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Adv Health Sci Educ Theory Pract. 2018 Aug;23(3):587-599. doi: 10.1007/s10459-018-9816-3. Epub 2018 Feb 17.

Adaptive reinventing: implicit bias and the co-construction of social change.

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Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
London Health Sciences Centre, London, ON, Canada.
Maastricht University, Maastricht, Netherlands.
Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.


Emerging research on implicit bias recognition and management within health professions describes individually focused educational interventions without considering workplace influences. Workplace learning theories highlight how individual agency and workplace structures dynamically interact to produce change within individuals and learning environments. Promoting awareness of individual biases shaped by clinical learning environments may therefore represent a unique type of workplace learning. We sought to explore how individuals and the workplace learning environment interact once awareness of implicit biases are triggered within learners. In accordance with longitudinal case study methodology and informed by constructivist grounded theory, we conducted multiple longitudinal interviews with physician and nurse participants over 12 months. Our results suggest that implicit bias recognition provokes dissonance among participants leading to frustration, and critical questioning of workplace constraints. Once awareness is triggered, participants began reflecting on their biases and engaging in explicit behavioural changes that influenced the perception of structural changes within the learning environment itself. Collaboration, communication and role modeling within teams appeared to facilitate the process as individual and workplace affordances were gradually transformed. Our findings suggest a potential model for understanding how individual learners adaptively reinvent their role in response to disruptions in their learning environment.


Dissonance; Implicit bias; Stereotyping; Stigma; Workplace learning


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