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Association of American Medical Colleges Tomorrow's Doctors, Tomorrow's Cures®

Medical Schools and Teaching Hospitals Address Unconscious Bias in Leadership Recruitment

AAMC Reporter March 2013

—By Rebecca Greenberg

As the U.S. patient population becomes increasingly diverse, medical schools and teaching hospitals are making efforts to cultivate diverse faculty leadership.

AAMC benchmarks show that approximately 50 percent of all medical school graduates are women and a growing number are minorities underrepresented in medicine. Yet only 20 percent of full professors are women, and even smaller numbers come from minority or ethnically diverse backgrounds. From these groups, fewer still, become department heads and deans.

With a culture that openly champions diversity, why don’t the numbers reflect it?

Over the past decade and a half, research on “unconscious” or “implicit” bias has intensified. A widely referenced 2003 Harvard Business Review article, “How (Un)ethical Are You?” by leading scholar on implicit association Mahzarin Banaji and colleagues, says these biases stem from our natural tendency to make judgments that help us organize our social worlds. While recruiters may not think that culturally ingrained preferences and aversions influence their choices, research shows they are highly influential on decision making, particularly when time is scarce.

“As humans we are all subject to many biases in information processing, which usually serve us well as physicians because we are able to make rapid decisions based on partial information,” said Molly Carnes, M.D., co-director of the Women in Science and Engineering Leadership Institute (WISELI) and a professor of medicine, psychiatry, and industrial and systems engineering at the University of Wisconsin-Madison. “But these same kinds of cognitive processes can work against us in social contexts—such as hiring and education.”

A 2009 AAMC Analysis in Brief details four studies in which participants were asked to rate the skills of equally qualified fictitious applicants who varied by gender, race, and ethnicity. Overall, reviewers tended to prefer males over females, and white and Asian applicants over black applicants. The brief cites four more studies showing these same biases play out in real-life hiring and evaluation processes.

New evidence also indicates that unconsciously held biases can activate, even against one’s own identity group. A September 2012 Yale study published in Proceedings of the National Academy of Sciences showed that female scientists were just as likely as their male counterparts to unfairly favor male applicants for a lab manager position, and were complicit in offering women lower salaries.

Carnes, who has made significant contributions to the literature on unconscious gender bias in academic medicine, highlights another troubling finding from the research: Our conscious estimations of objectivity in decision making have little bearing on our actual objectivity. She believes that if more faculty members were made aware of the universality of biases, “it would mitigate the likelihood that they would influence decision making.”

One tool that schools are using to help faculty recognize their own biases, especially those faculty who may be uncomfortable or unwilling to acknowledge the prevalence of biases, is the Implicit Association Test, or IAT. The IAT uses fractional differentials in reaction time to track positive and negative responses to different words and images. Variations of the IAT can be used to identify potential biases toward specific groups, such as women or people of color. Although some challenge its accuracy, millions of IAT results have shown that unconscious bias toward historically marginalized groups is extremely common.

“It doesn’t matter how tolerant you are; it doesn’t matter how committed you are to diversity, equity, and justice,” said Anne Wright, Ph.D., senior associate dean of faculty affairs at the University of Arizona College of Medicine.

“We were raised in a society where males are more valued than females and whites more highly than people with different racial or ethnic backgrounds, and this has an influence when we look at a candidate for a position.”

Wright, who adapted a University of Arizona search committee orientation to address the hiring and advancement of women in medical schools, says the problem of unconscious bias must be addressed on both individual and institutional levels.

Stanford University School of Medicine has adopted this two-pronged approach. According to Hannah Valantine, M.D., senior associate dean of faculty affairs at Stanford’s Office of Diversity and Leadership, university department chairs and division chiefs present search committees with the latest data on unconscious bias, and then committee members are asked to take a version of the IAT that focuses on gender bias.

Afterward, to mitigate bias when selecting and reviewing candidates, faculty are asked to adhere to institutional strategies such as clarifying job criteria, removing language from job postings that might discourage certain groups, employing a similar interview structure for all candidates, and allowing adequate time for proper vetting.

A growing number of schools are implementing similar strategies to curb unconscious bias. More research will determine whether efforts such as these will result in greater numbers of women and minorities in leadership positions at medical schools and teaching hospitals.

In the meantime, Valantine stresses, “We are facing complex problems [in medicine] that will require diverse perspectives to solve. The extent to which we can retain diverse faculty will drive our excellence in education, research, and patient care.”

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“As humans we are all subject to many biases in information processing… But these same kinds of cognitive processes can work against us in social contexts—such as hiring and education.”

—Molly Carnes, M.D.