Anne C. Gill

Helping medical learners recognise and manage unconscious bias toward certain patient groups.

Medical Education 2012: 46: 80–88

When best intentions aren't enough: helping medical students develop strategies for managing bias about patients.

Introduction/AimsImplicit bias can impact physician–patient interactions, alter treatment recommendations, and perpetuate health disparities. Medical educators need methods for raising student awareness about the impact of bias on medical care.SettingSeventy-two third-year medical student volunteers participated in facilitated small group discussions about bias.Program DescriptionWe tested an educational intervention to promote group-based reflection among medical students about implicit bias.Program EvaluationWe assessed how the reflective discussion influenced students’ identification of strategies for identifying and managing their potential biases regarding patients. 67% of the students (n = 48) identified alternate strategies at post-session. A chi-square analysis demonstrated that the distribution of these strategies changed significantly from pre-session to post-session

Fostering students’ reflection about bias in healthcare: Cognitive dissonance and the role of personal and normative standards

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Student-derived solutions to address barriers hindering reports of unprofessional behaviour

, including reductions in the use of internal feedback and humanism and corresponding increases in the use of reflection, debriefing and other strategies.DiscussionGroup-based reflection sessions, with a provocative trigger to foster engagement, may be effective educational tools for fostering shifts in student reflection about bias in encounters and willingness to discuss potential biases with colleagues, with implications for reducing health disparities.

Responding to moderate breaches in professionalism: an intervention for medical students

Objectives—To increase proper use of seat belts and car seats, thereby reducing morbidity and mortality from motor vehicle collisions. Setting—The Vehicle Injury Prevention program community intervention was implemented in Houston, Texas. Effectiveness data are limited to “target area one”, an impoverished neighborhood in northeast Harris County. Methods—This multifaceted public health education campaign brought together six segments of the community: education, health, government, law enforcement, private industry, and the media, to improve restraint use. It was evaluated by observation of proper restraint use before and nine months after implementation. Trained, independent observers made observations of occupants in the target area and at two comparison sites. Pre-post differences in restraint compliance were calculated by a standard binomial proportion test. Results—Motorists in target area one significantly improved their restraint use by 15% (p<0.05) from 39% pre-intervention to 54% post-intervention, whereas use in the comparison neighborhoods remained unchanged. Conclusions—Implementation of a public health education program, combined with economic incentives to increase vehicle restraint use, can be successful with multifaceted community support.

Integrating narrative medicine into clinical care.

Background: To reduce cognitive dissonance about ones beliefs or behavior, individuals may compare their behavior to personal and/or normative standards. The details of this reflection process are unclear. Aims: We examined how medical students compare their behavior or beliefs to standards in discussions about implicit bias, and explored if and how different reflective pathways (preserving vs. reconciling) are associated with each standard. Methods: Third-year students engaged in a small-group discussion about bias. Some students and group facilitators also participated in a debriefing about the experience. Using qualitative methods, the transcripts from these 11 sessions were analyzed for evidence of student comparison to a standard and of reflection pathways. Results: Of 557 text units, 75.8% could be coded with a standard and/or a path of reflection. Students referenced personal and normative standards about equally, and preserved or reconciled existing beliefs about equally. Uses of normative standards were associated with preservation-type reflection, and uses of personal standards with reconciliation-type reflection. Conclusions: Normative expectations of physicians are sometimes used to provoke students’ consideration of implicit biases about patients. To encourage critical reflection and reconciliation of biased beliefs or behavior, educators should frame reflective activities as a personal exercise rather than as a requirement.

Near-peers improve patient safety training in the preclinical curriculum

BACKGROUND AND OBJECTIVE: Although nonphysician reentry transitions have been characterized in literature, little is known about the reentry physicians in general, or residents in particular. We conducted a qualitative study to explore pediatric residents’ reentry, using reverse culture shock as a conceptual framework. METHODS: Eighteen pediatric residents who completed global health experiences in Africa (9 categorical residents with 1-month elective, 9 global child health residents with 12-month training) participated in interviews that included a card-sort to solicit emotional responses consistent with the conceptual framework. Data in the form of interview transcripts were coded and analyzed according to principles of grounded theory. RESULTS: All pediatric residents, despite variable time abroad, reported a range of emotional responses on reentry to residency. Global child health residents felt disconnection and frustration more intensely than categorical residents, whereas categorical residents felt invigoration more intensely than global child health residents. Although residents met with program leadership after their return, no resident described these meetings as a formal debriefing, and few described a deliberate strategy for processing emotions on reentry. CONCLUSIONS: Consistent with reverse culture shock, pediatric residents felt a range of emotions as they move toward a steady state of acculturating back into their residency program. Residency programs might consider creating safety nets to help cultivate support for residents when they reenter training.

A Teaching Oath: A Commitment to Medical Students’ Learning and Development

Barriers hinder medical students from reporting breaches in professional behaviour, which can adversely impact institutional culture. No studies have reported student perspectives on how to address these barriers successfully. Our study (i) evaluated the likelihood of reporting based on violation severity, (ii) assessed barriers to reporting and (iii) elicited students’ proposed solutions.