Unconscious Bias: The Double-Edged Sword

By Damon Williams

October 21, 2019

Unconscious biases (UBs) are learned stereotypes that are automatic, unintentional, deeply engrained, universal, and able to influence behavior. We are all subject to unconscious bias because they arise from our nature as human beings to categorize things as we experience them; categorizing other humans is no exception. Often times, these biases may unfairly subject certain social groups to mistreatment and prejudice and may have severe psychological consequences in those affected.

In her recent publication in the Thoracic Surgery Clinics Journal, Associate Professor of Cardiothoracic Surgery Dr. Leah Backhus comprehensively explores the complex topic of UB and discusses the positive and negative effects that it has on surgical education with a spotlight on cardiothoracic surgery. She details how the “hidden brain” can be beneficial by hastening decision-making in time-sensitive situations, such as during a thoracic surgery operation. However, it can also have negative effects on trainees, such as contributing to feelings of alienation, negatively impacting their performance, damaging their mental health, and at times playing a role in which specialty they choose or how well they excel in their chosen field. These effects are especially prevalent in our female and African American trainees. Backhus provides striking statistics from the American Board of Surgery In-Training Examination surveys showing that African American surgical residents are less likely to believe they can count on their peers for help. Other survey data report that male surgical trainees have a 12.7% higher rate of milestone attainment throughout residency programs compared to their female counterparts. Importantly, this is in spite of evidence demonstrating equal surgical board pass rates.

In this article, Dr. Backhus and her colleagues call for change by urging our Medical Education leaders to address the effects of UB at every stage of the medical education process, from undergraduates in the process of applying to medical school, to residency training and beyond. Furthermore, she stresses the need for more diverse faculty members to help promote a more diverse network of ideas and backgrounds for our trainees. Lastly, she suggests efforts towards combating the effects of UB by implementing the Implicit Association Test (IAT), a tool that gives participants scenarios in which they are required to respond quickly and intuitively in an effort to point out exactly which biases are unconsciously engrained. Importantly, 67% of medical school faculty believed that knowing their IAT results would be helpful in reducing bias in medical school admissions. Requiring faculty, administrators, and students to participate in the test will bring UBs to the forefront and combat them effectively.

As the medical (and pre-medical) education student body continues to become more diverse and inclusive to individuals of all backgrounds, it is important to shed light on these issues with the added (and equally important) benefits towards reducing disparities in healthcare delivery and health outcomes for our patients. Dr. Backhus is helping us take big leaps in the right direction by helping address and fix these issues in a healthy and positive way.