How to Identify and Address Bias/Discrimination/Racism
Faced by Fellows and Faculty
Bridgette L. Jones, MD MS
Associate Professor of Pediatrics
Section of Allergy/Asthma/Immunology & Division of
Pediatric Clinical Pharmacology
Children’s Mercy
University of Missouri-Kansas City Medical School
AAAAI/ACAAI Program Directors Annual Meeting 2021
• Take a deep breath
• We will get uncomfortable
• We will learn
• We will grow
https://implicit.harvard.edu/implicit/takeatest.html
Drivers of Increased Equity/Diversity Attention: Professional Standards
➢ LCME Standards “The faculty and students must demonstrate an understanding of the manner in which people of
diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. (IS 16)
➢ Medical students should learn to recognize and appropriately address gender and cultural biases in health care delivery, while considering first the health of the patient.”
➢ AAMC “We as individuals, as an association, as part of the academic medicine community, and as members of society need to do our own work, individually and collectively, to create a shared vision of the AAMC and academic medicine institutions as diverse, equitable, inclusive, and anti-racist organizations. “
“Pediatricians and other child health professionals must be prepared to discuss and counsel families of all races on the effects of exposure to racism as victims, bystanders, and perpetrators”
The new policy approved by the American Medical Association, representing physicians and medical students from every state and medical specialty, opposes all forms of racism as a threat to public health and calls on AMA to take prescribed steps to combat racism, including: (1) acknowledging the harm caused by racism and unconscious bias within medical research and health care; (2) identifying tactics to counter racism and mitigate its health effects; (3) encouraging medical education curricula to promote a greater understanding of the topic; (4) supporting external policy development and funding for researching racism’s health risks and damages; and (5) working to prevent influences of racism and bias in health technology innovation. – November 2020
Unconscious (Implicit) Bias
• Unconscious biases are social stereotypes about certain groups of people that individuals form outside their own conscious awareness. Everyone holds unconscious beliefs about various social and identity groups, and these biases stem from one’s tendency to organize social worlds by categorizing.
• A natural phenomenon of quick thinking, forming automatic associations based on limited information
• Our cognitive functions rely on implicit associations
• We can be “blind” to our blindness”
Susan Wilson PhD MBA, UMKC Vice Chancellor Diversity and Inclusion
The circumstances of why someone ends up homeless or uninsured have an endless range; oftentimes it involves quite a bad hand dealt and a tragic story. The easier thing to do, rather than wrestle with any sobering details with the patients, is to chalk up their predicament as “they brought it on themselves” and they “deserve to be homeless.” Working through my month in the ER [emergency room] there were certain patients that were considered “frequent flyers,” and that reputation certainly had a negative connotation. Physicians viewed these patients as a nuisance, who just wanted a roof over their head for the night, and worst of all, weren’t even willing to pay money. This flippant attitude towards the indigent, uninsured community may create an atmosphere where only a surface level of medical treatment is given to those who have deep and chronic conditions.
Harrison et al. Proceedings Bayl Univ Med Center. 2019
• “Frequent Flyer”• From a “COVID House”• “No Show-er”• “Sickler”• “Asthmatic”
“Official acceptance of such prejudices may be uniquely harmful in normalizing discrimination”-J. Clarke Northwestern Law Review
Explicit Bias
• Explicit bias is a conscious positive or negative feeling and/or thought about groups or identity characteristics.• Because these attitudes are explicit in nature, they are espoused openly,
through overt and deliberate thoughts and actions
• “Girls can’t run as fast as boys”
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RECONSTRUCTION
CIVIL RIGHTS ACT
Racism is a System of power and oppression that structures
opportunities and assigns value based on race, unfairly disadvantaging
people (racial oppression), while unfairly advantaging others (racial
privilege & supremacy)Levels of Racism: Internalized-Interpersonal-Institutional-Structural
Aletha Maybank, MD, MPH Chief Diversity Officer AMA
INTERNALIZED RACISM. Occurs within an individual which can manifest as conscious or
unconscious beliefs about ourselves and others as well as senses of racial superiority or inferiority.
Operates on a psychological level.
Interpersonal racism. Occurs between individuals. Often manifests as intentional or unintentional discriminatory
acts of omission or commission that are based on prejudice (i.e. hate crimes, slurs, microaggressions)
Internalized racism. Involves interconnected institutions, whose linkages are historically rooted and
culturally reinforced. It refers to the totality of ways in which societies foster racial discrimination, through
mutually reinforcing inequitable systems that in turn reinforce discriminatory beliefs, values, and
distribution of resources, which together affect the risk of adverse health outcomes.
Racism is racial prejudice backed by power and resources
(Feigan et al, 1994)
LEVELS OF RACISM
https://www.youtube.com/watch?v=ybDa0gSuAcgAletha Maybank, MD, MPH Chief Diversity Officer AMA
Internalized racism. Occurs within an individual often manifesting as an implicit sense of racial
superiority or inferiority (i.e. implicit bias, stereotyping, stereotype threat)
INTERPERSONAL RACISM. Occurs between individuals. Often manifests as intentional or unintentional
discriminatory acts of omission or commission that are based on prejudice (i.e. hate crimes, slurs, microaggressions).
When we bring our private beliefs into our communications and interactions with others of a different race. Institutional racism. Occurs within and between institutions. Often manifests as discriminatory treatment,
practices, and policies that result in inequitable opportunities and impacts for marginalized racialized groups.
Internalized racism. Involves interconnected institutions, whose linkages are historically rooted and
culturally reinforced. It refers to the totality of ways in which societies foster racial discrimination, through
mutually reinforcing inequitable systems that in turn reinforce discriminatory beliefs, values, and
distribution of resources, which together affect the risk of adverse health outcomes.
Racism is racial prejudice backed by power and resources
(Feigan et al, 1994)
LEVELS OF RACISM
Aletha Maybank, MD, MPH Chief Diversity Officer AMA
Racism is racial prejudice backed by power and resources
(Feigan et al, 1994)
Internalized racism. Occurs within an individual often manifesting as an implicit sense of racial
superiority or inferiority (i.e. implicit bias, stereotyping, stereotype threat)
Interpersonal racism. Occurs between individuals. Often manifests as intentional or unintentional discriminatory
acts of omission or commission that are based on prejudice (i.e. hate crimes, slurs, microaggressions)
INSTITUTIONAL RACISM. Occurs within and between institutions. Often manifests as discriminatory treatment,
practices, and policies that result in inequitable opportunities and impacts for marginalized racialized groups and
create and sustain racialized outcomes.Internalized racism. Involves interconnected institutions, whose linkages are historically rooted and
culturally reinforced. It refers to the totality of ways in which societies foster racial discrimination, through
mutually reinforcing inequitable systems that in turn reinforce discriminatory beliefs, values, and
distribution of resources, which together affect the risk of adverse health outcomes.
LEVELS OF RACISM
Aletha Maybank, MD, MPH Chief Diversity Officer AMA
“Racial inequity is a problem of bad policy, not bad people.”
—Ibram X. Kendi, How to Be an Antiracist
Internalized racism. Occurs within an individual often manifesting as an implicit sense of racial
superiority or inferiority (i.e. implicit bias, stereotyping, stereotype threat)
Interpersonal racism. Occurs between individuals. Often manifests as intentional or unintentional discriminatory
acts of omission or commission that are based on prejudice (i.e. hate crimes, slurs, microaggressions)
Institutional racism. Occurs within and between institutions. Often manifests as discriminatory treatment,
practices, and policies that result in inequitable opportunities and impacts for marginalized racialized groups.
STRUCTURAL RACISM. Involves interconnected institutions, whose linkages are historically rooted and
culturally reinforced. It refers to the totality of ways in which societies foster racial discrimination, through
mutually reinforcing inequitable systems that in turn reinforce discriminatory beliefs, values, and
distribution of resources, which together affect the risk of adverse health outcomes.
Racism is racial prejudice backed by power and resources
(Feigan et al, 1994)
LEVELS OF RACISM
Aletha Maybank, MD, MPH Chief Diversity Officer AMA
Asthma UC/ED/Hospitalization at Children’s Mercy
>4 times Annual Visits, 2016-2018
Implicit Association Test
• https://implicit.harvard.edu/implicit/takeatest.html
Acknowledge that Unconscious Bias is Common!
Implicit associations are common and pervasive in the general population (data on 10m)
> 75% of the millions of Race IAT test takers show some level of an implicit preference for White Americans vs. Black Americans (implicit pro-White bias)
This trend is found for other social biases such as gender, weight, ability, age, other areas
Conditions that increase bias
• Time pressure
• Ambiguity/incomplete information
• High emotion
• Compromised cognitive load
• Others?
Susan Wilson PhD MBA, UMKC Vice Chancellor Diversity and Inclusion
The myth of the unbiased physician
Tiffani Johnson. Comparison of Physician Implicit Racial Bias Toward Adults Versus Children Academic Pediatrics, 2017-03-01, Volume 17, Issue 2, Pages 120-126
Among the many physical distinctions that Jefferson described to justify the condition of slaves in the republic, one was “a difference of structure in the pulmonary apparatus”
“The smaller lung capacity of the colored race is in itself proof of an inferior physical organism” said Gould in 1869, a driver of race-based spirometry correction”
RACE CORRECTION IS NOT A WAY TO CAPTURE THE LIVED EXPERIENCE OF RACISM, AND IT SHOULD BE ELIMINATED
Braun L. Chest. 2020 .PMID: 33263290.
ANNALS OF FAMILY MEDICINE. VOL. 16, NO. 3.MAY/JUNE 2018
•I have been taught since an early age that people of my own race can become doctors.
•Throughout my education, I could succeed academically without people questioning whether my accomplishments were attributable to affirmative action or my
own abilities.
•During college and medical school, I never struggled to find professors and academic role models who shared my race.
•When I walk into an exam room with a person of color, patients invariably assume I am the doctor in charge, even if the person of color is my attending.
•If I respond to a call for medical assistance on an airplane, people will assume I am really a physician because of my race.
•Every American hospital I have ever entered contained portraits of department chairs and hospital presidents who are physicians of my race, reminding
me of my race’s importance since the founding of these institutions.
•Even if I forget my identification badge, I can walk into the hospital and know that security guards will probably not stop me because of the color of my skin.
•When I travel to and from the hospital late at night as required by my job, I do not fear that I will be stopped, delayed, unjustly detained,
inappropriately touched, injured, or killed by the police because of my race.
•I can attend most professional meetings confident that I will be surrounded by physicians who look like me, and that we will likely have mutual acquaintances
who also share our race.
•I can speak my native language in my own dialect in professional settings without being viewed as uneducated or out-of-place.
•I can criticize medical institutions without being cast as a cultural outsider.
•I can name racism in my professional workspace and not be accused of being angry, potentially violent, or excessively emotional.
•When patients tell me they are “glad to have a white doctor,” I am not personally threatened, and I can choose to confront their racism or ignore it.
Uncovering our Blind Spots
I used to live in NYC
I take care of under-served children
I have POC in my family
I voted for Obama
I grew up poor
We had to move to our neighborhood for the schools
Adapted from Robin DiAngelo
I have done advocacy/mission work
I don’t see color
Uncovering our Blind Spots
• How racially diverse was your neighborhood(s) growing up? What messages did you get about race from the geography of race?
• When is the first time you had a teacher of the same race(s) as you? How often did that happen? When did you first have a teacher of a different race than you? How often did that happen? Why is that important?
• How often have you been to a wedding that was virtually all white?
• How often have you been to a funeral that was virtually all white?
• What are some of the ways in which your race has shaped your life?
• What are some of the ways in which your race(s) has shaped your life?
Adapted from Robin DiAngelo
“The opposite of racist isn’t “not racist. It is anti-racist”
How do we Counter the Racism around us?
Countering Bias
• https://www.youtube.com/watch?v=-053AUVYPw8
https://www.youtube.com/watch?v=-053AUVYPw8
ADDRESSING RACISM IN YOUR TRAINING PROGRAM
• DO• Acknowledge that bias/racism
exists
• Educate yourself
• Be intentional about increasing diversity in your programs
• Make mistakes
• Speak up/be an ally/be an upstander ESPECIALLY when it is uncomfortable
• DON’T• Deny that bias/racism exists in
your institution/department/
program
• Place the burden of “diversity work” on Black/brown trainees
• Ask your Black/brown trainees/colleagues to “teach you”
• Remain silent in order to remain comfortable
USE YOUR POWER AS LEADERS IN YOUR INSTITUTIONS
#SoMe
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“But staying comfortable, leaving one topic or another out of the discussion, and softening culpability keeps us from conflict in the short term and ensures that nothing substantially improves over the long term. Instead, what health professionals need to do is critically assess where and how we can change course.” –Esther Choo, MD 2019
