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and obese don’t receive routine screenings as often as those who are not overweight or obese. Minority women, especially African-American and Hispanic women, are much more likely to die during or after childbirth than women who are not minorities. “Even when socioeconomic status and insurance payer status are equal, we know that these gaps still exist,” Pasha said. “So we know that a lot of it has to do with implicit bias.”
Jabraan Pasha, M.D., of the School of Community Medicine presents workshops on implicit bias to students, residents, faculty and many others beyond campus.
Physician-Educator Gives Implicit Bias Workshops on Campus and Beyond In healthcare, as in many areas of society, people take in mountains of information every day and often make decisions subconsciously without asking the conscious brain to weigh in. Many times, those decisions are sound and lead to good outcomes. But subconscious decision-making, by its nature, opens the door to implicit bias. Even though implicit bias occurs outside of a person’s awareness, it still drives decisions and affects outcomes. In the healthcare arena, that equates to health disparities. Internal medicine physician Jabraan Pasha, M.D., an assistant professor at the OU-TU School of Community Medicine, has immersed himself in the study of implicit bias and created a workshop that he presents locally and around the world. The key to dealing with implicit bias is understanding that no one is immune to it, he said. “Simply acknowledging that implicit bias is a reality for most of us is the first step,” Pasha said. “Implicit bias doesn’t have anything to do with our intentions, but the outcomes are the same no matter what the intentions are. There’s no way to protect against it if we don’t know it’s there.” In healthcare, implicit bias can be found in several well-documented ways. Women receive fewer necessary cardiac interventions than men do, Pasha said, because healthcare providers often don’t think their symptoms are associated with heart disease. African-American patients do not get their pain treated as aggressively as non-African-American patients. People who are overweight
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Even though his workshop addresses a serious subject, Pasha said he strikes a lighthearted tone so that participants are more open to talking about their experiences. He also stresses that people must separate the feelings of guilt and shame from the idea of implicit bias. “Most healthcare providers want to provide good, unbiased care,” he said. “We don’t want to people to feel shameful about it because then they’re not going to face it. Once you remove that barrier, the acknowledgement and awareness piece becomes much easier.” During his presentations, Pasha talks about disparities not only in healthcare but in other high-stakes areas like criminal justice, employment and education. Participants share their experiences, both of being biased or experiencing bias. They also brainstorm and talk about methods of reducing implicit bias at both an individual and institutional level. Once the workshop is over, Pasha encourages participants to take online implicit bias association tests developed at Harvard. Multiple tests are offered in the areas of age, sexual orientation, race, religion, skin tone, disability and others. He also introduces the concept of how the tests work by having participants take an implicit association test about flowers and insects. The results are never surprising – most people have positive associations with flowers and negative for insects. Though simplified, the example sets the stage for a person to take the tests on their own. “Taking those tests can tell you that you have a propensity for bias toward certain groups,” he said. “It doesn’t necessarily mean that you have had discriminatory practices toward someone, but it tells you that you’re more likely to. That’s a good thing because it puts us on notice so that we can be more conscious about our thoughts and the decisions we make. It allows us to step back and say, ‘Am I making this decision based on enough information, or am I filling in the blanks and making this decision based on some biases that I have?’” Pasha teaches implicit bias to medical students going into their third year on both the Tulsa and Oklahoma City campus, as well as to PA students and in residency programs. He’s given the presentation to the Association of American Medical Colleges, the Royal College of Physicians and Surgeons of Canada, and to groups in Paris and Portugal. He has also presented the workshop to many organizations outside healthcare. “The good thing about the workshop is that it’s relevant to everyone,” he said. “I also believe that everyone should take the implicit association tests. It is important to not be too upset with what the results show. Stepping up and taking these tests say more about you as a person than the results.”
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