1932

Abstract

Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers’ work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities.

Keyword(s): biasdisparityequityracism
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2022-04-05
2024-04-15
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Literature Cited

  1. 1. 
    AAMC (Assoc. Am. Med. Coll.). Figure 2. Percentage of applicants to U.S. medical schools by race/ethnicity (alone), academic year 2018–2019 Washington, DC: AAMC https://www.aamc.org/data-reports/workforce/interactive-data/figure-2-percentage-applicants-us-medical-schools-race/ethnicity-alone-academic-year-2018-2019
  2. 2. 
    Amutah C, Greenidge K, Mante A, Munyikwa M, Surya SL et al. 2021. Misrepresenting race—the role of medical schools in propagating physician bias. N. Engl. J. Med. 384:872–78
    [Google Scholar]
  3. 3. 
    Andreychik M, Gill M. 2012. Do negative implicit associations indicate negative attitudes? Social explanations moderate whether ostensible “negative” associations are prejudice-based or empathy-based. J. Exp. Soc. Psychol. 48:1082–93
    [Google Scholar]
  4. 4. 
    Axt JR, Ebersole CR, Nosek BA. 2014. The rules of implicit evaluation by race, religion, and age. Psychol. Sci. 25:1804–15
    [Google Scholar]
  5. 5. 
    Blair IV, Steiner JF, Fairclough DL, Hanratty R, Price DW et al. 2013. Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Ann. Fam. Med. 11:43–52
    [Google Scholar]
  6. 6. 
    Blanchard J, Lurie N 2004. R-E-S-P-E-C-T: patient reports of disrespect in the health care setting and its impact on care. J. Fam. Pract. 53:721–30
    [Google Scholar]
  7. 7. 
    Boatright D, O'Connor PG, Miller JE 2020. Racial privilege and medical student awards: addressing racial disparities in Alpha Omega Alpha honor society membership. J. Gen. Intern. Med. 35:3348–51
    [Google Scholar]
  8. 8. 
    Bright HR, Nokes K 2019. Impact of a discussion series on race on medical student perceptions of bias in health care. PRiMER 3:29
    [Google Scholar]
  9. 9. 
    Bullock JL, Lockspeiser T, Del Pino-Jones A, Richards R, Teherani A, Hauer KE 2020. They don't see a lot of people my color: a mixed methods study of racial/ethnic stereotype threat among medical students on core clerkships. Acad. Med. 95:S58–66
    [Google Scholar]
  10. 10. 
    Burgess DJ. 2010. Are providers more likely to contribute to healthcare disparities under high levels of cognitive load? How features of the healthcare setting may lead to biases in medical decision making. Med. Decis. Mak. 30:246–57
    [Google Scholar]
  11. 11. 
    Burgess DJ, Warren J, Phelan S, Dovidio J, van Ryn M. 2010. Stereotype threat and health disparities: what medical educators and future physicians need to know. J. Gen. Intern. Med. 25:Suppl. 2S169–77
    [Google Scholar]
  12. 12. 
    Butkus R, Serchen J, Moyer DV, Bornstein SS, Hingle ST et al. 2018. Achieving gender equity in physician compensation and career advancement: a position paper of the American College of Physicians. Ann. Intern. Med. 168:721–23
    [Google Scholar]
  13. 13. 
    Cahn PS. 2017. Recognizing and reckoning with unconscious bias: a workshop for health professions faculty search committees. MedEdPORTAL 13:10544
    [Google Scholar]
  14. 14. 
    Capers Q, Clinchot D, McDougle L, Greenwald AG 2017. Implicit racial bias in medical school admissions. Acad. Med. 92:365–69
    [Google Scholar]
  15. 15. 
    Carnes M, Devine PG, Isaac C, Manwell LB, Ford CE et al. 2012. Promoting institutional change through bias literacy. J. Divers. High. Educ. 5:263–77
    [Google Scholar]
  16. 16. 
    Cerdeña JP, Plaisime MV, Tsai J. 2020. From race-based to race-conscious medicine: how anti-racist uprisings call us to act. Lancet 396:1125–28
    [Google Scholar]
  17. 17. 
    Chapman MV, Hall WJ, Lee K, Colby R, Coyne-Beasley T et al. 2018. Making a difference in medical trainees’ attitudes toward Latino patients: a pilot study of an intervention to modify implicit and explicit attitudes. Soc. Sci. Med. 199:202–8
    [Google Scholar]
  18. 18. 
    Cooper LA, Roter DL, Carson KA, Beach MC, Sabin JA et al. 2012. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am. J. Public Health 102:979–87
    [Google Scholar]
  19. 19. 
    Dankwa-Mullan I, Pérez-Stable EJ. 2016. Addressing health disparities is a place-based issue. Am. J. Public Health 106:637–39
    [Google Scholar]
  20. 20. 
    Dasgupta N. 2013. Implicit attitudes and beliefs adapt to situations: a decade of research on the malleability of implicit prejudice, stereotypes, and the self-concept. Adv. Exp. Soc. Psychol. 1:233–79
    [Google Scholar]
  21. 21. 
    Dasgupta N, Greenwald AG. 2001. On the malleability of automatic attitudes: combating automatic prejudice with images of admired and disliked individuals. J. Personal. Soc. Psychol. 81:800–14
    [Google Scholar]
  22. 22. 
    Daumeyer N, Onyeador I, Brown X, Richeson J. 2019. Consequences of attributing discrimination to implicit versus explicit bias. J. Exp. Soc. Psychol. 84:103812
    [Google Scholar]
  23. 23. 
    Davis DLF, Tran-Taylor D, Imbert E, Wong JO, Chou CL. 2021. Start the way you want to finish: an intensive diversity, equity, inclusion orientation curriculum in undergraduate medical education. J. Med. Educ. Curric. Dev. 8:23821205211000352
    [Google Scholar]
  24. 24. 
    Devine P, Forscher P, Austin A, Cox W 2012. Long-term reduction in implicit race bias: a prejudice habit-breaking intervention. J. Exp. Soc. Psychol. 48:1267–78
    [Google Scholar]
  25. 25. 
    Dooling K, McClung N, Chamberland M, Marin M, Wallace M et al. 2020. The Advisory Committee on Immunization Practices’ interim recommendation for allocating initial supplies of COVID-19 vaccine—United States, 2020. Morb. Mortal. Wkly. Rep. 69:491857–59
    [Google Scholar]
  26. 26. 
    Dyrbye LN, Thomas MR, Eacker A, Harper W, Massie FS et al. 2007. Race, ethnicity, and medical student well-being in the United States. Arch. Intern. Med. 167:2103–9
    [Google Scholar]
  27. 27. 
    Eiroa-Orosa FJ, Lomascolo M, Tosas-Fernández A 2021. Efficacy of an intervention to reduce stigma beliefs and attitudes among primary care and mental health professionals: two cluster randomised-controlled trials. Int. J. Environ. Res. Public Health 18:31214
    [Google Scholar]
  28. 28. 
    Ellison J, Gunther C, Campbell MB, English R, Lazarus C 2021. Critical consciousness as a framework for health equity-focused peer learning. MedEdPORTAL 17:11145
    [Google Scholar]
  29. 29. 
    FitzGerald C, Hurst S 2017. Implicit bias in healthcare professionals: a systematic review. BMC Med. Ethics 18:19
    [Google Scholar]
  30. 30. 
    FitzGerald C, Martin A, Berner D, Hurst S. 2019. Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: a systematic review. BMC Psychol. 7:29
    [Google Scholar]
  31. 31. 
    Fnais N, Soobiah C, Chen MH, Lillie E, Perrier L et al. 2014. Harassment and discrimination in medical training: a systematic review and meta-analysis. Acad. Med. 89:817–27
    [Google Scholar]
  32. 32. 
    Fox AB, Earnshaw VA, Taverna EC, Vogt D. 2018. Conceptualizing and measuring mental illness stigma: the mental illness stigma framework and critical review of measures. Stigma Health 3:348–76
    [Google Scholar]
  33. 33. 
    Ghosh-Choudhary S, Carleton N, Flynn JL, Kliment CR 2021. Strategies for achieving gender equity and work-life integration in physician-scientist training. Acad. Med. https://doi.org/10.1097/ACM.0000000000004246
    [Crossref] [Google Scholar]
  34. 34. 
    Ginther DK, Haak LL, Schaffer WT, Kington R. 2012. Are race, ethnicity, and medical school affiliation associated with NIH R01 type 1 award probability for physician investigators?. Acad. Med. 87:1516–24
    [Google Scholar]
  35. 35. 
    Girod S, Fassiotto M, Grewal D, Ku MC, Sriram N et al. 2016. Reducing implicit gender leadership bias in academic medicine with an educational intervention. Acad. Med. 91:1143–50
    [Google Scholar]
  36. 36. 
    Gonzalez CM, Kim MY, Marantz PR. 2014. Implicit bias and its relation to health disparities: a teaching program and survey of medical students. Teach. Learn. Med. 26:64–71
    [Google Scholar]
  37. 37. 
    Gonzalez CM, Noah YS, Correa N, Archer-Dyer H, Weingarten-Arams J, Sukhera J. 2021. Qualitative analysis of medical student reflections on the implicit association test. Med. Educ. 55:741–48
    [Google Scholar]
  38. 38. 
    Gonzalez CM, Walker SA, Rodriguez N, Karp E, Marantz PR. 2020. It can be done! A skills-based elective in implicit bias recognition and management for preclinical medical students. Acad. Med. 95:S150–55
    [Google Scholar]
  39. 39. 
    Goodman MS, Plepys CM, Bather JR, Kelliher RM, Healton CG. 2020. Racial/ethnic diversity in academic public health: 20-year update. Public Health Rep. 135:74–81
    [Google Scholar]
  40. 40. 
    Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL et al. 2007. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J. Gen. Intern. Med. 22:1231–38
    [Google Scholar]
  41. 41. 
    Greenwald AG, Banaji MR. 1995. Implicit social cognition: attitudes, self-esteem, and stereotypes. Psychol. Rev. 102:4–27
    [Google Scholar]
  42. 42. 
    Greenwald AG, Banaji MR, Nosek BA. 2015. Statistically small effects of the implicit association test can have societally large effects. J. Personal. Soc. Psychol. 108:553–61
    [Google Scholar]
  43. 43. 
    Greenwald AG, Krieger L. 2006. Implicit bias: scientific foundations. Calif. Law Rev. 94:945–67
    [Google Scholar]
  44. 44. 
    Greenwald AG, Nosek BA, Banaji MR. 2003. Understanding and using the implicit association test: I. An improved scoring algorithm. J. Personal. Soc. Psychol. 85:197–216
    [Google Scholar]
  45. 45. 
    Greenwald AG, Poehlman TA, Uhlmann EL, Banaji MR 2009. Understanding and using the implicit association test: III. Meta-analysis of predictive validity. J. Personal. Soc. Psychol. 97:17–41
    [Google Scholar]
  46. 46. 
    Gross JJ. 2002. Emotion regulation: affective, cognitive, and social consequences. Psychophysiology 39:281–91
    [Google Scholar]
  47. 47. 
    Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW et al. 2015. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am. J. Public Health 105:e60–76
    [Google Scholar]
  48. 48. 
    Hernandez RA, Haidet P, Gill AC, Teal CR. 2013. Fostering students’ reflection about bias in healthcare: cognitive dissonance and the role of personal and normative standards. Med. Teach. 35:e1082–89
    [Google Scholar]
  49. 49. 
    Hinton PR. 1993. The Perception of People Hove, East Sussex, UK: Psychol. Press. , 1st ed..
  50. 50. 
    Hoffman KM, Trawalter S, Axt JR, Oliver MN. 2016. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. PNAS 113:4296–301
    [Google Scholar]
  51. 51. 
    Horst A, Schwartz BD, Fisher JA, Michels N, Van Winkle LJ. 2019. Selecting and performing service-learning in a team-based learning format fosters dissonance, reflective capacity, self-examination, bias mitigation, and compassionate behavior in prospective medical students. Int. J. Environ. Res. Public Health 16:203926
    [Google Scholar]
  52. 52. 
    Jochemsen-van der Leeuw HG, van Dijk N, van Etten-Jamaludin FS, Wieringa-de Waard M. 2013. The attributes of the clinical trainer as a role model: a systematic review. Acad. Med. 88:26–34
    [Google Scholar]
  53. 53. 
    Johnson TJ, Hickey RW, Switzer GE, Miller E, Winger DG et al. 2016. The impact of cognitive stress-ors in the emergency department on physician implicit racial bias. Acad. Emerg. Med. 23:297–305
    [Google Scholar]
  54. 54. 
    Jones CP. 2000. Levels of racism: a theoretic framework and a gardener's tale. Am. J. Public Health 90:1212–15
    [Google Scholar]
  55. 55. 
    Katz AD, Hoyt WT. 2014. The influence of multicultural counseling competence and anti-Black prejudice on therapists’ outcome expectancies. J. Couns. Psychol. 61:299–305
    [Google Scholar]
  56. 56. 
    Kushner RF, Zeiss DM, Feinglass JM, Yelen M. 2014. An obesity educational intervention for medical students addressing weight bias and communication skills using standardized patients. BMC Med. Educ. 14:53
    [Google Scholar]
  57. 57. 
    Lai CK, Skinner AL, Cooley E, Murrar S, Brauer M et al. 2016. Reducing implicit racial preferences: II. Intervention effectiveness across time. J. Exp. Psychol. Gen. 145:1001–16
    [Google Scholar]
  58. 58. 
    Lee M, Tasa-Vinyals E, Gahagan J. 2021. Improving the LGBTQ2S+ cultural competency of healthcare trainees: advancing health professional education. Can. Med. Educ. J. 12:e7–20
    [Google Scholar]
  59. 59. 
    Leslie KF, Sawning S, Shaw MA, Martin LJ, Simpson RC et al. 2018. Changes in medical student implicit attitudes following a health equity curricular intervention. Med. Teach. 40:372–78
    [Google Scholar]
  60. 60. 
    Lett LA, Orji WU, Sebro R. 2018. Declining racial and ethnic representation in clinical academic medicine: a longitudinal study of 16 US medical specialties. PLOS ONE 13:e0207274
    [Google Scholar]
  61. 61. 
    Lofton S, Grant AK. 2021. Outcomes and intentionality of action planning in photovoice: a literature review. Health Promot. Pract. 22:318–37
    [Google Scholar]
  62. 62. 
    Ly DP, Seabury SA, Jena AB. 2016. Differences in incomes of physicians in the United States by race and sex: observational study. BMJ 353:i2923
    [Google Scholar]
  63. 63. 
    Maina IW, Belton TD, Ginzberg S, Singh A, Johnson TJ. 2018. A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Soc. Sci. Med. 199:219–29
    [Google Scholar]
  64. 64. 
    Mateo CM, Williams DR 2020. Addressing bias and reducing discrimination: the professional responsibility of health care providers. Acad. Med. 95:S5–10
    [Google Scholar]
  65. 65. 
    Mateo CM, Williams DR 2020. More than words: a vision to address bias and reduce discrimination in the health professions learning environment. Acad. Med. 95:S169–77
    [Google Scholar]
  66. 66. 
    Matharu K, Shapiro JF, Hammer RR, Kravitz RL, Wilson MD, Fitzgerald FT 2014. Reducing obesity prejudice in medical education. Educ. Health 27:231–37
    [Google Scholar]
  67. 67. 
    Metzl JM, Maybank A, De Maio F. 2020. Responding to the COVID-19 pandemic: the need for a structurally competent health care system. JAMA 324:231–32
    [Google Scholar]
  68. 68. 
    Mezirow J. 1997. Transformative learning: theory to practice. New Dir. Adult Contin. Educ. 1997:5–12
    [Google Scholar]
  69. 69. 
    Mitchell G, Tetlock P 2017. Popularity as a poor proxy for utility: the case of implicit prejudice. Psychological Science Under Scrutiny: Recent Challenges and Proposed Solutions S Lilienfeld, I Waldman 164–95 West Sussex, UK: Wiley & Sons
    [Google Scholar]
  70. 70. 
    Muramatsu N, Chin MH. 2022. Battling structural racism against Asians in the United States: call for public health to make the “invisible” visible. J. Public Health Manag. Pract. 28:Suppl. 1S3–8
    [Google Scholar]
  71. 71. 
    National Academy of Sciences (US) NtAoEU, and Institute of Medicine (US) Committee on Maximizing the Potential of Women in Academic Science and Engineering 2007. Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering Washington, DC: National Academies Press
  72. 72. 
    The Anti-Oppression Network. Allyship https://theantioppressionnetwork.com/allyship
    [Google Scholar]
  73. 73. 
    Nosek B, Riskind R. 2012. Policy implications of implicit social cognition. Soc. Issues Policy Rev. 6:113–47
    [Google Scholar]
  74. 74. 
    Osseo-Asare A, Balasuriya L, Huot SJ, Keene D, Berg D et al. 2018. Minority resident physicians’ views on the role of race/ethnicity in their training experiences in the workplace. JAMA Netw. Open 1:e182723
    [Google Scholar]
  75. 75. 
    Osta K, Vasquez H. Implicit bias and structural racialization Oakland, CA: National Equity Project https://www.nationalequityproject.org/frameworks/implicit-bias-structural-racialization?rq=%20implicit%20bias
  76. 76. 
    Pager D, Shepherd H. 2008. The sociology of discrimination: racial discrimination in employment, housing, credit, and consumer markets. Annu. Rev. Sociol. 34:181–209
    [Google Scholar]
  77. 77. 
    Papish A, Kassam A, Modgill G, Vaz G, Zanussi L, Patten S 2013. Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial. BMC Med. Educ. 13:141
    [Google Scholar]
  78. 78. 
    Peek ME, Lopez FY, Williams HS, Xu LJ, McNulty MC et al. 2016. Development of a conceptual framework for understanding shared decision making among African-American LGBT patients and their clinicians. J. Gen. Intern. Med. 31:677–87
    [Google Scholar]
  79. 79. 
    Peek ME, Simons RA, Parker WF, Ansell DA, Rogers SO, Edmonds BT 2021. COVID-19 among African Americans: an action plan for mitigating disparities. Am. J. Public Health 111:286–92
    [Google Scholar]
  80. 80. 
    Peek ME, Vela MB, Chin MH. 2020. Practical lessons for teaching about race and racism: successfully leading free, frank, and fearless discussions. Acad. Med. 95:S139–44
    [Google Scholar]
  81. 81. 
    Penner LA, Hagiwara N, Eggly S, Gaertner SL, Albrecht TL, Dovidio JF 2013. Racial healthcare disparities: a social psychological analysis. Eur. Rev. Soc. Psychol. 24:70–122
    [Google Scholar]
  82. 82. 
    Perdomo J, Tolliver D, Hsu H, He Y, Nash KA et al. 2019. Health equity rounds: an interdisciplinary case conference to address implicit bias and structural racism for faculty and trainees. MedEdPORTAL 15:10858
    [Google Scholar]
  83. 83. 
    Pettigrew TF. 1998. Intergroup contact theory. Annu. Rev. Psychol. 49:65–85
    [Google Scholar]
  84. 84. 
    Phelan SM, Burke SE, Cunningham BA, Perry SP, Hardeman RR et al. 2019. The effects of racism in medical education on students’ decisions to practice in underserved or minority communities. Acad. Med. 94:1178–89
    [Google Scholar]
  85. 85. 
    Phelan SM, Burke SE, Hardeman RR, White RO, Przedworski J et al. 2017. Medical school factors associated with changes in implicit and explicit bias against gay and lesbian people among 3492 graduating medical students. J. Gen. Intern. Med. 32:111193–201 Erratum 2018. J. Gen. Intern. Med. 33(9):1586
    [Google Scholar]
  86. 86. 
    Phelan SM, Dovidio JF, Puhl RM, Burgess DJ, Nelson DB et al. 2014. Implicit and explicit weight bias in a national sample of 4,732 medical students: the medical student CHANGES study. Obesity 22:1201–8
    [Google Scholar]
  87. 87. 
    Poustchi Y, Saks NS, Piasecki AK, Hahn KA, Ferrante JM. 2013. Brief intervention effective in reducing weight bias in medical students. Fam. Med. 45:345–48
    [Google Scholar]
  88. 88. 
    Raj A, Kumra T, Darmstadt GL, Freund KM. 2019. Achieving gender and social equality: More than gender parity is needed. Acad. Med. 94:1658–64
    [Google Scholar]
  89. 89. 
    Rajput V, Mookerjee A, Cagande C 2017. The contemporary hidden curriculum in medical education. MedEdPublish 6:41
    [Google Scholar]
  90. 90. 
    Raney J, Pal R, Lee T, Saenz SR, Bhushan D et al. 2021. Words matter: an antibias workshop for health care professionals to reduce stigmatizing language. MedEdPORTAL 17:11115
    [Google Scholar]
  91. 91. 
    Ross DA, Boatright D, Nunez-Smith M, Jordan A, Chekroud A, Moore EZ 2017. Differences in words used to describe racial and gender groups in medical student performance evaluations. PLOS ONE 12:e0181659
    [Google Scholar]
  92. 92. 
    Ryujin DT, Collett D, Mulitalo KE. 2016. From safe to brave spaces: a component of social justice curriculum in physician assistant education. J. Physician Assist. Educ. 27:86–88
    [Google Scholar]
  93. 93. 
    Sabin JA, Greenwald AG. 2012. The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. Am. J. Public Health 102:988–95
    [Google Scholar]
  94. 94. 
    Schultz PL, Baker J. 2017. Teaching strategies to increase nursing student acceptance and management of unconscious bias. J. Nurs. Educ. 56:692–96
    [Google Scholar]
  95. 95. 
    Sevo R, Chubin DE. 2010. Bias literacy: a review of concepts in research on gender discrimination and the U.S. context. Women in Engineering, Science and Technology: Education and Career Challenges A Cater-Steel, E Cater 21–49 Hershey, PA: IGI Global
    [Google Scholar]
  96. 96. 
    Sherman MD, Ricco J, Nelson SC, Nezhad SJ, Prasad S. 2019. Implicit bias training in a residency program: aiming for enduring effects. Fam. Med. 51:677–81
    [Google Scholar]
  97. 97. 
    Staats C, Capatosto K, Wright R, Contractor D 2015. State of the science: implicit bias review 2015 Rep., Kirwan Inst. The Ohio State Univ: http://kirwaninstitute.osu.edu/implicit-bias-training/resources/2015-implicit-bias-review.pdf
  98. 98. 
    Stewart T, Wubbena ZC. 2015. A systematic review of service-learning in medical education: 1998–2012. Teach. Learn. Med. 27:115–22
    [Google Scholar]
  99. 99. 
    Stone J, Moskowitz GB, Zestcott CA, Wolsiefer KJ. 2020. Testing active learning workshops for reducing implicit stereotyping of Hispanics by majority and minority group medical students. Stigma Health 5:94–103
    [Google Scholar]
  100. 100. 
    Sukhera J, Watling CJ, Gonzalez CM. 2020. Implicit bias in health professions: from recognition to transformation. Acad. Med. 95:717–23
    [Google Scholar]
  101. 101. 
    Sukhera J, Wodzinski M, Rehman M, Gonzalez CM 2019. The implicit association test in health professions education: a meta-narrative review. Perspect. Med. Educ. 8:267–75
    [Google Scholar]
  102. 102. 
    Teherani A, Hauer KE, Fernandez A, King TE, Lucey C. 2018. How small differences in assessed clinical performance amplify to large differences in grades and awards: a cascade with serious consequences for students underrepresented in medicine. Acad. Med. 93:1286–92
    [Google Scholar]
  103. 103. 
    Tung EL, Cagney KA, Peek ME, Chin MH. 2017. Spatial context and health inequity: reconfiguring race, place, and poverty. J. Urban Health 94:757–63
    [Google Scholar]
  104. 104. 
    Vela MB, Chin MH, Peek ME. 2021. Keeping our promise—supporting trainees from groups that are underrepresented in medicine. N. Engl. J. Med. 385:487–89
    [Google Scholar]
  105. 105. 
    Wheeler M, de Bourmont S, Paul-Emile K, Pfeffinger A, McMullen A et al. 2019. Physician and trainee experiences with patient bias. JAMA Intern. Med. 179:1678–85
    [Google Scholar]
  106. 106. 
    Williams DR. 1997. Race and health: basic questions, emerging directions. Ann. Epidemiol. 7:322–33
    [Google Scholar]
  107. 107. 
    Williams DR, Lawrence JA, Davis BA. 2019. Racism and health: evidence and needed research. Annu. Rev. Public Health 40:105–25
    [Google Scholar]
  108. 108. 
    Williams DR, Lawrence JA, Davis BA, Vu C. 2019. Understanding how discrimination can affect health. Health Serv. Res. 54:Suppl. 21374–88
    [Google Scholar]
  109. 109. 
    Wu D, Saint-Hilaire L, Pineda A, Hessler D, Saba GW et al. 2019. The efficacy of an antioppression curriculum for health professionals. Fam. Med. 51:22–30
    [Google Scholar]
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