When determining a bias and its impact on the care provided, helpful questions could be: ● Does it impact the amount of time I am spending with any patients? If so, is there a pattern of who I spend more or less time with that is attributed to the bias? ● Does it lessen my empathy and belief in the patient's well-being? ● Does it affect my decision of what treatment I offer the patient? ● Does it influence the way I communicate with the patient? Healthcare Consideration: How to Start Reflecting For more information on how to self-reflect, there is a reflection toolkit at https://www.ed.ac.uk/reflection/ reflectors-toolkit. The reflection toolkit shares frameworks for help with writing out scenarios and reflecting on them, including:
Word Cloud: When you think about the purpose of self- reflection, in a word, what hinders you from participating in reflecting? Neuroplasticity Biases can be changed. From a neurological viewpoint, it is well established that biases begin with how our brain interprets things. However, due to the brain's neuroplasticity (also called neural plasticity and brain plasticity), this is not a permanently wired response. Through this course, I will refer to it as neuroplasticity. Neuroplasticity is specific to the adaptive structural and functional changes within the brain. It is believed that experiences are stored in the brain. Through new experiences, we are able to shift our unconscious thought patterns and thereby reduce, change, or eliminate our implicit biases by reorganizing our brain's structure, functions, and connections—neuroplasticity (Mateos- Aparicio & Rodriguez-Moreno, 2019; Puderbaugh & Emmady, 2022). See Figure 3 on the path of changing implicit biases within the brain. Figure 3. Neuroplasticity’s Role in Changing Biases
● What? So what? Now what? ● Integrated reflective cycle ● The 5R framework for reflection ● The four F's of active reviewing
These frameworks focus on writing down the facts along with your feelings, looking for the why in your feelings, and finally determining how you should respond in the future. Reflection is essential not only for the individual but also for organizations. Organizations should make it routine to review missions and values for relevancy in what services are offered through the lenses of cultural competence and biases. Examples of questions that can be asked are: ● Are the mission statement and the organization's values congruent with the cultural needs of the community served? ● Does the organization have procedures in place to properly serve cross-culturally? ● Do we have culturally congruent operating guidelines, procedures, and policies? ● Is the attitude and atmosphere of our business biased toward any cultural groups served within our community? ● Is our building showing diversity, inclusion, and equality to all who enter? Strategies to Disrupt Bias In 2012, Devine and colleagues identified five strategies based on the Prejudice Habit Model for disrupting biases. These strategies are still referred to in the newest literature around mitigating biases. The idea behind the strategies is to produce a change in behavior by treating biases as if they are an unwanted habit. Unwanted habits such as nail biting are broken through awareness of them and being motivated to make an effort to break them. While the use and practice of the strategies will take being mindful, they are great additions to your toolkit for mitigating personal biases. As we discuss these strategies, we are individualized in whom we define as like us or not like us. As discussed earlier in the course, our brain codes people as like us (in-group) or not like us (out-group). The following strategies can be used purposefully with our identified out-group and are known as habit-breaking interventions. These strategies have been proven effective over time in independently reducing personal biases that are enduring in their knowledge and beliefs of out-group biases. But motivation, awareness, and self-reflection are needed so that one can be consistent with their use (Forscher et al., 2017; IHI Team, 2017)
Note: Adapted from Agarwal, 2020; Mateos-Apricio & Rodriguez- Moreno, 2019; Puderbaugh & Emmady, 2022
Stereotypical response: Recognize your response is based on a stereotype Action : Recognize it is a stereotype, identify why it occurred, and develop an alternative unbiases response Counterstereotypic imaging: Use your imagery to recall someone that counters the typical stereotype in your bias to provide a concrete example demonstrating the inaccuracies of the stereotype Action : When addressing an uneducated stereotype, think of someone within that group that is well educated and successful. An example: For persons of color—Dr. Martin Luther King Jr.; for women—Julie Sweet. Increasing opportunities for contact : Seek out purposeful opportunities to engage with out-group members through positive interactions Action : Purposefully expand your network of friends by attending events where you know the out-group is present
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