UNASSIGNED: Clinician implicit racial bias (IB) may lead to lower quality care and adverse health outcomes for Black patients. Educational efforts to train clinicians to mitigate IB vary widely and have insufficient evidence of impact. We developed and pilot-tested an evidence-based clinician IB curriculum, \"REACHing Equity.\"
UNASSIGNED: To assess acceptability and feasibility, we conducted an uncontrolled one-arm pilot trial with post-intervention assessments. REACHing Equity is designed for clinicians to: (1) acquire knowledge about IB and its impact on healthcare, (2) increase awareness of one\'s own capacity for IB, and (3) develop skills to mitigate IB in the clinical encounter. We delivered REACHing Equity virtually in three facilitated, interactive sessions over 7-9 weeks. Participants were health care providers who completed baseline and end-of-study evaluation surveys.
UNASSIGNED: Of approximately 1,592 clinicians invited, 37 participated, of whom 29 self-identified as women and 24 as non-Hispanic White. Attendance averaged 90% per session; 78% attended all 3 sessions. Response rate for evaluation surveys was 67%. Most respondents agreed or strongly agreed that the curriculum objectives were met, and that REACHing Equity equipped them to mitigate the impact of implicit bias in clinical care. Participants consistently reported higher self-efficacy for mitigating IB after compared to before completing the curriculum.
UNASSIGNED: Despite apparent barriers to clinician participation, we demonstrated feasibility and acceptability of the REACHing Equity intervention. Further research is needed to develop objective measures of uptake and clinician skill, test the impact of REACHing Equity on clinically relevant outcomes, and refine the curriculum for uptake and dissemination.ClinicalTrials.gov ID: NCT03415308.

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Medical training embraces simulation-based education. One important topic that has recently been added to the simulation curriculum at the University of Toronto is unconscious bias. This educational innovation project evaluates a simulation that could be used as a novel instructional design strategy to teach unconscious bias. The simulation involved two resuscitation scenarios with a similar clinical trajectory. Each resuscitation was led by standardized physicians of different binary genders, followed by a debrief with highly trained facilitators. Tangible educational takeaways on team dynamic variation between different gendered team leaders were discussed following the simulation, highlighting its benefit to resident education on bias awareness and response. Limitations include inevitable unconscious bias in facilitators and unequal gender representation in the learner participants, which may impact simulation effectiveness. The findings support translating this simulation to other forms of bias education in future simulation development.
RéSUMé: La formation médicale englobe l’éducation basée sur la simulation. Un sujet important qui a récemment été ajouté au programme de simulation de l’Université de Toronto est celui des préjugés inconscients. Ce projet d’innovation éducative évalue une simulation qui pourrait être utilisée comme une nouvelle stratégie de conception pédagogique pour enseigner les préjugés inconscients. La simulation a impliqué deux scénarios de réanimation avec une trajectoire clinique similaire. Chaque réanimation a été menée par des médecins standardisés de sexe binaire différent, suivis d’un débriefing avec des facilitateurs hautement qualifiés. Après la simulation, on a discuté de points concrets à retenir sur la variation de la dynamique d’équipe entre les différents chefs d’équipe selon le sexe, en soulignant les avantages pour l’éducation des résidents sur la sensibilisation aux préjugés et la réponse. Les limites comprennent des préjugés inconscients inévitables chez les animateurs et une représentation inégale des sexes chez les apprenants participants, ce qui peut avoir une incidence sur l’efficacité de la simulation. Les résultats appuient la traduction de cette simulation à d’autres formes de formation sur les préjugés dans le développement futur de la simulation.

UNASSIGNED: Providers\' unconscious biases reinforce health disparities through negative direct patient care and interactions with colleagues.
UNASSIGNED: We created a workshop grounded in Critical Race Theory and the importance of different intersectionalities to improve medical trainees\' self-assessment of their implicit biases in curated facilitated spaces.
UNASSIGNED: A total of 44 UCSF first-year clinical anesthesiology residents (CA-1) (95% response rate) and 23 surgery residents in their research year (77% response rate) participated in this workshop over 4 separate sessions in September 2020 and 2021. Quantitative data from a pre-/post-workshop survey was analyzed via a paired t test to evaluate our workshop\'s effectiveness. Feedback on efficacy was obtained by coding themes from our survey\'s open-ended questions.
UNASSIGNED: The workshop was evaluated positively by a total of 65 of 67 participants in the post-workshop survey. On a 5-point Likert scale, participants self-reported they agreed that their unconscious biases affect their clinical interactions from a pre-workshop mean of 3.3 (SD ± 1.32) to a post-workshop mean of 3.9 (SD ± 0.87, P = .008).
UNASSIGNED: Our findings suggest that this workshop was effective for perioperative residents and can be extrapolated to all residents by tailoring the workshop to their respective work environments.

UNASSIGNED: At the conclusion of residency candidate interview days, faculty interviewers commonly meet as a group to reach conclusions about candidate evaluations based on shared information. These conclusions ultimately translate into rank list position for The Residency Match. The primary objective is to determine if the post-interview discussion influences the final scores assigned by each interviewer, and to investigate whether interviewer characteristics are significantly associated with the likelihood of changing their score. Based on Foucault\'s \'theory of discourse\' and Bourdieu\'s \'social capital theory,\' we hypothesized that interviewer characteristics, and the discourse itself, would contribute to score changes after a post-interview discussion regarding emergency medicine residency candidates.
UNASSIGNED: We conducted a cross-sectional observational study of candidate scores for all candidates to a four-year emergency medicine residency program affiliated with Yale University School of Medicine during a single application cycle. The magnitude and direction of score changes, if any, after group discussion were plotted and grouped by interviewer academic rank. We created a logistic regression model to determine the odds that candidate scores changed from pre- and post-discussion ratings related to specific interviewer factors.
UNASSIGNED: A total of 24 interviewers and 211 candidates created 471 unique interviewer-candidate scoring interactions, with 216 (45.8%) changing post-discussion. All interviewers ranked junior to professor were significantly more likely to change their score compared to professors. Interviewers who were women had significantly lower odds of changing their individual scores following group discussion (p=0.020; OR 0.49, 95% CI 0.26-0.89).
UNASSIGNED: Interviewers with lower academic rank had higher odds of changing their post-discussion scores of residency candidates compared to professors. Future work is needed to further characterize the influencing factors and could help create more equitable decision processes during the residency candidate ranking process.

OBJECTIVE: To investigate how nurses\' implicit and explicit attitudes towards people with disabilities (PWD) compare to (1) other healthcare providers and (2) non-healthcare providers.
METHODS: We present an analysis of secondary data from the publicly available disability Implicit Association Test (IAT). We compare the explicit and implicit attitudes towards PWD for (1) nurses (n = 24,545), (2) other healthcare providers (n = 57,818) and (3) non-healthcare providers (n = 547,966) for a total of 630,238 respondents, between 2006 and 2021.
METHODS: We use publicly available data for the Disability IAT from Open Science Framework repository of Project Implicit available at https://osf.io/tx5fi/.
UNASSIGNED: STROBE checklist.
RESULTS: There is a distinct contrast between nurses\' explicit and implicit attitudes. While nurses have more positive explicit attitudes towards PWD compared to other groups, they also have more negative implicit attitudes towards PWD. As such there is a contrast between nurses\' stated (explicit) attitudes and their unconscious (implicit) attitudes towards PWD. Further, we find that implicit bias towards PWD-among all groups-has not improved over the 15 year period of our sample.
CONCLUSIONS: We present a contrast between nurses\' explicit and implicit attitude towards PWD compared to non-healthcare providers. We posit that implicit bias is driven by a combination of workload and stress which drives nurses to unconscious modes of thinking more frequently.
CONCLUSIONS: We discuss three potential tools for improved educational praxis regarding treatment of PWD; (1) more PWD service user involvement, (2) the use of mindfulness techniques to reduce stress and (3) the use of patient contact simulation to promote education and understanding.
UNASSIGNED: There is no patient or public contribution.

Diversity, equity, and inclusion (DEI) are fundamental to a just healthcare system, yet academic radiology continues to grapple with the underrepresentation of women and underrepresented minorities (URMs). This study investigates demographic disparities within academic radiology and proposes strategies to enhance DEI. Through analysis of demographic data and a review of successful DEI initiatives, I identified a severe underrepresentation of URMs and women throughout every stage of the radiology pipeline. Challenges such as implicit bias, financial barriers, and lack of mentorship contribute to this disparity. However, promising initiatives like the Radiology Leadership Institute and the Association of University Radiologists Mentorship Program offer examples of progress in diversifying the field. To achieve true DEI in academic radiology, a multifaceted approach is essential, encompassing early outreach, financial aid, mentorship, inclusive recruitment, and a commitment to fostering a welcoming environment. Continuous evaluation and adaptation of these initiatives will pave the way for a more equitable and inclusive future in radiology.

This article provides an analysis of representational issues associated with interview-based animated documentary productions directed by non-autistic filmmakers, attempting to represent one or more autistic participants. The article draws insights from three case studies: A Is for Autism (Webb 1992), An Alien in the Playground (Glynne 2009) and the author\'s own practice-based research film, Drawing on Autism (Widdowson 2021). Drawing insights from psychoanalysis, film theory and ethnography, the article will examine animated documentary practice in terms of the risks of Othering participants, look for evidence of the filmmaker\'s unconscious bias and consider how the cinematic gaze can be used to decode ideological systems that informed their construction. From this analysis, the author reaches the conclusion that the properties of documentaries, that rely on animation rather than live-action cinematography, present a specific set of ethical responsibilities that skew towards issues of representation.

OBJECTIVE: Unconscious bias can impact manner of speaker introductions in formal academic settings. We examined speaker introductions at the Society of Vascular Surgeons Annual Meeting to determine factors associated with non-professional address.
METHODS: We examined speaker introductions from the 2019 SVS Vascular Annual Meeting. Professional title with either full name or last name was considered professional address. Speaker and moderator demographics were collected. Univariate and multivariate logistic regression analyses were performed to identify associations between introduction and speaker and moderator characteristics.
RESULTS: 336 talks met inclusion criteria. Both speakers and moderators were more likely to be white (63.4 ​% and 65.8 ​%,p ​= ​0.92), man (75.6 ​% and 74.4 ​%,p ​= ​0.82) and full professor rank (34.5 ​% and 42.3 ​%, p ​< ​0.001). On multivariable regression, non-professional address was associated with speaker rank of trainee (OR 3.13, p ​= ​0.05) and when moderator was white (OR 2.42, p ​= ​0.03).
CONCLUSIONS: This study emphasizes the potential negative impact of unconscious bias at a national meeting for vascular surgeons and the need to mitigate this effect at the organization level.

Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist.
We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021.
A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies.
Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.