Confronting implicit bias toward patients: a scoping review of post-graduate physician curricula

Abstract

Background: Physicians' behavior may unknowingly be impacted by prejudice and thereby contribute to healthcare inequities. Despite increasingly robust data demonstrating physician implicit bias (The Office of Minority Health. Minority Population Profiles, 2021; COVID-19 Shines Light on Health Disparities, National Conference of State Legislatures 2021), the evidence behind how to change this with training programs remains unclear. This scoping review therefore reports on the implementation, outcomes, and characteristics of post-graduate physician implicit bias curricula.

Methods: The authors conducted a literature review using scoping review methodology. They searched 7 databases in February and November 2020 for English-language academic and gray literature on implicit bias curricula for physicians at all levels of post-graduate training. Ten reviewers screened studies for eligibility independently, then extracted data from these studies and compiled it into a chart and analytical summary.

Results: Of the 4,599 articles screened, this review identified 90 articles on implicit bias interventions for post-graduate physicians. Inductive data analysis revealed a spectrum of educational approaches, which were categorized int o 4 educational models called Competence, Skills-Based, Social Contact, and Critical Models. The most commonly reported strength was the interactive nature of the curricula (26%), and the most frequently identified challenges were related to time and resources available (53%). Half of the interventions discussed facilitator preparation, and the majority (62%) evaluated outcomes using pre and post self-assessments.

Conclusions: This review provides a comprehensive synthesis of the literature on physician implicit bias curricula. It is our goal that this supports medical educators in applying and improving aspects of these interventions in their own programs.

Keywords: Curriculum; Implicit bias; Post graduate medical education; Prejudice; Stereotype.

Fig. 1

Flowchart of the screening process using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [11] † We assigned reviewers for full text review such that the screeners for each article’s full text were different from the screeners for its title/abstract review. This ensured that each article was screened in total by 4 different reviewers, in order to minimize effects of individual biases or subjective interpretations of criteria ‡ We imported sources cited in the bibliographies of included studies into Covidence and repeated the two-phase screening process

Fig. 2

Number (%) falling into each of the 4 levels of Kirkpatrick’s Triangle for Program Evaluation [13], of 53 articles identified