Implicit Bias in Health Car ____________________________________________________________________
whose demographic background is different from staff or other invited presenters is also a good practice [120]. Some have suggested that even just hanging photos and having computer screensavers reflecting positive images of various social groups could help to reduce negative associations [94].
In general, the sample sizes were small. It is also unclear how generalizable the findings are, given many of the research participants were college psychology students. The 30 studies included in the meta-analysis were cross-sectional (not longi- tudinal) and only measured short-term outcomes, and there is some concern about “one shot” interventions, given the fact that implicit biases are deeply embedded. Would simply acknowledging the existence of implicit biases be sufficient to eliminate them [95; 96]? Or would such a confession act as an illusion to having self-actualized and moved beyond the bias [95]? Others have questioned the effectiveness interventions to reduce implicit biases on a long-term basis and suggest that institutional strategies to identify and address biases may be more effective [121]. One example is the University of Wash- ington’s School of Medicine’s online reporting mechanism, which allows individuals who are either third-party observers or who are targets to report issues. When necessary, follow- up to reported incidents are conducted by human resources. Optimally, implicit bias interventions involve continual prac- tice to address deeply habitual implicit biases or interventions that target structural factors [95; 96].
EFFECTIVENESS OF IMPLICIT BIAS INTERVENTIONS
The effectiveness of implicit bias trainings and interventions has been scrutinized. In a 2019 systematic review, different types of implicit bias reduction interventions were evaluated. A meta-analysis of empirical studies published between May 2005 and April 2015 identified eight different classifications of interventions [13]: • Engaging with others’ perspectives, consciousness-rais- ing, or imagining contact with outgroup: Participants either imagine how the outgroup thinks and feels, imagine having contact with the outgroup, or are made aware of the way the outgroup is marginalized or given new information about the outgroup. • Identifying the self with the outgroup: Participants perform tasks that lessen barriers between themselves and the outgroup. • Exposure to counter-stereotypical exemplars: Partici- pants are exposed to exemplars that contradict negative stereotypes of the outgroup. • Appeal to egalitarian values: Participants are encour- aged to activate egalitarian goals or think about multiculturalism, cooperation, or tolerance. • Evaluative conditioning: Participants perform tasks to strengthen counter-stereotypical associations. • Inducing emotion: Emotions or moods are induced in participants. • Intentional strategies to overcome biases: Participants are instructed to implement strategies to over-ride or suppress their biases. • Pharmacotherapy Interventions found to be the most effective were, in order from most to least, [13]:
ROLE OF INTERPROFESSIONAL COLLABORATION AND PRACTICE AND IMPLICIT BIASES
The study of implicit bias is appropriately interdisciplinary, representing social psychology, medicine, health psychol- ogy, neuroscience, counseling, mental health, gerontology, LGBTQ+ studies, religious studies, and disability studies [13]. Therefore, implicit bias empirical research and curricula training development lends itself well to interprofessional collaboration and practice (ICP). One of the core features of ICP is sharing—professionals from different disciplines share their philosophies, values, perspec- tives, data, and strategies for planning of interventions [97]. ICP also involves the sharing of roles, responsibilities, deci- sion making, and power [98]. Everyone on the team employs their expertise, knowledge, and skills, working collectively on a shared, patient-centered goal or outcome [98; 99]. Another feature of ICP is interdependency. Instead of working in an autonomous manner, each team member’s contributions are valued and maximized, which ultimately leads to synergy [97]. At the heart of this are two other key features: mutual trust/respect and communication [99]. In order to share responsibilities, the differing roles and expertise are respected. ICP is a powerful tool to mitigate implicit biases. The inherent characteristics of ICP—enhanced communications, trust, and shared decision making—should help reduce implicit biases in the team. At the heart of ICP is also the promotion of equity, which builds in accountability and can facilitate learning about and increased awareness of members’ implicit biases [122].
• Intentional strategies to overcome biases • Exposure to counter-stereotypical exemplars • Identifying self with the outgroup • Evaluative conditioning • Inducing emotions
For implicit bias interventions to be effective, they must be grounded in social psychological theories and incorporate perspective taking, building partnerships, and emotional regulation (e.g., mindfulness) to help reduce stress [39].
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