Breaking the Bias Habit

Transcription

1 Breaking the Bias Habit Molly Carnes, MD, MS Professor, Departments of Medicine, Psychiatry, and Industrial & Systems Engineering University of Wisconsin-Madison Director Women Veterans Health William S. Middleton Memorial Veterans Hospital

2 Acknowledgements NIH: K07 AG00744; T32 AG00265; R01 GM088477; DP4 GM096822; R01 GM111002; GM and GM NSF: ADVANCE Institutional Transformation Award ; Partnership for Adaptation, Implementation, and Dissemination SBE UW-Madison Department of Medicine, School of Medicine and Public Health, College of Engineering, School of Education and Office of the Vice Chancellor for Research and Graduate Education

3 Molly Carnes, MD, MS Professor Director, Center for Women s Health Research Co-Director, Women in Science & Engineering Leadership Institute (WISELI) Patricia Devine, PhD Professor Chair, Department of Psychology Cecilia Ford, PhD Professor Departments of English and Sociology Angela Byars-Winston, PhD Associate Professor, Department of Medicine Associate Scientist, Center for Women s Health Research Eve Fine, PhD Associate Researcher Women in Science & Engineering Leadership Institute (WISELI) Wairimu Magua, MS PhD Program Industrial and Systems Engineering Jennifer Sheridan, PhD Associate Scientist Executive/Research Director, Women in Science & Engineering Leadership Institute (WISELI) Carol Isaac, PhD Assistant Professor Mercer University Linda Baier Manwell, MS Research Program Manager, GIM National Training Coordinator, Women s Health Primary Care, Veteran s Health Administration Anna Kaatz, MA, MPH, PhD Research Associate, Center for Women s Health Research Tyson Pankey, MPH Graduate Assistant, Center for Women s Health Research PhD Student, UW-Madison Counseling Psychology Christine Kolehmainen, MD, MS Women s Health Physician Wm. S. Middleton VA Hospital

4 Assumptions of leader, scientist and men (but not women) align Men = agentic Decisive Authoritative Strong Assertive logical Independent Scientist Leader Women = communal Nurturing Gentle Supportive Relational Emotional Dependent

5 Gender bias habits of mind may explain Women faculty offered fewer opportunities for advancement (Wright et al, 2003; Shollen et al., 2009; Blumenthal et al., 2017) Women faculty provided fewer institutional resources and lower pay (Tesch et al. JAMA, 1995; Carr et al. Ann Int Med, 1998; Ash et al. Ann Int Med, 2004; Jagsi et al., 2012; Jena et al., 2016; Jagsi et al., 2017) Women internal medicine residents express fear of appearing bossy when directing codes (Kolehmainen et al., 2014) Descriptions of medical students in MSPEs suggest subtle gender tracking of women toward communal specialties and men toward agentic specialties (Isaac et al., 2010) Women physician faculty received lower medical student teaching evaluations than their male counterparts (Morgan et al., 2016) Physicians were more likely to diagnose a male patient with COPD (Chapman, et al., 2001) and offer a male patient TKA than a female patient with identical clinical presentations (Borkoff et al.,2008)

6 Is there gender tracking within Internal Medicine? Specialty %Women Salary Most communal GIM Endo ID GI Cardiology Most agentic Interventional CVD Linzer et al. JGIM 2017, 32(1):

7 Breaking the bias habit takes more than good intentions Awareness Motivation Self-efficacy Positive outcome expectations Deliberate practice e.g. Bandura, 1977, 1991; Devine, et al., 2000, 2005; Plant & Devine, 2008; Ericsson, et al., 1993; Prochaska & DiClemente, 1983, 1994

8 Cluster randomized trial of gender bias habit-reducing intervention 92 STEMM depts. 2,290 faculty 46 experimental 1,137 faculty Attendance/dept 31% ± 21 Overall 310 = 26% 46 control 1,153 faculty Baseline, 3 d & 3 months Survey response: 587 (52%) Baseline, 3 d & 3 months Survey response: 567(49%) Carnes et al. Acad Med 90 (2): , 2015

9 Personal Bias Reduction Strategies Stereotype Replacement Counter-Stereotypic Imaging Individuating Perspective-Taking Increase Opportunities for Contact (e.g., Galinsky & Moskowitz J Pers Soc Psychol 2000; Monteith et al., Pers Soc Psychol Rev 1998; Blair et al., J Pers Soc Psychol 2001) Plus 2 that DON T work: Stereotype Suppression Too Strong a Belief in One s Personal Objectivity (e.g. Macrae et al. J Pers Soc Psychol 1994; Uhlmann & Cohen. Organ Behav Hum Decis Process 2007)

10 Differences Between Experimental and Control Departments Compared With Difference at Baseline (IAT in D-scores; others on 7-point Likert scales) * * 0.4 * * * * ⱡ 3-Day 3-Month N = 92 departments; 1154 faculty (50.4% response rate) IAT= Implicit Association Test (standardized D-score) *P < 0.05; models adjusted for faculty gender and rank ⱡ P < 0.05 for action at 3 months when comparing only experimental depts with 25% attendance

11 Breaking gender bias habits of faculty improved department climate Study of Faculty Worklife: Faculty surveyed baseline and after 46 depts received workshop; 41%, 43% response (N=671 responded both times) Experimental vs. control showed improvements in climate: Research valued (P=0.024) Fit in department (P=0.019) Comfort raising personal/family issues that conflict with department activities (P=0.025) Carnes et al. Acad Med 90 (2): , 2015

12 BRIM Study: Bias Reduction in Internal Medicine Cluster randomized study in other departments of medicine Revise gender bias workshop to include bias more broadly (race, religion, BMI, SES) Include bias habit-reduction in both Clinical decision-making Professional interactions Participating departments of medicine Presentation of standardized workshop by experienced presenters All materials Pre-post climate survey