Module part

Module 1b: Introduction

Researchers at Harvard have developed over a dozen tests for measuring implicit bias related to race, sexuality, disability, religion, and other forms of prejudice as part of Project Implicit. Visit the projects Take a Test site (link below) and take TWO of the IATs (one must be the Race IAT) (you may also choose to take other tests). After you view your results, reflect on the test itself, your experience taking the test, and your interpretation of the results.
Answer the following 6 questions in the submission text box

Summarize the module readings in one paragraph (don’t be vague)
Define implicit bias in your own words
What additional test did you take? What were your results for both tests?
Have you ever thought about what biases you have and how they shape how you interact with others? why or why not? 
What are your thoughts about this activity? (feelings, responses, etc)
Was this activity eye-opening? why or why not?


The Journal of Infectious Diseases

S62 • jid 2019:220 (Suppl 2) • Marcelin et al

Correspondence: J. R. Marcelin, MD, Division of Infectious Diseases, University of Nebraska
Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198-5400 (jasmine.marcelin@

The Journal of Infectious Diseases® 2019;220(S2):S62–73
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society
of America. All rights reserved. For permissions, e-mail:
DOI: 10.1093/infdis/jiz214

The Impact of Unconscious Bias in Healthcare: How to
Recognize and Mitigate It
Jasmine R Marcelin,1, Dawd S. Siraj,2 Robert Victor,3 Shaila Kotadia,3 and Yvonne A Maldonado3

1University of Nebraska Medical Center, Omaha; 2University of Wisconsin, Madison; and 3Stanford University School of Medicine, California

The increasing diversity in the US population is reflected in the patients who healthcare professionals treat. Unfortunately, this
diversity is not always represented by the demographic characteristics of healthcare professionals themselves. Patients from under-
represented groups in the United States can experience the effects of unintentional cognitive (unconscious) biases that derive from
cultural stereotypes in ways that perpetuate health inequities. Unconscious bias can also affect healthcare professionals in many
ways, including patient-clinician interactions, hiring and promotion, and their own interprofessional interactions. The strategies
described in this article can help us recognize and mitigate unconscious bias and can help create an equitable environment in health-
care, including the field of infectious diseases.

Keywords. Unconscious bias; diversity and inclusion; mitigating strategies.

There is compelling evidence that increasing diversity in the
healthcare workforce improves healthcare delivery, espe-
cially to underrepresented segments of the population [1, 2].
Although we are familiar with the term “underrepresented mi-
nority” (URM), the Association of American Medical Colleges,
has coined a similar term, which can be interchangeable:
“Underrepresented in medicine means those racial and ethnic
populations that are underrepresented in the medical profes-
sion relative to their numbers in the general population” [3].
However, this definition does not include other nonracial or
ethnic groups that may be underrepresented in medicine, such
as lesbian, gay, bisexual, transgender, or questioning/queer
(LGBTQ) individuals or persons with disabilities. US census
data estimate that the prevalence of African American and
Hispanic individuals in the US population is 13% and 18%, re-
spectively [4], while the prevalence of Americans identifying as
LGBT was estimated by Gallup in 2017 to be about 4.5% [5]. Yet
African American and Hispanic physicians account for a mere
6% and 5%, respectively, of medical school graduates, and ac-

Clinical Gastroenterology and Hepatology 2020;18:1417–1426
Fasiha Kanwal, Section Editor
Improving Patient-Provider Relationships to Improve Health

Douglas A. Drossman*,‡,§,jj and Johannah Ruddy*,jj
*Center for Education and Practice of Biopsychosocial Care, DrossmanCare, Durham, North Carolina; ‡UNC Center for
Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; §Drossman
Gastroenterology, DrossmanCare, Durham, North Carolina; and kRome Foundation, Raleigh, North Carolina
Abbreviations used in this paper: DGBI, disorder of gut-brain interaction;
EHR, electronic health record; IBS, irritable bowel syndrome; PPR, pa-
tient-provider relationship; RVU, relative value unit.

Most current article

© 2020 by the AGA Institute
Changes in our health care system have posed challenges
for the patient-provider relationship (PPR) and may have
negative consequences. For the clinician, due to lower re-
imbursements from third party payers, and increased
administrative tasks such as the electronic medical record
(EMR) and certification requirements, clinic visit time is
now one-fifth that of decades ago. Clinicians may order
diagnostic studies and imaging as a substitute for face to
face time as it is seen to save time and increase relative
value units (RVUs). As a result, the medical interview is
very abbreviated, and the physical examination is dis-
appearing. This occurs at the expense of the physician-
patient relationship. Now there is limited time to gather
relevant information, to understand the context of the
illness, and address patient needs. For the clinician there is
reduced satisfaction, loss of the meaningfulness of caring
for patients, and possibly increased risk for burnout, and
malpractice. This may lead to negative attitudes and be-
haviors toward patients, particularly for those with
nonstructural diagnoses (eg, disorders of gut-brain inter-
action) which are given lower priority than those with
acute or structural illness. In turn, patients experience a
diminution in their role in the relationship and respond to
adverse clinician behaviors with a lack of connection,
frustration, and at times self-blame and stigmatization. To
reverse this downward trend and re-establish an effective
PPR changes are needed: 1) improving educational
methods to provide skills to enhance patient-centered
care, 2) incentivizing educators who teach and clinicians
who practice patient-centered care, and 3) research sup-
port to demonstrate successful outcomes in satisfaction,
adherence and clinical outcomes.

Keywords: Patient-provider Relationship; Communication;
Medical Interview; Patient Care; Health Care; Diagnosis.

Changes in health care are moving clinicians awayfromtheidealsofprovidingthepatient-focusedtype
of care that brought them into the field. There is greater
pressure to see more patients in less time and, wit

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