The Prevalence of Implicit Biases in Practicing Physical Therapists and Strategies for Improvement

The Prevalence of Implicit Biases in Practicing Physical Therapists and Strategies for Improvement

By: Bria Dunn, SPT

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Background

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My interest in implicit bias is a multifaceted one reflecting both personal and professional experiences. As a black woman, I have experienced microaggressions on the basis of my race, gender, and sometimes the intersectionality of these characteristics. However, I also acknowledge my privilege as a person who is well educated, non-disabled, and comes from a middle-class family. In the healthcare system, I have witnessed firsthand as a student physical therapist that many of these same characteristics can unknowingly factor into the way patients/clients are perceived and received, both positively and negatively, by their healthcare providers. Unlike me, however, our patients/clients are often seen at very vulnerable periods in their lives induced by illness and/or injury.

I first became aware of the concept of implicit bias, or unconscious bias, during a social psychology course as a psychology double major at UNC-Chapel Hill. When Dr. Dana McCarty presented the opportunity this past summer to collaborate on research investigating the prevalence of implicit bias among practicing physical therapists, the first of its kind, I knew that I had to act on her offer. Since then, I have had the pleasure of working with Dana and Jennell McIntosh, my classmate and co-principal investigator, on this project specifically examining race- and disability-related implicit biases. What began as a prevalence study has progressively evolved to recognize the need to educate and address implicit bias in physical therapy practice and healthcare in general.

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Statement of Need

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Nearly all of the available research about implicit bias in healthcare focuses on physicians and nurses and, to my dismay, shows that healthcare providers harbor low to moderate levels of implicit bias toward racial/ethnic minorities and individuals with disabilities.^1,2 Furthermore, biases like these have been shown to significantly impede patient-provider interactions, clinical decision-making, and patient health behaviors and outcomes.^1,2 Individual healthcare providers and their employers, the physical therapy profession, and healthcare as a whole must begin to identify any implicit biases we harbor and employ strategies to reduce these biases given the profound impact on the quality of patient care we deliver and related outcomes. 

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 Products

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A poster sharing findings from the research described above that I conducted with Dana and Jennell these past two semesters. We have discussed potentially presenting our research at the annual North Carolina Physical Therapy Association Conference this upcoming fall or through other professional venues.

A handout intended for healthcare providers and employers that describes implicit bias, the impact in healthcare, and provides evidence-based bias reduction strategies. The handout has been designed for use by individual clinicians as well as to facilitate meaningful conversation among professionals about the subject matter. Additionally, the handout will supplement an upcoming lecture about implicit bias in healthcare given by Dana at UNC Healthcare in late May.

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  Associated Work

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 This past fall, I focused my efforts in the PHYT 752: Evidence Based Practice II course on learning more about implicit bias. I searched and assessed the available research for strategies to reduce implicit bias in physical therapists but ultimately had to expand my search to include healthcare providers in general. In developing the Critically Appraised Topic (CAT), it first became evident to me that the study of implicit bias in healthcare is still a relatively new and limited one.

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Evaluation

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Evaluation has been an on-going process throughout developing my capstone project and products thanks to my capstone committee members, past clinical instructors (CIs) and classmates. I selected my capstone committee members based on their backgrounds developing written materials on behalf of the Division of Physical Therapy and as clinicians. They reviewed initial drafts of my capstone products and gave their feedback. I incorporated this feedback into editing the handout for final review by my past three CIs and classmates. I asked these individuals to review the handout as trusted healthcare providers who may realistically be incorporating materials like these into a staff meeting or “lunch and learn.” Similarly, I asked three classmates to review the handout, as we will soon be practicing clinicians. For the poster, I relied on the feedback of my committee members alone especially Dr. Jo Gupta who has a background in research.

My past CIs and classmates submitted their formal evaluations of the handout anonymously via a Google Forms survey. Respondents were generally very pleased with my handout but one individual who identified himself or herself as a physical therapist suggested I provide more detail about bias reduction strategies. He or she stated that as a busy clinician, they would have little time to do additional follow-up on these strategies as described. Detail is something I weighed versus the length of the handout with respect to clinicians’ busy schedules, but it is nice to know that my intended audience is willing to devote more time to this subject matter if additional information is provided for them. This is something I will consider going forward with this product.

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Self-Reflection

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Throughout this process, I have been challenged in working towards many of the personal and professional goals I set for myself during my time in the UNC DPT program. Developing our research project, the CAT, and capstone products has forced me to think critically about and employ evidence-based practice for a subject matter that is growing but important. Evidence-based practice was daunting initially but because of these specific learning activities and the structure of the third-year of the curriculum, I will enter practice as a new clinician confident in my ability to identify and appraise best evidence. I have also become more confident in my background and abilities as a student and young professional. I learned quickly that asking for informal feedback too often or from too many sources, much like motor learning principles, complicates progress towards the end goal. I found myself sifting through countless suggestions and recommendations but ultimately resolved to trust myself and my best judgment in finalizing my capstone products.

I am most proud, however, of the contribution our research and my capstone products will make to the profession in identifying issues and interventions related to “diversity” and “cultural competence.” I feel that healthcare providers and employers commonly use this jargon on trend with growing interest in the field but with relatively little direct intervention. Although the subject matter of implicit bias is potentially sensitive and I was conscious in my attempts not to accuse or offend, this is a crucial conversation that must be had to better ourselves personally and professionally. I plan to take these products and my new knowledge with me into my final clinical rotation at Carolinas Healthcare System where I have already connected with a therapy manager who does great work in the system’s diversity and inclusion efforts. Although I do not know where I will end up as a new clinician yet, I know this topic is both relevant and significant regardless of setting or specialty. 

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Acknowledgements

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Dr. Dana McCarty, PT, DPT, PCS, C/NDT—Thank you for an amazing opportunity to collaborate on this first of its kind research with you. What began as us tossing around ideas in your office this past summer has blossomed into beautiful research and capstone projects, and you have opened up so many professional opportunities for us to share our work. I am forever grateful for how much time and energy you have invested into this process and me as a student throughout my time in the UNC DPT program. 

Drs. Laurie Ray, MPT, PhD and Lisa Johnston, PT, MS, DPT—Thank you for invaluable feedback in editing and finalizing my handout for print and distribution as well as your unwavering support throughout my time in the UNC DPT program.

Dr. Jo Gupta, PT, PhD —Thank you for insightful feedback in editing and finalizing my poster for this project and potential presentation. You have been nothing but welcoming to me since I shadowed at the faculty clinic as an undergraduate and your support of this project in my final year of PT school feels as if it has brought everything “full circle” if you will.

Jennell McIntosh, SPT, co-principal investigator, classmate, roommate, and friend—There’s no one else I would’ve wanted to labor on this research or conquer every step of PT school with! Like always, we were able to capitalize on each other’s strengths and complement each other’s weaknesses to produce meaningful research that inspired both of our capstone projects and products. I look forward to sharing in your future successes with you!

Dr. Richard Faldowski, PhD–Thank you for the insight and support you provided in tackling data analysis with our research. Dana, Jennell and I literally couldn’t have completed it without you.

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 References

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1. Hall WJ, Chapman MV, Lee KM, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review. Am J Public Health 2015;105(12):e60-76. doi:10.2105/AJPH.2015.302903.
2. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017;18(1):19. doi:10.1186/s12910-017-0179-8.

Image retrieved from: Unconscious Bias: We’ve All Got It. Now What? Education Matters website: http://www.educatingmatters.co.uk/blog/unconscious-bias-weve-got-now/. Published February 23, 2017. Accessed April 17, 2018.