Course overview The purpose of this course is to provide a historical context of race and racism and its relationship to the development of racial implicit bias. The development of implicit bias will be discussed
along with research demonstrating the impact of implicit bias on the clinical encounter. Recommendations for mitigating implicit bias are offered.
INTRODUCTION
Although implicit or unconscious bias and its impact on healthcare can be understood in relationship to a range of identity characteristics (age, gender, sexual orientation, etc.), The enslavement of Africans The first Africans were brought to this country forcibly on ships, arriving on the Southern shores of our nation. Packed body- next-to-body in the hull of ships, those that survived disease, malnutrition, and abuse entered this country as cargo…property. White farmers and various businessmen purchased Africans to plant and harvest crops and to cook, clean homes, and care for their children. They were the property of the individuals and families that purchased them. This forced enslavement of Africans was maintained by a system of inhumane physical and psychological abuse, norms, accepted practices, and laws. As property , Africans weren't considered human. They were property to be purchased, sold,and even named in the will of individuals before they died, like one might leave a house or wagon to a spouse or children. Like the evaluation or assessment of a used car or house, enslaved Africans were evaluated and rated according to their fitness and/or physical defects. They were not viewed as human beings on par with Whites (Franklin & Higginbotham, 2011). The ingrained nature of this racist system afforded any White person the right to stop any African American individual, question them, search them, and even physically abuse them. These actions were accepted practice and, in many cases, were part of legal codes and regulations. Thus, the systemic and structural nature of racism in this country was not only built on the economic practice of enslaving African Americans for individual and family profit, but was built on the practices, beliefs, and laws that created and supported the belief that Africans were not fully human (Medical News Today, 2021). In the 18th and 19th centuries the support of this belief of inhumanity took the form of scientific racism or pseudoscience. Many people, both professionals and laypersons,thought that Definition Implicit bias can be defined as those attitudes, beliefs, and stereotypes that affect our understanding, behavior, and actions in an unconscious (implicit) manner. A relatively small portion of the information the brain processes is conscious. The majority of information is processed unconsciously, out of awareness. As people process this information, their unconscious association can reinforce stereotypes that most often differ from their conscious assessment of an individual or group. An act to amend Sections 2190.1 and 3524.5 of, and to add Section 2736.5 to, the Business and Professions Code, relating to healing arts. [ Approved by Governor October 02, 2019. Filed with Secretary of State October 02, 2019.] LEGISLATIVE COUNSEL'S DIGEST This bill would require the Board of Registered Nursing, by January 1, 2022, to adopt regulations requiring all continuing education courses for its licensees to contain curriculum that includes specified instruction in the understanding of implicit bias in treatment. Beginning January 1, 2023, the bill would require continuing education providers to comply with these provisions and would require the board to audit education providers for compliance with these provisions, as specified. Assembly Bill No. 241 Assembly Bill No. 241 CHAPTER 417
implicit bias related to race is particularly salient in the United States. This focus on racial implicit bias can be understood in the context of the history of race and racism in America.
African American people had an innate tendency to want to run away from the confinement of the plantation, had thicker skin and skulls, and had fewer nerve endings and therefore could endure more pain. This rationale was often used for the extreme brutalization and whipping experienced by African American men, women, and children (Gilder Lerhman Institute of American History, 2021). These beliefs contributed to the medical experimentation conducted on African American bodies, sometimes without any attempt to reduce the pain and suffering of African American patients or experimental subjects (Cohen, 2021; Dimuro, 2018). Although current laws, policies, and accepted medical practices have eliminated the horrendous abuses of African American bodies, it is important to recognize how deeply embedded many of the beliefs and perceptions of African American people are within American culture, both consciously and implicitly. A 2016 study revealed that almost half of the medical students and residents surveyed endorsed notions of pseudoscience, believing that African American people had thicker skin, less sensitive nerve endings, and experienced less pain than Whites (Hoffman et al, 2016; Skibba, 2019). In spite of conscious endorsements of equity, fairness, social justice, and providing the highest level of care, there is this parallel process of unconscious or implicit bias. It is not that providers are inherently bad. Rather, they are human and prone to internalize, to a greater or lesser extent, the beliefs and stereotypes resulting from centuries of systemic and structural racism. These beliefs and internalized stereotypes can cause physicians to behave in ways that violate their deeply held values of fairness and equity. The process is unconscious or implicit. These unconscious associations can contribute to the unequal treatment of people based on their race, ethnicity, gender, gender identity, age, disability, sexual orientation, etc. Although implicit bias and unconscious associations can be a subtle influence on cognition and behavior, their impact on decisions can be significant (DeAngelis, 2019; Edgoose et al., 2019). California is a leader in recognizing the criticality of implicit bias in healthcare (California Legislative Information, 2021). THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. The Legislature finds and declares all of the following: a. Implicit bias, meaning the attitudes or internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner, exists, and often contributes to unequal treatment of people based on race, ethnicity, gender identity,sexual orientation, age, disability, and other characteristics. b. Implicit bias contributes to health disparities by affecting the behavior of physicians and surgeons, nurses, physician assistants, and other healing arts licensees. c. Evidence of racial and ethnic disparities in healthcare is remarkably consistent across a range of illnesses and healthcare services. Racial and ethnic disparities remain even after adjusting for socioeconomic differences,
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Book Code: PYIL1824
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