Cited by 495Social and Intergroup PsychologyCultural Competency in Health CareRacial and Ethnic Identity Research
The DOI matches its Crossref record; 127 of the 130 references it cites were found in a registry or an index; none of the 120 sources its claims cite is checked for support yet.
Reducing Racial Bias Among Health Care Providers: Lessons from Social-Cognitive Psychology
Open accessBurgess, Diana, van Ryn, Michelle, Dovidio, John, Saha, Somnath·2007·Journal of General Internal Medicine
Abstract
The paper sets forth a set of evidence-based recommendations for interventions to combat unintentional bias among health care providers, drawing upon theory and research in social cognitive psychology. Our primary aim is to provide a framework that outlines strategies and skills, which can be taught to medical trainees and practicing physicians, to prevent unconscious racial attitudes and stereotypes from negatively influencing the course and outcomes of clinical encounters. These strategies and skills are designed to: 1) enhance internal motivation to reduce bias, while avoiding external pressure; 2) increase understanding about the psychological basis of bias; 3) enhance providers' confidence in their ability to successfully interact with socially dissimilar patients; 4) enhance emotional regulation skills; and 5) improve the ability to build partnerships with patients. We emphasize the need for programs to provide a nonthreatening environment in which to practice new skills and the need to avoid making providers ashamed of having racial, ethnic, or cultural stereotypes. These recommendations are also intended to provide a springboard for research on interventions to reduce unintentional racial bias in health care.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This paper proposes a social-cognitive framework of five strategies to help health care providers prevent unconscious racial stereotypes from negatively affecting clinical encounters. It argues that interventions should build internal motivation, understanding, confidence, emotional regulation, empathy/perspective taking, and partnership building, while cautioning that these recommendations have not yet been tested in health care.
Key findings
- The paper recommends five intervention targets: (1) enhance internal motivation to reduce bias while avoiding external pressure; (2) increase understanding of the psychological basis of bias; (3) enhance providers’ confidence in interacting with socially dissimilar patients; (4) enhance emotional regulation skills; and (5) improve the ability to build partnerships with patients.
- It warns that stereotype suppression can produce a “rebound effect,” increased social distancing, and depletion of cognitive resources; it recommends recognizing stereotypes and using counter-strategies rather than trying to actively suppress them.
- It highlights individuation, positive emotion, perspective taking/affective empathy, and common ingroup/partnership building as promising mechanisms from social-cognitive research; it notes that empathy has been shown to decline over medical training and physicians’ careers, suggesting interventions may need repetition.
- It states that the recommendations are based on empirical work mostly not conducted in health care providers and settings, and should undergo rigorous evaluation before widespread adoption.
Methods
- Design: conceptual/recommendation paper, not an empirical study; it sets forth evidence-based recommendations drawing on theory and research in social cognitive psychology.
- Data or sample: Not stated in the paper; no primary data, sample, or systematic review is described.
- Main analysis: narrative synthesis of theory and prior research, organized around a conceptual model (Figure 1) emphasizing motivation, information, skills, and emotion in interracial interaction.
Limitations
- Paper-stated: most supporting empirical work was not conducted in health care providers and settings; future interventions need rigorous evaluation, including attention to unintended consequences.
- Paper-stated: changing habits may temporarily increase cognitive burden, strategies take time and practice to become automatic, and the recommendations are not comprehensive or necessarily stand-alone programs.
- Evident from the text: there are no primary data or formal systematic review, and the proposed strategies remain untested in health care, so their effectiveness and potential harms are unknown.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Crossref · 10.1007/s11606-007-0160-1
Cites
127 of 127 references verified0 citation errors · 0 not checkable
Statistics
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Verification
Claims the paper makes
43 Not checked yet · 13 Own interpretation
None of the sources cited for this claim have been checked yet.
In the paper
“(3) providers interact less effectively with minority than with white patients.32–37”
What the sources say
- Not checked yetcites [32] Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907–15. source
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- Not checked yetcites [34] Hooper EM, Comstock LM, Goodwin JM, Goodwin JS. Patient characteristics that influence physician behavior. Med Care. 1982;20(6):630–8 source
- Not checked yetcites [35] Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health. 2004;94(12):2084–90. source
- Not checked yetcites [36] Cooper LA, Beach MC, Johnson RL, Inui TS. Delving below the surface. Understanding how race and ethnicity influence relationships in health care. J Gen Intern Med. 2006;21(suppl 1):S21–7. source
- Not checked yetcites [37] Cooper LA, Roter D. Patient–provider communication: the effect of race and ethnicity on process and outcomes of healthcare. In: Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: confronting racial and ethnic disparities in healthcare. Washington, D.C.: The National Academies Press; 2003:552–93.
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In the paper
“These programs, however, typically focus on improving providers’ cross-cultural communication skills and, as such, are likely to have only limited effects on the unconscious cognitive processes that result in stereotype activation and application.”
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In the paper
“(2) application of such stereotypes frequently occurs outside conscious awareness26–31”
What the sources say
- Not checked yetcites [26] Banaji M, Greenwald AG. Implicit stereotyping and prejudice. In: Zanna MP, Olson JM, eds. The Psychology of Prejudice, The Ontario Symposium, vol. 7: 55–76.
- Not checked yetcites [27] Devine PG, Monteith MJ. Automaticity and control in stereotyping. In: Chaiken S, Trope Y, eds. Dual-process Theories in Social Psychology. New York: Guilford Press; 1999:339–60
- Not checked yetcites [28] Dovidio JF, Gaertner SL. On the nature of contemporary prejudice: The causes, consequences, and challenges of aversive racism. In: Eberhardt JL, Fiske, ST eds. Racism: The problem and the Response. Newbury Park, CA: Sage; 1998.
- Not checked yetcites [29] Dovidio JF, Kawakami K, Gaertner SL. Implicit and explicit prejudice and interracial interaction. J Pers Soc Psychol. 2002;82(1):62–8. source
- Not checked yetcites [30] Fazio RH, Jackson JR, Dunton BC, Williams CJ. Variability in automatic activation as an unobtrusive measure of racial attitudes: a bona fide pipeline? J Pers Soc Psychol. 1995;69(6):1013–27. source
- Not checked yetcites [31] Wilson TD, Lindsey S, Schooler TY. A model of dual attitudes. Psychol Rev. 2000;107(1):101–26. source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Whites spontaneously associate different health conditions with Whites and Blacks. 41”
What the sources say
- Not checked yetcites [41] Hunt JS, Rothmann TL, Rothman AJ, Iyer SN, McGorty EK. Implicit and explicit associations between health problems and social groups. Psychol Health. In press.
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In the paper
“There is significant evidence that (1) health care providers hold stereotypes—based on patient race, class, sex, and other characteristics4–17—that influence their interpretation of behaviors and symptoms, and their clinical decisions17–25”
What the sources say
- Not checked yetcites [4] van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50(6):813–28. source
- Not checked yetcites [5] van Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. 2002;40(suppl):I 140–51.
- Not checked yetcites [6] Burgess DJ, Fu SS, van Ryn M. Why do providers contribute to disparities and what can be done about it? J Gen Intern Med. 2004;19(11):1154–9. source
- Not checked yetcites [7] Kelly CE. Bringing homophobia out of the closet: antigay bias within the patient–physician relationship. Pharos Alpha Omega Alpha Honor Med Soc. 1992;55(1):2–8.
- Not checked yetcites [8] Kelly JA, St Lawrence JS, Smith S, Hood HV, Cook DJ. Medical students’ attitudes toward AIDS and homosexual patients. J Med Educ. 1987;62(7):549–56.
- Not checked yetcites [9] Kelly JA, St Lawrence JS, Smith S, Jr., Hood HV, Cook DJ. Stigmatization of AIDS patients by physicians. Am J Public Health. 1987;77(7):789–91. source
- Not checked yetcites [10] Lewis G, Croft-Jeffreys C, David A. Are British psychiatrists racist? Br J Psychiatry. 1990;157:410–15. source
- Not checked yetcites [11] Like R, Zyzanski SJ. Patient satisfaction with the clinical encounter: social psychological determinants. Soc Sci Med. 1987;24(4):351–7. source
- Not checked yetcites [12] Porter JR, Beuf AH. The effect of a racially consonant medical context on adjustment of African-American patients to physical disability. Med Anthropol. 1994;16(1):1–16. source
- Not checked yetcites [13] Rosenthal MP, Diamond JJ, Rabinowitz HK, et al. Influence of income, hours worked, and loan repayment on medical students’ decision to pursue a primary care career. JAMA. 1994;271(12):914–7. source
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In the paper
“The most successful way to alleviate intergroup anxiety and increase provider confidence is through direct “contact” with members of other groups.71,72”
What the sources say
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In the paper
“may interpret signs of anxiety displayed by White providers as reflecting negative attitudes.69”
What the sources say
- Not checked yetcites [69] Dovidio JF, Gaertner SE, Kawakami K, Hodson G. Why can’t we just get along? Interpersonal biases and interracial distrust. Cultural Diversity and Ethnic Minority Psychology. 2002;8(2):88–102. source
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In the paper
“Stereotype suppression also can result in increased social distancing, thus potentially undermining the interpersonal quality of the encounter.61”
What the sources say
- Not checked yetcites [61] Macrae C, Bodenhausen GV, Milne AB, Jetten J. Out of mind but back in sight: stereotypes on the rebound. J Pers Soc Psychol. 1994;67(5):808–17. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“Promoting awareness of the social and historical context of race, the evidence documenting racial disparities in the quality of health care,2 and the evidence that provider bias may contribute to those disparities15 may also help in nurturing internal motivation to reduce bias, based on a sense of fairness.”
What the sources say
- Not checked yetcites [2] Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, D.C.: National Academy Press; 2002.
- Not checked yetcites [15] Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340(8):618–26. source
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In the paper
“Even automatically activated prejudice and stereotypes can be inhibited when people are perceived more in terms of their particular qualities than primarily as members of social categories.50”
What the sources say
- Not checked yetcites [50] Blair IV. The malleability of automatic stereotypes and prejudice. Pers Soc Psychol Rev. 2002;6:242–61. source
plainconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“Nonverbal behaviors associated with anxiousness overlap considerably with cues of dislike.70”
What the sources say
- Not checked yetcites [70] Dovidio JF, Hebl M, Richeson J, Shelton JN. Nonverbal communication, race, and intergroup interaction. In: Manusov V, Patterson ML, eds. Handbook of Nonverbal Communication. Thousand Oaks, CA: Sage; 2006. source
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In the paper
“Anticipated public censure can have paradoxical effects.57,58”
What the sources say
- Not checked yetcites [57] Devine PG, Plant E, Amodio DM, Harmon-Jones E, Vance SL. The regulation of explicit and implicit race bias: the role of motivations to respond without prejudice. J Pers Soc Psychol. 2002;82(5):835–48. source
- Not checked yetcites [58] Plant EAD, Patricia G. Responses to other-imposed pro-Black pressure: acceptance or backlash? J Exp Soc Psychol. 2001;37:486–501. source
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In the paper
“Thus interactive, facilitated discussions, particularly in which people interact in individualized ways, among colleagues of different race and ethnicity may be one method to enhance providers’ confidence in interracial interactions.”
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In the paper
“Stereotype suppression (e.g., trying to push away any stereotypic thoughts that arise while in the presence of an African-American patient) can lead to a number of negative, unintended consequences.”
What the sources say
- Not checked yetcites [61] Macrae C, Bodenhausen GV, Milne AB, Jetten J. Out of mind but back in sight: stereotypes on the rebound. J Pers Soc Psychol. 1994;67(5):808–17. source
- Not checked yetcites [62] Macrae CN, Bodenhausen GV, Milne AB. Saying no to unwanted thoughts: self-focus and the regulation of mental life. J Pers Soc Psychol. 1998;74(3):578–89. source
- Not checked yetcites [63] Wenzlaff RMW, Daniel M. Thought suppression. Annu Rev Psychol. 2000;51:59–91. source
- Not checked yetcites [64] Wyer NA, Sherman JW, Stroessner SJ. The roles of motivation and ability in controlling the consequences of stereotype suppression. Pers Soc Psychol Bull. 2000;26(1):13–25. source
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In the paper
“To the extent that many people are unaware of their biases, there is little motivation for change.”
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In the paper
“Promising evidence in social cognitive psychology indicates that with sufficient motivation, cognitive resources, and effort, people are able to focus on the unique qualities of individuals, rather than on the groups they belong to, in forming impressions and behaving toward others.48,49”
What the sources say
- Not checked yetcites [48] Brewer MB. A dual process model of impression formation. In: Wyer TSSRS, ed. Advances in Social Cognition. Vol I. Hillsdale, NJ: Erlbaum; 1988:1–36.
- Not checked yetcites [49] Fiske ST, Lin M, Neuberg SL. The continuum model: ten years later. In: Trope SCY, ed. Dual Process Theories in Social Psychology. New York: Guilford; 1999:211–54.
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In the paper
“The consequences of this unintentional bias ultimately may be as adverse as more overt biases.42–44”
What the sources say
- Not checked yetcites [42] Brewer MB, Brown RJ. Intergroup relations. In: Gilbert DT, Fiske ST, Lindzey G, eds. The Handbook of Social Psychology (4th ed). Boston, MA: McGraw-Hill; 1998.
- Not checked yetcites [43] Dovidio JF, Gaertner SL. Aversive racism. In: Zanna MP, ed. Advances in Experimental Social Psychology. Vol 36. San Diego, CA: Academic Press; 2004:1–51.
- Not checked yetcites [44] Tajfel H, ed. Differentiation between Social Groups: Studies in the Social Psychology of Intergroup Relations. Oxford, England: Academic Press; 1978.
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In the paper
“Non-White patients, who may be particularly vigilant for signs of prejudice or rejection,68”
What the sources say
- Not checked yetcites [68] Vorauer JD, Kumhyr SM. Is this about you or me? Self- versus other-directed judgments and feelings in response to intergroup interaction. Pers Soc Psychol Bull. 2001;27:706–19. source
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“These procedures can engender negative emotional states54,55 that motivate people to become more sensitive to and attempt to counteract the effects of unconscious prejudice and stereotypes.”
What the sources say
- Not checked yetcites [54] Leippe MR, Eistenstadt D. Generalization of dissonance reduction: Decreasing prejudice through induced compliance. J Pers Soc Psychol. 1994;67:395–413. source
- Not checked yetcites [55] Rokeach M. The Nature of Human Values. New York: Free Press; 1973.
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In the paper
“However, for people who believe that they are unbiased and aspire to be nonprejudiced, it may be possible to capitalize on their good intentions to motivate efforts to reduce their unconscious biases once they become aware of them.”
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In the paper
“Empathy has both cognitive and affective components.79,80”
What the sources say
- Not checked yetcites [79] Batson CD. Altruism and prosocial behavior. In: Gilbert DT, Fiske ST, Lindzey G, eds. The Handbook of Social Psychology, No. 2. New York, NY: McGraw-Hill; 1998:282–316.
- Not checked yetcites [80] Dovidio JF, Gaertner SL, Stewart TL, Esses VM, ten Vergert M. From intervention to outcomes: processes in the reduction of bias. In: Stephan WG, Vogt P, eds. Intergroup Relations Programs: Practice, Research, and Theory. New York Teachers College Press; 2004:243–65.
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Studies of patient-centered care suggest significant benefits in terms of patient satisfaction and medical outcomes.110–114”
What the sources say
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In the paper
“Similarly, one study found that physicians rated as “empathetic/compassionate” by their peers had less stereotypic attitudes toward patients than physicians classified as low on empathy.85”
What the sources say
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In the paper
“Creating a partnership, which produces a common group identity, reduces conscious and unconscious racial biases among Whites in interracial interactions.98,108”
What the sources say
- Not checked yetcites [98] Gaertner SL, Dovidio JF. Reducing Intergroup Bias: The Common Ingroup Identity Model. Philadelphia, PA, US: Psychology Press. 2000;212.
- Not checked yetcites [108] Nier JA, Gaertner SL, Dovidio JF, et al. Changing interracial evaluations and behavior: the effects of a common group identity. Group Proces Intergroup Relat. 2001;4:299–316. source
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In the paper
“Whether people perceive another as a partner on the “same team” (i.e., as part of the same group, the “ingroup”) or as a member of a different groups (“outgroup”) has profound implications on their reactions to the other.42,98–101”
What the sources say
- Not checked yetcites [42] Brewer MB, Brown RJ. Intergroup relations. In: Gilbert DT, Fiske ST, Lindzey G, eds. The Handbook of Social Psychology (4th ed). Boston, MA: McGraw-Hill; 1998.
- Not checked yetcites [98] Gaertner SL, Dovidio JF. Reducing Intergroup Bias: The Common Ingroup Identity Model. Philadelphia, PA, US: Psychology Press. 2000;212.
- Not checked yetcites [99] Fiske ST. Stereotyping, Prejudice, and Discrimination. Vol 2., 4th ed. Boston: McGraw-Hill; 1998.
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In the paper
“Perceptions of common ingroup membership also increase psychological bond and feelings of “oneness” that facilitate perspective taking82 and the arousal of empathy in response to their needs or problems.105–107”
What the sources say
- Not checked yetcites [82] Dovidio JF, ten Vergert M, Stewart TL, et al. Perspective and prejudice: antecedents and mediating mechanisms. Pers Soc Psychol Bull. 2004;30(12):1537–49. source
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In the paper
“Thus, it will take time and practice before providers are able to execute the strategies we have discussed in an automatic way, and to therefore fully realize their purported benefit.”
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In the paper
“Many studies have documented the positive effect of provider empathy on patients, which include increased patient satisfaction, adherence, self-efficacy, perceptions of control, less emotional distress, and better outcomes.87–90”
What the sources say
- Not checked yetcites [87] Beck RS, Daughtridge R, Sloane PD. Physician–patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002;15(1):25–38.
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boosteddirect- Asserted: passes — The authors put it forward as true.
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In the paper
“For instance, one study found that non-Hispanic White psychologists viewing videotapes of an actress playing a patient reported less empathy when the patient was described as Hispanic rather than White.78”
What the sources say
- Not checked yetcites [78] Arroyo JA. Psychotherapist bias with Hispanics: an analog study. Hisp J Behav Sci. 1996;18(21–8). source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These reactions are so ingrained and fundamental that they occur automatically, without awareness or intention.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: unclear — It is unclear why the paper says it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“There is also some evidence that having providers take on the role of patients in role-play exercises can increase empathy among health care providers. This strategy might be useful in team discussions of difficult patients.95–97”
What the sources say
- Not checked yetcites [95] Cosgray RE, Davidhizar RE, Grostefon JD, Powell M, Wringer PH. A day in the life of an inpatient: an experiential game to promote empathy for individuals in a psychiatric hospital. Arch Psychiatr Nurs. 1990;4(6):354–9. source
- Not checked yetcites [96] Henderson P, Johnson MH. Assisting medical students to conduct empathic conversations with patients from a sexual medicine clinic. Sex Transm Infect. 2002;78(4):246–9. source
- Not checked yetcites [97] Seaberg DC, Godwin SA, Perry SJ. Teaching patient empathy: the ED visit program. Acad Emerg Med. 2000;7(12):1433–6. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“Partnership building can improve the effectiveness of patient–provider interactions by reframing the interaction as one between collaborating equals, rather than between one high-status person, the provider, and one low-status person, the patient.98”
What the sources say
- Not checked yetcites [98] Gaertner SL, Dovidio JF. Reducing Intergroup Bias: The Common Ingroup Identity Model. Philadelphia, PA, US: Psychology Press. 2000;212.
plaindirect- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 22
- Probably not a substantial claim. 2
In the paper
“Whites tend to have unconscious stereotypes of Whites as intelligent, successful, and educated, and of Blacks as aggressive, impulsive, and lazy,40”
What the sources say
- Not checked yetcites [40] Wittenbrink B, Judd CM, Park B. Evidence for racial prejudice at the implicit level and its relationship with questionnaire measures. J Pers Soc Psychol. 1997;72(2):262–74. source
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“overt expressions of prejudice and negative racial stereotypes have declined substantially over time, as norms condemning bias and endorsing racial equality have become stronger and more widespread across the population.38,39”
What the sources say
- Not checked yetcites [38] Schuman H, Steeh C, Bobo L, Krysan M. Racial attitudes in America: Trends and interpretations, 2nd ed. Cambridge, MA: Harvard University Press; 1997.
- Not checked yetcites [39] Bobo L. Racial attitudes and relations at the close of the twentieth century. In: Smelser NJ, Wilson WJ, Mitchell F, eds. Racial trends and their consequences. Washington, DC: National Academy Press; 2001:264–301.
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“even consciously egalitarian people may hold negative ethnic and racial stereotypes and attitudes,26–31 of which they may not be fully conscious.”
What the sources say
- Not checked yetcites [26] Banaji M, Greenwald AG. Implicit stereotyping and prejudice. In: Zanna MP, Olson JM, eds. The Psychology of Prejudice, The Ontario Symposium, vol. 7: 55–76.
- Not checked yetcites [27] Devine PG, Monteith MJ. Automaticity and control in stereotyping. In: Chaiken S, Trope Y, eds. Dual-process Theories in Social Psychology. New York: Guilford Press; 1999:339–60
- Not checked yetcites [28] Dovidio JF, Gaertner SL. On the nature of contemporary prejudice: The causes, consequences, and challenges of aversive racism. In: Eberhardt JL, Fiske, ST eds. Racism: The problem and the Response. Newbury Park, CA: Sage; 1998.
- Not checked yetcites [29] Dovidio JF, Kawakami K, Gaertner SL. Implicit and explicit prejudice and interracial interaction. J Pers Soc Psychol. 2002;82(1):62–8. source
- Not checked yetcites [30] Fazio RH, Jackson JR, Dunton BC, Williams CJ. Variability in automatic activation as an unobtrusive measure of racial attitudes: a bona fide pipeline? J Pers Soc Psychol. 1995;69(6):1013–27. source
- Not checked yetcites [31] Wilson TD, Lindsey S, Schooler TY. A model of dual attitudes. Psychol Rev. 2000;107(1):101–26. source
hedged- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“as unconscious biases are “habits of mind”,31,45 learned over time through repeated personal experiences and cultural socialization, they are highly resistant to change.46”
What the sources say
- Not checked yetcites [31] Wilson TD, Lindsey S, Schooler TY. A model of dual attitudes. Psychol Rev. 2000;107(1):101–26. source
- Not checked yetcites [45] Devine PG, Monteith MJ. The role of discrepancy-associated affect in prejudice reduction. In: Mackie DM, Hamilton DL, eds. Affect, Cognition and Stereotyping: Interactive Processes In Intergroup Perception. Orlando, FL: Academic Press; 1993:317–44. source
- Not checked yetcites [46] Kawakami K, Dovidio JF, Moll J, Hermsen S, Russin A. Just say no (to stereotyping): effects of training in the negation of stereotypic associations on stereotype activation. J Pers Soc Psychol. 2000;78(5):871–88. source
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“People tend to have less empathy for others perceived as dissimilar,77 including members of other social categories,67 which typically result in low rapport.29,35,37,69”
What the sources say
- Not checked yetcites [77] Krebs D. Empathy and altruism. J Pers Soc Psychol. 1975;32:1134–46. source
- Not checked yetcites [67] Plant E, Devine PG. The antecedents and implications of interracial anxiety. Pers Soc Psychol Bull. 2003;29(6):790–801. source
- Not checked yetcites [29] Dovidio JF, Kawakami K, Gaertner SL. Implicit and explicit prejudice and interracial interaction. J Pers Soc Psychol. 2002;82(1):62–8. source
- Not checked yetcites [35] Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health. 2004;94(12):2084–90. source
- Not checked yetcites [37] Cooper LA, Roter D. Patient–provider communication: the effect of race and ethnicity on process and outcomes of healthcare. In: Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: confronting racial and ethnic disparities in healthcare. Washington, D.C.: The National Academies Press; 2003:552–93.
- Not checked yetcites [69] Dovidio JF, Gaertner SE, Kawakami K, Hodson G. Why can’t we just get along? Interpersonal biases and interracial distrust. Cultural Diversity and Ethnic Minority Psychology. 2002;8(2):88–102. source
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Experiments testing the impact of instructions to avoid stereotyping have shown very short-term benefit with a “rebound effect,” in which the stereotype later recurred at a higher rate than among the control groups who were not instructed to suppress.61–64”
What the sources say
- Not checked yetcites [61] Macrae C, Bodenhausen GV, Milne AB, Jetten J. Out of mind but back in sight: stereotypes on the rebound. J Pers Soc Psychol. 1994;67(5):808–17. source
- Not checked yetcites [62] Macrae CN, Bodenhausen GV, Milne AB. Saying no to unwanted thoughts: self-focus and the regulation of mental life. J Pers Soc Psychol. 1998;74(3):578–89. source
- Not checked yetcites [63] Wenzlaff RMW, Daniel M. Thought suppression. Annu Rev Psychol. 2000;51:59–91. source
- Not checked yetcites [64] Wyer NA, Sherman JW, Stroessner SJ. The roles of motivation and ability in controlling the consequences of stereotype suppression. Pers Soc Psychol Bull. 2000;26(1):13–25. source
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Additionally, when time and circumstances allow, the use of stress-reducing techniques to enhance emotional well-being before patient encounters may help reduce racial bias.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
- Rests on an assumption: Stress and negative emotions may increase stereotyping.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As we have discussed earlier, much of contemporary racism occurs unintentionally, fueled by unconscious prejudice and stereotypes.”
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Enhancing provider empathy is a particularly promising strategy for increasing the effectiveness of patient–provider interactions generally, and especially for interracial interactions.”
plainconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Psychological research has shown that Whites often feel anxious when interacting with Blacks, because of a lack of positive experiences with interracial encounters, leading them to avoid such interactions.67”
What the sources say
- Not checked yetcites [67] Plant E, Devine PG. The antecedents and implications of interracial anxiety. Pers Soc Psychol Bull. 2003;29(6):790–801. source
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“For instance, in several studies, White subjects in whom positive emotions were induced more accurately recognized Black faces, suggesting that positive emotional states can lead to lower levels of racial categorization.74”
What the sources say
- Not checked yetcites [74] Johnson KJF, Barbara L. “We All Look the Same to Me”: positive emotions eliminate the own-race bias in face recognition. Psychol Sci. 2005;16:875–81. source
hedgeddirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“More generally, positive emotional states have been shown to broaden the scope of attention and the tendency to attend to new information,76 a mental state that is consistent with greater levels of individuation and lower levels of categorization.”
What the sources say
- Not checked yetcites [76] Sexton K, Adgate JL, Church TR, et al. Children’s exposure to environmental tobacco smoke: using diverse exposure metrics to document ethnic/racial differences. Environ Health Perspect. 2004;112(3):392–7. source
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Recent research suggests that providers who experience higher levels of positive emotion during clinical encounters may be less likely to categorize patients in terms of their racial, ethnic, or cultural group and more likely to view patients in terms of their individual attributes (i.e., individuation).”
hedgedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the context of the clinical encounter, this may translate into White providers’ engaging in avoidance behaviors and spending less time with non-White patients, leading to poorer patient–provider relationships.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Techniques that lead people to recognize their unconscious biases include exercises where they are prompted to compare what they would do and what they should do in a variety of intergroup circumstances,45 and recently developed procedures (such as the Implicit Association Test52,53) that can reveal unconscious prejudice and stereotypes.”
What the sources say
- Not checked yetcites [45] Devine PG, Monteith MJ. The role of discrepancy-associated affect in prejudice reduction. In: Mackie DM, Hamilton DL, eds. Affect, Cognition and Stereotyping: Interactive Processes In Intergroup Perception. Orlando, FL: Academic Press; 1993:317–44. source
- Not checked yetcites [52] Greenwald AG, McGhee DE, Schwartz JLK. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74(6):1464–80. source
- Not checked yetcites [53] Nosek BA. Moderators of the relationship between implicit and explicit evaluation. J Exp Psychol Gen. 2005;134:565–84. source
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In addition, suppressing stereotypes requires effort,65 which can deplete cognitive resources and adversely affect the ability to solve problems and make correct decisions.66”
What the sources say
- Not checked yetcites [65] Shelton JN, Richeson JA, Salvatore J, Trawalter S. Ironic effects of racial bias during interracial interactions. Psychol Sci. 2005;16:397–402. source
- Not checked yetcites [66] Richeson JA, Shelton JN. When prejudice does not pay: effects of interracial contact on executive function. Psychol Sci. 2003 14:287–90. source
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Positive emotion has also been shown to lead to the use of more inclusive social categories, so that people are more likely to view themselves as being part of a larger group,28,75 which can facilitate empathy and increase the capacity to see others as members of a common “ingroup,” as opposed to “outgroup.”43”
What the sources say
- Not checked yetcites [28] Dovidio JF, Gaertner SL. On the nature of contemporary prejudice: The causes, consequences, and challenges of aversive racism. In: Eberhardt JL, Fiske, ST eds. Racism: The problem and the Response. Newbury Park, CA: Sage; 1998.
- Not checked yetcites [75] Dovidio JF, Gaertner SL, Isen AM, Lowrance R. Group representations and intergroup bias: positive affect, similarity, and group size. Pers Soc Psychol Bull. 1995;21(8):856–65. source
- Not checked yetcites [43] Dovidio JF, Gaertner SL. Aversive racism. In: Zanna MP, ed. Advances in Experimental Social Psychology. Vol 36. San Diego, CA: Academic Press; 2004:1–51.
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In general, people retain information in a more detailed fashion, remember more positive information, and are more forgiving of behaviors for ingroup compared to outgroup members.102–104”
What the sources say
- Not checked yetcites [102] Hewstone M. The ‘ultimate attribution error’? A review of the literature on intergroup causal attribution. Eur J Soc Psychol. 1990;20:311–35. source
- Not checked yetcites [103] Howard JW, Rothbart M. Social categorization and memory for in-group and out-group behavior. J Pers Soc Psychol. 1980;38(2):301–10. source
- Not checked yetcites [104] Park B, Rothbart M. Perception of out-group homogeneity and levels of social categorization: memory for the subordinate attributes of in-group and out-group members. J Pers Soc Psychol. 1982;42(6):1051–68. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Unfortunately, empathy has been shown to decline over the course of medical training91–94 and the course of physicians’ medical careers,85 suggesting that interventions to increase empathy might need to be repeated over time to be effective.”
What the sources say
- Not checked yetcites [91] Bellini LM, Baime M, Shea J. Variation of mood and empathy during internship. JAMA. 2002;287:3143–46. source
- Not checked yetcites [92] Bellini LM, Shea JA. Mood change and empathy decline persist during three years of internal medicine training. Acad Med. 2005;80(2):164–7. source
- Not checked yetcites [93] Diseker RA, Michielutte R. An analysis of empathy in medical students before and following clinical experience. J Med Educ. 1981;56(12):1004–10.
- Not checked yetcites [94] Hojat M, Mangione S, Nasca TJ, et al. An empirical study of decline in empathy in medical school. Med Educ. 2004;38(9):934–41. source
- Not checked yetcites [85] Carmel S, Glick SM. Compassionate-empathic physicians: personality traits and socio-organizational factors that enhance or inhibit this behavior pattern. Soc Sci Med. 1996;43(8):1253–61. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Partnership-building between provider and patient would not only be expected to produce a more positive and responsive orientation of the provider to the patient, but also a more open and cooperative orientation of the patient to the provider.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, it is important to recognize that the initial stages of changing old habits and developing new skills are likely to temporarily result in greater cognitive burden for providers during clinical encounters.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
In the paper
“In practice, perspective taking and affective empathy are closely related: perspective taking arouses affective empathy, and affective empathy facilitates adopting the other’s perspective.79”
What the sources say
- Not checked yetcites [79] Batson CD. Altruism and prosocial behavior. In: Gilbert DT, Fiske ST, Lindzey G, eds. The Handbook of Social Psychology, No. 2. New York, NY: McGraw-Hill; 1998:282–316.
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Controlled laboratory studies instructing subjects to adopt a perspective associated with another person and his or her situation have been shown to reduce bias toward a range of stigmatized groups,81 including Blacks,82,83 and to inhibit the activation of unconscious stereotypes and prejudices.84”
What the sources say
- Not checked yetcites [81] Batson CD, Polycarpou MP, Harmon-Jones E, et al. Empathy and attitudes: can feeling for a member of a stigmatized group improve feelings toward the group? J Pers Soc Psychol. 1997;72(1):105–18. source
- Not checked yetcites [82] Dovidio JF, ten Vergert M, Stewart TL, et al. Perspective and prejudice: antecedents and mediating mechanisms. Pers Soc Psychol Bull. 2004;30(12):1537–49. source
- Not checked yetcites [83] Finlay KA, Stephan WG. Improving intergroup relations: the effects of empathy on racial attitudes. J Appl Soc Psychol. 2000;30(8):1720–37. source
- Not checked yetcites [84] Galinsky AD, Moskowitz GB. Perspective-taking: decreasing stereotype expression, stereotype accessibility, and in-group favoritism. J Pers Soc Psychol. 2000;78(4):708–24. source
boosteddirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Both ultimately produce more positive orientations toward the other person and a greater interest in the other’s welfare.86”
What the sources say
- Not checked yetcites [86] Batson CD, Kobrynowicz D, Dinnerstein JL, Kampf HC, Wilson AD. In a very different voice: unmasking moral hypocrisy. J Pers Soc Psychol. 1997;72(6):1335–48. source
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
24 of 24
The paper relies on this without support.
There has been relatively little discussion to date of how to mitigate the negative impact of unconscious racial stereotyping among health care providers.
“In fact, there has been relatively little discussion to date of how to mitigate the negative impact of unconscious racial stereotyping among health care providers, despite the acknowledged need to do so.32–35”
The paper relies on this without support.
The proposed strategies have not yet been tested in the realm of health care.
“It is important to note that these proposed strategies have not yet been tested in the realm of health care and should undergo rigorous evaluation before widespread adoption.”
The paper relies on this without support.
The cognitive strategy of categorization that gives rise to stereotyping and racial prejudice is a normal aspect of human cognition.
“current understanding posits that the cognitive strategy of categorization that gives rise to stereotyping and racial prejudice is a normal aspect of human cognition.”
The paper relies on this without support.
Stress and negative emotions may increase stereotyping.
“simply being aware that stress and negative emotions may increase stereotyping could make providers more vigilant about when their interactions with patients are likely to be biased.”
The paper relies on this without support.
In the United States, race, ethnicity, and sex represent automatically activated categories that form the basis for ingroup–outgroup differentiation.
“In the United States, race, ethnicity, and sex represent automatically activated categories that form the basis for ingroup–outgroup differentiation.”
The paper relies on this without support.
Most of the empirical work underlying the recommendations has not been conducted in health care providers and settings.
“First, although our recommendations are based on empirical work, most of that work has not been conducted in health care providers and settings.”
The paper relies on this without support.
The recommended social-cognitive strategies can prevent unconscious racial attitudes and stereotypes from negatively influencing the course and outcomes of clinical encounters.
“our recommended strategies are not intended to change these associations directly,47 but rather to give providers strategies and skills to prevent unconscious attitudes and stereotypes from influencing the course and outcomes of clinical encounters in negative ways.”
The paper relies on this without support.
Efforts such as enhancing empathy and partnership building are relevant to reducing provider bias.
“Efforts such as enhancing empathy and partnership building are relevant not only to reducing provider bias but to improving patient–provider relationships in general.”
The paper relies on this without support.
Efforts such as enhancing empathy and partnership building are relevant to improving patient–provider relationships in general.
“Efforts such as enhancing empathy and partnership building are relevant not only to reducing provider bias but to improving patient–provider relationships in general.”
9 of 9
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“The presence of implicit biases among healthcare professionals and the effect on quality of clinical care is a cause for concern [13–15].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [13]
In the citing paper
“There is emerging evidence that there are a broad range of social psychological interventions that are likely to reduce implicit bias among providers [76].”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [76]
Citations
Cites
(1973) · DigitalGeorgetown (Georgetown University Library) · Cited by 10,144
A meta-analytic test of intergroup contact theory.
Pettigrew, T. F., & Tropp, L. R. (2006) · Journal of personality and social psychology · doi:10.1037/0022-3514.90.5.751 · Cited by 9,708 · cited 1×
“The most successful way to alleviate intergroup anxiety and increase provider confidence is through direct “contact” with members of other groups.(71,72) Thus interactive, facilitated discussions, particularly in which people interact in individualized ways, among colleagues of different race and ethnicity Figure 1.”
BackgroundMeasuring individual differences in implicit cognition: the implicit association test
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Metadata
- Authors
- Burgess, D., van Ryn, M., Dovidio, J., & Saha, S.
- Affiliations
- University of Minnesota (US)
- Yale University (US)
- Oregon Health & Science University (US)
- Corresponding author
- Burgess, Diana
- Venue
- Journal of General Internal Medicine
- Published
- 2007-03-03
- Volume
- 22
- Issue
- 6
- Pages
- 882-887
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2219858
- OpenAlex
- W2011893684
- Semantic Scholar
- af83f6d663f2f8ef53290a246c6ad777273432ed
- Cited by
- 495
- References
- 130
- Citations by year
- 2026: 13 · 2025: 49 · 2024: 28 · 2023: 27 · 2022: 51 · 2021: 44 · 2020: 34 · 2019: 35 · 2018: 30 · 2017: 25 · 2016: 24 · 2015: 22 · 2014: 24 · 2013: 24 · 2012: 12
- FWCI
- 40.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University Libraries (University of Maryland) (submittedVersion)
- Digital Repository at the University of Maryland (University of Maryland College Park)
- Funders
- U.S. Department of Veterans Affairs
- Topics
- Social Sciences › Sociology and Political Science › Social and Intergroup Psychology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Cultural Competency in Health Care
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Keywords
- racial bias, healthcare workers, social cognitive psychology, bias reduction interventions, medical trainees, physician-patient interaction, emotion regulation, patient partnership, intrinsic motivation
- MeSH terms
- Attitude of Health Personnel, Delivery of Health Care, Health Personnel, Humans, Physician-Patient Relations, Prejudice, Race Relations, Social Perception, Stereotyping
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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