Brief online implicit bias education increases bias awareness among clinical teaching faculty

Figures & data

Table 1. Healthcare provider characteristics (N = 111)

Variables	N (%)
Age
30–39	38 (34.2)
40–49	29 (26.1)
50–59	25 (22.5)
60+	19 (17.1)
Gender identity
Male	33 (29.7)
Female	78 (70.3)
Ethnicity
Hispanic or Latino	8 (7.2)
Non-Hispanic or Latino	103 (92.8)
Race
White	81 (73.0)
Asian	10 (9.0)
Black	12 (10.8)
Mixed/other	8 (7.2)
Provider type
Medical doctor (MD)	63 (56.8)
Nurse practitioner (NP)/physician assistant (PA)	23 (20.7)
Other (registered nurse, clinical nurse educator, other)	25 (22.5)
U.S. Census Region
Northeast	25 (22.5)
Midwest	22 (19.8)
South	45 (40.5)
West	19 (17.1)
Healthcare system
Academic Healthcare System	80 (72.7)
Community Healthcare System	21 (19.1)
Other	9 (8.1)
Continuing education past year: race and diversity
Yes	74 (66.7)
No	37 (33.3)
Continuing education past year: gender equity
Yes	50 (45.0)
No	61 (55.0)
	Mean (SD) or %
Years in practice	18.6 (12.02)
Years current position	8.4 (7.64)
# Patients/week direct clinical contact	37.5 (30.3)

Table 2. Implicit race and gender attitudes overall and by sample characteristics (N = 111)

		Implicit race^a			Implicit gender^a
	N	M (SD)	Cohen’s d^b	p^c	M (SD)	Cohen’s d	p
Total sample		0.30 (0.43)	0.68	<0.001	0.38 (0.33)	1.15	<0.001
Age				0.77			0.40
30–39	38	0.25 (0.42)	0.60		0.40 (0.27)	1.52
40–49	29	0.36 (0.43)	0.84		0.30 (0.35)	0.86
50–59	25	0.28 (0.50)	0.70		0.45 (0.38)	1.18
60+	19	0.34 (0.4)	0.85		0.39 (0.36)	1.08
Self-reported gender identity				0.74			0.41
Male	33	0.41 (0.44)	0.93		0.41 (0.30)	1.37
Female	73	0.26 (0.42)	0.62		0.37 (0.35)	1.12
Ethnicity				0.80			0.46
Hispanic or Latino	8	0.27 (0.45)	0.60		0.48 (0.39)	1.23
Non-Hispanic or Latino	103	0.30 (0.44)	0.68		0.37 (0.33)	1.12
Race				<0.001			0.80
White	81	0.37 (0.40)	0.93		0.36 (0.35)	1.11
Asian	10	0.54 (0.28)	1.93		0.43 (0.28)	1.54
Black	12	−0.25 (0.29)	0.86		0.42 (0.30)	1.40
Mixed/other	8	0.15 (0.42)	0.34		0.45 (0.35)	1.29
Provider type				0.71			0.39
Medical doctor (MD)	63	0.32 (0.43)	0.74		0.36 (0.33)	1.09
Nurse practitioner (NP)/physician assistant (PA)	23	0.35 (0.36)	0.97		0.36 (0.33)	1.00
Other	25	0.24 (0.50)	0.48		0.46 (0.32)	1.44
U.S. Census Region				0.04			0.73
Northeast	25	0.41 (0.39)	1.05		0.41 (0.34)	1.21
Midwest	22	0.43 (0.36)	1.19		0.41 (0.28)	1.46
South	45	0.17 (0.45)	0.38		0.38 (0.36)	1.06
West	19	0.33 (0.47)	0.70		0.33 (0.47)	1.21
Healthcare system				0.84			0.33
Academic Healthcare System	80	0.31 (0.40)	0.78	0.21	0.39 (0.32)	1.22
Community Healthcare System	21	0.32 (0.58)	0.55		0.39 (0.37)	1.05
Other	8	0.23 (0.40)	0.56		0.22 (0.41)	0.55
Continuing education past year: race				0.22			0.16
Yes	74	0.27 (0.46)	0.59		0.35 (0.35)	1.00
No	37	0.36 (0.38)	0.95		0.43 (0.31)	1.39
Continuing education past year: gender equity				0.43			0.30
Yes	50	0.29 (0.40)	0.73		0.40 (0.36)	1.39
No	61	0.31 (0.46)	0.67		0.35 (0.35)	1.00

^aFor implicit measures, a positive score favors White on Race IAT and male and career on the Gender IAT, and a negative score indicates favoring Black/African American and female with family.

^bCohen d values are interpreted as follows: d = 0.2, small effect; d = 0.5, medium effect; and d = 0.80, large effect, Cohen, 1988.

^cANOVA and t-test of significance [value = 0]. Boldface indicates statistical significance (p<0.05).

Table 3. Explicit race and gender attitudes overall and by sample characteristics (N = 111)

		Explicit Race^a			Explicit career^b,c				Explicit family^b, c
	N	M (SD)	Cohen’s d	p	M (SD)	Cohen’s d	p	M (SD)		Cohen’s d	p
Total sample	111	0.04 (0.74)	0.05	0.61	0.66 (0.97)	0.68	<0.001	0.83(1.00)		0.83	<0.001
Age				0.23			0.95				0.77
30–39	38	−0.16 (0.89)	0.18		0.73 (1.04)	0.96		−0.79 (1.12)		0.71
40–49	29	0.10 (0.67)	0.15		0.62 (1.05)	0.92		−0.97 (0.82)		1.18
50–59	25	0.12 (0.67)	0.30		0.67 (0.82)	0.81		−0.88 1.03)		0.97
60+	19	0.22 (0.55)	0.41		0.58 (0.96)	0.6		−0.67 (0.97)		0.69
Self-reported gender identity				0.18			0.86				0.08
Male	32	0.16 (0.63)	0.25		0.5 (0.95)	0.53		−0.82 (0.81)		1.01
Female	78	−0.01 (0.78)	0.01		0.73 (0.97)	0.74		−0.84 (1.07)		0.79
Ethnicity				0.28			0.11				0.66
Hispanic or Latino	8	0.0 0(0.93)	0		−0.88 (1.36)	0.74		−1.38 (1.06)		1.30
Non-Hispanic or Latino	103	−0.04 (0.73)	0.04		0.64 (0.94)	0.68		−0.79 (0.98)		0.81
Race				0.01			0.40				0.58
White	81	0.17 (0.54)	0.31		0.59 (0.90)	0.66		−0.86 (0.9)		0.96
Asian	9	0.0 (0.70)	0		1.10 (1.20)	0.83		−1.10 (0.74)		1.49
Black	12	−0.67 (1.23)	0.54		0.83 (1.34)	0.62		−0.67 (1.72)		0.39
Mixed/other	8	−0.25 (1.04)	0.24		0.50 (0.76)	0.66		−0.50 (0.76)		0.66
Provider type				0.77			0.36				0.13
Medical doctor (MD)	63	0 .00 (0.76)	0		0.61 (0.93)	0.66		−1.00 (0.91)		1.1
Nurse practitioner (NP)/physician assistant (PA)	23	0.13 (0.87)	0.15		0.91 (1.08)	0.50		−0.56 (1.12)		0.50
Other	25	0.04 (0.54)	0.07		0.54 (0.98)	0.55		−0.67 (0.96)		0.70
U.S. Census Region				0.23			0.55				0.97
Northeast	25	0.13 (0.54)	0.33		0.72 (0.89)	0.81		−0.76 (0.93)		0.82
Midwest	22	0.23 (0.69)	0.24		0.55 (0.67)	0.82		−0.81 (0.87)		0.93
South	45	−0.13 (0.89)	0.15		0.78 (1.22)	0.64		−0.86 (1.19)		0.72
West	19	0.11 (0.57)	0.19		0.42 (0.61)	0.69		−0.89 (0.74)		0.74
Healthcare system				0.94			0.54				0.01
Academic Healthcare System	80	0.03 (0.75)	0.04		0.65 (1.00)	0.65		−1.00 (0.93)		1.06
Community Healthcare System	21	0.05 (0.89)	0.05		0.48 (0.75)	0.64		−0.28 (1.15)		0.25
Other	9	0.11 (0.33)	0.11		0.89 (0.93)	0.98		−0.75 (0.71)		1.06
Continuing education past year: diverse populations				0.01							0.52
Yes	74	0.01 (0.82)	0.01		0.53 (0.90)	0.59		−0.75 (1.02)		0.74
No	37	0.08 (0.55)	0.15		0.92 (1.06)	0.86		−1.00 (0.93)		1.08
Continuing education past year: gender equity				0.33			0.86				0.40
Yes	50	0.14 (0.79)	0.17		0.56 (0.99)	1.38		−0.92 (0.93)		0.99
No	61	0.05 (0.69)	0.07		0.74 (0.94)	1		−0.77 (1.05)		0.96

^aFor the three explicit measures, a positive score favors White on the race measure. For the two gender explicit measures, a positive score associates male with career, and a negative score associates female with family.

^bANOVA and t-test of significance [value = 0]. Boldface indicates statistical significance (p<0.05).

^cCohen d values are interpreted as follows: d = 0.2, small effect; d = 0.5, medium effect; and d = 0.80, large effect, Cohen, 1988.

Table 4. Pre- and post-course bias awareness (N = 111)

		Pre	Post
Bias awareness score^a	N	M (SD)	M (SD)	p^b
In most situations, I am objective in decision-making	111	2.08 (0.99)	2.09 (0.99)	0.88
Biases do not usually influence my decision-making	111	2.91 (1.29)	2.86 (1.3)	0.52
Men and women vary in the types of biases they have against people	109	2.56 (1.15)	2.75 (1.12)	0.08
People in today’s society tend to treat people of different social groups (i.e., race, gender, and class) equally	111	4.38 (1.56)	4.54 (1.6)	0.29
Society has reached a point where all people, regardless of background, have equal opportunities for achievement	111	5.04 (1.34)	5.26 (1.2)	0.00
In healthcare, bias is no longer a problem in patient care	111	5.41 (0.88)	5.32 (0.87)	0.18
In healthcare, bias is no longer a problem in training	110	5.08 (1.17)	5.15 (1.05)	0.42
In healthcare, bias is no longer a problem in diverse workforce	114	5.14 (1.18)	5.14 (1.11)	0.89
Bias awareness difference	N	M (SD)	M (SD)	p
Composite (8-item average)	111	4.06 (0.76)	4.14 (0.73)	0.03
Bias awareness difference by domain
Bias awareness personal	111	2.50 (1.01)	2.47 (1.04)	0.67
Bias awareness societal	111	4.00 (0.95)	4.48 (0.78)	0.00
Bias awareness in healthcare	111	5.19 (0.99)	5.22 (0.96)	0.86

^aBias awareness score: 1 = strongly agree, 2 = moderately agree, 3 = slightly agree, 4 = slightly disagree, 5 = moderately disagree, and 6 = strongly disagree.

^bPre- and post-bias awareness score difference, one-sample t-test, t-test value = 0. Boldface indicates statistical significance (p<0.05).

Table 5. Implicit and explicit bias and bias awareness change (N = 111)

	Implicit race	Implicit gender	Explicit race	Explicit career	Explicit family	Bias awareness difference
Implicit race	1
Implicit gender	.258**	1
Explicit race	.207*	.055	1
Explicit career	.024	.180	.082	1
Explicit family	.002	−.130	−.196**	−.407**	1
Bias awareness difference	.129	−.021	−.069	−.104	−.071	1

Pearson correlation: **Correlation is significant at 0.01 level, *correlation is significant at 0.05 level.