Investigating the Relationship between Resident Physician Implicit Bias and Language Use during a Clinical Encounter with Hispanic Patients.

Prior research suggests that the implicit biases of physicians are negatively associated with quality of medical care and patient satisfaction among minority patients. However, relatively little is known about how physicians express these subtle forms of bias in patient interactions. This study examined the implicit and explicit anti-Hispanic biases of 53 resident physicians and the relationship between anti-Hispanic bias and language use during outpatient medical appointments with 291 Hispanic patients. Physician implicit bias was positively associated with use of interrogatives and work-related words and negatively associated with the use of prepositions and relativity-related words (e.g., words related to time and the future). These findings contribute to the growing body of evidence suggesting that, in addition to nonverbal and paraverbal behaviors, providers may communicate implicit bias to patients through the words they use during a clinical visit.

Internal conflict and prejudice-regulation: Emotional ambivalence buffers against defensive responding to implicit bias feedback.

Becoming aware of bias is essential for prejudice-regulation. However, attempts to make people aware of bias through feedback often elicits defensive reactions that undermine mitigation efforts. In the present article, we introduce state emotional ambivalence-the simultaneous experience of positive and negative emotions "in the present moment"-as a buffer against defensive responding to implicit bias feedback. Two studies (N = 507) demonstrate that implicit bias feedback (vs. no feedback) increases defensiveness (rating the test as less valid, credible, and objective). However, high (vs. low) state emotional ambivalence, which was independent of bias feedback, attenuates this relationship between bias feedback and defensiveness, accounting for a larger share of the variance than negative emotions alone. In turn, this reduced defensiveness among individuals high (vs. low) in emotional ambivalence was associated with increased awareness of bias in the self and others. Results suggest that state emotional ambivalence is associated with increased bias awareness by creating a mindset in which individuals are less defensive to potentially threatening information about their own implicit racial bias. These results have important implications for research on stereotyping and prejudice, emotional ambivalence and psychological conflict, and defensiveness.

Testing active learning workshops for reducing implicit stereotyping of Hispanics by majority and minority group medical students.

The present research tested if having first year medical students complete active learning workshops would reduce their implicit stereotyping of Hispanics as medically noncompliant. The workshops were tested with 78-majority (White) group, 16-target minority (Hispanic, African-American and American-Indian) group, and 42-non-target minority (Asian-American and foreign born students from East Asia and Southeast Asia) group students in the 2018 and 2021 classes in the American Southwest. Prior to the workshops, students completed an implicit association test (IAT), and then participated in two workshops that covered the psychology of intergroup bias, the role of implicit bias in patient care, and activities for learning six strategies for controlling the implicit stereotyping of patients. The results showed that before the workshops, the level of implicit stereotyping of Hispanics was significant for the majority and non-target minority group students, but it was not significant for the target minority group students. After the workshops, target minority students again showed no bias, and implicit stereotyping was significantly lower for the majority group students, but not for the non-target minority students. The results suggest that the workshops may have been effective for majority group and target minority group students, but that more cultural tailoring of the materials and activities may be necessary to address implicit bias among some minority group medical students.

On the updating of spontaneous impressions.

A large body of work has shown that perceivers form spontaneous inferences about others' characteristics (e.g., mean, bad) as soon as they observe their behaviors. However, a question that has not been addressed by previous research is the integration of contingencies of those actions (e.g., perceivers' ultimate goals) that are typically learned over time into the initial spontaneous impressions of those others. Three experiments examined updating of spontaneously formed trait inferences (STIs) and evaluative inferences (SEIs) as a function of the contingency information that alters the meaning of the initial information. All three studies showed that perceivers update their SEIs (both positive and negative) immediately after learning about the contingencies (i.e., transforming information). STIs, however, were not updated, even when the contingency information was provided immediately after the initial behavior information (Experiment 3). Instead, in all three experiments participants formed multiple STIs; one from the behavior information before and one from the information after the contingency. It was only when participants had the opportunity to elaborate on their trait judgments within explicit measures that they revised their judgments and aligned them with the contingency information. The results and the implications of the findings are discussed in light of the theoretical models suggesting separate mechanisms of semantic and evaluative processing in person perception. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Goal versus trait explanations: Causal attributions beyond the trait-situation dichotomy.

In 4 studies, we show that two behavioral dimensions specified in Kelley's (1967) model of attribution, consistency and distinctiveness of behaviors, determine perceivers' likelihood to explain others' behaviors in terms of their goals versus traits. Participants tended to attribute the cause of others' behaviors to their goals (vs. traits and other characteristics) when behaviors were characterized by high distinctiveness (Study 1A & 1B) or low consistency (Study 2). On the other hand, traits were ascribed as predominant causal explanations when behaviors had low distinctiveness or high consistency. Study 3 investigated the combined effect of those behavioral dimensions on causal attributions and showed that behaviors with high distinctiveness and consistency as well as low distinctiveness and consistency trigger goal attributions. We discuss the implications of the present research in terms of going beyond the dominant approach of trait-situation dichotomy in attribution research. (PsycINFO Database Record

Distortion in time perception as a result of concern about appearing biased.

Two experiments illustrate that the perception of a given time duration slows when white participants observe faces of black men, but only if participants are concerned with appearing biased. In Experiment 1 the concern with the appearance of bias is measured as a chronic state using the external motivation to respond without prejudice scale (Plant & Devine, 1998). In Experiment 2 it is manipulated by varying the race of the experimenter (black versus white). Time perception is assessed via a temporal discrimination task commonly used in the literature. Models of time perception identify arousal as a factor that causes perceived time to slow, and we speculate that arousal arising in intergroup interactions can alter time perception.

On Race and Time.

Arousal is known to shape time perception, and heightened arousal causes one to perceive that time has slowed (i.e., a given length of time feels longer than it actually is). The current experiments illustrate that among White people who experience arousal when contemplating race (specifically those for whom appearing biased is an ongoing concern), time perception slows when they observe faces of Black men. We asked participants to judge the duration of presentation for faces of White and Black men (shown for periods ranging from 300 to 1,200 ms) relative to a standard duration of 600 ms. Evidence of bias emerged when White participants concerned with bias saw faces of Black men (e.g., durations of less than 600 ms were perceived as being greater than 600 ms). The current findings have implications for intergroup interactions in which timing is essential-for example, length of job interviews, police officers' perception of the length of an encounter and when force should be initiated, and doctors' perception of the length of medical encounters. Racially biased time perception is a new form of implicit bias, one exerted at the perceptual level.

The conscious roots of selfless, unconscious goals.

We counter Huang & Bargh's (H&B's) metaphoric description of the unconscious, selfish goal on three points. First, we argue, unconscious goals are rooted in conscious choices related to well-being. Second, unconscious goal pursuit occurs through early-stage orienting mechanisms that promote individuals' well-being. Third, unconscious goals work selflessly, resulting in their own demise.

Documenting Nursing and Medical Students' Stereotypes about Hispanic and American Indian Patients.

OBJECTIVE: Hispanic Americans and American Indians face significant health disparities compared with White Americans. Research suggests that stereotyping of minority patients by members of the medical community is an important antecedent of race and ethnicity-based health disparities. This work has primarily focused on physicians' perceptions, however, and little research has examined the stereotypes healthcare personnel associate with Hispanic and American Indian patients. The present study assesses: 1) the health-related stereotypes both nursing and medical students hold about Hispanic and American Indian patients, and 2) nursing and medical students' motivation to treat Hispanic and American Indian patients in an unbiased manner. DESIGN: Participants completed a questionnaire assessing their awareness of stereotypes that healthcare professionals associate with Hispanic and American Indian patients then completed measures of their motivation to treat Hispanics and American Indians in an unbiased manner. RESULTS: Despite being highly motivated to treat Hispanic and American Indian individuals fairly, the majority of participants reported awareness of stereotypes associating these patient groups with noncompliance, risky health behavior, and difficulty understanding and/or communicating health-related information. CONCLUSION: This research provides direct evidence for negative health-related stereotypes associated with two understudied minority patient groups-Hispanics and American Indians-among both nursing and medical personnel.

Evidence of nonconscious stereotyping of Hispanic patients by nursing and medical students.

BACKGROUND: Current research on nonconscious stereotyping in healthcare is limited by an emphasis on practicing physicians' beliefs about African American patients and by heavy reliance on a measure of nonconscious processes that allows participants to exert control over their behaviors if they are motivated to appear nonbiased. OBJECTIVES: The present research examined whether nursing and medical students exhibit nonconscious activation of stereotypes about Hispanic patients using a task that subliminally primes patient ethnicity. It was hypothesized that participants would exhibit greater activation of noncompliance and health risk stereotypes after subliminal exposure to Hispanic faces compared with non-Hispanic White faces and, because ethnicity was primed outside of conscious awareness, that explicit motivations to control prejudice would not moderate stereotype activation. METHODS: Nursing and medical students completed a sequential priming task that measured the speed with which they recognized words related to noncompliance and health risk after subliminal exposure to Hispanic and non-Hispanic White faces. They then completed explicit measures of their motivation to control prejudice against Hispanics. RESULTS: Both nursing and medical students exhibited greater activation of noncompliance and health risk words after subliminal exposure to Hispanic faces, compared with non-Hispanic White faces. Explicit motivations to control prejudice did not moderate stereotype activation. DISCUSSION: These findings show that, regardless of their motivation to treat Hispanics fairly, nursing and medical students exhibit nonconscious activation of negative stereotypes when they encounter Hispanics. Implications are discussed.

Implicit stereotyping and medical decisions: unconscious stereotype activation in practitioners' thoughts about African Americans.

OBJECTIVES: We investigated whether stereotypes unconsciously influence the thinking and behavior of physicians, as they have been shown to do in other professional settings, such as among law enforcement personnel and teachers. METHODS: We conducted 2 studies to examine whether stereotypes are implicitly activated in physicians. Study 1 assessed what diseases and treatments doctors associate with African Americans. Study 2 presented these (and control terms) to doctors as part of a computerized task. Subliminal images of African American and White men appeared prior to each word, and reaction times to words were recorded. RESULTS: When primed with an African American face, doctors reacted more quickly for stereotypical diseases, indicating an implicit association of certain diseases with African Americans. These comprised not only diseases African Americans are genetically predisposed to, but also conditions and social behaviors with no biological association (e.g., obesity, drug abuse). CONCLUSIONS: We found implicit stereotyping among physicians; faces they never consciously saw altered performance. This suggests that diagnoses and treatment of African American patients may be biased, even in the absence of the practitioner's intent or awareness.

Non-conscious bias in medical decision making: what can be done to reduce it?

CONTEXT: Non-conscious stereotyping and prejudice contribute to racial and ethnic disparities in health care. Contemporary training in cultural competence is insufficient to reduce these problems because even educated, culturally sensitive, egalitarian individuals can activate and use their biases without being aware they are doing so. However, these problems can be reduced by workshops and learning modules that focus on the psychology of non-conscious bias. THE PSYCHOLOGY OF NON-CONSCIOUS BIAS: Research in social psychology shows that over time stereotypes and prejudices become invisible to those who rely on them. Automatic categorisation of an individual as a member of a social group can unconsciously trigger the thoughts (stereotypes) and feelings (prejudices) associated with that group, even if these reactions are explicitly denied and rejected. This implies that, when activated, implicit negative attitudes and stereotypes shape how medical professionals evaluate and interact with minority group patients. This creates differential diagnosis and treatment, makes minority group patients uncomfortable and discourages them from seeking or complying with treatment. PITFALLS IN CULTURAL COMPETENCE TRAINING: Cultural competence training involves teaching students to use race and ethnicity to diagnose and treat minority group patients, but to avoid stereotyping them by over-generalising cultural knowledge to individuals. However, the Culturally and Linguistically Appropriate Services (CLAS) standards do not specify how these goals should be accomplished and psychological research shows that common approaches like stereotype suppression are ineffective for reducing non-conscious bias. To effectively address bias in health care, training in cultural competence should incorporate research on the psychology of non-conscious stereotyping and prejudice. TRAINING IN IMPLICIT BIAS ENHANCES CULTURAL COMPETENCE: Workshops or other learning modules that help medical professionals learn about non-conscious processes can provide them with skills that reduce bias when they interact with minority group patients. Examples of such skills in action include automatically activating egalitarian goals, looking for common identities and counter-stereotypical information, and taking the perspective of the minority group patient.

Crowded minds: the implicit bystander effect.

Five studies merged the priming methodology with the bystander apathy literature and demonstrate how merely priming a social context at Time 1 leads to less helping behavior on a subsequent, completely unrelated task at Time 2. In Study 1, participants who imagined being with a group at Time 1 pledged significantly fewer dollars on a charity-giving measure at Time 2 than did those who imagined being alone with one other person. Studies 2-5 build converging evidence with hypothetical and real helping behavior measures and demonstrate that participants who imagine the presence of others show facilitation to words associated with unaccountable on a lexical decision task. Implications for social group research and the priming methodology are discussed.