Trends in Medicine: Understanding Implicit Bias as a Component of Patient Care

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In 2020 Maryland’s state legislature passed a law requiring all health care providers in perinatal units to receive implicit bias training once every two years. Delegate Joseline Peña-Melnyk, the law’s sponsor, cited the striking disparity in maternal mortality rates (four times as high for black women than white women in Maryland) as the initial reasoning. However, in 2021, after seeing the pandemic’s devastation concentrated in minority zip codes, she introduced and the legislature passed an expanded bill. Implicit bias training was mandated as a licensing requirement for all healthcare professionals.

Implicit bias training is predicated on the belief that most people hold unconscious biases related to race, gender, socioeconomic status, or weight. For many, the hidden biases directly contradict their conscious or stated views. And these latent stereotypes can take hold in times of multi-tasking, stress, or fatigue, which, in a healthcare environment, can impact care. “Health care providers, like everyone else … have an active way of processing information that is very conscious, but then we have these unconscious or implicit ways of processing information,” said Dr. Lisa Cooper, a researcher on racial health disparities at Johns Hopkins University. “There are things we’ve been exposed to throughout our lives that lead us to think and behave in certain ways. We think certain things but aren’t aware that we are thinking them.” The training seeks to bring awareness and acknowledgement of those hidden stereotypes so that a provider can notice when they’re occurring and proactively work against biases.

Since 2019, five states—including Maryland—have adopted policies requiring implicit bias training for at least some segment of health care workers. And, more recently, eight additional states have had lawmakers introduce bills. It doesn’t stop there. Medical schools, including leading programs like Harvard, Icahn School of Medicine at Mt. Sinai, and Ohio State, have incorporated the training into their curriculum.

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