res. Public Health 2022, 19(2), 679; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19020679 - 07 Jan 2022
Cited by 8 | Viewed by 3921
Abstract
Clinician bias has been identified as a potential contributor to persistent healthcare disparities across many medical specialties and service settings. Few studies have examined strategies to reduce clinician bias, especially in mental healthcare, despite decades of research evidencing service and outcome disparities in [...] Read more.
Clinician bias has been identified as a potential contributor to persistent healthcare disparities across many medical specialties and service settings. Few studies have examined strategies to reduce clinician bias, especially in mental healthcare, despite decades of research evidencing service and outcome disparities in adult and pediatric populations. This manuscript describes an intervention development study and a pilot feasibility trial of the Virtual Implicit Bias Reduction and Neutralization Training (VIBRANT) for mental health clinicians in schools—where most youth in the U.S. access mental healthcare. Clinicians (N = 12) in the feasibility study—a non-randomized open trial—rated VIBRANT as highly usable, appropriate, acceptable, and feasible for their school-based practice. Preliminarily, clinicians appeared to demonstrate improvements in implicit bias knowledge, use of bias-management strategies, and implicit biases (as measured by the Implicit Association Test [IAT]) post-training. Moreover, putative mediators (e.g., clinicians’ VIBRANT strategies use, IAT D scores) and outcome variables (e.g., clinician-rated quality of rapport) generally demonstrated correlations in the expected directions. These pilot results suggest that brief and highly scalable online interventions such as VIBRANT are feasible and promising for addressing implicit bias among healthcare providers (e.g., mental health clinicians) and can have potential downstream impacts on minoritized youth’s care experience. Full article
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10 pages, 345 KiB  
Article
Physiotherapy Students’ Experiences about Ethical Situations Encountered in Clinical Practices
by Marta Aguilar-Rodríguez, Kati Kulju, David Hernández-Guillén, María Isabel Mármol-López, Felipe Querol-Giner and Elena Marques-Sule
Int. J. Environ. Res. Public Health 2021, 18(16), 8489; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18168489 - 11 Aug 2021
Cited by 6 | Viewed by 3711
Abstract
(1) Background: It is important to explore the ethical situations that physiotherapy students encountered in their clinical practices. (2) Methods: Qualitative, explorative, descriptive study. The participants included third-year physiotherapy students. They had to write five narratives about ethical situations encountered in their clinical [...] Read more.
(1) Background: It is important to explore the ethical situations that physiotherapy students encountered in their clinical practices. (2) Methods: Qualitative, explorative, descriptive study. The participants included third-year physiotherapy students. They had to write five narratives about ethical situations encountered in their clinical practices. Krippendorff’s method for qualitative content analysis was used to cluster units within the data to identify emergent themes. The study protocol was approved by the authors’ University Ethic Committee of Human Research (H1515588244257). (3) Result: 280 narratives were reported by 64 students (23.34 ± 4.20 years, 59% women). Eight categories were identified from the qualitative analysis of the data: (a) professional responsibility, (b) professional competence, (c), beneficence, (d) equality and justice, (e) autonomy, (f) confidentiality, (g) respect for privacy, and (h) sincerity. All participants were informed and provided written informed consent. (4) Conclusions: Ethical principles were frequently violated in physiotherapy. Experiences of physiotherapy students must be examined to tailor educational interventions prior to their initiation into practice. Ethics education is needed in workplaces and should be increased in basic education. Facilitating the ethical awareness of future physiotherapists is a challenge for university teachers who provide ethical competence training. Full article
15 pages, 678 KiB  
Article
Impact of a Pandemic and Remote Learning on Team Development and Elements of Compassion in Prospective Medical Students Taking a Medical Humanities Course
by Lon J. Van Winkle, Brian D. Schwartz, Alexis Horst, Jensen A. Fisher, Nicole Michels and Bradley O. Thornock
Int. J. Environ. Res. Public Health 2021, 18(9), 4856; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094856 - 02 May 2021
Cited by 7 | Viewed by 2706
Abstract
Introduction: We reported previously that when teams of students reflect on readings about communication, unconscious bias, and service-learning, their critical reflection, implicit bias mitigation, empathy, and compassionate behavior all increase. However, would these gains occur when intimate classroom settings, in-person team meetings, and [...] Read more.
Introduction: We reported previously that when teams of students reflect on readings about communication, unconscious bias, and service-learning, their critical reflection, implicit bias mitigation, empathy, and compassionate behavior all increase. However, would these gains occur when intimate classroom settings, in-person team meetings, and direct interactions with people served were lost owing to the COVID-19 pandemic and remote learning? Methods: Before an online Medical Humanities course began in August 2020 and following the course in December 2020, 61 prospective medical students (54.1% female) completed reliable surveys of their reflective capacity (RC) and cognitive empathy (compassion). Students also completed surveys about their implicit biases and team community service in December 2020. Results: Both RC and empathy scores increased in students after they reflected on difficulties in communication, unconscious biases, and team service-learning experiences in the course. In written reflections, they reported how their compassionate behavior also grew owing to bias mitigation. Most students concurred that “unconscious bias might affect some of (their) clinical decisions or behaviors as a healthcare professional” and vowed to remain aware of these biases in clinical settings. Conclusions: Compared to previous years, the pandemic and remote learning had minimal effects on the benefits of our Medical Humanities course. Full article
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20 pages, 403 KiB  
Article
Nursing Lecturers’ Perception and Experience of Teaching Cultural Competence: A European Qualitative Study
by Isabel Antón-Solanas, Isabel Huércanos-Esparza, Nadia Hamam-Alcober, Valérie Vanceulebroeck, Shana Dehaes, Indrani Kalkan, Nuran Kömürcü, Margarida Coelho, Teresa Coelho, Antonio Casa-Nova, Raul Cordeiro, Enrique Ramón-Arbués, Sergio Moreno-González and Elena Tambo-Lizalde
Int. J. Environ. Res. Public Health 2021, 18(3), 1357; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031357 - 02 Feb 2021
Cited by 13 | Viewed by 6286
Abstract
Cultural competence is an essential component in providing effective and culturally responsive healthcare services, reducing health inequalities, challenging racism in health care and improving patient safety, satisfaction and health outcomes. It is thus reasonable that undergraduate nursing students can develop cultural competency through [...] Read more.
Cultural competence is an essential component in providing effective and culturally responsive healthcare services, reducing health inequalities, challenging racism in health care and improving patient safety, satisfaction and health outcomes. It is thus reasonable that undergraduate nursing students can develop cultural competency through education and training. The aim of this paper was to investigate nursing lecturers’ perception and experience of teaching cultural competence in four undergraduate nursing programs. A phenomenological approach was selected to illicit nursing lecturers’ perception of culture and experience of teaching cultural competence. Semi-structured personal interviews were held with a sample of 24 lecturers from four European universities. The anonymized transcripts were analyzed qualitatively following Braun and Clark’s phases for thematic analysis. Six themes and fifteen subthemes emerged from thematic analysis of the transcripts. Cultural competence was not explicitly integrated in the nursing curricula. Instead, the lecturers used mainly examples and case studies to illustrate the theory. The integration of cultural content in the modules was unplanned and not based on a specific model. Nursing programs should be examined to establish how cultural content is integrated in the curricula; clear guidelines and standards for a systematic integration of cultural content in the nursing curriculum should be developed. Full article

Review

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15 pages, 371 KiB  
Review
Understanding Healthcare Students’ Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings
by Olivia Rochelle Joseph, Stuart W. Flint, Rianna Raymond-Williams, Rossby Awadzi and Judith Johnson
Int. J. Environ. Res. Public Health 2021, 18(23), 12771; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312771 - 03 Dec 2021
Cited by 15 | Viewed by 6188
Abstract
Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare [...] Read more.
Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students. Full article
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