A systemic approach to the psychology of racial bias within individuals and society.

Historically, the field of psychology has focused on racial biases at an individual level, considering the effects of various stimuli on individual racial attitudes and biases. This approach has provided valuable information, but not enough focus has been placed on the systemic nature of racial biases. In this Review, we examine the bidirectional relation between individual-level racial biases and broader societal systems through a systemic lens. We argue that systemic factors operating across levels - from the interpersonal to the cultural - contribute to the production and reinforcement of racial biases in children and adults. We consider the effects of five systemic factors on racial biases in the USA: power and privilege disparities, cultural narratives and values, segregated communities, shared stereotypes and nonverbal messages. We discuss evidence that these factors shape individual-level racial biases, and that individual-level biases shape systems and institutions to reproduce systemic racial biases and inequalities. We conclude with suggestions for interventions that could limit the effects of these influences and discuss future directions for the field.

The impact of neighborhoods and friendships on interracial anxiety among medical students and residents: A report from the medical student CHANGES study.

OBJECTIVE: To examine the experience of interracial anxiety among health professionals and how it may affect the quality of their interactions with patients from racially marginalized populations. We explored the influence of prior interracial exposure-specifically through childhood neighborhoods, college student bodies, and friend groups-on interracial anxiety among medical students and residents. We also examined whether levels of interracial anxiety change from medical school through residency. DATA SOURCE: Web-based longitudinal survey data from the Medical Student Cognitive Habits and Growth Evaluation Study. STUDY DESIGN: We used a retrospective longitudinal design with four observations for each trainee. The study population consisted of non-Black US medical trainees surveyed in their 1st and 4th years of medical school and 2nd and 3rd years of residency. Mixed effects longitudinal models were used to assess predictors of interracial anxiety and assess changes in interracial anxiety scores over time. PRINCIPAL FINDINGS: In total, 3155 non-Black medical trainees were followed for 7 years. Seventy-eight percent grew up in predominantly White neighborhoods. Living in predominantly White neighborhoods and having less racially diverse friends were associated with higher levels of interracial anxiety among medical trainees. Trainees' interracial anxiety scores did not substantially change over time; interracial anxiety was highest in the 1st year of medical school, lowest in the 4th year, and increased slightly during residency. CONCLUSIONS: Neighborhood and friend group composition had independent effects on interracial anxiety, indicating that premedical racial socialization may affect medical trainees' preparedness to interact effectively with diverse patient populations. Additionally, the lack of substantial change in interracial anxiety throughout medical training suggests the importance of providing curricular tools and structure (e.g., instituting interracial cooperative learning activities) to foster the development of healthy interracial relationships.

Racial Socialization Messages in White Parents' Discussions of Current Events Involving Racism With Their Adolescents.

This study presents a thematic analysis of socialization messages about race and racism in White parents' reports of their discussions with adolescents about current events involving racism (e.g., police brutality toward Black Americans). Two samples of White parents of primarily White adolescents ages 14-17 were recruited online in September 2019 (Study 1, N = 123) and June 2020 (Study 2, N = 104). Key themes included color-conscious messages, color-blind messages, endorsing equal treatment, and references to Whiteness. Rates of discussion in 2020 (79-81%) were double that of 2019 (40.2-43.4%). However, color-conscious messages were less common in 2020 compared to 2019, and references to Whiteness were rare in 2020. Color-blind messages were similarly prevalent across both studies.

Reckless gambles and responsible ventures: Racialized prototypes of risk-taking.

Risk-taking is sometimes admired and sometimes disparaged. In this research, we examine previously unexplored questions concerning how membership in social groups is related to expectations and perceptions of risk-taking. We propose that prototypes of risk-takers incorporate racial associations. We conducted five studies (NTotal = 1,603, predominantly White residents of the United States) examining whether prototypes of risk-takers-primarily reckless and responsible ones-activate racial stereotypes and discrimination. We first focused on whether participants perceive Black (vs. White) men as more likely to engage in risk-taking, broadly construed (Study 1). Next, we tested whether the trait attributions (Studies 2 and 3) and mental images constructed with the reverse correlation task (Study 3) of reckless risk-takers are more stereotypically Black (and less White) than responsible risk-takers. In Study 4, we employed an investment game to investigate participants' willingness to trust targets we depicted using the racialized mental images of reckless and responsible risk-takers derived from Study 3. A final study examined whether thinking about reckless risk-takers evokes Black stereotypes broadly, including even positive stereotype content. Findings confirmed that reckless risk-takers were imagined as more phenotypically Black and as having more stereotypically Black traits (both positive and negative), compared with responsible risk-takers. Theoretical and practical implications for this novel stereotype content in the domain of risk are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Applying the Evidence We Have: Support for Having Race Conversations in White U.S. Families.

Popular press articles have advocated for parent-child conversations about race and racism to prevent children from developing racial biases, yet empirical investigations of the impact of racial socialization in White U.S. families are scarce. In an article published in Perspectives on Psychological Science in 2020, Scott et al. warned that, given the lack of empirical evidence, parents might actually do more harm than good by talking to their children about race. In this comment, we draw upon the literature on (a) racial socialization, (b) parenting and parent-child discourse, and (c) the role of nonverbal communication in parental socialization to inform our understanding of parents' ability to engage in race-related conversations in the absence of empirical guidance. We also highlight emerging evidence of the potential benefits of these conversations (even if parents are uncomfortable). In sum, the wealth of existing literature suggests that parents can successfully navigate challenging conversations with their children-which tends to result in better outcomes for children than avoiding those conversations. Thus, although we support Scott et al.'s call for researchers to develop more empirical research, we part with the authors' assertion that researchers need to wait for more sufficient evidence before providing recommendations to White parents-we believe that the time for White families to begin talking about race and racism is now.

Testing a Self-Affirmation Intervention for Improving the Psychosocial Health of Black and White Medical Students in the US.

Self-affirmation interventions have been shown to mitigate the negative psychological effects of stereotype threat on Black students in secondary and undergraduate education. However, there is currently limited research testing whether Black students in medical schools may also experience the negative influences of stereotype threat. Until now, it has been unclear whether Black (vs. White) students experience a lower sense of belonging in medical school and whether they can benefit from self-affirmation interventions during medical training. With a longitudinal field experiment, we tested (a) whether Black (vs. White) medical students in the US experience decrements in psychological well-being (i.e., fatigue, depression, anxiety), sense of belonging, perceived residency competitiveness, and residency goal stability; and (b) the extent to which a self-affirmation intervention would ameliorate any observed disparities in these outcomes for Black students. With a sample of 234 Black and 182 White medical students across 50 schools in the US, we found that Black students tended to report more fatigue and less belonging than White students; however, the self-affirmation intervention did not significantly influence students' fatigue, depression, anxiety, or belonging. Unexpectedly, Black students in the self-affirmation (vs. control) condition reported lower perceived competitiveness for residency. White students' perceived competitiveness for residency was unaffected by the intervention. Exploratory analyses revealed that Black (vs. White) students were less likely to indicate stable residency goals over time, which may be an indication of threat; however, this racial gap was eliminated with the intervention. We discuss the plausible reasons for these findings and provide recommendations for future work in this area.

Socialization of racial ideology by White parents.

Objectives: The ways that White American parents socialize their children to think about and interact with racial out-groups are not well understood. The goals of this study were to explore the degree to which White parents endorse contradictory racial ideologies, and the reasons behind the presence versus absence of parent-child discussions of race-related current events (e.g., Trayvon Martin, Michael Brown, or the Charleston church shooting). Method: We recruited a sample of White parents of children ages 8-12 on Amazon MechanicalTurk (N = 165, 66.1% female, M-age = 36.67) and applied a qualitative thematic analysis to their answers to open-ended probes regarding racial discussions with their children. Results: Results revealed both color-blind and color-conscious racial ideology communicated by White parents. Thirty-seven percent of White parents endorsed a mixture of color-blind and color-conscious ideology. The majority of parents did not discuss race-related current events with their children; many believed these discussions were either too negative or unnecessary. Conclusions: The results indicate that White parents have the potential to be agents of change that socialize color-conscious beliefs in their children, but many are reinforcing the current system of color-blind indifference to racial inequality. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Open science, communal culture, and women's participation in the movement to improve science.

Science is undergoing rapid change with the movement to improve science focused largely on reproducibility/replicability and open science practices. This moment of change-in which science turns inward to examine its methods and practices-provides an opportunity to address its historic lack of diversity and noninclusive culture. Through network modeling and semantic analysis, we provide an initial exploration of the structure, cultural frames, and women's participation in the open science and reproducibility literatures (n = 2,926 articles and conference proceedings). Network analyses suggest that the open science and reproducibility literatures are emerging relatively independently of each other, sharing few common papers or authors. We next examine whether the literatures differentially incorporate collaborative, prosocial ideals that are known to engage members of underrepresented groups more than independent, winner-takes-all approaches. We find that open science has a more connected, collaborative structure than does reproducibility. Semantic analyses of paper abstracts reveal that these literatures have adopted different cultural frames: open science includes more explicitly communal and prosocial language than does reproducibility. Finally, consistent with literature suggesting the diversity benefits of communal and prosocial purposes, we find that women publish more frequently in high-status author positions (first or last) within open science (vs. reproducibility). Furthermore, this finding is further patterned by team size and time. Women are more represented in larger teams within reproducibility, and women's participation is increasing in open science over time and decreasing in reproducibility. We conclude with actionable suggestions for cultivating a more prosocial and diverse culture of science.

Not Quite Monoracial: Biracial Stereotypes Explored.

Stereotypes often guide our perceptions of members of social groups. However, research has yet to document what stereotypes may exist for the fastest growing youth demographic in the United States-biracial individuals. Across seven studies (N = 1,104), we investigate what stereotypes are attributed to various biracial groups, whether biracial individuals are stereotyped as more similar to their lower status monoracial parent group (trait hypodescent), and whether contact moderates these stereotypes. Results provide evidence of some universal biracial stereotypes that are applied to all biracial groups: attractive and not fitting in or belonging. We also find that all biracial groups are attributed a number of unique stereotypes (i.e., which are not associated with their monoracial parent groups). However, across all studies, we find little evidence of trait hypodescent and no evidence that the tendency to engage in trait hypodescent varies as a function of contact.

The Value of Interracial Contact for Reducing Anti-Black Bias Among Non-Black Physicians: A Cognitive Habits and Growth Evaluation (CHANGE) Study Report.

Although scholars have long studied circumstances that shape prejudice, inquiry into factors associated with long-term prejudice reduction has been more limited. Using a 6-year longitudinal study of non-Black physicians in training (N = 3,134), we examined the effect of three medical-school factors-interracial contact, medical-school environment, and diversity training-on explicit and implicit racial bias measured during medical residency. When accounting for all three factors, previous contact, and baseline bias, we found that quality of contact continued to predict lower explicit and implicit bias, although the effects were very small. Racial climate, modeling of bias, and hours of diversity training in medical school were not consistently related to less explicit or implicit bias during residency. These results highlight the benefits of interracial contact during an impactful experience such as medical school. Ultimately, professional institutions can play a role in reducing anti-Black bias by encouraging more frequent, and especially more favorable, interracial contact.

The Effects of Racism in Medical Education on Students' Decisions to Practice in Underserved or Minority Communities.

PURPOSE: The purpose of this study was to examine the relationship between manifestations of racism in medical school and subsequent changes in graduating medical students' intentions to practice in underserved or minority communities, compared with their attitudes and intentions at matriculation. METHOD: The authors used repeated-measures data from a longitudinal study of 3,756 students at 49 U.S. medical schools that were collected from 2010 to 2014. They conducted generalized linear mixed models to estimate whether manifestations of racism in school curricula/policies, school culture/climate, or student attitudes/behaviors predicted first- to fourth-year changes in students' intentions to practice in underserved communities or primarily with minority populations. Analyses were stratified by students' practice intentions (no/undecided/yes) at matriculation. RESULTS: Students' more negative explicit racial attitudes were associated with decreased intention to practice with underserved or minority populations at graduation. Service learning experiences and a curriculum focused on improving minority health were associated with increased intention to practice in underserved communities. A curriculum focused on minority health/disparities, students' perceived skill at developing relationships with minority patients, the proportion of minority students at the school, and the perception of a tense interracial environment were all associated with increased intention to care for minority patients. CONCLUSIONS: This study provides evidence that racism manifested at multiple levels in medical schools was associated with graduating students' decisions to provide care in high-need communities. Strategies to identify and eliminate structural racism and its manifestations in medical school are needed.

Correction to: Medical School Factors Associated with Changes in Implicit and Explicit Bias Against Gay and Lesbian People among 3492 Graduating Medical Students.

Due to a tagging error, two authors were incorrectly listed in indexing systems. Brook W. Cunningham should be B.A. Cunningham and Mark W. Yeazel should be M.W. Yeazel for indexing purposes.

A comparison of clinicians' racial biases in the United States and France.

RATIONALE: Clinician bias contributes to racial disparities in healthcare, but its effects may be indirect and culturally specific. OBJECTIVE: The present work aims to investigate clinicians' perceptions of Black versus White patients' personal responsibility for their health, whether this variable predicts racial bias against Black patients, and whether this effect differs between the U.S. and France. METHOD: American (N = 83) and French (N = 81) clinicians were randomly assigned to report their impressions of an identical Black or White male patient based on a physician's notes. We measured clinicians' views of the patient's anticipated improvement and adherence to treatment and their perceptions concerning how personally responsible the patient was for his health. RESULTS: Whereas French clinicians did not exhibit significant racial bias on the measures of interest, American clinicians rated a hypothetical White patient, compared to an identical Black patient, as significantly more likely to improve, adhere to treatment, and be personally responsible for his health. Moreover, in the U.S., personal responsibility mediated the racial difference in expected improvement, such that as the White patient was seen as more personally responsible for his health, he was also viewed as more likely to improve. CONCLUSION: The present work indicates that American clinicians displayed less optimistic expectations for the medical treatment and health of a Black male patient, relative to a White male patient, and that this racial bias was related to their view of the Black patient as being less personally responsible for his health relative to the White patient. French clinicians did not show this pattern of racial bias, suggesting the importance of considering cultural influences for understanding racial biases in healthcare and health.

Beyond Generalized Sexual Prejudice: Need for Closure Predicts Negative Attitudes Toward Bisexual People Relative to Gay/Lesbian People.

Increasing evidence suggests that bisexual people are sometimes evaluated more negatively than heterosexual and gay/lesbian people. A common theoretical account for this discrepancy argues that bisexuality is perceived by some as introducing ambiguity into a binary model of sexuality. The present brief report tests a single key prediction of this theory, that evaluations of bisexual people have a unique relationship with Need for Closure (NFC), a dispositional preference for simple ways of structuring information. Participants (n=3406) were heterosexual medical students from a stratified random sample of 49 U.S. medical schools. As in prior research, bisexual targets were evaluated slightly more negatively than gay/lesbian targets overall. More importantly for the present investigation, higher levels of NFC predicted negative evaluations of bisexual people after accounting for negative evaluations of gay/lesbian people, and higher levels of NFC also predicted an explicit evaluative preference for gay/lesbian people over bisexual people. These results suggest that differences in evaluations of sexual minority groups partially reflect different psychological processes, and that NFC may have a special relevance for bisexual targets even beyond its general association with prejudice. The practical value of testing this theory on new physicians is also discussed.

Medical School Factors Associated with Changes in Implicit and Explicit Bias Against Gay and Lesbian People among 3492 Graduating Medical Students.

BACKGROUND: Implicit and explicit bias among providers can influence the quality of healthcare. Efforts to address sexual orientation bias in new physicians are hampered by a lack of knowledge of school factors that influence bias among students. OBJECTIVE: To determine whether medical school curriculum, role modeling, diversity climate, and contact with sexual minorities predict bias among graduating students against gay and lesbian people. DESIGN: Prospective cohort study. PARTICIPANTS: A sample of 4732 first-year medical students was recruited from a stratified random sample of 49 US medical schools in the fall of 2010 (81% response; 55% of eligible), of which 94.5% (4473) identified as heterosexual. Seventy-eight percent of baseline respondents (3492) completed a follow-up survey in their final semester (spring 2014). MAIN MEASURES: Medical school predictors included formal curriculum, role modeling, diversity climate, and contact with sexual minorities. Outcomes were year 4 implicit and explicit bias against gay men and lesbian women, adjusted for bias at year 1. KEY RESULTS: In multivariate models, lower explicit bias against gay men and lesbian women was associated with more favorable contact with LGBT faculty, residents, students, and patients, and perceived skill and preparedness for providing care to LGBT patients. Greater explicit bias against lesbian women was associated with discrimination reported by sexual minority students (b = 1.43 [0.16, 2.71]; p = 0.03). Lower implicit sexual orientation bias was associated with more frequent contact with LGBT faculty, residents, students, and patients (b = -0.04 [-0.07, -0.01); p = 0.008). Greater implicit bias was associated with more faculty role modeling of discriminatory behavior (b = 0.34 [0.11, 0.57); p = 0.004). CONCLUSIONS: Medical schools may reduce bias against sexual minority patients by reducing negative role modeling, improving the diversity climate, and improving student preparedness to care for this population.

Informal Training Experiences and Explicit Bias Against African Americans among Medical Students.

Despite the widespread inclusion of diversity-related curricula in US medical training, racial disparities in the quality of care and physician bias in medical treatment persist. The present study examined the effects of both formal and informal experiences on non-African American medical students' (N=2922) attitudes toward African Americans in a longitudinal study of 49 randomly selected US medical schools. We assessed the effects experiences related to medical training, accounting for prior experiences and attitudes. Contact with African Americans predicted positive attitudes toward African Americans relative to White people, even beyond the effects of prior attitudes. Furthermore, students who reported witnessing instructors making negative racial comments or jokes were significantly more willing to express racial bias themselves, even after accounting for the effects of contact. Examining the effects of informal experiences on racial attitudes may help develop a more effective medical training environment and reduce racial disparities in healthcare.

Medical students' learning orientation regarding interracial interactions affects preparedness to care for minority patients: a report from Medical Student CHANGES.

BACKGROUND: There is a paucity of evidence on how to train medical students to provide equitable, high quality care to racial and ethnic minority patients. We test the hypothesis that medical schools' ability to foster a learning orientation toward interracial interactions (i.e., that students can improve their ability to successfully interact with people of another race and learn from their mistakes), will contribute to white medical students' readiness to care for racial minority patients. We then test the hypothesis that white medical students who perceive their medical school environment as supporting a learning orientation will benefit more from disparities training. METHODS: Prospective observational study involving web-based questionnaires administered during first (2010) and last (2014) semesters of medical school to 2394 white medical students from a stratified, random sample of 49 U.S. medical schools. Analysis used data from students' last semester to build mixed effects hierarchical models in order to assess the effects of medical school interracial learning orientation, calculated at both the school and individual (student) level, on key dependent measures. RESULTS: School differences in learning orientation explained part of the school difference in readiness to care for minority patients. However, individual differences in learning orientation accounted for individual differences in readiness, even after controlling for school-level learning orientation. Individual differences in learning orientation significantly moderated the effect of disparities training on white students' readiness to care for minority patients. Specifically, white medical students who perceived a high level of learning orientation in their medical schools regarding interracial interactions benefited more from training to address disparities. CONCLUSIONS: Coursework aimed at reducing healthcare disparities and improving the care of racial minority patients was only effective when white medical students perceived their school as having a learning orientation toward interracial interactions. Results suggest that medical school faculty should present interracial encounters as opportunities to practice skills shown to reduce bias, and faculty and students should be encouraged to learn from one another about mistakes in interracial encounters. Future research should explore aspects of the medical school environment that contribute to an interracial learning orientation.

Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study.

PURPOSE: Diversification of the physician workforce continues to be a national priority; however, a paucity of knowledge about the medical school experience for African American medical students limits our ability to achieve this goal. Previous studies document that African American medical students are at greater risk for depression and anxiety. This study moves beyond these findings to explore the role of racial identity (the extent to which a person normatively defines her/himself with regard to race) and its relationship to well-being for African American medical students in their first year of training. METHODS: This study used baseline data from the Medical Student Cognitive Habits and Growth Evaluation (CHANGE) Study; a large national longitudinal cohort study of 4732 medical students at 49 medical schools in the US racial identity for African American students (n = 301) was assessed using the centrality sub-scale of the Multidimensional Inventory of Black Identity. Generalized linear regression models with a Poisson regression family distribution were used to estimate the relative risks of depression, anxiety, and perceived stress. RESULTS: First year African American medical students who had lower levels of racial identity were less likely to experience depressive and anxiety symptoms in their first year of medical school. After controlling for other important social predictors of poor mental health (gender and SES), this finding remained significant. CONCLUSIONS: Results increase knowledge about the role of race as a core part of an individual's self-concept. These findings provide new insight into the relationship between racial identity and psychological distress, particularly with respect to a group of high-achieving young adults.