Unconscious Bias

No one recognizes they have implicit bias, and everyone has it to different degrees about different groups.

Every woman in surgery or medicine has experienced implicit bias, and colleagues from underrepresented minorities or with gender differences experience it even more profoundly.

Microaggressions are 'very tiny paper cuts'—not blatant prejudice but repeated small insults like men talking over women or minorities, 'mansplaining,' and the 'he-peat' (a woman's idea ignored until a man repeats it).

People in dominant positions (not those experiencing microaggressions) are responsible for calling out bias when they notice it.

Implicit bias testing at Hopkins in 2005-2006 demonstrated that people can have bias based simply on group affiliation (Hopkins vs. Harvard) and that white preference exists because white individuals get more recognition and opportunities.

All search committees at Wake Forest now must go through implicit bias testing and examination before making hiring decisions.

Unconscious biases are associations, likes, or dislikes occurring outside of awareness and control, and can influence decision-making so that even pure-hearted, egalitarian people may treat patients differently based on gender, race, age, height, or weight.

There is data that physicians, when they see an underrepresented minority, make an unconscious association with medical noncompliance.

If you are in a dominant group (white, male, Protestant, cisgender), you never have to think about your social identity because you've had all the privilege and social power associated with it—the 'fish in water' analogy.

There is not a single person who doesn't have implicit bias; it's a matter of recognizing it and deciding what to do about it.

To diversify panels, one should be intentional: start with excellence as the criterion, then actively seek recommendations from colleagues outside one's immediate network, ask trainees whom they admire, and reach out via email or text.

When choosing panelists, people typically default to 'who do I know' or 'who are my buddies' rather than systematically identifying the most qualified experts, which perpetuates bias.

One should replace shame about implicit bias test results with surprise and action, recognizing that bias stems from upbringing, community, and media exposure—not personal moral failure.

Appreciative inquiry—asking questions and listening to understand others' experiences—is a key strategy for overcoming implicit bias.

Addressing implicit bias is a journey that will make you extremely uncomfortable, and when you get uncomfortable, that means you're making progress.

The book 'White Fragility' by Robin DiAngelo explains how people, especially white people, often respond defensively or irrationally when confronted about race, and helps readers understand their responsibility to respond appropriately.

Research-proven strategy: find common group identities with patients or interviewees (first-born child, grew up on a farm, sports fan, etc.) because discovering shared group membership reduces unconscious bias.

Perspective-taking—imagining what a patient went through to get to the appointment (parking, time off work, arranging childcare)—develops empathy, and empathy actively opposes unconscious bias.

After mandatory implicit bias training for the admissions committee at Ohio State, the college admitted the most diverse class in its history the very next cycle.

In a wrestling match between your conscious mind and your unconscious mind, your conscious mind will win every time—so knowing your biases and when you're at highest risk allows you to overcome them.

Unconscious bias is most likely to 'drive the bus' during times of high cognitive load, time pressure, and sleep deprivation—conditions familiar to all physicians.

'Consider the opposite' strategy: before making a decision based on data, force yourself to review the data again looking for evidence supporting the opposite conclusion, which blunts the impact of unconscious bias.

Implicit bias tests should not be used to screen people out of jobs or committees because unconscious associations reflect years of stimuli, not conscious intent; instead, use them to guide education and professional development.

True leaders now want to listen, understand, and help when trainees or colleagues raise concerns about bias or discrimination.

There is nothing radical about trying to do the right thing regarding inclusion; if someone views you as radical for teaching about implicit bias, they are in a small percentage who can't hear you, and you should politely walk away.

It is powerful and important to have white males publicly support diversity and inclusion initiatives, as their voices carry weight in changing institutional culture.