State Mandated Implicit Bias Training for Healthcare Professionals

[DynamicDidactic]

To piggy back of the other thread, this is now becoming more common:

Mandated Implicit Bias Training for Health Professionals—A Step Toward Equity in Health Care

This JAMA Forum discusses ways that mandated implicit bias training for health professionals can focus on specific clinical areas and populations, advance the evidence base on the effective elements of implicit bias training, and establish qualifications for trainers.

jamanetwork.com

Training programs have arisen to address the negative effects of implicit bias, and California, Maryland, Michigan, Minnesota, and Washington recently passed legislation mandating implicit bias training for at least some categories of health professionals.

To bring it home, MD and MI require this for psychologists (not sure about the other states). I understand that CE is generally a bit of a joke and likely most people are receiving poor CE. However, requiring ethics, cultural diversity, and suicide trainings makes a lot more sense to me. Implicit bias is a much more controversial topic and mandatory training will likely extend to many states soon enough.

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[WisNeuro]

To piggy back of the other thread, this is now becoming more common:

Mandated Implicit Bias Training for Health Professionals—A Step Toward Equity in Health Care

This JAMA Forum discusses ways that mandated implicit bias training for health professionals can focus on specific clinical areas and populations, advance the evidence base on the effective elements of implicit bias training, and establish qualifications for trainers.

jamanetwork.com

To bring it home, MD and MI require this for psychologists (not sure about the other states). I understand that CE is generally a bit of a joke and likely most people are receiving poor CE. However, requiring ethics, cultural diversity, and suicide trainings makes a lot more sense to me. Implicit bias is a much more controversial topic and mandatory training will likely extend to many states soon enough.

The last implicit bias training I went to asked me to examine the effect of my "white violence." Which, was defined as merely my physical presence in the presence of a PoC. Yeah...nope.

 

[DynamicDidactic]

The last implicit bias training I went to asked me to examine the effect of my "white violence." Which, was defined as merely my physical presence in the presence of a PoC. Yeah...nope.

Do you remember who designed that training (e.g., psychologist, social worker)?

 

[WisNeuro]

Do you remember who designed that training (e.g., psychologist, social worker)?

I don't know if the presenters were the designers, but included SW and psychologists. This was part of a broader training.

 

[cara susanna]

I'm not someone who denies the existence of privilege or bias, but implicit bias bothers me because of the empirical limitations surrounding the construct. We discussed the literature a lot in social psych back in grad school and it isn't necessarily measuring what people think it is.

 

[calimich]

I wonder how confirmation bias, availability heuristic, out-group homogeneity effect are working here?

I also wonder, if presented with evidence of a "good" (by your standards) implicit bias training, what the thoughts might be?
"This isn't like the other implicit bias trainings, this one is different."
"This one is pretty good, for an implicit bias training."

Or maybe minds already been made up and closed, that any training involving implicit bias is inherently flawed?

 

[PsyDr]

From someone smarter than me: CEs about ethics are not going to make someone ethical.

I doubt CEs about bias are going to make someone less biased.

 

[calimich]

From someone smarter than me: CEs about ethics are not going to make someone ethical.

I doubt CEs about bias are going to make someone less biased.

I agree, and they'll still likely meet licensure requirements.

I think we have a whole other thread about poor quality, even laughable CEs. Yes, similar variance exists within the bias CEs.

 

[PsyDr]

I agree, and they'll still likely meet licensure requirements.

I think we have a whole other thread about poor quality, even laughable CEs. Yes, similar variance exists within the bias CEs.

It's not about poor quality. There is no amount of information that will stop someone from engaging in some bad behaviors.

Most of these license requirements functionally move the ball from negligence (e.g., "I didn't know that wasn't okay"), to malice (e.g., "I knew it was wrong and I still did it"). Or they serve a political purpose (e.g., "see, we care about opioids/trafficking/whatever").

 

[BuckeyeLove]

Wasn't this stuff debunked? At least in the ways in which it has historically been promulgated?

 

[smalltownpsych]

The phrase State mandated training makes me want to reject it right off the bat. I am more likely to volunteer for and have done quite a few CEUs on multicultural and diversity issues and treatment with various population including various minorities. When it comes to something labeled as “implicit bias training” I have an immediate negative response. This is typically explained as it being a threat to my privilege and I will grant that could be a part of it, but I actually don’t think that is really the whole truth. Part of what makes me an effective clinician is that I have a very good intuitive sense of what is healthy vs unhealthy and my sense of and experience with the current direction of training in this area is not so much whether they are “good trainings” or not, it is more based on a weighing of beneficence vs. maleficence. In other words, I sense that some of the concepts and inherent assumptions being promoted are actually more harmful than helpful.

 

[R. Matey]

These may stimulate some discussion:

Recent critical review in Perspectives of Psych Science: https://journals.sagepub.com/doi/10.1177/1745691619863798?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub 0pubmed

Addresses critics here:

Invalid Claims About the Validity of Implicit Association Tests by Prisoners of the Implicit Social-Cognition Paradigm - PMC

In a prior publication, I used structural equation modeling of multimethod data to examine the construct validity of Implicit Association Tests. The results showed no evidence that IATs measure implicit constructs (e.g., implicit self-esteem, ...

www.ncbi.nlm.nih.gov

 

[futureapppsy2]

I have concerns about implicit bias training actually increasing implicit bias, similar to how disability simulation trainings actually increase ableism and racial discrimination simulations (e.g., blue eyed students get to oppress the others) often reinforce that being the one to oppress others often is really reinforcing, leading not to “discrimination is bad”, but “being the one with the power to discriminate is a high.”

 

[WisNeuro]

I have concerns about implicit bias training actually increasing implicit bias, similar to how disability simulation trainings actually increase ableism and racial discrimination simulations (e.g., blue eyed students get to oppress the others) often reinforce that being the one to oppress others often is really reinforcing, leading not to “discrimination is bad”, but “being the one with the power to discriminate is a high.”

I think my biggest issue at least anecdotally is that "trainings" in this area go with an adversarial bent from the very beginning. If anything, they seem to turn off people who otherwise agree with the underlying sentiments, and further entrench the beliefs of those who were already fairly opposed to begin with.

Speaking to your point, do you have any research about those simulation studies and ableism? I'm curious now.

 

[R. Matey]

Like psychotherapy, I think format of intervention delivery and educator competence are major issues here.

 

[futureapppsy2]

I think my biggest issue at least anecdotally is that "trainings" in this area go with an adversarial bent from the very beginning. If anything, they seem to turn off people who otherwise agree with the underlying sentiments, and further entrench the beliefs of those who were already fairly opposed to begin with.

Speaking to your point, do you have any research about those simulation studies and ableism? I'm curious now.

Yep, there’s a whole body of it! I can post some references later (May be in a week, because I’m in a massive work crunch for the next week).

 

[deleted1129370]

It's not about poor quality. There is no amount of information that will stop someone from engaging in some bad behaviors.

Most of these license requirements functionally move the ball from negligence (e.g., "I didn't know that wasn't okay"), to malice (e.g., "I knew it was wrong and I still did it"). Or they serve a political purpose (e.g., "see, we care about opioids/trafficking/whatever").

AKA: virtue signaling. "hey folks, we the APA recognize we were racist back in the day, we sorry, all is good, you can trust us now that we've cleaned up our act and did XYZ. Let's be friends."

 

[WisNeuro]

Yep, there’s a whole body of it! I can post some references later (May be in a week, because I’m in a massive work crunch for the next week).

No rush. Just something I wanted to add to my back burner reading list when I get more time as well. Appreciate it.

 

[PikminOC]

To piggy back of the other thread, this is now becoming more common:

Mandated Implicit Bias Training for Health Professionals—A Step Toward Equity in Health Care

This JAMA Forum discusses ways that mandated implicit bias training for health professionals can focus on specific clinical areas and populations, advance the evidence base on the effective elements of implicit bias training, and establish qualifications for trainers.

jamanetwork.com

To bring it home, MD and MI require this for psychologists (not sure about the other states). I understand that CE is generally a bit of a joke and likely most people are receiving poor CE. However, requiring ethics, cultural diversity, and suicide trainings makes a lot more sense to me. Implicit bias is a much more controversial topic and mandatory training will likely extend to many states soon enough.

Any free courses on this?

 

[ClinicalABA]

The problem with these large-scope "trainings"-regardless of topic- is that they are not actually training anything. There are generally not any objectively expressed outcomes focused on specific behavior change (other than the nebulous "participants will gain knowledge" stuff), there is no clear opportunity for trainees to practice and receive feedback on any new skills, and there is no objective measure of participants' mastery (and, no, getting the correct answers on 8/10 multiple choice questions is not indicative of anything important. They are also often not very interactive, so participants can't comment or ask questions. When there is opportunity for interaction, the "trainers" often lack the presentation skills to keep things on track. Waste of time for everyone involved. We'd all be better served to get together for a weekend, smoke a brisket, drink some nice beer and bourbon, and have some friendly discussions about why we think the way we do (with a rule/understanding that we aren't there to change the way anyone else thinks).

 

[Sanman]

Having published some literature on implicit bias way before it was cool, I think these requirements are bit silly. Part of the issue in implicit bias, is that it is implicit because people think they are right. A big part of change is having more diverse voices in the conversation, not trying to change those that are already biased.

 

[bluecolourskies]

It's not about poor quality. There is no amount of information that will stop someone from engaging in some bad behaviors.

Most of these license requirements functionally move the ball from negligence (e.g., "I didn't know that wasn't okay"), to malice (e.g., "I knew it was wrong and I still did it"). Or they serve a political purpose (e.g., "see, we care about opioids/trafficking/whatever").

Same logic as- If we inundate soldiers with SHARP trainings, we will stop sexual harassment from occurring. The only reason soldiers engaged in that behavior is because the poor things just weren’t aware of what sexual harassment looks like.

 

[ClinicalABA]

It's not about poor quality. There is no amount of information that will stop someone from engaging in some bad behaviors.

Most of these license requirements functionally move the ball from negligence (e.g., "I didn't know that wasn't okay"), to malice (e.g., "I knew it was wrong and I still did it"). Or they serve a political purpose (e.g., "see, we care about opioids/trafficking/whatever").

Yeah- for my CT license, I'm required to do an hour CEU every few years related to "veterans' issues." I have no training or experience working with veterans, and for the past ten years my practice has almost exclusively focused on toddlers. Not sure what that 1 hour every few years is supposed to accomplish.

 

[deleted1129370]

Yeah- for my CT license, I'm required to do an hour CEU every few years related to "veterans' issues." I have no training or experience working with veterans, and for the past ten years my practice has almost exclusively focused on toddlers. Not sure what that 1 hour every few years is supposed to accomplish.

For the eventual child-soldiers we will have....

 

[WisNeuro]

Yeah- for my CT license, I'm required to do an hour CEU every few years related to "veterans' issues." I have no training or experience working with veterans, and for the past ten years my practice has almost exclusively focused on toddlers. Not sure what that 1 hour every few years is supposed to accomplish.

One of my biggest issues with mandating specific CEUs. They may not pertain to someone's actual practice, or the quality of CEUs in that area can be very poor. Also, if you are mandating CEUs of a specific type, you better be providing those types of CEUs free of charge.

 

[AcronymAllergy]

One of my biggest issues with mandating specific CEUs. They may not pertain to someone's actual practice, or the quality of CEUs in that area can be very poor. Also, if you are mandating CEUs of a specific type, you better be providing those types of CEUs free of charge.

I can see requiring that some number of CEUs must relate to a broad topic like (e.g., primarily something like ethics or diversity). Beyond that, leave it up to the psychologist to decide.

 

[PsyDr]

I find it interesting, that clinical professions are mandatorily educated about political matters. I doubt my CPA has to take diversity CEUs.

Someone is going to use the Duane v Buck to challenge state diversity training.

 

[PikminOC]

I find it interesting, that clinical professions are mandatorily educated about political matters. I doubt my CPA has to take diversity CEUs.

Someone is going to use the Duane v Buck to challenge state diversity training.

Who has the time, energy or money to fight it?

 

[borne_before]

Is there a consensus that this stuff is iatrogenic?

 

[bluecolourskies]

I find it interesting, that clinical professions are mandatorily educated about political matters. I doubt my CPA has to take diversity CEUs.

Someone is going to use the Duane v Buck to challenge state diversity training.

Just to be a devil’s advocate, wouldn’t we need to be more aware of diversity and cultural issues than a CPA, because this has more potential to inform how we do our work?

 

[PsyDr]

Just to be a devil’s advocate, wouldn’t we need to be more aware of diversity and cultural issues than a CPA, because this has more potential to inform how we do our work?

There is a professional expectation that we should know culture bound syndromes, and ethnically mediated medical illnesses.

These professional expectations are unrelated to what is being taught regarding race, profession, equity/equality, and bias.

Who has the time, energy or money to fight it?

A retired, 24hr news watching, retired person, who is debating whether to renew their license or not. Right?

 

[Sanman]

Who has the time, energy or money to fight it?

Anyone who happens to be friends with a law school professor. Law students are cheap labor.

 

[PikminOC]

There is a professional expectation that we should know culture bound syndromes, and ethnically mediated medical illnesses.

These professional expectations are unrelated to what is being taught regarding race, profession, equity/equality, and bias.



A retired, 24hr news watching, retired person, who is debating whether to renew their license or not. Right?

If retires then why do they need a license?

 

[PikminOC]

Anyone who happens to be friends with a law school professor. Law students are cheap labor.

Who wants to challenge the board?

 

[PsyDr]

If retires then why do they need a license?

Exactly. It's a very realistic person, who has money from a lifetime of work, is politically motivated from watching incendiary news, and has no reason to fear the board.

 

[PikminOC]

Exactly. It's a very realistic person, who has money from a lifetime of work, is politically motivated from watching incendiary news, and has no reason to fear the board.

And is also on the way out and doesn't care. He got his.

 

[WisNeuro]

Who wants to challenge the board?

I can currently name a handful of people here who would gladly challenge. I can also name a lawyer who would probably do it pro bono. Also, these are usually legislative statute changes, not unilateral board actions.

 

[PikminOC]

I can currently name a handful of people here who would gladly challenge. I can also name a lawyer who would probably do it pro bono. Also, these are usually legislative statute changes, not unilateral board actions.

Lmk how it turns out.

 

[WisNeuro]

Lmk how it turns out.

If it gets passed here, I'll keep the board updated

 

[DynamicDidactic]

Who has the time, energy or money to fight it?

I think the field of psychology needs to come to a consensus on this issue. Though, a lot of people have banked their careers on the topic, so it would take a while to turn the tide (if that is indeed what the empirical literature continues to indicate).

 

[DynamicDidactic]

Addresses critics here:

Invalid Claims About the Validity of Implicit Association Tests by Prisoners of the Implicit Social-Cognition Paradigm - PMC

In a prior publication, I used structural equation modeling of multimethod data to examine the construct validity of Implicit Association Tests. The results showed no evidence that IATs measure implicit constructs (e.g., implicit self-esteem, ...

www.ncbi.nlm.nih.gov

I haven't seen a roasting like that since the Great Chicago Fire.

I thought it would be possible to resolve some of the disagreement in a direct and open communication with the authors because the disagreement is about modeling of the same data. I was surprised when the authors declined this offer, given that Bar-Anan coauthored an article that praised the virtues of open scientific communication (Nosek & Bar-Anan, 2012).

The second response (Kurdi et al., 2021) is a confusing 7,000-word article that is short of facts, filled with false claims, and requires more fact-checking than a Trump interview.

Like presidential debates, the commentaries and my response present radically different views of reality. In one world, IATs are valid and useful tools that have led to countless new insights into human behavior. In the other world, IATs are noisy measures that add nothing to the information we already get from cheaper self-reports. Readers not well versed in the literature are likely to be confused rather than informed by these conflicting accounts. Although we may expect such vehement disagreement in politics, we should not expect it among scientists.

 

[DynamicDidactic]

I wonder how confirmation bias, availability heuristic, out-group homogeneity effect are working here?

I also wonder, if presented with evidence of a "good" (by your standards) implicit bias training, what the thoughts might be?
"This isn't like the other implicit bias trainings, this one is different."
"This one is pretty good, for an implicit bias training."

Or maybe minds already been made up and closed, that any training involving implicit bias is inherently flawed?

I pride myself on learning from what I learn in this field.

I try to, as much as I can, be guided by the science. I, as all humans, will be biased and I do my best to be on the lookout for that bias. If high-quality data were to be available, that would sway my view of the IAT a great deal. I try not to be cynical but skeptical. I have been swayed by data (and theory) on topics I originally viewed differently.