Confidence, Connection & Collaboration: Creating a Scalable Bias Reduction Improvement Coaching Train-the-Trainer Program to Mitigate Implicit Bias across a Medical Center

Abstract

Problem: Academic medical centers need to mitigate the negative effects of implicit bias with approaches that are empirically-based, scalable, sustainable, and specific to departmental needs. Guided by Kotter’s Model of Change to create and sustain cultural change, we developed the Bias Reduction Improvement Coaching Program (BRIC), a two-year, train-the-trainer implicit bias coaching program designed to meet the increasing demand for bias training across a university medical center. Intervention: BRIC trained a cohort of faculty and staff as coaches during four quarterly training sessions in Year 1 that covered 1) the science of bias, 2) bias in selection and hiring, 3) bias in mentoring, and 4) bias in promotion, retention, and workplace culture. In Year 2, coaches attended two booster sessions and delivered at least two presentations. BRIC raises awareness of bias mitigation strategies in a scalable way by uniquely building capacity through department-level champions, providing programming that addresses the ‘local context,’ and setting a foundation for sustained institutional change. Context: In a U.S. academic medical center, 27 faculty and staff from 24 departments were trained as inaugural BRIC coaches. We assessed outcomes at multiple levels: BRIC coach outcomes (feedback on the training sessions; coach knowledge, attitudes, and skills), departmental-level outcomes (program attendee feedback, knowledge, and intentions) and institutional outcomes (activities to sustain change). Impact: After Year 1, coaches reported high satisfaction with BRIC and a statistically significant increase in self-efficacy in their abilities to recognize, mitigate, and teach about implicit bias. In Year 2, attendees at BRIC coach presentations reported an increase in bias mitigation knowledge, and the majority committed to taking follow-up action (e.g., taking an Implicit Association Test). Coaches also launched activities for sustaining change at the broader university and beyond. Lessons Learned: The BRIC Program indicates a high level of interest in receiving bias mitigation training, both among individuals who applied to be BRIC coaches and among presentation attendees. BRIC’s initial success supports future expansion. The model appears scalable and sustainable; future efforts will formalize the emerging community of practice around bias mitigation and measure elements of on-going institutional culture change.

Keywords:

• Implicit bias
• bias mitigation
• train-the-trainer
• faculty development

Acknowledgements

The authors want to express their appreciation to Dr. Edward Healton, Executive Vice President for Health Sciences and Dr. Elliott Crooke, Vice President of Faculty & Academic Affairs for funding the BRIC program. The authors would also like to thank Dr. Nady Golestaneh, past President of Georgetown Women in Medicine for her support and advocacy for the BRIC program proposal, as well as Joshua Blair, ODEI Innovation Associate who assisted with the review of earlier design drafts of the BRIC model. We are also grateful to Karen Walters, Strategic Project Manager with the GUMC Office of Faculty and Academic Affairs and BRIC coach who provided iterative feedback, new ideas, and ongoing support for the launch of the second cohort. The authors would also like to thank Dr. Holly Korthas for her editing support. Finally, we thank all the BRIC coaches for their time, engagement and strong commitment to raising awareness about and providing strategies to mitigate implicit bias.

Ethical approval

The Georgetown University Medical Center Institutional Review Board determined the evaluation (STUDY00002827) described herein to be exempt from review on September 25, 2020.

Additional information

Funding

This work was supported by Georgetown University Medical Center.