SCCM Resource Library-Me? Biased? The Development and Management of Unconscious Bias in Us All

Video Transcription

Hello and welcome to the session on Me Biased, the development and management of unconscious  bias in us all. I'm Roshni Sridharan. I am the moderator for the session and also a speaker  for one of the topics. I'm an anesthesiologist intensivist at the Cleveland Clinic Foundation  and the director for the Anesthesiology Critical Care Medicine Fellowship. I'm the current vice chair for the Diversity and Inclusion Committee of the SCCM. I will be speaking  on implementation of unbiased training in critical care leadership. We have two other fantastic speakers for this session, Dr. Veena Satyapriya and Dr. Anne Thompson. Dr. Veena  Satyapriya is an assistant professor of anesthesiology and critical care medicine at The Ohio State  University. She is the medical director for the Extracorporeal Life Support Program and the assistant director for cardiac clinical affairs at the OSU. She is also the co-chair  for the Diversity, Equity and Inclusion Committee of the Department of Anesthesiology. She will  be speaking on ways to recognize unconscious bias. Dr. Anne Thompson is currently the vice dean of the University of Pittsburgh School of Medicine and a professor of critical care  medicine. She is a past president of the Society of Critical Care Medicine. She's currently  actively engaged in teaching about unconscious bias in healthcare and creating critical steps  towards mitigating its impact on medical education, healthcare, and professional development.  She will be speaking on ways to mitigate unconscious bias. Welcome to both our speakers and to  all our attendees, and I'm looking forward to a fantastic session. I'm Dr. Roshni Sridharan,  and I'll be speaking on the implementation of unbiased training in critical care leadership.  I have nothing to disclose. The learning objectives of this session are that by the end of the  session, learners will be able to define unconscious bias, describe the impact of unconscious bias  in leadership, describe implementation strategies to mitigate unconscious bias in critical care  leadership. All of us have implicit biases. It's part of being human. From an evolutionary standpoint, it was developed as a safety or defense measure to differentiate self from  others who get inside harm. Although we have evolved and do not live in that environment anymore, these evolutionary traits still exist. We have certain natural people preferences  who look and sound like us and have similar interests. The important aspect is to be aware and have an understanding of what our biases are so we can prevent them from playing a  role in our day-to-day life and the decisions that we make. Implicit biases play a significant  role in our everyday life. The impact is even more significant when people in leadership roles  harbor biases and are not aware of them. The impact is profound when these biases are collected,  which is when the group as a whole have biases that they are unaware of and act on them.  Implicit biases that leaders are unaware of most often tend to be their Achilles heel.  It can affect development of effective and efficient teams, not just the teams that we're comfortable hanging out with or talking to. It affects recruitment of the most qualified  candidate, and it affects the evaluation, promotion, and professional development of members of the team. Given the impact that implicit biases have on organizations and  individuals, bias mitigation strategies have been looked at extensively. I will briefly introduce and touch upon these strategies, and Dr. Anne Thompson will be talking about  bias mitigation strategies in detail in her talk. Broadly, these strategies can be looked at from  the perspective of the individual and from the organization. From an individual perspective,  identifying and reflecting on personal biases, having an awareness, and consistently challenging stereotypes is key. From an organizational perspective, leadership commitment to an  unbiased environment and implementing meaningful diversity training in team members is a primary  driver of change. Diversifying experiences intentionally, creating a culture of curiosity  and cultural humility, and providing mentorship and sponsorship opportunities are other strategies  to mitigate bias. From a leadership standpoint, the work done by Burke and Dillon, published by  Deloitte University Press, talks about six signature traits of an inclusive leader. An inclusive leader has to be aware of their biases, curious, and open to change. For a leader to  create an unbiased environment for their team, development of these six traits play a vital role.  Cognizance, which is awareness of their own implicit biases, openness and curiosity to  explore others' perspectives, cultural humility and intelligence to recognize that not everyone  views the world from the same cultural lens, creating a culture of collaboration and recognition  that a diverse thinking team is always better than any one individual, leading by example and  showing courage and commitment to creation of an unbiased environment. When talking about the  various implementation strategies for this bias in leaders, I will tie them into these key skills  that we just talked about. The strategies that I have listed for bias training in leadership  are with the goal of helping leaders create a diverse, inclusive, and equitable environment  for their teams, where everyone feels appreciated and recognized for their uniqueness and differences  that they bring to the table. To create an environment where team members are aware of their own implicit biases and are consistently working to mitigate the impact of their biases.  These strategies include creation and having an awareness and recognition of implicit biases,  communication skills training, coaching and mentoring training, a deliberate creation of  diverse search committees, provision of de-identified CVs and objective criteria for recruitment  early on in the process, promotion of team wellness, and deliberate education to mitigate racism and bias. The first step in the process of mitigating bias at any level  is creation of awareness and recognition. I will touch upon it briefly, but Dr. Satya Priya will  be talking about recognition of bias in great detail in her talk. The implicit association test is a great tool to bring awareness and recognition to one's implicit biases.  When bias education is coupled with the IAT, it helps with a reflection on how our biases can impact our day-to-day life and the decisions we make and the people around us.  It brings about a distinct awareness of the congruence between what we think our thoughts and ideas are and what we subconsciously associate details with. There are multiple  versions of the IAT, as is shown here, like for race, there's one for gender and career, and so on and so forth. All leaders should be required to take the implicit association test  to bring their biases to their attention and to help them succeed in creating an environment that is inclusive, diverse, and unbiased.  Effective communication skills is probably the most important skill set required for a leader  to succeed, more so to create the safe, brave, and unbiased culture we're talking about. Taking leaders through communication skills training can help them develop the skill set.  Going back to the six key traits that we talked about, effective communication skills will help with curiosity, collaboration, and development of cultural intelligence.  The REDI model for healthcare communication was developed at the Cleveland Clinic at our  Center for Excellence in Healthcare Communication. The course focuses on developing a skill set to  enhance relationship-centered communication by adding more tools to the communication toolbox  that convey value and respect with every conversation, demonstrating verbal and nonverbal empathy, engaging in reflective listening, exploring another's perspective, collaborative  planning, and engaging in a dialogue through word or conversation. Although this course was developed to enhance patient-provider relationships and experience, it can vary  will be translated, and we have translated it to interpersonal and interprofessional communication.  At this time, all of our professional staff members are required to go through this course to enhance their communication skills. On a daily basis, we observe things around us,  and based on our biases, we select specific information and we make assumptions based on  them. Although not rooted in hard facts, we tend to believe these assumptions draw conclusions and  also tend to act upon these conclusions that we've drawn. Pretty much, we tend to climb the ladder  of inference very quickly. Effective communication skills will help us climb down this ladder with openness and curiosity and helps mitigate the impact of our biases on our actions.  The bottom line is that to help leaders succeed in their role and create an unbiased environment, communication skills training is vital.  Professional development of team members depends to a great extent on coaching and mentorship that  is provided to them to realize their true potential. It is well documented that underrepresented  minorities do not have the equal opportunities for mentorship and eventually sponsorship,  creating a barrier for their professional growth and development.  Taking leaders through coaching and mentorship workshops coupled with bias training can help mitigate this barrier and enhance communication and effectiveness with diverse mentees.  Search committees are appointed to choose leaders for key positions. It is essential that leaders  ensure that these search committees are diverse and well represented with individuals from all  levels. There is evidence to suggest that having search committee members take the IAT before the  process begins can help bring awareness to their individual biases and reduce the impact of their biases on the decisions that they make. Establishment of criteria or qualifications  for specific positions and removal of photographs from CVs for the initial phases of the selection  process can help create some objectivity to the recruitment process during recruitment.  It is important to actively question stereotypes to eliminate the effect of individual biases.  One of my favorites is when someone says that an individual would be a good fit. I think it's a  great moment to pause and explore what kind of fit we are talking about and if we're talking about  a collective comfort in hanging out with a person versus a specific quality or their qualification  for a position. There's evidence to suggest that implicit biases tend to become more apparent  when people are tired, sleep deprived, and burnt out. As leaders aiming to create an unbiased  environment, it is important to focus on team wellness, sleep deprivation mitigation strategies,  and to conduct retreats for focused discussion to enhance wellness among the team members.  The next important aspect is once we have implemented all these initiatives to assess the impact of these initiatives. One of the ways we could do that is to survey our team members  and assess their feeling on inclusiveness. Once we get results of these surveys, we can evaluate these results and identify specific areas where we could focus on for improvement.  This is an interesting thing that I saw in a paper that was introduced to me probably a  couple of weeks ago. This was published ahead of print in CHEST. Dr. Quinn Capers and his team  from OSU, they came up with a novel educational exercise to introduce intentional training  in the recognition and mitigation of bias. The process that they describe is very interesting,  which involves a facilitated review or discussion of witnessed incidents raising concerns of implicit  or explicit bias. For leaders who are aiming to develop an environment which is divide of biases,  this could be a great initiative to start with the team members to increase an awareness of biases and to identify ways to mitigate them.  Finally, the take-home points for all of us, whether or not we are leaders in our institutions, is to be aware of our individual biases before they start impacting our actions.  It's to be open and to be systematic and transparent in our decision-making processes.  Now, if an unintentional microaggression due to our implicit biases do occur,  it's important to own your actions and its consequences, evaluate its impact, and always remember that the intent and the impact could be completely different from each other,  to reach out and rebuild trust with the person with whom this microaggression occurred.  Most importantly, it is important to self-reinforce behaviors that prevent this bias in the future.  And I would like to conclude with the words of Yolanda King, where she says,  what we need to do is to learn to respect and embrace our differences until our differences don't make a difference in how we are treated. Thank you, everyone, for this opportunity,  and hope you have a fantastic Congress. Hello. Thank you for your time. My name is Veena Satyapriya. I'm an anesthesiologist and an intensivist at The Ohio State University Wexner  Medical Center. Today, I'm going to be tackling the topic of identifying unconscious bias in healthcare. I have no relevant disclosures to tell you about today. So, systems-based  assessments and plans guide how we care for the critically ill. It's just what we do in the ICU.  We pay painstaking attention to details in the management of shock, ARDS, acute kidney injury,  and so on. Because we know tackling these issues are life-saving, and we continue to allow data  to guide best practices and improve outcomes in all facets of the critically ill patients  with single or multi-system organ dysfunction. Today, I'm going to talk to you about a system  that's been under-recognized and under-treated in the ICU, and that is the role of bias and how  it informs some of the decisions that we make. So, I'm going to spend the next 15 minutes talking  about what implicit bias is, why it matters, and tools we can use to recognize this in the workplace.  So, it's not always easy to look in the mirror and possibly see things we may not want to see,  but we desperately need to because it's there. The discomfort you may be feeling or may feel  is necessary right now because healthcare workers are not immune to development of implicit biases  and stereotypes, and in fact, we might be making clinical decisions based on potentially negative stereotypes that we implicitly believe. So, how do we even define it? It matters.  Implicit bias. We hear this term. We hear it all the time, but what does it actually mean?  Let's start by breaking it down so we can better understand these two loaded words.  Bias is a perception or belief of a thing, a person, a place, anything that's informed by our  own stereotypes and beliefs. So, for today's discussion, bias will be used in reference to  the treatment of our patients. Bias is a product of who you are, who your patient is, and for better  or worse, your past experiences with an individual with similarities to the person you may be  seeing right in front of you. Bias is a product of where you live now, where you grew up, who raised  you, what you watch on television, and what you read on the internet. Every experience of our past  and present define the elements of bias you carry within you. Implicit is a descriptive term, and it suggests something outside of our conscious awareness, deep under the surface.  This thing remains a strong informant of our views on the world, largely because we don't even  realize it's there. So, putting that together, implicit biases involve associations outside our  conscious awareness about a group that can affect your judgment and potentially even your treatment  of individuals. While these biases can be positive or negative, most often we refer to the negative  evaluation of a group, because in healthcare, this negative evaluation is what can potentially have the most deadly consequences. So, why do we need to recognize our blind spots?  In 2003, Alan Nelson and his colleagues published a report titled Unequal Treatment, which identified racial and ethnic healthcare disparities in the incidence,  prevalence, and complications of hypertension, heart disease, and diabetes. They found outcomes to be persistently worse in minority groups, and most notably in the Black,  Hispanic, Pacific Islander, Asian, and American Indian, and Alaska Native groups.  And they were noted to have worse quality outcomes than their white counterparts.  This phenomenon has been recognized across all fields across medicine, from cancer care to pediatrics and infant mortality, and the data keeps coming.  Since that time, further evidence has been published suggesting that healthcare providers'  perceptions of patients vary depending on their race or ethnicity, further fueling what the authors concluded in their original landmark report, and that is that bias, stereotyping,  prejudice, and clinical uncertainty on the part of healthcare providers may be contributing to  racial and ethnic disparities in healthcare. And so, while ethnic and racial disparities are  often what first may come to your mind when we're talking about bias and disparities in care,  there are innumerable categories of potentially vulnerable populations that extend across racial,  socioeconomic, ethnic, gender, and sexual orientation boundaries, just to name a few.  So, since that original landmark study, we've continued to identify and recognize that, in spite of these strides made, disparities persist. This past tumultuous year has shown us  that we as healthcare providers recognize our duty to stand up, recognize, and call out racism as a  public health crisis. But even as we work to remove these identifiable and obvious explicit barriers, clearly something is still causing inequity. And so, for that, we must be fully  aware of the unconscious biases that permeate our framing of every patient encounter. In critical  care, there are subtle nuances that can lead us to deviate from established bundles and care  protocols. That's the art of medicine. We've developed these protocols using evidence knowing  that deviations can cause, can have negative impacts on care. Unfortunately, sometimes deviations  arise from implicit biases hidden deep in our conscience. And if that happens, then we are  wittingly or unwittingly complicit in potentiating these disparities in healthcare. For instance,  bystander CPR and associated outcomes are worse in women than in men. Longer ED boarding times  for African Americans awaiting ICU admissions persist, which has also been linked to poorer  outcomes. And so, as healthcare providers, we're bound by duty to do no harm. This comes with no  qualifiers or exclusions to any one group. With that, it's imperative to recognize that a negative  evaluation can lead to unequal or disadvantaged treatment to those who may already be a vulnerable  population. This is what's been described as a corrosive disadvantage. Or, in other words, disadvantage is likely to lead to further disadvantages. So, implicit biases, then,  if they're unchecked, have the potential to affect our clinical judgment and behavior and potentiate these disparities in healthcare. So, if you take nothing else from this brief  presentation, please carry this with you and be mindful of it in your practice. Implicit biases affect clinical judgment and behavior and potentiate disparities in healthcare.  This temporary discomfort is imperative. We need to feel it to recognize it, and only then can we  find solutions to treat it. So, how do we look for it? How do we measure it? We've talked about  what it is and why it's important. Well, this is an emerging area of healthcare research, and we're still trying to understand how to recognize the impact on patient experience  and care. And so, while some data exists signaling a correlation between these things, we cannot begin to explore that relationship without first knowing how to identify it.  So, various methods have been developed in order to measure implicit bias. They can be broken up into three broad types of testing categories. The first are self-reported  questionnaires, and while information can be gleaned with respect to an individual's attitudes  toward a subject, it's difficult to separate whether these represent explicit or implicit  biases, and so are probably not the best way to identify unconscious biases in healthcare providers.  The assumption method is frequently applied in bioethics literature and involves measuring differences in responses to identical clinical vignettes with one key difference,  such as sexual orientation or race, socioeconomic status, etc., of the individual in the example.  We assume the testee is explicitly motivated to disregard these key differences in making  decisions. The tester looks for differences in treatment decisions that correlate with the key  difference to indirectly identify implicit bias. And finally, implicit bias measures or implicit  measures to recognize bias are widely accepted within the field of psychology, and these include the effective priming task, the effective Simon task, and the  implicit association test. These tests aim to identify psychological attributes without requiring participants to report a subjective  assessment of these attributes. So in priming tasks, participants are presented with a prime or a stimulus, for example a brown face, that's followed by  a positive or negative target word, and we're asked to quickly determine whether the target word is positive or negative. If the prime leads to faster  responses to positive words, the prime stimulus is assumed to be associated with a positive balance, but if the prime stimulus facilitates response to  negative words, it's assumed to be associated with a negative balance. We can interpret that implicit bias exists when processing and  categorization occurs faster, and in the case of a negative balance, you can imagine how this can pave the way for a negative patient experience or treatment  bias and errors that are disparate in the ICU. The implicit association test, or IAT, is probably something many of you have experience with and possibly have  taken at some point in your career. It measures strengths of associations between concepts and evaluations or stereotypes. The testee is primed with a  concept and a range of good words and bad words. Strength is measured based on a rate of association between the concept and evaluation. So essentially  the response is easier and categorization is faster when related items share the same response. So for instance, if we're looking for implicit  biases towards obese people, we would say that one has an implicit preference for thin people relative to obese if they are faster to associate thin people in  good words relative to when obese people in good words on the flip side. So a  review paper was published in BMC Medical Ethics looking at studies involving health care workers measuring implicit biases using assumption methods  and implicit measures. They found that bias exists with respect to the following dimensions. Race and ethnicity, gender, socioeconomic status, age, mental  illness, weight, diagnosis of AIDS, brain injured patients, IV drug abusers, disability, and social circumstances. Furthermore, the socio-demographic  characteristics of the health care providers being tested actually correlated with levels of bias. For example, male staff showed significantly  more frustration and less sympathy or empathy with self-harming patients than their female counterparts. On the other hand, pediatricians showed less implicit  race bias than other physician specialties. Implicit bias affects health care providers' behaviors and patient-provider communication. In the  review paper that we talked about on the previous slide, 20 of the 25 assumption studies showed bias of some sort as demonstrated by treatment recommendations,  diagnoses, number of questions asked, or test order. Another review published in 2018 looked at studies using the IAT to measure racial and ethnic biases. 23 of  those studies reviewed looked at bias in health care outcomes. Two of the studies in particular I wanted to call your attention to with the arrows.  One showed that pediatricians with stronger pro-white bias were less likely to prescribe post-op opioids to black children compared to white  children. Another found that counselors that showed pro-white biases were associated with poor therapeutic bonds between the counselor and  their black patients in comparison to their white patients. So these are just a few examples of a growing body of literature indicating that bias not only  affects the patient experience and our relationships with our patients, but they also may have an effect or begin to have an effect on our diagnosis and treatment  patterns, and that these two issues are not mutually exclusive. So I went over a lot of information in a very short time. I want to thank you for allowing me to  discuss implicit bias and how it can affect our work as health care providers in critical care. We cannot begin to discuss what to do about this major  systemic blind spot without understanding its impact on patient care, and so recognizing that those two things go hand-in-hand are a vital piece  of understanding what implicit bias is. And so in conclusion, implicit biases represent a barrier to impartial care in all of us. There are validated tools  available to identify it. Evidence supports the association of poor patient- provider interactions that are associated with implicit biases.  Further studies are needed to define the true impact of provider bias on patient outcomes. And finally, we need a plan as a critical care community to address  implicit bias in the ICU. I've included my references, and I appreciate your time. Thank you. Hello everyone. It's a pleasure to be here today. We'll be  talking about how to mitigate unconscious bias. As a disclosure, I can simply say that I have done extensive teaching about unconscious bias in  health care and academia, and I've occasionally been paid honoraria for that teaching. Few of any of us come to work to provide inadequate biased  interactions with our students and colleagues or to provide care for our patients. We don't like to think of ourselves as bias. Early in our careers,  we pledged that we will not permit considerations of age, disease, or disability, creed, ethnic origin, gender, nationality, political affiliation, or  anything else to intervene between me and my duty to my patient. Especially in academia, we believe in the meritocracy and tend to deny bias. And  yet, the literature provides significant evidence that there is bias by both men and women in assessment of our students, residents and faculty, evaluations of  grants and manuscripts, and patient treatment. How does this come to be? All of us have multiple elements in our background that contribute to our social  identity. Doesn't matter whether you're from a small town or a big city, Texas or New England, whether you're black, white, Asian, what gender you are, what  institutions you belong to, what your socioeconomic status is, how old you are, and surely what media you attend to. Whatever your background is, it has  contributed to your social identity, and has a tremendous impact on how you think about people and events in the world. From these many elements of our  background, we put together beliefs about what a good person is like, how they act, what they believe. When they're different, not us, we commonly make quick  unconscious decisions and assumptions about them. These assumptions happen so quickly, that we often don't even recognize that they're based on our past  experience rather than the person in front of us. We see them as actual observations, facts. And this contributes to this sense that I think we all  recognize of us versus them, where we look across the river, if you will, at what they see as good and proper, but we consider bad or even wrong or even bad.  Some characteristics are readily observed, and may trigger immediate bias. These include race, ethnicity, gender, age, but there are many others that are  much less evident, but may still trigger bias. It's probably not possible to be human without having some of these biases. So what are we to do to mitigate  the impact of bias in all of us, I think we need to attend to both personal efforts and organization or institutional efforts. From a personal  point of view, we need to seek to recognize and mitigate our own personal biases. And from a larger point of view, we need to work to mitigate the  enormous impact of our collective biases on the health systems we work in and the care we provide. Personal actions include recognizing and accepting that  we have bias. And I would suggest taking some implicit association tests that are readily available online. And also think about those elements of your  background, and current connections that you have, and what all of it has in terms of impact on your thinking and values. Develop the capacity to sign a  flashlight on yourself. Where are my biases showing? Why did I come to such a quick assessment of this person or this event? Where are my strong emotions  coming from? Make a point of getting to know colleagues and others who aren't like you. It can be enormously enriching and enlightening. Try to take the other  person's perspective when you feel one of those strong reactions happening. And seek feedback about whether you could be missing something important that's going  on in the environment around you. This is hard, and probably lifelong work. I've been working on this for many years, and still I can feel my biases cropping up  unwanted rather frequently. It's important to educate yourself, whoever you are, not just whether you're white, not just if you're male, we all have our  biases. These days, I feel like there's an emergency need to understand the impact of race in America. And there are some wonderful materials available that  are eye-opening and have an enormous tendency to move us toward implementing change. This is the New York Times 1619 project, the American Bar Association's  21-Day Racial Equity Habit-Building Challenge, and the National Museum of African American History and Culture Talking About Race. Of course, it doesn't  end there. When you've digested that, keep going. Learn about inequities related to other groups and populations within our country. One of the things that's  important to understand are microaggressions. Learn about them, and then teach bystander and upstander interventions. Our biases can lead to  microaggressions. We may not even recognize them in our own comments. We might not notice them coming from others, but the people on the receiving  end do. Learn about common examples, because there's nothing micro in terms of the effect of microaggressions. We need to support our trainees, colleagues,  and patients in the face of microaggressions, because not doing so implies that we are complicit with the sentiment that they carry. Work with your  team to think about how you would respond if you witness one. Have prepared words to respond during an event, and then debrief about the episode  afterwards. The variations on these microaggressions is nearly infinite. Get to know what some of the most common ones are, and when you  understand them and recognize them, help your colleagues to intervene. Most of us need help knowing how to react and what to say. We have a badge buddy, something  that attaches behind our hospital identity badge, that involves interrupting, questioning, educating, or echoing to help, and some examples of  what you might say to draw attention and gently correct episodes of microaggressions.  Institutional, departmental, ICU actions require multi-professional efforts. We need pipeline programs, and all of us should participate in or even develop  programs that reach into high schools, colleges, professional schools, residencies, for people of color and other minority aspirants. Providing  shadowing opportunities and mentoring can draw people we need in our professions into them. We also need to identify diversity champions in every  division. If there's a woman or a person of color who wants the role and has the bandwidth, that's great, but it's also important to strongly consider a  champion from, if you will, the mainstream who collaborates with other diversity leaders. It's simply not fair to always burden the group that is the minority  with the work needed to draw new members from that community into our institutions. Part of that, of course, means improving searches. An important  element of that can be widening your network. Ask women, people of color, to announce a search to their communities, to their networks. Contact specific  colleagues and ask specifically for candidates that represent underrepresented minority groups. One of the things I think could be very  helpful is if SCCM and other professional societies developed robust databases that supplemented job boards to help us all identify people that we  would like to recruit. We should diversify our search committees, even if you need to go outside your own group to find the necessary diversity. And then  develop guidelines of what you're looking for, a list of must haves, nice to haves, and require that the pool of your initial candidates includes the  minorities you're seeking. I would particularly point you to a very nice resource on the University of Washington's website called Resources  for Hiring a Diverse Faculty. It has a number of really valuable ideas. Once you've recruited people, you need to provide professional support, especially  for women and people of color, and be aware of the sort of double effect, the intersection of race and gender. We need to continue to provide focused  professional development, mentoring, sponsorship, leadership opportunities,  and unbiased letters of references. One of the things that can expose us all to excellent people from groups that are not well represented is to examine our  list of grand round speakers and work hard to diversify it. We need to educate everyone about everyday events. 4% of men as opposed to 30% of women report  having experienced sexual harassment. White people are much less likely to experience racial putdowns. Not having these experiences allows us to doubt  that they actually occur. A good thing is to develop an educational tool for everyday conversation. Our Department of Medicine has developed a series of  slides called It Happened to Us that appear on occasion in departmental  electronic messaging boards. These are simply cases or examples of events that have occurred to various people in the department. They go out up without  comment. They're in a variety of places within the department. They prompt people to think about unusual, upsetting, biased interactions that they may  personally never witness, but that someone in the department, perhaps several people, have experienced. Simply reading about them prompts discussion  by people who happen to be standing there together or may come together at some other time. Another thing that can help is to develop a mechanism for  reporting concerning behaviors. It should be confidential, and the material submitted should be reliably reviewed by a safe person or team. From those  reports, there should be trustworthy, fair investigation, and then a response to try to correct problems that can be documented. Periodically, a summary of  what has been done to try to address the problems identified so that people understand that their reports lead to action. Something I've just recently  heard about has been called bias rounds, sort of like some of us have ethics conferences or ethics rounds. In this case, what's been suggested is to review  cases where explicit or implicit bias may have played a role in what tests are ordered or what medical decisions are made, and then have a robust discussion  about why did it happen? Was it based on clear thinking, or was it triggered by bias, and could we do something about it? Perhaps my final suggestion would be  one that's, I think, one of the most high-value QI projects I can imagine us performing. There was a paper in the New England Journal, I think just last year,  called Creating Real Change in Academic Medical Centers, How Social Movements Can Be Timely Catalysts. The team at Brigham and Women's Hospital looked at some  problems they had documented a decade ago in the management of patients with heart failure, black versus white, and noticed inequities. They looked at those  same patients roughly 10 years later, recognized that the inequities persisted and set about changing the conditions that led to those inequities. I think if  we all review the literature and see what's relevant to the medicine we practice, does any of the literature that points to inequitable treatment or  outcomes apply to us? If it does, look at our own data and see if we have a similar problem. Or alternatively, examine a common diagnosis or treatment or  testing procedure in your unit and see if there are disparities in the management or outcomes in your patients. And if you find them, begin a project to  decrease those inequities. Mitigating our bias will be a heavy lift. The impact won't be corrected quickly or easily. It applies to all of our professions. Not  one of us is exemplary. We'll need repeated education. Overcoming past habits will take a lot of work. It will take time to develop these bias  interfering skills and avoid having those skills degrade over time. It means that we need to frequently reexamine our efforts and see if we're still making  progress. Our discussion today is barely a beginning. But I know that the people involved in this panel are willing to talk with you at the end of this and in  the future. Thank you very much.

Video Summary

In this video, three speakers discuss the topic of unconscious bias in various aspects of healthcare. Dr. Roshni Sridharan, an anesthesiologist intensivist, talks about the implementation of unbiased training in critical care leadership. She emphasizes the importance of being aware of personal biases and challenges stereotypes. Dr. Veena Satyapriya, an assistant professor of anesthesiology and critical care medicine, focuses on ways to recognize unconscious bias in healthcare. She explains how implicit biases can impact patient care and outcomes, and the need to mitigate them. Dr. Anne Thompson, vice dean of the University of Pittsburgh School of Medicine, addresses strategies to mitigate unconscious bias. She highlights the importance of personal efforts, such as recognizing and accepting bias, as well as institutional actions, including improving diversity in search committees and providing support for underrepresented groups. She also suggests educational initiatives, such as microaggression awareness and bystander interventions. The overall message is that recognizing and addressing unconscious bias is crucial for creating an inclusive and equitable healthcare environment.

Asset Subtitle

Professional Development and Education, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Define implicit bias and describe its impact in academic medicine and critical care
Describe tools that can be used to recognize implicit bias and mitigate its impact in recruiting a diverse and talented pool of critical care professionals
Explore resources clinicians can use to mitigate the impact of bias in the clinical realm

Implementation of Unbias Training for Critical Care Leadership
Roshni S. Sreedharan

Looking in the Mirror: How to Recognize Unconscious Bias
Sree V. Satyapriya

Through the Looking Glass: How to Mitigate Unconscious Bias
Ann E. Thompson

Meta Tag

Content Type Presentation

Knowledge Area Professional Development and Education

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Learning Pathway Introduction to the ICU

Membership Level Select

Tag Communication

Tag Team Leadership

Year 2021

Keywords

unconscious bias

healthcare

critical care leadership

implicit biases

patient care

diversity

support for underrepresented groups

inclusive healthcare

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