Addressing the Blind Spots: Strategies to Address and Combat Implicit Biases

Addressing the Blind Spots: Strategies to Address and Combat Implicit Biases

By: Jennell McIntosh, SPT

Background:

My interest in healthcare disparities and ways to address them really sparked during my undergraduate career and my passion grew during my time as a leader of my university’s chapter of the National Association for the Advancement of Colored People (NAACP). Through my work with the NAACP and my clinical observation experiences in preparation for applying to PT school, I began to further my passion for addressing healthcare disparities and also realize that these disparities affect certain populations on the basis of many characteristics, not just race or ethnicity. I had the opportunity to complete the majority of my clinical observation hours at Bellevue Hospital in New York City and during my time there I was exposed to patients and clinicians of all different races, backgrounds, cultures, sexual orientations, and socioeconomic statuses which opened my eyes to the many factors that can impact the presence of healthcare disparities.

During the first semester of the DPT program, this realization and my passion grew even more during our Psychosocial Aspects of Disability and Illness course. After the culmination of the course, I wanted to dig deeper into how I could make a difference in my own personal practice as well as in the field of physical therapy. Physical therapists have the amazing opportunity to form positive, substantial relationships with their patients and because of this opportunity, I believe that PTs can lead the effort to address the attitudes and behaviors that can perpetuate healthcare disparities in certain populations. This capstone and the research leading up to its completion is my effort to make a difference.

Purpose:

Implicit biases are unconscious or automatic attitudes or stereotypes towards an individual based on social group membership, categories or traits.¹ These biases can be either positive or negative and when they are negative they can lead to the perpetuation of healthcare disparities by impacting the clinical decisions made by healthcare practitioners such as PTs.² The prevalence of implicit biases regarding characteristics such as race and disability status have been studied in other healthcare professionals such as nurses and physicians but the evidence of implicit biases in physical therapists is very limited.³ Through my qualitative research efforts with Dr. Dana McCarty and my classmate Bria Dunn, I’ve been able to begin to explore the prevalence of implicit biases in PTs affiliated with the clinical experiences and affiliations of UNC’s program via a survey and the Implicit Association Tests (IATs). Additionally, I developed a Critically Appraised Topic delving deeper into if education on implicit biases towards individuals with disabilities as a first year PT student can reduce implicit bias at graduation. While the evidence appraised was not strong enough statistically to firmly suggest that the use of implicit bias curricula reduces implicit biases, it did provide preliminary evidence for some benefit to such curricula as well as the need for more research into the topic.^4,5

Summer reading of the book BlindSpot: Hidden Biases of Good People as well as taking the IATs regarding race, obesity, and disability was added to the schedule for the Psychosocial Aspects of Disability and Illness course for the Fall of 2017. BindSpot was written by two of the creators of the Implicit Association Tests and it is an interactive explanation of implicit biases and how they can impact social interactions and our daily lives. First year students were asked to write a reflective paper after reading the book and taking the IATs prior to an in class discussion of what they learned from the assignment. My capstone presentation serves to further this discussion by delving into evidence based strategies to address implicit biases in the clinical setting.

Statement of Need:

The students in the class of 2020 were the first to complete the assignment on implicit biases and during the planning of my capstone project I spoke with Dr. Debbie Thorpe about ways that this portion of her course could be improved by my research into the topic. The feedback she received from the students after the assignment was that they would like to learn about ways to address their biases after the in depth self-assessment that the assignment requires. The purpose of my capstone is to meet this need by adding a module regarding strategies to address implicit biases to the course schedule.

Products:

The product of my capstone project is a an educational module on strategies to address implicit biases that includes:

• a Prezi presentation (can be accessed at this link: https://prezi.com/view/EPNoERnpXdB2hr448Aj9/)
• Presentation Comments along with 5 practice cases
• Strategies to Address Implicit Bias handout

If it is possible, I plan to present the module in Dr. Thorpe’s course for the next cohort of students who start the DPT program in the Fall of 2018. If this is not possible, I’ve provided the notes and presentation materials to Dr. Thorpe and she will present it herself.

Evaluation:

Throughout the creation of this project, I’ve been in communication with my capstone committee and received feedback on my materials. They have all been very helpful especially with achieving the most efficient wording of phrases in the presentation.I presented the educational module to a group of my peers from the class of 2020 as well as the class of 2018 on April 3, 2018 as a test run in order to receive feedback prior to including the educational module in the course. At the end of the presentation, I handed out an Evaluation form and made appropriate changes based on the feedback received. The major theme of the feedback was the need for a short handout detailing the strategies to help participants follow along with the presentation. I created the handout and added this product to my capstone project after this feedback.

Self-reflection:

The process of creating this capstone project has been very rewarding for me and I was able to meet all of my personal learning objectives. While the goal of the project was to educate others on strategies to address implicit biases, I had the additional benefit of learning these strategies myself. One of my most important professional goals is to be a culturally sensitive physical therapist who can meet the needs of my patients regardless of their background. Another professional goal of mine is to increase the diversity of the field of physical therapy and while this project doesn’t do that directly, it aids in the creation of PTs who can better serve a more diverse patient population.

Completing the research necessary for this capstone project has also been a learning process that will help me become a better physical therapist. My work in the Evidence Based Practice II course as well as with Dr. McCarty and Bria Dunn has improved my ability to find and utilize evidence and this ability will help me to be a better clinician in my future practice. I also aspire to one day be an educator and this exposure to creating an educational module has been eye-opening for me. The most beneficial part for me was the evaluations and feedback from the students and professors who attended my presentation. I will carry this feedback and experience with me as a practice and eventually become an educator in the field of physical therapy.

My hope is that the future of physical therapy is well prepared to take on the challenge of addressing the nation’s healthcare disparities and I believe that addressing implicit biases is a great place to begin this journey. I’m excited to have found a way to marry my passion for social justice with my passion for physical therapy. Being an active participant in the start of this journey in UNC’s DPT program has been a very rewarding experience for me.

Acknowledgements:

I want to thank Dr. Dana McCarty, Dr. Debbie Thorpe, and Dr. Laurie Ray for being a part of my capstone committee. Each of you were a monumental part of making this capstone project a reality and your expertise guided me to success.

Dr. Dana McCarty , my capstone advisor: Thank you for helping me bring this idea to life and for sharing my passion for creating a more culturally sensitive field of physical therapy. Your energy and realism have kept me focused and provided my the amazing opportunity to research something I’ve always been interested in.

Dr. Debbie Thorpe- Thank you for creating the opportunity for me to share my passion and this project as a part of your course. Your encouragement and feedback helped me have the ability to add to the program’s curriculum. I never dreamed that I’d have the chance to leave my mark in a course and it’s an amazing feeling.

Dr. Laurie Ray- Thank you for sharing your expertise and passion for making the field of physical therapy more culturally sensitive. Your input and enthusiasm is for increasing awareness of implicit biases and ways to address them as well as for pediatric physical therapy is inspiring.

I also want to thank my research partner, classmate, and friend Bria Dunn for all of your encouragement and advice. I could not have picked a better person to work on this research with and I’m excited to see the amazing PT you become.

Lastly, I want to thank Dr. Monica Scott for reaching out to me during my PT school application process on LinkedIn and letting me know that DPT can indeed look like me. Your short message of encouragement meant the world to me and I’m so grateful for your kind spirit and generosity.

References:

1. Greenwald AG, Krieger LH. Implicit Bias: Scientific Foundations. California Law Review. 2006;94:945-967. doi: 10.2307/20439056
2. Staats, C, Capatosto, K, Wright, R., and Jackson, V.W. State of the science: Implicit bias review. Kirwan Institute for the Study of Race and Ethnicity. 2016. http://kirwaninstitute.osu.edu/wp-content/uploads/2016/07/implicit-bias-2016.pdf
3. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 2017;18 doi: 10.1186/s12910-017-0179-8
4. Morgan PE, Lo K. Enhancing positive attitudes towards disability: evaluation of an integrated physiotherapy program. Disability and Rehabilitation. 2013;35(4):300-305. doi:10.3109/09638288.2012.691941.
5. Symons AB, Morley CP, McGuigan D, Akl EA. A curriculum on care for people with disabilities: effects on medical student self-reported attitudes and comfort level. Disability and Health Journal. 2014;7(1):88-95. doi:10.1016/j.dhjo.2013.08.006.

Image retrieved from: http://mleslinger.com/course/implicit-bias/