Examining the presence, consequences, and reduction of implicit bias in health care: A narrative review

“For example, Teal et al. (2010) had medical students complete a Black/White race Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) and then participate in peer discussion groups to discuss their experience with the IAT and their observations about implicit bias during ongoing…”

“…increasing awareness of the subtle ways in which bias may affect judgment and behavior, a ground-breaking report by the Institute of Medicine (IOM; Smedley et al., 2002) concluded that unrecognized or implicit bias among health care providers may contribute to health disparities, but additional…”

“Indeed, a vast amount of research shows that perceived discrimination may undermine health among stigmatized groups (for a review see Pascoe & Richman, 2009).”

“Cultural humility is another US-developed concept originating in the 1990s [22].”

“The divisive framing of cross-cultural interactions as essentially ‘ culture-clashes ’ that require behavioural adjustment from the ‘ out-group ’ only, appears to indulge our natural impulse for in-group favouritism and ensuing out-group derogation [36].”

“It is a more systemic approach focusing on both personal attitudes, communication and organisational policies [4].”

“Moreover, the evidence for health care professional racial bias on patient outcomes is unclear [58, 59].”

“A national survey by The Commonwealth Fund (Collins et al., 2002) found that compared to Whites, Hispanics and African Americans were nearly twice as likely to report problems communicating with their providers, 14 times more likely to believe that they would receive better health care if they were of a different ethn…”

“The problem of underrepresentation continues after medical school where there is reduced diversity in postgraduate training programmes and academic careers [37–39].”

“Key aspects to success, consistent with the literature, included early involvement and engagement of leadership, use of integrated didactic and interactive learning, and content that was easily accessible and grounded in scientific literature [11, 17, 18].”

“Health care Zestcott et al. (2016) describe disparities in how patients are treated in medical facilities between minorities and their Caucasian counterparts, which demonstrates implicit bias.”

“Healthcare workers are not cut off from the world, we watch the same news, television programmes, read the same books and newspapers as any other member of society; research in the USA has shown that physicians who took the Implicit Association Test appear to demonstrate the same prevalence of anti-Black, pro-White im…”

“Unfortunately, many of us tend to have a defensive resistance to the issue when provided information and feedback about implicit bias.(3) Efforts to determine how implicit biases result in health disparities is in its infancy, but awareness is the first step.”

“Nonetheless, being made aware of implicit biases through, for example, feedback from an IAT, may motivate people to address these – if the feedback and reflection activities do not induce defensiveness that can lead to denial of the bias (Zestcott et al., 2016).”

“Implicit bias has been well documented as impacting both the behavior and judgment of health care providers (Zestcott et al., 2016).”

“Zestcott, Blair, and Stone (2016) propose that it is this impact on patients’ perception, trust and judgement of the HCP which may account for a larger proportion of observed disparities than, for instance, differences in prescription, as these factors are known to influence engagement and…”