Pre-test:
(ANSWER KEY IS DISPLAYED AT THE BOTTOM OF THIS PAGE.)
1. Almost half of all medical students and residents polled in a 2016 study believed that Black people had thicker skin, less sensitive nerve endings, and experienced less pain than Whites. A. True B. False 2. Implicit bias implies a conscious judgment regarding an individual based on a particular characteristic.
A. True B. False 3. Implicit bias may be influenced by: A. Race B. Sexual orientation C. Age D. All of the above 4. The strategy of “pausing” for the purpose of mitigating implicit bias may be described as: A. Pausing to evaluate a patient’s body language before engaging in conversation B. Pausing to fully review the medical record C. Pausing to reflect on the kind of associations that you may be making about the patient D. Pausing to check the amount of time available for your consultation 5. The implicit association test: A. Measures conscious judgment of specific individual characteristics
B. Is available only to health care professionals C. Must be completed for medical licensing D. Measures strength of associations to specific individual characteristics
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. 2 In the 18 th and 19 th century, the support of this belief of inhumanity took the form of scientific racism or pseudoscience. Many people, both professionals and laypersons, thought that 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. 3 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. 4,5 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, 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. 6,7 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. 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. These unconscious associations can contribute to the unequal treatment of people based on their race, ethnicity, gender, gender identity, age, disability, sexual orientation, etc.
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.), 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. 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. 1
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