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J Gen Intern Med. 2019 May;34(5):692-698. doi: 10.1007/s11606-019-04891-1.

A Qualitative Study of New York Medical Student Views on Implicit Bias Instruction: Implications for Curriculum Development.

Author information

1
Albert Einstein College of Medicine, Bronx, NY, USA. crgonzal@montefiore.org.
2
Montefiore Medical Center-Weiler Division, 1825 Eastchester Road, DOM 2-76, Bronx, NY, 10461, USA. crgonzal@montefiore.org.
3
La Universidad Iberoamericana, Santo Domingo, Dominican Republic.
4
Montefiore Medical Center-Weiler Division, 1825 Eastchester Road, DOM 2-76, Bronx, NY, 10461, USA.
5
Albert Einstein College of Medicine, Bronx, NY, USA.
6
Office of Academic Affiliations, Veterans Administration, Washington, D.C., USA.
7
George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
8
University of Michigan Medical School, Ann Arbor, MI, USA.
9
F. Edward H├ębert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

Abstract

BACKGROUND:

For at least the past two decades, medical educators have worked to improve patient communication and health care delivery to diverse patient populations; despite efforts, patients continue to report prejudice and bias during their clinical encounters. Targeted instruction in implicit bias recognition and management may promote the delivery of equitable care, but students at times resist this instruction. Little guidance exists to overcome this resistance and to engage students in implicit bias instruction; instruction over time could lead to eventual skill development that is necessary to mitigate the influence of implicit bias on clinical practice behaviors.

OBJECTIVE:

To explore student perceptions of challenges and opportunities when participating in implicit bias instruction.

APPROACH:

We conducted a qualitative study that involved 11 focus groups with medical students across each of the four class years to explore their perceptions of challenges and opportunities related to participating in such instruction. We analyzed transcripts for themes.

KEY RESULTS:

Our analysis suggests a range of attitudes toward implicit bias instruction and identifies contextual factors that may influence these attitudes. The themes were (1) resistance; (2) shame; (3) the negative role of the hidden curriculum; and (4) structural barriers to student engagement. Students expressed resistance to implicit bias instruction; some of these attitudes are fueled from concerns of anticipated shame within the learning environment. Participants also indicated that student engagement in implicit bias instruction was influenced by the hidden curriculum and structural barriers.

CONCLUSIONS:

These insights can inform future curriculum development efforts. Considerations related to instructional design and programmatic decision-making are highlighted. These considerations for implicit bias instruction may provide useful frameworks for educators looking for opportunities to minimize student resistance and maximize engagement in multi-session instruction in implicit bias recognition and management.

KEYWORDS:

curriculum development; health disparities; implicit bias; medical education; unconscious bias

PMID:
30993612
PMCID:
PMC6502892
[Available on 2020-05-01]
DOI:
10.1007/s11606-019-04891-1

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