Implicit bias, Stereotypes, and Surgery
As a teenager, I distinctly remember making an impassioned plea to my parents to let me study German, rather than take on an extra unit in Mathematics. I had never been good at Math, and felt I would ‘do better’ at a language, particularly in my HSC year. Interestingly, I did just as well at Math as German in my final exams, but the belief that Maths was my ‘Achilles heel’ has always stuck with me.
I hadn’t given it recent thought, but happened across a research article last week which found that girls often internalize implicit attitudes related to gender and math performance.
‘By the age of 9, girls have been shown to exhibit the unconscious beliefs that females have a preference for language over that of math. The stronger these implicit beliefs are, the less likely girls and women are to pursue math performance in school. Such unconscious beliefs are also believed to a play a role in inhibiting women from pursuing careers in science, technology, engineering, and mathematics (STEM) fields.’ (1)
It's fascinating, isn’t it, that our natural associations ie. The way we are shaped to think/feel can have such long lasting effects on our lives? And what does that mean for doctors, who strive to make the ‘right’ decisions for their patients every day?
Understanding Implicit Bias
Implicit bias is an unconscious automatic association made between individuals who share a particular characteristic, and one or more attributes or valuations e.g. female/kind. They are different from stereotypes, which involve a more belief – like association between a concept with a full description, and a category e.g. Asian/better math ability. These associations are shown to result in biased behavior, even by those professionally driven to act without bias, and doctors are no exception.
Our unconscious stereotypes or attitudes can affect what we say and what we do without our knowledge. Repercussions are significant, with research that suggests that women are more likely to receive less intensive treatment for a heart attack, and physicians were less likely to discuss contraception and sexually transmitted disease is with LGBTQI patients, resulting in poorer overall standards of care (2).
Reducing Implicit Bias
Although the research into this area is relatively new, social experiments have demonstrated that implicit bias can be reduced in the short-term by simple interventions such as bias education programs which generate concern and discussion, and involves leaders in the workplace.
Providing counter stereotypic exposure may also be used to reduce implicit bias. And example of this would be insuring that speaking panels at conferences have representation which is diverse. Repeated exposure to counter stereotypes has been shown to build new associations that combat implicit bias3. When more diverse people are seen in roles of power and influence, the expected impact can be a slow dismantling of stereotypes.
The Role of Mentoring
The strong supportive mentor has the potential to make an impact on the career of any of our co-workers, medical students or other junior health care workers. Mentorship is considered difficult, time-consuming, and the effect may not be immediate enough to make it an attractive proposition. There is no doubt that building personal connections overall reduces workplace based stereotypes, and increases the opportunities for contact between people who may not be in the same demographic groups. This has a lasting impact on decreasing bias in the workplace overall, and is a model that works well in surgery, which by its very nature requires collaboration among health providers to achieve better outcomes for our patients.
Steffens, M. C., Jelenec, P., & Noack, P. (2010). On the leaky math pipeline: Comparing implicit math-gender stereotypes and math withdrawal in female and male children and adolescents. Journal of Educational Psychology, 102(4), 947–963. https://doi.org/10.1037/a0019920
DiBrito, Sandra R., Lopez CM., Jones C., et al. (2019) Reducing Implicit Bias: Association of Women Surgeons #HeForShe Task Force Best Practice Recommendations. Journal of the American College of Surgeons, Volume 228, Issue 3, 303 – 309
FitzGerald, C., Martin, A., Berner, D. et al. (2019) Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: a systematic review. BMC Psychol 7, 29. https://doi.org/10.1186/s40359-019-0299-7