Day at the museum: An experiential bias intervention

Abstract

Implicit biases affect health care delivery. Clinicians must gain insight into their own biases to provide equitable care and mitigate factors affecting their judgement. This training should begin early; however, engaging medical trainees in bias education is challenging. Traditional didactics provide a textbook understanding that bias is ‘bad’ and has negative impacts on clinical care. Less attention is given to how to introspectively examine one's own biases, or coping with this unnerving, emotional process that may threaten one's identity as an equitable physician. Without tools to build insight or manage this discomfort, physicians may practice avoidance that blinds them to their own biased behaviour. However, evaluation of learning is hampered by social desirability, as trainees often worry about perception of their knowledge and skills. Innovative education can create psychologically safer educational spaces where trainees can more readily and honestly engage with introspective learning.

This project focused on using an art museum setting to create a safer educational space for child and adolescent psychiatry fellows during their cultural psychiatry curriculum. Two consecutive cohorts of fellows engaged in museum-based activities designed to prime cognitive and emotional experiences around bias. Fellows engaged in activities that challenged their immediate perspectives, for example, interpreting artwork while only viewing parts of it. Facilitated group discussions centred around identifying different perspectives, struggling with incomplete information and deepening reflections on how these concepts apply to patient care. To assess the learning experience, survey and focus group data were collected prior to, immediately after, and approximately 1 month post. This study was exempt from IRB review.

All participants reported this experience enhanced their ability to process personal biases through reflective, reflexive and interpretive activities. All participants recommended this experience to other training programmes, including recommendations to expand to a full day and move it earlier in the training year. One challenge was that all fellows scored high on pre-test measures of bias awareness as assessed by the Best Intentions¹ Questionnaire. This limited our ability to evaluate how the experience increased awareness of bias and its impact. On the other hand, restriction of range on a Likert scale survey is expected in this context, where the ‘right’ answer is obvious and social desirability is primed. The qualitative data were much more revealing. Fellows expressed that it was significantly easier to sit with the discomfort of making biased interpretations when it applied to artwork. Using art to facilitate discussions, participants acknowledged having only a snapshot of information, which allowed them to safely reflect on how this mirrors clinical situations, noting the importance of humility, curiosity and tolerance of distress and ambiguity while making decisions in medicine. Themes in qualitative responses included deepening understanding of how biases impact: the ability to capture a patient's experience, clinical decision-making, patient experience and health outcomes. One month post, fellows reported increased efforts to reflect on their biases' clinical impact and increased comfort in discussing difficult moments with peers and supervisors. Museum-based activities are a novel and effective approach to facilitate experiential learning about bias.

Stephanie M. Davidson: Conceptualization; investigation; funding acquisition; writing – original draft; methodology; visualization; writing – review and editing; formal analysis; project administration; data curation; resources. Izabela Milaniak: Writing – original draft; writing – review and editing; formal analysis. Sarah H. Arshad: Conceptualization; writing – original draft; methodology; visualization; writing – review and editing; investigation; funding acquisition. Melissa Xanthopoulos: Conceptualization; writing – original draft; funding acquisition; methodology; visualization; writing – review and editing; formal analysis; data curation; supervision.

No authors report any conflicts of interest.