Unconscious biases are common in healthcare

Research has shown that most people, regardless of their academic or employment background, have developed unconscious biases. The Association of American Medical Colleges (AAMC) defines these biases as “social stereotypes about certain demographics or groups of people that individuals form outside of their own conscious awareness.”

In healthcare, unconscious biases could cause physicians to treat people different based solely on their race or ethnicity and could have dire results. To make practitioners aware of these potential problems, the AAMC recently launched a training program where it trains faculty members and physicians to examine their unconscious biases

“If you haven’t had a lot of experience with someone who is very different from you, your biases actually are necessary,” AAMC chief diversity officer Marc Nivet, EdD, MBA, told Health Exec. “They become shortcuts that we all use to try to connect with people and to try to understand...I think people equate unconscious biases with being bad, but they’re not bad. They’re just tools that we use to navigate the world.” 

However, Nivet said there can be negative consequences to such biases, and they can be especially dangerous in a healthcare setting. As one example, Nivet said a previous study showed physicians gave African Americans less dosage of pain medications because doctors had an unconscious bias that African Americans have a higher tolerance for pain and a tendency to misuse opioids.

The AAMC began extensively evaluating unconscious bias two years ago. Nivet and his colleagues reviewed the literature and developed an evidence-based curriculum. The organization runs training programs at its headquarters in Washington, D.C., and also travels to institutions such as Harvard Medical School and the University of California, San Francisco, to work with healthcare professionals on recognizing their unconscious biases. The sessions are one or three and a half days.

During the sessions, AAMC uses the Implicit Association Test, which was created at Harvard University and measures the strength of associations between concepts and evaluations or stereotypes. Participants also examine why they believe their subconscious associations and why the biases sometimes contradict their values.

“[Unconscious biases] are important in healthcare because it could be having unintended implications at the point of care,” Nivet said. “These historic associations someone has about a person who may be Mexican American or African American may play out in how they communicate and the body language they use, which could impact trust. We know the patient-provider trust is an important element in the healthcare environment.”

The AAMC is also identifying unconscious biases in medical schools in terms of enrollment, class structures and other factors. The AAMC is working with researchers from the Mayo Medical School, the University of Minnesota and Yale University on the Medical Student Cognitive Habit and Growth Evaluation study that examines changes in medical students’ well-being, experiences and attitudes between their first year of medical school and the end of their last year of medical school.

“I think you’re going to see every medical school in this country make investments in understanding the unconscious biases within their structures and systems and how we educate future physicians,” Nivet said. “We have to because the United States is becoming extremely diverse, and rapidly so. I think it’s going to be critical that not just medical schools but healthcare systems themselves begin to do unconscious bias training for their existing providers, as well.”