Changes in medical student implicit attitudes following a health equity curricular intervention

Abstract

Purpose: This study assessed the: (1) effect of an LGBTQI + health equity curriculum (eQuality) on implicit attitudes among first (M1) and second year (M2) medical students and (2) utility of dedicated time to explore implicit bias.

Method: Implicit biases were assessed at baseline using implicit association tests (IAT) for all M2s and a random sample of first years (M1A). These students were then debriefed on strategies to mitigate bias. Following eQuality, all M1 and M2s completed post-intervention IATs. The remaining first years (M1B) were then debriefed. Paired sample t-tests assessed differences between pre/post. Independent sample t-tests assessed differences in post-IATs between M1 groups.

Results: IATs indicated preferences for “Straight,” “White,” and “Thin” at both pre and post. M2s demonstrated statistically significant improvements pre to post for sexuality (p = 0.01) and race (p = 0.03). There were significant differences in post-intervention IAT scores between M1As who received the IAT and debriefing prior to eQuality and M1Bs for sexuality (p = 0.002) and race (p = 0.046). There were no significant changes for weight.

Conclusion: eQuality reduced implicit preference for “Straight” and “White.” Differences in M1 post-intervention IAT scores between groups suggest dedicating time to debrief implicit attitudes enhances bias mitigation.

Acknowledgements

The authors would like to thank the eQuality Steering Committee, particularly Dr. Amy Holthouser and Stacie Steinbock, for their leadership in this curricular initiative; Dean Toni Ganzel, whose continued support has made our work possible; and the UME Medical Education Research Unit, LGBT Center, and Health Sciences Center Office of Diversity and Inclusion for providing significant financial and staff support.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Implicit bias: A positive or negative automatic mental attitude towards a person, concept, or group that an individual holds at an unconscious level without conscious intention (Greenwald and Banaji 1995).

Additional information

Notes on contributors

Katie F. Leslie

Katie F. Leslie, PhD, is Program Manager, Health Sciences Center Office of Diversity and Inclusion, University of Louisville, Louisville, Kentucky.

Susan Sawning

Susan Sawning, MSSW, is Director of Undergraduate Medical Education Research, University of Louisville School of Medicine, Louisville, Kentucky.

M. Ann Shaw

M. Ann Shaw, MD, MA, is Professor of Medicine and Vice Dean for Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky.

Leslee J. Martin

Leslee J. Martin, MA, is Director of Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky.

Ryan C. Simpson

Ryan C. Simpson, MDA, is Assistant Director, Health Sciences Center Office of Diversity and Inclusion, University of Louisville, Louisville, Kentucky

Jennifer E. Stephens

Jennifer E. Stephens, BA, is Program Coordinator, Senior, Undergraduate Medical Education Office, University of Louisville School of Medicine, Louisville, Kentucky

V. Faye Jones

V. Faye Jones, MD, PhD, MSPH, is Professor of Pediatrics and Associate Vice President for Health Affairs/Diversity Initiatives, Health Sciences Center Office of Diversity and Inclusion, University of Louisville, Louisville, Kentucky