I m Not Biased.Am I? Lessons in Implicit Bias. Disclosures. Learning Objectives

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1 I m Not Biased.Am I? Lessons in Implicit Bias Disclosures none Anneke Schroen, MD, MPH Michael D. Williams, MD Department of Surgery Grand Rounds University of Virginia January 27, 2016 Learning Objectives 1. To improve awareness of implicit bias and the role it may play in our daily lives 2. To gain awareness of tools and resources to identify unconscious bias in oneself and one s environment 3. To identify strategies that mitigate the influence of implicit bias 4. To begin an open and frank dialogue about implicit bias and its effects Explicit Bias and Prejudice Explicit Bias Intentional, controllable beliefs or attitudes Often consciously recognized and expressed Reflective May differ from implicit biases! Prejudice Open expression of hostility, dislike, and disrespect Unfair negative attitude toward a person of a social group or the entire social group 1

2 Shift to importance of implicit bias Today less and less likely to see explicit acts of aggression towards an out group and more likely to see acts of helping the in group Hidden discrimination Cumulative advantage / disadvantage Research shows implicit bias does predict discriminatory behavior Recommended Read Implicit Bias and Stereotype Implicit Bias Attitudes or preferences that affect our understanding, actions, or decisions largely below conscious awareness Also known as implicit social cognition Automatic Stereotype Association of a set of traits to all members of a group Can be both positive and negative traits More commonly exist for groups who do not have the default characteristics of a group/society and are more commonly unfavorable 2

3 Schemas Patterns of thought or behavior that organizes categories of information or relationships Similar to stereotypes, but more neutral and inclusive Tend to remain unchanged Contradictory information viewed as exception or distorted to fit the schema Influence how we judge others and how we expect to be judged Schemas Widely shared within a culture Both men and women hold them re. gender Both US whites and people of color re. race/ethnicity People in specific jobs and disciplines Relied upon more under some circumstances Time pressure Ambiguity Stress from competing tasks or obligations Lack of critical mass Fiske (2002). Current Directions in Psychological Science, 11, Potential impact of implicit bias in academic medicine Patient care Health disparities Challenges to MD patient relationship Hiring Evaluations Promotion / Awards Fellowship / Professional networks IMPLICIT & EXPLICIT ATTITUDES ABOUT RACE AMONG PHYSICIANS Implicit (unconscious) and explicit (self reported) attitudes about race measured using Implicit Association Test Subsample of 2,535 MDs Positive mean indicates preference for whites, negative mean indicates preference for African Americans WM WF AAM AAF AsM AsF HM HF Explicit Implicit Sabin JA et al. J Health Care Poor Underserved. 2009:

4 Patient Care Evidence supports differences in analgesia surgery / procedural interventions research / clinical trial participation Institute of Medicine. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academies Press; EFFECT OF RACE AND SEX ON PHYSICIANS RECOMMENDATIONS FOR CARDIAC CATHETERIZATION 720 physicians in full time clinical practice and attended 1997 ACP meeting or 1996 AAFP meeting asked to assess videos of 8 actors portraying patients with CP and accompanying stress tests Asked whether they wished to refer the patient for cardiac catheterization adjusted for: Physicians assessment of the probability of CAD Age of the patient Level of coronary risk Type of chest pain Results of EST Black (vs White) Odds Ratio Female (vs Male) 0.4 BF (vs WM) Schulman KA et al. N Engl J Med 1999; 340: Sickle Cell Disease vs Cystic Fibrosis 2011 Data Hiring and Evaluations SCD CF Strouse JJ et al. Blood 2013; 122:

5 Who to Hire: John or Jennifer? Who to Hire? Faculty participants rated the male applicant as significantly more competent and hireable than the (identical) female applicant. Participants also selected higher starting salary and offered more career mentoring to the male applicant. Female faculty members were just as likely as their male colleagues to favor the male student. Faculty members bias was independent of their gender, scientific discipline, age, and tenure status suggests that it is likely unintentional, generated from widespread cultural stereotypes rather than a conscious intention to harm women. Evaluation of Identical CVs Karen Brian When evaluating identical application packages, male and female University psychology professors preferred 2:1 to hire Brian over Karen as an assistant professor. When evaluating a more experienced record (at the point of promotion to tenure), reservations were expressed four times more often when the name was female Steinpreis, R.E., Anders, K.A., & Ritzke, D. (1999) The Impact of Gender on the Review of the Curricula Vitae of Job Applicants and Tenure Candidates: A National Empirical Study.Sex Roles, Vol. 41, Nos. 7/8, 509. Evaluation of Identical CVs: Mothers When evaluating identical applications: Evaluators rated mothers as less competent and committed to paid work than nonmothers. Mothers were less likely to be recommended for hire, promotion, and management, and were offered lower starting salaries than nonmothers. Prospective employers called mothers back about half as often as nonmothers. Mother Nonmother Active in PTA Correll, Benard and Paik (2007) American Journal of Sociology, 112 (5),

6 Evaluation of Identical CVs: Fathers When evaluating identical applications: Fathers were seen as more committed to paid work and offered higher starting salaries than nonfathers. Fathers were not disadvantaged in the hiring process. Father Nonfather Active in PTA Interview Calls: Are Emily and Greg more employable than Keisha and Jamal? White names received 50% more calls for interviews than African American names. For White names, a higher quality resume elicited 30% more calls. For African American names, the increase was only 9% for a higher quality resume. Correll, Benard and Paik (2007) American Journal of Sociology, 112 (5), Bertrand, M. & Mullainathan, S. (2004) Are Emily and Greg More Employable Than Lakisha and Jamal? A Field Experiment On Labor Market Discrimination. American Economic Review, v94(4, Sep), Letters of Recommendation Letters for men included more references to CV, publications, patients, and colleagues Letters for women were Shorter Contained more doubt raisers (hedges, faint praise, irrelevancies) Had more references to personal life Examples: It s amazing how much she s accomplished. She excelled in every task she chose to take on. It appears her health is stable. Trix, F. & Psenka, C. (2003) Exploring the Color of Glass: Letters of Recommendation for Female and Male Medical Faculty. Discourse & Society, 14: Letters of Recommendation Linguistic comparison of 886 letters for faculty (235 male, 42 female) Standout adjectives more commonly used for males MOST GIFTED RISING STAR BEST QUALIFIED Letters with more standout words had more ability as opposed to grindstone words TALENTED HARDWORKING SMART CONSCIENTIOUS Schmader et al. Sex Roles 2007; 57: 509 6

7 Critical Mass Affects the Use of Schemas When there are many individuals from any group, we differentiate among them as individuals and cannot rely on group based schemas. In both experimental and field settings, increasing the number of female applicants increased the ratings of female applicants and employees. Valian (1998) Why So Slow? The Advancement of Women. Cambridge: MIT Press, p. 280; Heilman (1980) Organizational Behavior and Human Performance, 26: ; Sackett et al (1991), Journal of Applied Psychology, 76(2): Accumulation of Advantage and Disadvantage Any one slight may seem minor, but since small imbalances and disadvantages accrue, they can have major consequences in salary, promotion, and prestige, including advancement to leadership positions. Mountains are molehills piled one on top of the other. (Valian, 1998, p. 4) Merton (1948) Antioch Review, 8, and (1968) Science, 159, Valian (1998) Why So Slow? The Advancement of Women. Cambridge: MIT Press, p Implicit Association Test Project Implicit founded in 1998 Co developers of Implicit Association Test Mahzarin Banaji Harvard University Anthony Greenwald University of Washington Brian Nosek University of Virginia Measures strength of association between concepts and evaluations or stereotypes 7

8 Implicit Association Test Multiple tests on race, gender, age, weight, disability, religion, etc Gender & Career/Family Gender & Science/Humanities Race Evidence shows moderate correlation between IAT and behavior Practices and Policies Recruitment of applicant pool o Increase representation of low base-rate groups How deliberations are completed o Decrease ambiguity in criteria o Specify criteria of scholarly productivity, research funding, teaching ability, ability to be a conscientious member, fit with the department s priorities o Increase/document knowledge of candidates o Rely on evidence o Avoid use of global judgments 8