OPEN ACCESSJanuary 19, 2010

Best Intentions: Using the Implicit Associations Test to Promote Reflection About Personal Bias

    Anne Gill, DrPH1, Britta Thompson, PhD2, Cayla Teal, PhD3, Rachel Shada, MHR4, Ernest Fruge, PhD5, Gracielia Villarreal, MD6, Cindy Patton, MS7, Paul Haidet, MD, MPH8
    1 Baylor College of Medicine
    2 Baylor College of Medicine
    3 Baylor College of Medicine
    4 Baylor College of Medicine
    5 Baylor College of Medicine
    6 Baylor College of Medicine
    7 Baylor College of Medicine
    8 Baylor College of Medicine


    Introduction: This exercise is a small-group discussion about bias for medical students who have had at least some clinical experience. It is designed to cultivate awareness that bias is inherent in all humans, including physicians, and can impact patient care. The aim is to foster self-reflection through an exercise that challenges assumptions about personal bias. Methods: The Implicit Association Test (IAT) is used as a trigger, and a small-group discussion format is used to create reflection about personal biases and their effects on clinical decisions. Students discuss what it was like to take the IAT, how they felt when they got their results, if their results were expected, when bias can be helpful, clinical experiences with bias, and what they will do with their results. The content is presented as a set of guidelines and features materials for training facilitators and conducting the discussion. These materials comprise an outline of the exercise, advance preparation assignments, instructions for students, and a small-group facilitator guide. The materials also include evaluation tools consisting of pre- and postdiscussion student surveys and facilitator postdiscussion surveys. Results: As evidence that the IAT does generate meaningful discussion in a facilitated small group, we report the analysis of our pilot data (n = 72). Our exercise resulted in an increase in the perception that personal bias could have an impact on patient relationships (p < .001) among students reporting a lower belief that bias can have impact (n = 6). Among students who rated themselves as having a lower self-awareness prior to the exercise (n = 14), there was an increase in self-awareness of personal bias after the exercise (p < .001). Finally, students reported significant increases (p < .01) in the perception that the IAT was an effective tool for generating small-group discussion about personal bias (p < .001) and that the reflection exercises and small-group discussions were effective tools for raising awareness about personal bias (p < .001) after attending the session. Discussion: Our results suggest that the primary value of this exercise lies not simply in taking the IAT but rather in the cognitive processing of the IAT and other potential biases that takes place during the small-group session. The IAT in conjunction with the discussion appears to be what leads to increased self-awareness and self-reflection.

    Educational Objectives

    By the end of the module, learners will be able to:

    1. Acknowledge that bias is inherent in physicians' perspectives.

    2. Recognize the importance of self-reflection as a method for understanding their own biases.

    3. Verbalize the impact of stereotyping or personal bias on medical decision-making.

    4. List strategies to mitigate physician bias in patient care.