Hard to watch, huh? So I've shown this to several clinical departments, and I appreciate it. I'm not going to ask you the questions here, but when I ask those departments, I ask them two questions. I say, number one, how many of you feel that that doctor and nurse, that they're really bad people? Raise your hand. And nobody raises their hand. And then the second question I ask is, how many of you think it's possible that on a given call night, when you're multitasking, when you're sleep-deprived, when you're pulled in different directions, that that could be you behaving that way? And slowly, several hands go up. And that really is the important point. You don't have to be a bad person for these unconscious biases to take hold and express themselves and how we treat each other. That was a real case. So a follow-up, as you saw, she did code. She went to the cath lab. It was a STEMI. Her right corneal artery was occluded. They got it open. She didn't die. She survived. But she survived with a severely damaged heart. And of course, now the rest of her life will deal with severe congestive heart failure. So that goes towards answering the question, what's the worst that can happen? So what we're going to do now is actually talk about some bias mitigation strategies and use cases to demonstrate how to use these bias mitigation strategies. And these strategies are not hard. Let me just take you through them. So one of them is called common identity formation. This one takes advantage of the fact that we all belong to certain groups. Now when I say groups, I don't mean race or gender or sexual identity. I mean groups like grew up on a farm, speaks more than one language, immigrated from a different country, plays a musical instrument. It turns out if you're in that group, you automatically have a bond with others who are in that group. And just knowing that, just finding that out, that you're a Dallas Cowboys fan and they're a Dallas Cowboys fan, just finding that out that you belong to the same common group actually inhibits the neural pathways that activate the unconscious negative bias. So you're probably saying to yourself, oh, well, I do that all the time anyway. When I see a patient, I always ask them some things about themselves. Well, that's good. Maybe you didn't know it, but that is an anti-implicit bias strategy. So keep it up. The next one is perspective taking. Force yourself to see the world through their eyes. What is their life like? Just really force yourself to do that for about 20 seconds. What does it feel like to be them? When you do that, you develop empathy and that's the key. Empathy actively opposes unconscious negative bias. Third is consider the opposite. This one is my favorite. Once you've done your review of the information, whether it's a patient you're seeing, maybe you're meeting your neighbor for the first time, maybe you're interviewing somebody for a job. You've reviewed the data. You're about to make a decision. Time out. Call a time out. This time, re-review the data again, but your assignment now is to find evidence to convince you of the opposite of your first conclusion. Then make a decision. This process has been shown to reduce the impact of our unconscious negative bias. And finally, counter-stereotypical exemplars. If you focus on somebody that you know, that you hold in high esteem, that shares something in common with this person right in front of you, that will bring down any negative bias you have about them. So this is a first case. You sit on the board of trustees for the American Consortium of Cardiothoracic Surgeons. The current president is stepping down after completing his two-year term, and applications for the new president are being reviewed by your committee. This is a high-profile position with significant time commitment. And you, as leaders, you're on that search committee. So you get an application from Dr. Jones. She's female. She's white. She has two years' experience of being the director of cardiothoracic surgery at the medium-sized academic medical center. She expanded the cardiovascular service line and started a new CT surgery training program at the institution. She previously worked at a small regional medical center and helped grow the program through expansive outreach. She has three kids, ages two, five, and nine. She grew up in a small Midwestern town and attended college on an academic scholarship and worked waiting tables and doing modeling gigs. She also wrote an essay on the challenges facing patients in surgical specialties. So this is her bio. What implicit biases might affect your decision in hiring her? So I think you guys touched on most of it. Two years' experience, is that enough? Two years' experience to then be running the Society of Cardiothoracic Surgery? Is she too young? The looks, right? Some people said that they were put off by the modeling gigs. Does she look like a surgeon? Does she have that typical surgeon look? She doesn't really, does she look like the people in our organization? And is this the face that we want to associate with that high-profile position? Someone mentioned it. She has three young kids. Being the leader of this consortium, it's very time-consuming. And you know that taking care of three kids, two, five, and nine, for those of you who have kids in that age group, you know the amount of things that you have to do in terms of schools and extracurricular activities for one, much less three. So the time commitment that she has to deal with her kids and then have enough time for the professional activities that she needs to do, that could be a challenge. So these are some important things that you mentioned. And the modeling gigs. That's weird, right? Not really typical for medicine. And if we're all honest, I think just looking at the modeling gigs would probably give us some pause in terms of whether this is a person we would want to be leading the consortium of cardiothoracic surgeons. And she wrote an essay on the challenges facing parents in surgical specialties. Is she one of those controversial people who will be tweeting every single day about every single thing that happens and feel victimized whenever things don't go her way? These are legitimate thoughts to have. But there's some bias mitigation strategies that we can use that Quinn is going to walk us through to see how we can reduce that level of biases that we have against her. So you're a nephrologist and sit on the kidney transplant committee. You help decide. So as a member of this committee, you are helping to decide which kidney failure patients should be considered for a kidney transplant. So you know this is a very important job because if they don't get a kidney transplant, you know what happens long term or short term, they're going to die at some point and have a lot of hospitalizations, comorbidities, et cetera. So this is a really, really important decision that you need to make. We also know that kidneys aren't a dime a dozen. We don't have enough organs for donation. So the allocation of these organs is also very important for us as a committee as well as for patients. So Mr. Jenkins, he's male. He's black or African-American. He's 41 years old. He has hypertensive renal disease, end-stage renal disease, hemodialysis for the past three years. No other major medical problems. He has a history of medical noncompliance in the past. He's been married for 19 years, lives at home with wife and two young sons. He works the same job at downtown printing press for the past 13 years and he does not have reliable transportation. So you're on the transplant committee and you're having to decide who receives a kidney or not and Mr. Jenkins' application comes up. What are the negative biases that you may have against Mr. Jenkins that you think would preclude him from getting one of those kidneys? So when we've done this before, these are some of the negative biases that come up. Some people have commented on his general appearance, not just the fact that he's black or African-American. They say he looks angry, he looks like an angry man. These are some of the things that they say. He's male, black, medical noncompliance and does not have reliable transportation. These are usually the things that come up in these discussions that you've mentioned here today. So you sit on a search committee for the next president of the university and this is a picture that comes with it. So she's Dr. Lee. She's female. She's Chinese. 30 years in higher education. Last job 10 years as provost of a mid-sized state school. She finished high school at age 14, finished college at 17, had a PhD by age 21. She had a JD by age 24. She pursued legal education at her last two academic jobs and she's considered a giant in the legal education system. She migrated from the U.S. from China with family at age eight. Elite chess champion, married. One child who's age nine is a violinist, a violin soloist with the symphony. And she once wrote an essay criticizing legacy admission in American universities. And she's now applying for this job, the next president of your university. So what are the negative implicit biases that might affect or impact your decision? And so she's female. She's Chinese. She's like a tiger mom. She seemed like she's very aggressive in terms of her career path. She has a child who's nine and already a soloist in the symphony. These are all things... Is she going to just come here and disrupt whatever we do? She's probably very young.

unconscious bias

healthcare decision-making

impact

biased judgments

bias mitigation strategies