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. 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 The ingrained nature of this racist system afforded any White person the right to stop any Black 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 Africans 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 eighteenth and nineteenth centuries, the support of this belief of inhumanity took the form of scientific
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 U.S. This focus on racial implicit bias can be understood in the context of the history of race and racism in America.
INTRODUCTION
racism or pseudoscience. Many people, both professionals and laypersons, thought that Black 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 in the context of the extreme brutalization and whipping experienced by Black 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 Black patients or experimental subjects. 4,5 Although current laws, policies, and accepted medical practices have eliminated the horrendous abuses of Black bodies, it is important to recognize how deeply embedded many of the beliefs and perceptions of Black 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 Black people had thicker skin, had 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, 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.
DEFINITIONS
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 Unconscious Bias There are two types of biases. ● Conscious bias (also known as explicit bias) ● Unconscious bias (also known as implicit bias; UCSF, Office of Diversity and Outreach) The Effects of Unconscious Bias Unconscious biases can prevent individuals from making objective decisions. They can cause people to overlook great ideas and ignore an individual’s potential, and they can impact every facet of work, from recruiting staff to leadership effectiveness, communication, decision making, and workplace interactions.
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, and so on. Although implicit bias and unconscious associations can be a subtle influence on cognition and behavior, their impact on decisions can be significant. 8,9 Types of Unconscious Bias The “Similar to Me” Effect: Preferring people who are similar to ourselves or who have shared interests and experiences over those who are different from us. First Impressions Bias: The tendency to rely too heavily on one trait or piece of information (positive or negative) when making decisions (usually the first piece of information acquired on that subject). Attribution Error or Stereotyping: Guessing or making assumptions about causes of events or behaviors; often based on preconceived and group identity.
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Book Code: PCIL1525
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