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To generate anonymous impressions/thoughts

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Our cultural heritage is complex and sometimes complicated.

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What are the core competencies for nurses/clinicians? What skills and knowledge do nurses need to have to be effective in their jobs?

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What are the core competencies for nurses/clinicians? What skills and knowledge do nurses need to have to be effective in their jobs?

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Building Bridges, Not Walls: Promoting Cultural Competence & Humility in Nursing

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Cultural competence and humility are essential skills in nursing. Learn how to demonstrate cultural humility in your everyday interactions

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Marcelin, J.R., Siraj, D.S., Victor, R., Kotadia, S., & Maldonado, Y.A. (2019). The impact of unconscious bias in healthcare: How to recognize and mitigate it. The Journal of Infectious Diseases, 220(S2), S62-73

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Spector, R.E. (2017). Building Cultural and linguistic competence. Cultural diversity in health and illness (9th ed., pp 1-33). Pearson Education Inc.

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From the perspective of care providers (nurses & physicians)

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From the perspective of care providers (nurses & physicians)

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Driving Hawk Sneve, V. (1999/97). The trickster and the troll. Author's Note; Chapters 1-4 (ix-19). University of Nebraska Press.

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Cultural Humility YouTbue

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YouTube cultural humility - Google Search

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This is a 30 minute documentary titled, “Cultural Humility: People, Principles and Practices,” by Vivian Chavez, 2012, Associate Professor of Health…

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2023-09-28 PTTC: The Importance of Cultural Humility in Prevention

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Student diversity enhances learning and can present both challenges and opportunities for discussion leadership. Some of these challenges/opportunities relate to identities that may be visible (e.g., gender, race) or invisible (e.g., sexual orientation, socio-economic status, political and religious affiliation, physical or mental disability, veteran status).

This section addresses some potential "blind spots" around student identities and offers advice on discussing sensitive topics that allow students to engage with their own values and those of others.

Addressing Common Blind Spots

Below are some "blind spots" that are common in the classroom and suggestions on how to address them.

Generalizing about students based on their group membership
For example, using differential call patterns or making comments that suggest that students with military experience are tough or that engineering students like to do numbers.

Suggestion: Drawing on student experiences can greatly enrich the class discussion, as long as instructors avoid making generalizations about students based on those experiences.
Asking a student to speak for an entire demographic group

For example, calling on a French student for the French or European perspective on an issue.
Unintentionally marginalizing students with invisible social identities
Suggestions: Include in the conversation students from both within and outside of the demographic group under discussion, with an explicit understanding that none of these students' perspectives are necessarily representative of their entire demographic group. If faced with multiple instances in which specific demographic groups are being discussed, use varied approaches to calling patterns (e.g., don't always begin by calling on a member of the demographic group in question). In discussions of sensitive topics, you may wish to call more than once on students showing passion. It may be, for example, that during discussions of race, you may wish to call more than once on students of color who have their hands up multiple times.

For example, using language that implicitly holds as a norm heterosexuality, Democratic Party affiliation, high socioeconomic status, or heavy drinking during social events.
Challenging students differentially based on their demographic group
Suggestions: Use neutral references (e.g., "partner," "spouse"), avoid in-group/out-group comments (e.g., "those people" or "people like us"). Avoid partisan political comments.

For example, disproportionately calling on male students to perform quantitative analyses or female students to discuss work-life balance or shopping.
Using US-centric (or sports) references.
Suggestions: Probe student comments, engage students in tough role plays, pose difficult questions to all students, irrespective of gender, race, or ESL status, to provide them with equal opportunity for development.

For example, referencing baseball to illustrate a point.
Assuming that students are comfortable revealing their invisible identities in the classroom
Suggestions: Use analogies that are broadly accessible to make all students feel included in the discussion. Include references to non-US contexts.

For example, students may reveal their sexual orientation, a history of mental or physical illness, veteran status, political or religious affiliation to an instructor or a few sectionmates but not to the entire class.
Assuming that a student belongs to a particular demographic group based on the student's appearance
Suggestions: Be mindful of unintentionally disclosing private information about students. If a student raises his/her hand during a class discussion relevant to such private information-and you call on that student-do not specify the reason for doing so.

For example, inferring that a student grew up in Asia because the student looks Asian or assuming that an Asian student is from China.
Mispronouncing student names
Suggestions: Ask whether anyone with the experience in a particular area would like to share it with the class. Use the information on classcards to learn about student backgrounds.

For example, mispronouncing or avoiding the use of students' names when calling on them to participate or when referring to their comments.
Reserving discussions of issues related to diversity primarily to female and/or minority protagonists
Suggestions: Carefully review pronunciations provided on student classcards. Ask your Section Chair for guidance on identifying or pronouncing challenging names. Announce on the first day of class that you want to make sure to pronounce everyone's name correctly, and encourage students to let you know if you are mispronouncing their name. Reach out directly to students whose names you find difficult to pronounce and ask for guidance.

For example, only using a case with a female protagonist to discuss gender discrimination at work or work/life challenges, which may signal that these issues are relevant only to women or minorities and/or reduce the protagonist to a single social identity.

Suggestion: Discuss issues related to social identities across cases, regardless of the protagonist's demographic group (e.g., "Would the protagonist's actions be perceived differently if he were a woman or a racial or sexual-orientation minority? Note: Ask such questions only if you are able to allocate sufficient time to discuss them.)

The ability to discuss sensitive topics is critical to building students' leadership capabilities. To provide a foundation for these topics in class, instructors can set discussion expectations at the beginning of the course and take advantage of opportunities along the way to help students build their capabilities in framing arguments, listening attentively, articulating responses, and exercising judgment. In a course introduction, for example, instructors may invite students to raise sensitive issues and concerns, encouraging the class to approach these topics with curiosity, candor, and respect.

Discussing Sensitive Topics

Approaches for managing the discussion of sensitive topics include purposeful actions at the beginning of class, at the time a challenging moment occurs in class, and at the end of a challenging discussion.

At the beginning of class

If a class session involves a potentially sensitive or controversial topic, industry, organization, or protagonist-or if the case includes problematic language or characterizations-the instructor may find it helpful to:

Raise the issue preemptively and encourage an open and respectful exchange.

"I want to acknowledge upfront that today's class involves a [topic/industry/company/ protagonist] that some of us may find [difficult/disturbing/offensive]."

If the issue relates to a central teaching objective of the class:

"I would encourage us all to engage candidly and respectfully in a conversation about a topic that increasingly affects the environment in which [managers/leaders] operate."

If the issue is not the focus of the class discussion:

"Although the primary purpose of today's class is [X], I want to make [Y] a discussable issue if anyone feels strongly about addressing it at some point in the conversation. I am also happy to continue discussion of these issues after class."

Emphasize the importance of keeping the focus on ideas, content, arguments, and implications - not the person delivering them. Suggest the students be particularly patient as they and their classmates work to describe their views and arguments.

Consider referring back to the norms set at the beginning of the course and drawing on examples of previous successful discussions.

During class discussion

When a challenging moment arises in a class discussion, the instructor can choose to respond minimally, with a brief acknowledgment/commentary/redirect, or engage in dialogue with the student raising the point and potentially open the discussion to reactions from other students.

In deciding how to respond, the instructor should make every attempt to "read the room," paying attention to both verbal and non-verbal reactions (e.g., facial expressions, body language). In addition, the response will clearly depend on the nature of the comment - for example, how extreme it is and whether offense seems to be intended.

In general, the most effective responses are those involving inquiry-as opposed to debating or reprimanding a student-and protecting minority views to prevent a herd mentality from developing. Potential responses by the instructor include:

In the case of inappropriate or offensive language, rephrase the comment or invite the student to do so. Non-native speakers may be particularly susceptible to using problematic words or expressions without recognizing the impact. Note that other students may respond to such language with uncomfortable body language or awkward laughter.

In response to a student commenting on the price sensitivity of "low class" customers-"So are you suggesting that low-income customers are price sensitive?"

In response to a student referring to a female case protagonist as "a bitch" - "You seem to be getting a [strong] reaction from your classmates on that description. Would you like to rephrase that? [or Why don't you take another shot at that?"] [or "Whoa- let's push the reset button and have you start over."]

Use inquiry to give students making controversial statements an opportunity to explain or clarify their positions and possibly course-correct.

"Could you say a bit more about that?"

"How did you come to that conclusion?"

"Can you help us understand why you're assuming x/y/z/?"

Open up a discussion about a student's sensitive or controversial statement by soliciting reactions from other students. The instructor may return to the original student to respond after other views have been expressed.

"Let's get some reactions to that."

"Let's get some other perspectives."

"Does anyone see it very differently?"

If a student shares a sensitive personal story or perspective, thank the student and acknowledge the comment before transitioning back to the case discussion.

"[Student] has just shared a significant personal challenge he/she experienced related to this company's products. My guess is that he/she is not alone in this regard."

"How might the company think about these concerns?"

"What insights does that give you in the situation faced by the protagonist?"

At the end of discussion

Have a plan for bringing challenging discussions/debates to a close, which may include providing a synthesis, thanking students for sharing their views on sensitive topics, encouraging continued out-of-class discussions, or informing students about opportunities for after-class discussion and/or speakers. Instructors also may want to reach out to individual students via email or in-person to follow-up on a challenging moment in the discussion.

"This is an important topic. Although we have not been able to discuss all of the issues in-depth, we should recognize [core underlying tensions/key arguments]. I'd encourage you to continue discussing and reflecting upon these issues outside of class."

"This is an important topic. We won't be able to talk about it more today, but I will carve out time at the beginning of tomorrow's class so we can discuss it further."

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Diversity and Inclusion - Christensen Center for Teaching and Learning - Harvard Business School

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Student diversity enhances learning and can present both challenges and opportunities for discussion leadership. Some of these challenges/opportunities relate to identities that may be visible (e.g., gender, race) or invisible (e.g., sexual orientation, socio-economic status, political and religious affiliation, physical or mental disability, veteran status).

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Namaste

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Cultural Humility | Juliana Mosley, Ph.D. | TEDxWestChester

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22.2 Cultural Models - Population Health for Nurses | OpenStax

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This free textbook is an OpenStax resource written to increase student access to high-quality, peer-reviewed learning materials.

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Sagar, P.L. (2012). Madeleine Leininger's theory of culture care diversity and universality. Transcultural nursing theory and models (pp1-17). Springer Publishing Company

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Tips for Improving Social Presence and Student Interactions with Peers
Supplemental Video
Personal/Affective

Post introductions and expectations early.

Ask students to provide support for responses with examples/references, e.g. personal experiences, stories or other sources.

Share your own personal stories and professional experiences

Instructor and students should upload/share a profile pic

Address students by name

Create questions that encourage students to voice their opinion, perspective, personal experience

Incorporate discussions where students build pieces of their own projects, papers, etc. (e.g., 'share your research topic and 3 reasons why it is relevant for your personal development')

Open Communication

Create a "commons area" for off-topic discussions.

Provide a risk-free environment for sharing and exchange of ideas. (netiquette and peer review guidelines)

Use technology to support open discussions, Q&As (e.g., chat, Adobe Connect, etc.)

Summarize discussion threads weekly and participate throughout the week

Group Cohesion

Use appropriately sized small groups for discussions and activities

Ask or provide opportunities for student to share about their background and learning goals

Ask questions that encourage students to engage with other students in the class

Ask questions that prompt students to generate lists of information/data as a class

Provide assignments and opportunities for students to work collaboratively

Have small groups identify a team name and develop a team charter at the beginning of the course

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Online Teaching: Community and Discussions

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Tips for Improving Social Presence and Student Interactions with Peers Supplemental Video Personal/Affective Post introductions and expectations early. Ask students to provide support for responses with examples/references, e.g. personal experiences, stories or other sources.

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Teaching the Teachers: Development and Evaluation of a Racial Health Equity Curriculum for Faculty

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Teaching the Teachers: Development and Evaluation of a Racial Health Equity Curriculum for Faculty

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This training is from AAMC, but is adaptable to nursing/advanced practice.

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I hope to repeat the book club again until every faculty member has a copy and an opportunity to participate in book group.

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Guide to developing Anti-Racist Educational Materials

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Cultural Humility is a nursing competency

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Cultural Humility is a nursing competency

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Cultural Humility Is a Nursing Clinical Competency

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To confront the disparities that minority populations face in health care, organizations across the United States are recognizing that cultural humility is a clinical competency. Implicit and explicit…

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Navigating Cultural Humility in Nursing: A Holistic Approach

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Explore the transformative journey of embracing cultural humility in nursing. How it shapes professional interactions with diverse individuals & communities.

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Utilizing Cultural Humility as a Tool to Support Diversity in Clinical Research - ACRP

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As applied to the clinical research enterprise, “cultural humility” is a continuous process of self-orientation toward caring for others based on self-reflection and assessment, appreciation of others’ experiences, and expertise on the social and cultural context of their lives, with an openness to establishing strong relationships within the research team and with study subjects.

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A NEW E-LEARNING PROGRAM

This free, accredited e-learning program is designed for maternal health care providers and students seeking knowledge and skills related to cultural competency, cultural humility, person-centered care, and combating implicit bias across the continuum of maternal health care.

Testimonials

In Your Words

Hear from fellow CLAS champions about why culturally and linguistically appropriate services (CLAS) matter.

We'd also like to hear from you!

Share Your Story Send Us An Email

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

Martin Luther King, Jr.

"He who has health, has hope. And he who has hope, has everything."

Proverbs

"Ensuring access to quality, affordable health care helps create the opportunity for all citizens to achieve the American dream. Despite advances in medicine and technology, disparities remain in our health care system for too many Americans, including racial and ethnic minorities."

President Barack Obama

"To eliminate disparities, we must know enough (research); do enough (deliver the outcomes); care enough (commitment); and persevere enough (do not get discouraged)."

David Satcher, MD, PhD, Director, Morehouse School of Medicine

"It is health that is real wealth and not pieces of gold and silver."

Gandhi

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A NEW E-LEARNING PROGRAM This free, accredited e-learning program is designed for maternal health care providers and students seeking knowledge and skills related to cultural competency, cultural humility, person-centered care, and combating implicit bias across the continuum of maternal health care. Testimonials Hear from fellow CLAS champions about why culturally and linguistically appropriate services (CLAS) matter.

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Implicit bias refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner. Among the key attributes of implicit biases are the following:

Implicit or Unconscious: Activated unconsciously and involuntarily, without being explicitly controlled

Bias: This bias may skew toward either a favorable or an unfavorable assessment

Pervasiveness: Implicit attitudes and stereotypes are robust and pervasive

Regardless of whether implicit associations are positive or negative in nature, everyone is susceptible to implicit biases, including children.* Learn more about implicit bias by exploring the following resources.

*"State of the Science: Implicit Bias Review 2013," The Kirwan Institute

Advocates & Allies for Equity

To help create a more equitable environment and advance the professional interests of women faculty and staff and other underrepresented groups in your unit/department, The Women's Place invites you to participate in the Ohio State Advocates & Allies for Equity initiative. This program is designed to bring men further into the gender equity equation by building a cross-campus network of male Allies who share an understanding of the effects of implicit bias and systematic privilege and to introduce specific practical actions to help men better support women at the university.

To engage your department/unit and help change the culture at Ohio State, contact The Women's Place regarding the simple process of scheduling an Ally facilitation.

Host a Gender By Us™ Conversation

Gender By Us™ is a conversation tool created by The Women's Fund of Central Ohio to spark change. It is designed to convene conversations, challenging underlying gender social norms in a safe space that encourages transparent dialogue and generates change.

To check out a toolkit and host a small group conversation geared towards highlighting societal gender norms and how they show up in our personal lives and communities, contact womensplace@osu.edu.

Feminism and Gender Kit

The Student Life Multicultural Center (MCC) offers a Gender Kit and Community Kits that faculty, staff, and students can use to facilitate development relating to issues of diversity and social justice. With fun, flexible, and adaptable tools, the kits allow people to facilitate a deeper awareness of diversity and social justice issues within their communities to create healthier, more inclusive environments.

**Some of the following Kirwan resources are temporarily unavailable until end of September 2023**

Kirwan Institute Implicit Bias Resources

State of the Science Implicit Bias Review

The Kirwan Institute's implicit bias team is engaged throughout the year, compiling research and leading workshops and presentations in states and communities across the country as the desire for help understanding this important body of research continues to grow. Each year since 2013, Kirwan publishes the State of the Science Implicit Bias Review, which explores the newest developments in the field of implicit bias research and discourse. The review helps guide people in all professions in thinking about the real world implications of the research.

Download the State of the Science: Implicit Bias Review.

Implicit Bias Module Series

The Kirwan Institute offers the nation's first free and publicly available online implicit bias module series tailored specifically toward K-12 educators. These modules include a series of videos, activities, and resources that are uniquely tailored to the experience of those who work in a K-12 education setting or closely-related field. However, much of the content in Modules 1, 3, and 4 are generalizable enough to apply to most audiences.

Access the implicit bias module series.

More Kirwan Resources

Take the Implicit Association Test (IAT)

The Implicit Association Test (IAT) created by Project Implicit is a key assessment tool for learning about one's own biases by measuring attitudes and beliefs that people may be unwilling or unable to report. Take Project Implicit's online Implicit Association Tests to get a sense of your unconscious biases. After you click the link, find the US flag and click "GO!" to continue as a Guest or choose one of the two options on the right (if you choose to login, you will not have the option to choose which test you take). Then read the Preliminary Information and click "I wish to proceed."

OHR Workshop

Build foundational knowledge and skills to understand, identify and address implicit bias in the workplace at the Transforming Workplace Culture: Identifying and Addressing Implicit Bias workshop. This 2-hour, in-person workshop includes interactive activities and discussion to learn about the science behind implicit bias, how minds work and how to make small changes to align good intentions and behavior. Register in BuckeyeLearn for this workshop.

Confronting Prejudice: How to Protect Yourself and Help Others

Pepperdine University's online Master of Psychology program created this resource to educate readers on the prevalence of prejudice and implicit bias in society, including information about what marginalized groups are most likely to be harmed by prejudice. The resource features information about how one can be an ally and an advocate for change, as well as how people experiencing discrimination can build resilience against these types of behaviors. Access Confronting Prejudice.

Bias Assessment and Response Team (BART) Website

BART is a resource for anyone (staff, students and faculty) who needs to report an incident of bias or wants to explore and better understand issues, like bias and discrimination, and how to effectively respond. The BART website is a central, online clearinghouse for you to report an incident. It includes many links to campus and community resources, to better equip you with getting help after a bias incident.

Actions You Can Take to Reduce Implicit Bias

Raise awareness of implicit bias; take IAT tests and encourage others to take them as well
Awareness of implicit bias is a crucial starting point that may prompt individuals to seek out and implement further strategies. In our experience, most people find that becoming aware of their implicit biases helps them avoid those biases in decision making. (We mentioned IAT tests a number of times in this report, but they're so helpful and accessible, it bears repeating.)

Seek to identify and consciously acknowledge real group and individual differences
Cultivate greater awareness of and sensitivity to group and individual differences. Attend and offer training seminars, events, and opportunities to share information that acknowledge and promote an appreciation of group differences and multi-cultural viewpoints.

Routinely check thought processes and decisions for possible bias: Practice mindfulness
Actively engage in more thoughtful, deliberative information processing and be mindful of your decision-making processes. Mindfulness training helps facilitate these efforts. When sufficient effort is exerted to limit the effects of implicit biases on judgment, attempts to consciously control implicit bias can be successful.

Increase exposure to minority group members and counter-stereotypes
Distribute stories and pictures widely that portray stereotype-busting images: posters, newsletters, annual reports, speaker series, and podcasts are examples of media you can use to distribute this message. Increased contact with counter-stereotypes-specifically, increased exposure to underrepresented group members that contradict the social stereotype-can help individuals "unlearn" the associations that underlie implicit bias.

Reduce exposure to stereotypes
Identify and discard or change environmental cues such as images and language in any signage, pamphlets, brochures, instructional manuals, background music, or any other verbal or visual communications that trigger stereotype activation and implicit bias.

Take a first-person perspective of a member of a stereotyped group
Perspective taking increases psychological closeness to "other" groups, which ameliorates automatic group-based evaluations.

Practice individuation: Obtain and help others obtain specific information about people as individuals rather than as group members
Help prevent stereotypic inferences by encouraging people to evaluate members of a group based on individual, rather than group-based, attributes. Regularly remind yourself and others that majority group members aren't characterized by the actions of a few, unlike minority group members.

For the sources of these and other ideas, see:

Activities to Reduce Implicit Bias

You can use the following "get to know you" activities in your office/unit to help reduce implicit bias. The activities incorporate these actions from the list above: identifying and consciously acknowledging real group and individual differences; increasing exposure to minority group members and counter-stereotypes; and practicing individuation.

Start staff meetings with a check-in question that each attendee answers. Check-in usually starts with a volunteer and proceeds around the group. If an individual is not ready to speak, the turn is passed and another opportunity is offered after others have spoken. Not only does this help attendees be truly present and participate in the meeting, it's an effective tool to continuously learn more about others on your team.
Here are some examples of questions you can ask:

What's one new and interesting thing you've been thinking about lately?

What's one thing that brings you energy and joy?

What's one thing that you're really proud of that you'd like to share with the group?

What is one interest of yours that others in this group might not know about?

What aspect of your job brings you the most satisfaction?

What do you like best about _____ (weekends, vacation, the current season, etc.)?

Ask participants to bring an item related to their heritage and share its significance. You can change the instructions to be an item from their childhood or something they cherish, etc.

Spread out a collection of photos and ask participants to choose a photo that reveals information about them, such as a photo that depicts an aspect of their personality, and have them explain why they chose the particular photo.

Below are examples of ice breaker questions you can use at staff "get to know you" brown bag lunches. (Learn more about how the College of Engineering hosts these lunches in the 2014-2015 Status Report on Women at Ohio State):

What three people (dead or alive) would you invite to your dinner party?

For Valentine's day, what would be your perfect day off? (Doesn't have to be with a partner)

What's the best book you've read lately?

What's the best part of your job?

What would you do career-wise if you weren't in your current job?

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Implicit bias refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner. Among the key attributes of implicit biases are the following:

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“Education is the most powerful weapon which you can use to change the world.”

Mandela (1990)

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Anti-racism and theory: A Handbook for Educators

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Anti-racism and theory: A Handbook for Educators

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General Commission on Religion and Race of The UMC

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Deconstructing White Privilege with Dr. Robin DiAngelo

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Cultural Humility in nursing curriculum (tool kit).

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Cultural Humility in nursing curriculum (tool kit).

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Foronda, Cynthia PhD, RN, CNE, CHSE, ANEF, FAAN; Prather, Susan EdD, RN; Baptiste, Diana-Lyn DNP, RN, CNE, FAAN; Luctkar-Flude, Marian PhD, RN, CCSNE. Cultural Humility Toolkit. Nurse Educator 47(5):p 267-271, September/October 2022. | DOI: 10.1097/NNE.0000000000001182

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Specific tools for self-reflection/enhancement of courses

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Becoming an Accomplice in Decolonizing Nursing Knowledge

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Becoming an Accomplice in Decolonizing Nursing Knowledge

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From Nurseology

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Becoming an Accomplice in Decolonizing Nursing Knowledge

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Notable Works The recent attention that has emerged related to disparities in health and healthcare, along with acknowledgement of systemic racism, has been known and acknowledged in the nursing li…

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Nursing Curriculum: specific aspects to consider "Revolutionizing the Nursing Curriculum"

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Nursing Curriculum: specific aspects to consider "Revolutionizing the Nursing Curriculum"

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 Implicit Bias Training in Health Professions Education: A Scoping Review: Moving beyond "knows," or "knows how."

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 Implicit Bias Training in Health Professions Education: A Scoping Review: Moving beyond "knows," or "knows how."

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"In training both learners and their instructors, most studies reported only lower-tier assessment and evaluation outcomes (Miller’s [53] levels of “knows” or “knows how” and Kirkpatrick’s [54] levels of “reactions” or “learning”). In addition, most studies reported immediate post-curriculum outcomes rather than the long-term effects of participation in educational interventions. Although awareness, knowledge, and motivation are foundational to change, the question of whether various forms of IB education can change HPE learner behaviors, patient care delivery, and patient outcomes has not been addressed. The challenging nature of assessing a hidden construct and the paucity of published tools for assessing changes in IB in learners may explain why higher-level outcomes, such as behavioral change, were not evaluated in the included studies." Mavis, S.C. et al (2022), Implicit Bias Training in Health Professions Education: A Scoping Review. Med Sci Educ.,32(6):1541-1552. doi: 10.1007/s40670-022-01673-z. PMID: 36532396; PMCID: PMC9755456.

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Understanding Healthcare Students’ Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings

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Understanding Healthcare Students’ Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings

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Understanding Healthcare Students’ Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings

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Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students.