From unconsciously biased to bias awareness: a single site case study of the effectiveness of community-based implicit bias education amongst medical students.

Abstract

Objective: Community-based education places students' education in a community context and exposes students to patients' social and environmental circumstances. Studies that evaluate the effectiveness of community-based education on bias awareness regarding migrants are limited. This study answered the following questions: (1) How do students' knowledge, attitude, and skills regarding their cultural competencies, including ethnocultural empathy and implicit biases, change during community-based implicit bias education? (2) What is the perception of students towards this type of education?

Method: This single site case study used a pre-survey and post-survey consisting of the psychometric instrument Implicit Association Test and the questionnaire Scale of Ethnocultural Empathy as quantitative methods. These were combined with focus group interviews and qualitative analysis of reflection reports as qualitative methods. This study was conducted amongst third-year students of the bachelor of medicine at a medical faculty in the Netherlands. Thirty-five students completed the pre-survey and twenty-one students completed the post-survey. Thirty-eight students gave consent to analyze their reflection report. Twenty-three students took part in the group interviews.

Results and conclusion: The quantitative analysis showed that the students' scores on the ethnocultural empathy scale decreased. The biases for skin color and ethnicity reduced after the educational intervention based on the Implicit Association Test. The qualitative analysis showed that community-based implicit bias education increased students' knowledge about the network of non-profit governmental organizations in the domain of migrant health in the Netherlands, the needs of migrants, and the barriers migrants face in the healthcare system. Students' self-reported attitudes changed after the educational intervention, since their awareness increased of, for instance, the factors that play a role in migrant healthcare and the differences in epidemiology between patients with and without a migration background.

Clinical trial number: Not applicable.